Knowing when Disagreements are Deep 

DAVID M. ADAMS California State Polytechnic 
University, Pomona 

Abstract: Reasoned disagreement is a 
pervasive feature of public life, and the 
persistence of disagreement is sometimes 
troublesome, reflecting the need to make 
difficult decisions. Fogelin suggests that 
parties to a deep disagreement should 
abandon reason and switch to non-rational 
persuasion. But how are the parties to know 
when (if ever) to make such a switch? I 
argue that Fogelin's analysis doesn't clearly 
address this question, and that disputes 
arising in areas like medical decision making 
are such that the parties to them have 
reasons to act as if they can be rationally 
resolved even if they are deep. Fogelin's 
analysis is thus of limited value as regards 
the practical moral demand of addressing 
concrete moral dilemmas. 

Resume: Des desaccords sont frequents 
dans la vie publique et leur persistance 
engendre parfois des ennuis et un besoin 
de prendre des decisions difficiles. Fogelin 
suggere que les parties en desaccord 
devraient abandonner la raison et 
concentrer plutot sur la persuasion non 
rationnelle. Mais comment sauraient-ils 
quand (si jamais) changer d'approche ? 
J'avance que I'analyse de Fogelin 
n' adresse pas clairement cette question et 
Ie fait que les parties en desaccord dans 
des domaines telle que la medicine ont 
raison d'agir comme s'ils pouvaient 
rationnellement resoudre leurs desaccords, 
meme si ceux-ci sont profonds. L'analyse 
de Fogelin offre donc une aide limitee pour 
resoudre en pratique des dilemmes moraux 
concrets. 

Keywords: : Fogelin, deep disagreement, bioethics, Schiavo, artificial nutrition, consensus 

1. Introduction 

Reasoned disagreement is a pervasive feature of public life. Lawyers and judges debate 
the proper interpretation of a law; scientists argue over the best theory to account for 
observed data; educators disagree over how best to structure a curriculum; literary 
theorists divide over the correctness of a certain interpretation of a text; theologians 
and philosophers present and defend sharply opposing views on issues such as the 
existence of God and the immortality of the soul. And people from all manner of 
backgrounds argue for what are sometimes strongly contested positions on a whole 
variety of moral problems. Despite sometimes vigorous discussion, many of these 
disagreements remain unresolved. For some of these issues the lack of consensus 
causes most people no great concern (think, for example, of the metaphysical problem 
of the freedom of the will). Yet in other cases the persistence of disagreement can be 
greatly troubling, reflecting the pressing urgency that a resolution be found and a 

© Informal Logic Vol. 25, No.1 (2005): pp.65-77. 



66 David MAdams 

decision made: Should "creation science" be part of a high school curriculum? Should 
capital punishment be prohibited as unconstitutional? Should competent adults be 
permitted a "right to die"? 

But what if it is possible for some disagreements to have a logical structure that 
entirely precludes rational resolution? This is the alarming possibility raised by Robert 
Fogelin in "The Logic of Deep Disagreements" (1985). Fogelin argues that deep 
disagreements are ones in which the disputing parties lack a "normal" background 
context of shared standards and beliefs, and are instead confronted with a collision of 
competing sets of belief, incapable of being disentangled through rational 
argumentation. F ogelin's analysis of why some disputes are not amenable to reasoned 
resolution is richly suggestive of questions for further philosophical work. In this 
brief paper I pursue only one of these: What is the practical salience of Fogelin's 
picture of deep disagreement for those who are parties to actual and persistent disputes? 
To afford some focus on this question, and since I work both as a philosopher and as a 
clinical bioethicist in a large community medical center, I shall draw upon familiar 
and difficult disputes in clinical bioethics to test and assess some of Fogelin 's key 
claims. More specifically, I shall use the recent and highly-publicized case of Terri 
Schiavo as a lens through which to think about the import ofFogelin's account of deep 
moral disagreement. 

