支持医学上的分歧：为何我们应该就临终决策达成不同意见。
In Favour of Medical Dissensus: Why We Should Agree to Disagree About End-of-Life Decisions.
作者信息
Wilkinson Dominic, Truog Robert, Savulescu Julian
出版信息
Bioethics. 2016 Feb;30(2):109-18. doi: 10.1111/bioe.12162. Epub 2015 Apr 23.
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.
摘要
临终决策颇具争议。对于何时适宜限制维持生命的治疗，以及哪些姑息治疗选项是可允许的，存在不同观点。处理这类性质决策的一种方法认为达成共识至关重要。只有在所有或大多数护理人员达成一致时，才会做出限制治疗的决定。然而，我们认为，在临终决策中要求专业共识是错误的。在文章的第一部分，我们探讨支持达成一致的实际、伦理和法律因素。我们分析道德推理的主观和客观解释：达成一致对于决策既非必要条件也非充分条件。我们提出一种替代的决策规范——“专业意见分歧”规范。在文章的最后一部分，我们论述一致意见在临终政策中的作用。此类指导方针在伦理上可以基于意见分歧而非共识。分歧并不总是坏事。
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