In Favour of Medical Dissensus: Why We Should Agree to Disagree About End-of-Life Decisions

Bioethics. 2016 Feb;30(2):109-18. doi: 10.1111/bioe.12162. Epub 2015 Apr 23.


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.

Keywords: consensus; intensive care; medical ethics; neuroethics; withdrawing treatment.

MeSH terms

  • Congenital Abnormalities / therapy
  • Consensus*
  • Critical Care / ethics*
  • Decision Making / ethics*
  • Dissent and Disputes*
  • Ethics, Medical
  • Humans
  • Infant, Extremely Premature
  • Interdisciplinary Communication*
  • Morals*
  • Neonatology / ethics*
  • Neonatology / standards
  • Palliative Care / ethics*
  • Parents
  • Personal Autonomy
  • Physicians* / ethics
  • Physicians* / psychology
  • Practice Guidelines as Topic
  • Prognosis
  • Terminal Care / ethics*
  • Withholding Treatment / ethics*