At age 26, Schiavo suffered from severe brain damage due to lack of oxygen after 
her heart stopped (for reasons that are still not clear). Her husband waged a protracted 
and very public battle with her parents to remove the surgically implanted feeding 
tube that for many years sustained her body, insisting that he was simply following 
what he believed to be her wishes. While its notoriety might suggest that the Schiavo 
case was in some ways anomalous, the fact is that conflicts in the clinical setting over 
how best to care for the seriously ill are common and reflect both the continuing 
development of biomedical technology as well as the clash of widely divergent views 
regarding how best to use such tools. Complex decisions-for example, whether to 
continue the use of a ventilator to support respiration or to discontinue hemodialysis 
in patients with end-stage renal failure, whether to move a patient to "comfort care" or 
how best to interpret her advance health care directive-are a familiar part of the 
terrain in every health care institution, and frequently pit patients or their surrogates 
against each other or their physicians and nurses. 

The idea that there could be Fogelin-type deep disagreements in the field of 
biomedical ethics is disconcerting because the widely accepted response to coping 
with such dilemmas in the clinical setting has been to invoke procedures for seeking 
and reaching agreement-for doing, that is, precisely what Fogelin's diagnosis of 
persistently deep disagreement would say is impossible. Health care organizations 
have almost uniformly adopted a model of health care ethics consultation, typically 
conducted by an institutional "ethics committee," as a vehicle for providing guidance 
and counsel to those involved in disputes regarding clinical care. According to the 
widely influential report of the American Society for Bioethics and Humanities and 



Knowing when Disagreements are Deep 67 

its predecessor organizations, Core Competencies for Health Care Ethics 
Consultations (1998), I health care ethics consultation is to aim at bringing about a 
"consensus among involved parties" described by a range of "morally acceptable 
options" within the context of a particular clinical case. Health care ethics consultants 
are to assist in "the building of morally acceptable shared commitments" bounded by 
"societal values, law, and institutional policy." But if Fogelin's diagnosis of 
disagreements that are genuinely deep accurately describes the logic of bioethical 
disputes, the hope of reaching consensus through reasoned argument is illusory. If 
disagreements typical of the kind that arose in the Schiavo case can correctly be 
described as deep, then to urge family members, physicians, and those who sit on 
ethics committees to work toward consensus in dealing with difficult moral questions 
is to commend to them a futile task. As we shall see, Fogelin 's analysis would have it 
that instead of pursuing rational, argumentative discourse the parties to such futile 
debates ought frankly and openly to resort to non-rational persuasion in order to put 
an end to their differences. 

Fogelin's central claim seems to be that parties to a dispute ought to attempt to 
resolve their differences through collective rational deliberation unless their 
disagreement is deep, in which case they should give up on reason and switch to the 
use of persuasive tactics. The simple question I want briefly to investigate is: How are 
the parties to know when (if ever) to make that switch? My claim will be that Fogelin's 
analysis of deep disagreement doesn't clearly address this question, but that the nature 
of many persistent disputes, especially the moral disagreements that arise in such 
disciplines as modern medicine, are such that the parties to them have strong reasons 
to commit to the idea that they can be rationally resolved in spite of the possibility 
that such disagreements might ultimately turn out to be deep in Fogelin's sense. Thus, 
while theoretically of interest, Fogelin's analysis of the structure of deep disagreement 
is of limited value as concerns the practical moral realities of addressing concerted 
dilemmas in areas such as bioethics. 

I shall first reconstruct and clarify Fogelin's remarks on the nature of deep 
disagreement and then turn to the relevance of that account to the problem of knowing 
when a disagreement is deep, and the limited role of Fogel in's analysis of the structure 
of deep disagreement in practical moral deliberation. 

