From consumer choice to consumer welfare.

for patients with families. An adve cate for one person is morally d e barred fiom making decisions when more than one have legitimate interests at stake. We must, then, move beyond the ethics of the dyad or even the contemporary triad. Instead, we must learn to think in terms of family justice. Fairness to all concerned will be a major factor in determining both who should decide and also what is the appropriate treatment at the end of life. That’s the way decisions by and for people with families ought to be made-with everyone thinking about what will be best and fairest for all. This idea might seem hopeless b e cause families are so different and have such different conceptions of justice. We certainly have no theory of familial justice that is even r e motely adequate. But questions of family justice cannot be legitimately avoided. Attempts to do so marginalize people. If families emerge fiom their invisibility, we will all be able to see many cases in which benefits to patients are not suflicient to justify the burdens they impose on their families. Ask yourself, Would you rather lose your career and all your savings at age w-five, or lose a 50 percent chance of living an extra year with a terminal disease at age eighty-three? Would anyone prefer the chance of an extra year? But a health care system sensitive to the burdens treatment decisions impose on families is nowhere in sight. In fact, those who focus on the doctor-patient dyad will not even agree that such a system would be morally legitimate. In the foreseeable future, then, families will continue to be invisible, marginalized, or reduced to means. Costs will, no doubt, con-, tinue to be shifted to families. W6 will continue to be largely oblivioG to the impact of our health care system and our treatment decisions on their lives. In this context, the better the Earn; ily-the more loyal, sensitive, and loving the caregivers within the fami+the more we will take advantage of their resources and virtues. Un: