title: In Favour of Medical Dissensus: Why We Should Agree to Disagree About End-of-Life Decisions.
abstract: End-of-life decision-making is controversial. There are different views about when it is appropriate to limit life-sustaining treatment, and about what palliative options are permissible. One approach to decisions of this nature sees consensus as crucial. Decisions to limit treatment are made only if all or a majority of caregivers agree. We argue, however, that it is a mistake to require professional consensus in end-of-life decisions. In the first part of the article we explore practical, ethical, and legal factors that support agreement. We analyse subjective and objective accounts of moral reasoning: accord is neither necessary nor sufficient for decisions. We propose an alternative norm for decisions - that of 'professional dissensus'. In the final part of the article we address the role of agreement in end-of-life policy. Such guidelines can ethically be based on dissensus rather than consensus. Disagreement is not always a bad thing.
authors.forename: Dominic
authors.initials: D
authors.lastname: Wilkinson
authors.forename: Robert
authors.initials: R
authors.lastname: Truog
authors.forename: Julian
authors.initials: J
authors.lastname: Savulescu
mesh_terms: D000013:Congenital Abnormalities / Q000628:therapy; D032921:Consensus; D003422:Critical Care / Q000941:ethics*; D003657:Decision Making / Q000941:ethics*; D034462:Dissent and Disputes; D004992:Ethics, Medical; D006801:Humans; D062071:Infant, Extremely Premature; D033183:Interdisciplinary Communication; D009014:Morals; D009359:Neonatology / Q000941:ethics* / Q000592:standards; D010166:Palliative Care / Q000941:ethics*; D010290:Parents; D026684:Personal Autonomy; D010820:Physicians / Q000941:ethics / Q000523:psychology; D017410:Practice Guidelines as Topic; D011379:Prognosis; D013727:Terminal Care / Q000941:ethics*; D028761:Withholding Treatment / Q000941:ethics*
keywords: consensus; intensive care; medical ethics; neuroethics; withdrawing treatment