2. The Analysis of Deep Disagreement 

Though perhaps n<?t explicitly so framed. Fogelin's underlying ambition in "The 
Logic of Deep Disagreement" is to conduct a kind of Kant ian investigation into the 
conditions of the possibility of argumentative discourse: What are the conditions 
that make possible argumentative exchanges of the typical sort that Fogelin 
discusses? Fogelin's central conclusion is that argumentative discourse necessarily 
occurs against a background of broadly shared beliefs and commitments, including 
collectively understood procedures for the resolution of disagreements (p. 3). 
These widely shared beliefs form the logical scaffolding upon which the reasons 



68 David MAdams 

advanced in particular disputes are mounted and against which their salience and 
probity as relevant depends. To take an example from the clinical setting, imagine 
that two physicians are discussing a particular patient. "I removed him from the 
ventilator," says one. "Why?" "Because he is brain dead," replies the first. For this 
reply to constitute a satisfactory response to the query made, the exchange must 
have taken place against the backdrop of a complicated set of understandings 
about, e.g., what ventilators do, what the removal of a ventilator will cause, what 
constitutes brain death and the procedures and tests for confirming it, what makes 
brain death an irreversible state, why the death of brains matters in the way that 
(e.g.) the death of an appendix does not, and about the relevance of the state of 
brain death to the propriety of removing a ventilator. Fogelin's point just is that 
such ordinary exchanges would not be possible without the "normal" context of 
these shared understandings and standards. These background beliefs are already 
accepted implicitly by the disputants and thus available to be invoked, along with 
the professed reasons, to support a particular conclusion. As such, the shared 
context that makes argumentative discourse possible constitutes a set of joint 
epistemic standards to which the parties can appeal. In this way, argumentative 
exchanges that assume such a background of underlying agreement occur within 
a "normal argumentative context" (p. 4). 

But what if the shared beliefs characteristic of normal discourse are absent? 
Deep disagreements reflect an absence of a shared background of beliefs against 
which the proffered reasons can be expected to secure reasoned assent. Such 
disagreements occur in the absence of a shared background of assumptions where 
a clash of two or more sets of mutually supporting beliefs, each resting on distinct 
"framework propositions" or "forms of life" is revealed (p. 5). These framework 
propositions are argumentatively basic, such that they are immune to revision by 
appeal to the facts (p. 5). Fogelin himself suggests that contentious disputes in 
bioethics (e.g., the abortion debate) are deep in just this way. Those opposed to 
abortion (or to the use of embryonic stem cells or to the withdrawal of artificial 
support from comatose individuals) reason from one or another fundamental claim 
(e.g., the "sanctity of life") that either is wholly rejected by their opponents, or is 
invested with an entirely distinct meaning (p. 5). Deep disagreements are ones in 
which none of the contending parties are able to advance reasons as part of an 
argument that would compel their opponent to accept their position, thereby securing 
reasoned assent. Fogelin states that in the face of persistent disagreement "the 
way to put the debate on a rational basis is to surface ... background propositions 
and then discuss them directly"(p. 5). But, he observes, this won't work if the 
disagreement is deep. This is the "abnormal" context in which deep disagreement 
can arise. 

It is worth pausing to note several things here before proceeding further. First off, 
many disagreements-factual and moral-are the products of lack of relevant 
information, factual errors, mistakes in reasoning, or other such failures of deliberative 



Knowing when Disagreements are Deep 69 

rationality. (Recall Fogelin's discussion of disputants who are "dense" or "pig-
headed" (pp. 4-5).) But the presence of these deficiencies does not show that a 
disagreement is deep. A deep disagreement is (presumably) one that persists (or 
would persist) even if the parties were fully rational, completely informed of the 
relevant facts, and possessed of sufficient time and ability to deliberate fully. 

