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Journal of Family Theory & Review

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This review article analyzes 3 developments within the world of health care that involve concomitant changes in the scope of family and the form of family relationships. The first follows from construction of the informed‐consent doctrine and its implementation, the second stems from stunning innovations in reproductive technology, and the third involves the increasing significance of genetic information for medicine. The article suggests that an analysis of changing relationships within the world of health care may offer insights about shifts in the meaning of family. As social domains, the world of family and the world of health care have undergone similar transformations during the past half century. Shifts in the foundational assumptions in each domain—that of the family and that of health care—inform shifts in the other domain. Examining the actualization of these shifts can assist scholars and practitioners in guiding discourse and in resolving disputes among family members and among those who populate the world of health care, including clinicians, patients, and patients' family members.

Parallel transformations in key assumptions about personhood and about relationships among people have reshaped relationships within families and within the world of health care in the past 4 or 5 decades. More precisely, relationships within families and relationships between clinicians and patients increasingly resemble relationships in the marketplace. Fixed roles and statuses have largely been replaced by demands for choice as the terms of relationships are increasingly open to negotiation, and paternalism is no longer widely valued in either social domain. Unsurprisingly, these changes have been accompanied by controversy. Moreover, the changes have resulted in significant uncertainties about the shape of relationships and the meaning of personhood, both within families and between clinicians and patients. Confusion has been especially discomforting in situations that simultaneously challenge traditional family relationships and traditional understandings of the clinician–patient relationship.

This review examines three health‐care developments that have reshaped the roles of clinicians, patients, and family members to illustrate the character of parallel—and often synergistic—changes in the worlds of family and health care. In each of these contexts, conflicts between the goals of individualism (privileging individual autonomy) and those of community (privileging paternalism and group solidarity) have energized new understandings of relationships that were once understood through the lens of hierarchically organized communities. These developments have affected relationships among family members and relationships in the world of health care. Underlying shifts in both social domains have encouraged more flexibility and choice, which may prove fruitful for understanding new forms of family and for providing new understandings of relationships among clinicians, patients, and patients' family members. Construction of the informed‐consent doctrine, for instance, has dramatically reshaped relationships between patients and physicians (Schuck, 1994). Similarly, the increasing use of reproductive technologies has further challenged concepts of family as society and the law increasingly have relied on autonomous choice and intention to define families (Garrison, 2000).


Copyright 2014 by the National Council on Family Relations Published by Wiley at

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