Since this is primarily an adoption blog, this title may be misleading, but only in part. Our family is a family by choice, and we rechoose each other all the time.
Our extended family is even more "by choice" if by "by choice" we mean that neither biology nor law have very much to do with it. This means that my children are surrounded by additional aunts and uncles, and a self-proclaimed "third grandma" and it means that my children's "real" grandmother is third grandmother to my nieces and nephews on the other side. Good deal all around.
Except when it comes to a crisis.
When we agreed to be health care proxy(s) for a chosen family member P, we spent about three hours discussing her living will, her beliefs, her hopes, her expectations. We discussed hypotheticals in detail. She had similar conversations with her primary care physician, her neighbor, and her close relatives. She copied the document we all signed five times and sent copies to her primary care, her lawyer, us, and others to hold onto. She wasn't sick at the time, but she was serious. Now, suddenly, she's seriously ill.
Remember when I wrote about palliative care for our son's hamster? We used this term with our son because dh and I are committed to the ethics of palliative care and hospice -- not because we really thought there was much we could do in the way of palliation for a small animal. We believe in the sanctity of life and we believe that it is bound up with end of life issues.
"Real" family members wish to make other choices than what she'd wished, but these choices are not theirs to make (she knew this would happen). Now we're going to have to make choices we didn't want to have to make.
At one point it looked like our attempts to have everyone comply with her wishes would be overlooked because we were chosen-family, because her "real" family was vocal, and because doctors don't like to quit (which is generally a good thing) despite the legal documents. Now we are infinitely grateful to palliative care teams and hospital ethicists. And come what may, we are grateful for P's life and love and we are so thankful for her foresight and the guidance she provided us in that conversation and in her living will.