On a more general level, it has to be said that Fogelin is not always clear in his 
explanation of what is required of"nonnal" argumentative discourse. He asserts several 
times that normal discourse assumes "a context of broadly shared beliefs and 
preferences" (p. 3); at other points, however, he says that, minimally, normal 
discourse must be such that there "exist shared procedures for resolving 
disagreements" (p. 3). It seems to be his considered view that normal argumentative 
discourse typically includes both substantive beliefs that are shared (e.g., beliefs 
about the functioning of the brain and central nervous system) as well as shared 
procedures for resolving disagreements (e.g., accepted tests to verify lack of 
brain function). To see what Fogelin is claiming here, suppose that a physician and his 
colleague disagree on the substantive question of whether a particular patient has 
suffered brain death. The context of this disagreement is not abnormal-and so 
the disagreement is not deep-just so long as there are established criteria and 
specific confirmatory tests for brain death that constitute the accepted standard of 
practice with regard to ascertaining death on neurological grounds, criteria that 
allow the doctor and his colleague to settle the question of brain death in the 
particular case that concerns them. The existence of agreed upon procedures for 
what counts as evidence of brain death ensures that this disagreement is not deep. 
Put otherwise, lack of agreement on substantive beliefs (whatever they may be) is 
not sufficient to transform garden-variety divisions of opinion into deep 
disagreements-that only occurs when the parties cannot appeal to any standard, 
criterion, or test to which they are both committed and with which they can set 
about to resolve their differences. By contrast, imagine that a "pro-life" physician 
and a "pro-choice" physician are debating whether a first-trimester abortion for 
reasons other than preserving the life of the mother is morally permissible. Suppose 
that the first physician's beliefs are grounded in (say) the conviction that the fetus, 
as a person with rights, begins to exist from the point of conception; the second 
physician entirely rejects that judgment. Taken together, these basic convictions, 
each of which supports a set of further beliefs, are straightforwardly inconsistent. 
Presuming that there exists no decision-procedure or other method for resolving 
this inconsistency, the disagreement between the two disputants is deep. 

One last feature to note about Fogelin's account of deep disagreement is this: 
Fogelin claims that deep disagreements are ones in which sharp differences persist 
even when normal sources of discord have been addressed and resolved (p. 5). 
But this fact alone cannot describe a sufficient condition for a disagreement being 
deep, since a dispute can be practically speaking irresolvable yet not intractable. 
Consider, for example, the long-standing controversy over who really killed President 



70 David MAdams 

John Kennedy. This dispute may be incapable of being settled, not due to a failure 
of deliberative rationality or lack of agreement upon what types of information 
would settle the dispute, but because of lack of access to the relevant facts. Here 
we know what kinds of evidence would count, perhaps even decisively, in favor 
of one or another rival hypothesis about who killed Kennedy. The passage of time 
and paucity of remaining physical or other forms of evidence, however, simply 
does not afford sufficient data to isolate the correct explanation. In such a context 
the disagreement cannot be settled. But Fogelin makes it clear that deep 
disagreements must be ones in which the very conditions that make argumentative 
resolution of a debate possible simply do not exist (p. 5). 

3. The Schiavo Case and Deep Disagreement2 

Are moral disagreements of the sort raised in the Schiavo case deep? Is bioethical 
discourse regarding such cases necessarily abnormal? We can best approach these 
questions by setting out some of the issues raised in that case and reconstructing, at 
least in sketchy form, the kinds of claims made to support the opposing views taken 
on those issues. 

Terri Schiavo's case turned on numerous disagreements regarding, for example, 
what she would have wanted her loved ones to do for her, whether her husband ought to 
have been her surrogate decision maker, whether she could have been rehabilitated, 
the precise nature of her neurological condition, and (most controversially) whether 
it is morally permissible to remove a surgically implanted feeding tube from a patient 
who will die without it. Conflicting accounts were given by Schiavo's husband, Michael, 
and by her parents and their supporters of how Schiavo herself would have directed 
her care had she been able to do so. Michael contended that he had held conversations 
with his wife before her injury in which she had stated she would not wish to be kept 
alive on artificial support with such a grim prognosis; the parents insisted that Mrs. 
Schiavo had never expressed such views to anyone and that her husband never 
mentioned his wife's wishes until some years after her accident. They also pointed 
out that her Catholic upbringing would have inclined her to the Church's position on 
the provision of artificial nutrition-namely, that it may not permissibly be foregone. 
Others disputed this last claim, observing that Schiavo had left the church many years 
before her accident. 

