Incompletely Theorized Agreement and Accommodated Disagreement in the Surrogate Wars

Abstract

In this commentary, I argue that while the value-systems of healthcare providers and surrogate decision-makers might appear to be incommensurable, they share enough common ground over high-level principles that meaningful engagement between the two groups is possible. This engagement can happen through incompletely theorized agreements that allow discussants to focus on shared values while adhering to competing value-systems. Nonetheless, I argue that the privileging of both healthcare providers and their best interest value system within healthcare creates a continued and unjustified subordination of surrogate decision-makers that threatens to undermine the possibility of meaningful engagement between the two groups. As a solution, I suggest that end-of-life policies be structured in ways that emphasize common ground between healthcare providers and surrogate decision-makers while allowing the dissent of surrogate decision-makers to be a genuinely viable option whenever possible.

Keywords: Deep disagreement; End-of-life; Incompletely theorized agreements; Surrogate decision-making.