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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.

Original publication




Journal article



Publication Date





109 - 118


consensus, intensive care, medical ethics, neuroethics, withdrawing treatment, Congenital Abnormalities, Consensus, Critical Care, Decision Making, Dissent and Disputes, Ethics, Medical, Humans, Infant, Extremely Premature, Interdisciplinary Communication, Morals, Neonatology, Palliative Care, Parents, Personal Autonomy, Physicians, Practice Guidelines as Topic, Prognosis, Terminal Care, Withholding Treatment