Does the discordance of views over what Schiavo would herself have wanted 
constitute a deep disagreement? On balance, I do not think that it does. To begin with, 
it was never disputed by the warring parties that Schiavo's own considered judgments 
regarding the use of artificial supportive interventions should be respected if they 
could be discerned. Nor was it apparent that the parties disagreed as to the kinds of 
procedures that could generally be expected to yield evidence of an individual's 
considered views. (One procedure commonly used, though not by Schiavo herself, is 
the preparation of a written advance health care directive, in which one's convictions 
concerning the use of supportive interventions can be spelled out.) Moreover, it is 



Knowing when Disagreements are Deep 71 

apparent that, because Schiavo did not execute any written set of instructions, it 
may in fact not be possible to know her wishes clearly and convincingly. On 
Fogelin's view, then, this disagreement seems much like that over the death of 
President Kennedy: it is not necessarily deep, even though it is very likely practically 
irresolvable. 

Perhaps a more plausible candidate for a deep disagreement in the Schiavo case 
concerns the precise nature of her neurological condition: Was she in a "persistent 
vegetative state" (PVS), as her husband and some of her doctors contended? Or was 
she in a "minimally conscious state" (MCS), as maintained by her parents? (A patient 
in a PVS is entirely and permanently unresponsive to any stimuli; those in an MCS do 
possess some degree of awareness, albeit transient.) Did Schiavo have any degree of 
conscious awareness of herself and her surroundings? Were her facial expressions 
and guttural utterances the result of involuntary movements or attempts at meaningful 
responses and the conscious expression of pain and discomfort? Opinions differed 
sharply on these (related) questions, and remained so despite the findings of an autopsy, 
issued several months after Schiavo's death. The medical examiner found that "there 
was nothing in the autopsy inconsistent with persistent vegetative state," and that 
Schiavo's brain "showed marked global anoxic-ischemic encephalopathy resulting in 
massive cerebral atrophy" (Grady, 2005, p.5); yet Schiavo's parents pointed out 
that the examiner had found her to be "brain-injured, not brain dead" and that she 
had a strong heart (Hopfensperger, 2005, B 1). 

Unlike our earlier case involving determination of brain death, this nest of disputes 
regarding Schiavo's condition appears to have reflected not only a lack of any agreement 
on how precisely to characterize her neurological status, but also a deeper lack of 
consensus on what might constitute adequate procedures for determining whether, 
for any brain-injured patient, she is in a PVS or an MCS. In other words, there was 
here a lack of agreement both with respect to substantive beliefs (Can she feel pain?) 
and also with regard to procedural standards (How can we settle whether she is 
feeling pain?). In this way, the division over Schiavo's neurological status looks 
like a deep disagreement, and thus not one amenable to a reasoned argumentative 
resolution. Yet the inference to this conclusion could be challenged. For example, 
future developments in neuroscience could make it possible to make increasingly 
fine-grained assessments of patients with brain injuries, so that the precise 
boundaries between PVS and other neurological syndromes or states might be 
more sharply delineated and a uniformly accepted standard thereby worked out. 
This reply of course assumes something Fogelin may not be willing to grant: 
namely, that disagreements are not deep as long as it is possible for the disputants 
to develop procedures for resolving their dispute even though they have yet to do 
so. 

Certainly the most potentially contentious disagreement raised by the Schiavo 
case concerns the moral status of artificially-provided nutrition. Supporters of 
Schiavo's husband argued (in terminology made familiar by the Catholic church) that 



72 David MAdams 

artificial feeding tubes should be considered "extraordinary" means oflife support 
and thus not morally required if the benefit provided is outweighed by the burdens 
(suffering and indignity) imposed. Opponents of this view (including the Church 
itself) maintained that the provision of food is a response to a basic human need 
and ought not to be regarded as optional treatment. To remove a gastrostomy tube, 
according to the view of Schiavo's parents, is just to starve the patient to death. 
Here the contending views appear to be premised on basic convictions (Foge\in's 
"framework propositions") each of which is the denial of the other: 

and 

(1) Removing artificial nutrition and hydration is always an impermissible act 
of starvation. 

(2) Removing artificial nutrition and hydration is at least sometimes a 
permissible act of compassion and respect for patient autonomy. 

