The family is a socio-biological reality. Humans form socio-sexual pairs, which are often also reproductive units. How to characterize these social entities is a matter of considerable dispute, placing the family at the heart of cultural, social, and political disputes regarding the nature of appropriate law and public policy. Competing views of the family have important implications for healthcare policy and bioethics. On the one hand, there is an ontological-metaphysical account of the family, which appreciates the family as a ormative social reality that, as far as possible, should be realized by particular families. This account brings with it pre-existing roles for husbands and wives, fathers, mothers, and children. This view of the family tends to be multi-generational, looking back with respect and support to previous generations, while looking forward with love and concern to succeeding generations. This metaphysical-ontological view of the family is traditionally endorsed by Confucians and Christians. Because it regards the family as a normative socio-biological unit, it supports the autonomy and integrity of the family, treating members of the family somewhat as a state treats its citizens. This view of the family endorses family-based consent and policies of confidentiality in preference to individually oriented ones. It also favors forms of healthcare financing, such as family-oriented health savings accounts, that increase both the financial and the social capital of the family. This approach to the family, which is inclined toward authoritarian and authoritative parenting, tends to produce children who are better able to shoulder their future roles as adults. Finally, this view of the family favors the begetting of children. The traditional view of the family is currently under critical pressure from libertarian/liberal construals of the family, which regard the family as the creation of its members and/or as guided by overriding concerns for individual liberty and equality. This view is at peace with reproduction outside of wedlock, with limited family responsibility and autonomy that undermines status obligations to past generations, and to the production and nurturing of future generations. Non-traditional forms of family, including homosexual families, are accepted, if not affirmed. The libertarian/liberal construal of the family endorses individual, not family consent, for medical treatment. It also favors individually directed policies regarding confidentiality, and forms of financing that support the interests of individuals over those of families. Because of the account’s endorsement of individual freedom and/or individual liberty, it requires that adolescents in many if not most circumstances should be allowed to make their own healthcare decisions, even in the face of mounting evidence that adolescents do not usually have the capacity of decision-makers who have come of age. The libertarian/liberal account of the family is at best neutral to the begetting of children. The differences between these two approaches to the family bear not only on healthcare policy and bioethics, but also on the long-term financial and social stability of society. Quite different futures are at stake.