The Blood Of The Covenant Is Thicker Than The Water Of The Womb: The Ethical Obligation to Respect Chosen Families for Surrogate Decision Making

• Published in: The journal of hospital ethics Vol. 10; no. 2; pp. 73 - 74
• Main Author: Herron, Patrick
• Format: Journal Article
• Language: English
• Published: Washington MedStar Washington Hospital Center 01.09.2024
• Subjects: Decision making; Kinship; Medical personnel; Professional ethics
• ISSN: 1938-4955; 1938-4920

When patients are unable to make their own medical decisions, healthcare professionals have a legal and ethical duty to identify a surrogate. Historically, immediate family members have been called upon because they are assumed to have the strongest relationships as reflected in the commonly used saying, "blood is thicker than water." For many persons, family is not defined by DNA. Literary scholars have pointed to alternate interpretations of this text as noted in this abstract's title to reflect an alternate meaning in which the bonds of friendship or the covenant voluntarily establish between persons has greater significance than involuntary kinship. While societal perspectives of what constitutes a family has evolved, individuals whose personal knowledge and insights regarding a patient's values and preferences would meet expectations for being ethically appropriate surrogates are not legally recognized or at best, deemed less qualified than persons biologically related. If the justification for identifying a surrogate is to respect a patient's autonomy and promote their best interests, then healthcare professionals have an ethical duty to honor those relationships that reflect the deepest bonds the patient has chosen to be their family. Such relationships established outside of the parameters of biological or legal bonds are more frequently described as chosen family. The term has its foundational roots in the LGBTQ+ community. First written about by Kath Weston who analyzed the historical conditions, social meaning, and political implications of gender and sexual minorities who often experienced rejection and estrangement from their families of origin and in turn appropriated the language of kinship to represent an ethics of care amongst individuals often in the context of health and illness experiences. Chosen kinship is not unique to queer communities though as this call for care giving and mutual support outside of traditional bio-legal relationships is seen in other marginalized and disenfranchised communities. Traditional nuclear familial relationships are the basis for many states' and provinces' hierarchical frameworks for appointing surrogates for health care decision making but such a narrow structure denies the ethical legitimacy of chosen families and persons who are best suited to make decisions for the patient.