These claims are logically incompatible. And something very much like them seems 
to have animated the opposing factions in the sometimes ugly "culture war" that erupted 
throughout America as Schiavo neared the end of her life.3 It seems safe to conclude 
that the disagreement reflected in the juxtaposition of these claims is at least consistent 
with the disagreement being deep. 

4. Agreement, Consensus, and Non-Rational Persuasion 

Let us suppose, then, that at least some of the disputes raised by the Schiavo case 
are possibly deep injust Fogelin's sense. What ought to be the practical upshot of 
this fact? How ought the fact that a disagreement might turn out to be deep affect 
the conduct of the disputants themselves and those, such as members of hospital 
ethics committees, who are charged with the responsibility of assisting in the 
resolution of such disputes? 

Fogelin writes as if to say that, practically speaking, the import of the fact that a 
disagreement is deep is that the involved parties not further waste their efforts on 
rational argumentation. Quoting with approval Wittgenstein's remark that "at the end 
of reasons comes persuasion," (p. 6) Fogelin asks: Where the discourse is abnormal 
and we have to fall back upon persuasion, "what's so bad about using these 
[persuasive] techniques right from the start?" (p. 6). Fogelin's view seems to be 
that deep disagreements are not uncommon but nonetheless not particularly 
worrisome either, since one can always resort to non-rational means of persuasion in 
order to move opposing parties to a place of agreement. Fogelin implies that 
disagreements incapable of resolution through rational argumentation do not 
necessarily constitute a complete practical impasse, since the relevant beliefs can be 
changed without rational argumentation through the use of non-rational persuasion. 
Fogelin is almost entirely silent on what such non-rational techniques might include, 
though he does cite Wittgenstein's parenthetical remark "Think what happens when 
missionaries convert natives" (p. 6). Presumably, then, we could attempt to bring 
it about that those with contesting views are moved to agree, not "on the merits," 



Knowing when Disagreements are Deep 73 

as it were, but by virtue of (say) appeals to self-interest or fear or empathy. Appeals 
to authority or emotion, indoctrination techniques, and other rhetorical ploys and 
devices could all conceivably fall into the category of non-rational efforts to bring 
about or induce acceptance of a belief. 

So, where the discourse is abnormal, Fogelin's recommendation is to abandon 
rational deliberation in favor of these techniques of persuasion. In the context of 
bioethical decision-making, of course, this recommendation is plainly at odds with 
the accepted model for seeking to resolve disputes like those that arose in the Schiavo 
case. That model, as explained earlier, is bottomed on the attempt to resolve such 
disagreements through efforts at reaching consensus. To pursue this point further, it 
surely would not be sufficient on the consensus model simply to bring it about by 
non-rational means that those with previously discordant views now hold opinions 
that converge, such that there is unanimity of opinion in a difficult case. In that sense, 
'consensus' would merely be the name of an outcome: The ethics committee took a 
poll and (perhaps surprisingly) everyone voted the same way. But mere convergence 
of opinion or belief upon a particular concl usion is not sufficient for an agreement to 
count as an instance of"facilitated consensus"; the fact that the warring family members 
happen to arrive at the same moraljudgment in a particular case would not be sufficient 
grounds for claiming that a consensus decision had been reached. The ASBH Report s 
discussion of "facilitating consensus" indicates that it means to require more than 
merely a discovery that everyone gives assent to a given proposition, regardless of 
how that mutual assent comes about. "Consensus" is not simply the name of an outcome 
but an achievement-something produced by a form of collective moral reflection 
and deliberation, a process of being mutually convinced by reasons. This emphasizes 
the way in which the moral authority of an agreement depends in some way upon how 
it was developed. 

Non-rational means of persuasion could conceivably be used to move the parties 
involved in a Schiavo-type dispute to settle their differences with the negotiation of a 
compromise, motivated by (say) the skillful deployment of rhetorical tactics. But the 
facilitation of consensus oUght not, I think it is clear, to be viewed in this way. Suppose 
a physician wants her patient to undergo both a tracheostomy and the placement of a 
surgically implanted feeding tube; but the family rejects both. Imagine further that the 
ethics consultation in this case had sought, through non-rational appeals to self-interest 
or fear or what have you, to bring the contending parties to accept a compromise: 
the tracheostomy would be performed, but not the feeding tube insertion, so that 
each side would "come away from the table" with a concession. Why would it be 
wrong to produce agreement in this way by "splitting the difference" between 
rival views? The answer, I think, must have something to do with the belief that 
the moral goal of resolving bioethical disputes is to identify that course of action 
deemed somehow to be in the best interests of the patient. Striking a bargain or 
reaching a compromise between two opponents may meet their need to resolve 
their differences and move on, but the focus of ethics consultation is supposed to 
be the patient's well being, not those of the people around the table. To make 



74 David MAdams 

treatment decisions in this way based upon what will satisfy the rivals rather than 
what is in the best interests of the patient seems prima facie to exhibit a moral 
failing in the consultative process. 

The use of non-rational forms of persuasion to produce agreement, urged 
upon us by Fogelin's analysis, is therefore problematic, both procedurally and 
substantively, in attempts to settle serious and difficult bioethical problems. 
Procedurally, the goal in resolving bioethical disagreements, at least in the clinical 
setting, is not simply agreement secured by whatever (non-rational) means, but 
agreement that constitutes a genuine consensus-that is, agreement as the outcome 
of reasoned, collective deliberation. The resort to non-rational forms of persuasion, 
to the extent that they undercut the very possibility of such deliberation, is 
incompatible with the generally accepted process for coping with bioethical 
dilemmas. Moreover, the process whereby parties to a bioethical dispute reach 
consensus may properly be constrained substantively by moral norms (for example, 
the principle that medical decisions must reflect the patient's best interests) the 
salience of which cannot be captured by reliance upon non-rational manipulation 
of the parties to a disagreement. 

5. Knowing When a Disagreement is Deep 

F ogelin 's recommendation that those confronted with a deep disagreement abandon 
rational argumentative discourse faces a more significant hurdle than its inconsistency 
with the idea of collective moral decision making. For to forsake the pursuit of reasons 
makes sense as a recommendation only on the assumption that the disputants not only 
are locked in a deep disagreement, such that further efforts at rational deliberation 
would prove unavailing, but that they know they are. Here we come to a point 
crucial to the relevance of Fogelin's analysis to practical reasoning. Just how are 
we to know when the conditions that make argument possible are incapable of 
being satisfied? For any given case, in what way are we to know that we have 
correctly identified the disagreement at hand as deep or (which comes to the same 
thing) the discourse as "abnormal"? This question highlights an important feature 
of Fogelin's analysis. It purports to set out the logical features of a deep 
disagreement, but it does not specify any epistemic criteria sufficient to ground the 
belief that a given disagreement is in fact deep. More generally, Fogelin's analysis 
tells us what counts as a deep disagreement in the sense of limning its logical 
structure. But it doesn't tell us how to establish in a given case whether a particular 
dispute is amenable to rational resolution. 

How, then, can we tell when a disagreement is deep? As we have already seen, the 
fact that a persistent disagreement appears to the parties to be deep is no guarantee 
that it is. The dispute discussed above between those who support and those who reject 
the permissibility of removing artificial nutrition from a brain-damaged patient may 
seem to be irresolvable due to a lack of mutually accepted beliefs. But again the 



Knowing when Disagreements are Deep 75 

appearance of a deep disagreement here might turn out to be deceptive. Recall the 
two claims that look to be a stake in the Schiavo case: 

And 

(1) Removing artificial nutrition and hydration is always an impermissible act 
of starvation. 

(2) Removing artificial nutrition and hydration is at least sometimes a 
permissible act of compassion and respect for patient autonomy. 

Suppose now that discussion with the advocates of (1) and (2) reveals that they 
do in fact share a commitment to some third claim, say: 

(3) Disagreements over the use of artificial supportive medical interventions 
(such as tube feedings) should be settled by appeal to the best interests 
of the patient. 

According to Fogelin's analysis, the fact that proponents of (1) and (2) know that 
they share a commitment to (3), which purports to set out a procedure for resolving 
certain kinds of disagreement, seems sufficient to assure them (and us) that they 
are still operating within the realm of normal discourse. 

Confronted with this last contention, Fogelin might well object that if the parties 
on opposing sides of the debate over artificial nutrition can still arrive at opposing 
positions even in the face of a shared acceptance of (3), then it seems plain that the 
appeal to such an abstract procedural principle is doing no real work. Put another way, 
the mere fact that the disputants accept (3) is not sufficient to transform the context 
of their disagreement into normal discourse. For that to occur such shared beliefs 
must be capable of doing real argumentative work; it must be possible, that is, for 
the disputants to be brought argumentatively to resolve their disagreement over the 
permissibility of removing artificial nutrition by appeal to something like (3). But if 
that is in fact not possible, then mutual acceptance of(3) is logically compatible with 
the state of affairs in which supporters of(1) and of(2) deeply disagree. 

But Fogelin's rejoinder here misses the point of the epistemic worry raised by his 
recommendation to abandon rational argumentative discourse when disagreements 
are deep. For the problem is how the contestants are to know that none ofthe beliefs, 
commitments, or procedures to which they mutually assent could form the basis of:l 
reasoned resolution of their disagreement. Presumably, even people sharply divided 
over the moral status of artificial nutrition and hydration nonetheless share a multitude 
of factual and moral beliefs. But whether the parties are operating outside the 
scope of normal discourse, such that whatever beliefs they share are incapable of 
doing the work necessary to resolve their dispute, is precisely what the parties 
themselves need to know before they abandon their efforts to reason from shared 
beliefs in principles like (3) to a resolution of their differences. As a practical 
matter, it is not clear what could count on Fogelin's view as a discovery by the 
disputing parties that a disagreement is deep, since it could not confidently be 
concluded that the gulf separating proponents of (1) and (2) is unbridgeably deep 
unless all possible beliefs and commitments, substantive and procedural, for bridging 



76 David MAdams 

that gap are rejected by one or both of the parties. More generally, the logic of deep 
disagreement makes it impossible to specify a priori conditions such that, for any 
disagreement, satisfaction of just those conditions would be necessary and sufficient 
epistemically to conclude that the disagreement is deep. The only way for the 
parties to know whether such a state of affairs obtains is by continuing to work 
through an attempt at rational discourse, and this because thl: question of whether 
a given disagreement is deep can only be settled by exhausting the possible resources 
of normal discourse. All of this means that the only way for the parties to establish 
that their disagreement is deep is to reject the very path of non-rational persuasion 
recommended by Fogelin and concentrate instead on their collective efforts at 
mutual persuasion by reasons. The only way, in other words, to come to know 
whether discourse is normal is to proceed as if it is. 

To this, it may be asked why the disputing parties in the case of artificial 
feeding tubes couldn't reach a point where it would be apparent to them that they 
have exhausted the resources of normal discourse. The answer, I think, is that 
while certainly this is a logically possible result of collective deliberation, it is not a 
practically attainable end point. Problems in clinical bioethics cannot await the 
kind of systematic and comprehensive examination of the logical structure of 
systems of belief that would be required to demonstrate that "normal" conversation 
is no longer possible on a particular question. Indeed, a large part of what makes 
most bioethical dilemmas in clinical care so wrenching for those involved is the 
necessity to make decisions under conditions of uncertainty, and this because all 
of the possible courses of action open to a physician or family in such a case (for 
example, to start a patient on a ventilator now or to wait to do so) impose costs-
emotional, physical, and financial. Hence the moral pressure to make a decision 
and accept the consequences, whatever they may be. Under these circumstances, 
delaying the effort to arrive at a reasoned decision on the grounds that the 
disagreement might be one that is actually deep is itself a decision to impose costs 
and may be indefensible morally if those costs are greater than would be created 
by abandoning rational discourse and resorting to non-rational tactics to end the 
matter. And as we have seen, this claim is reinforced by the conclusion of the 
previous section that the widely-accepted bioethical goal of consensus presupposes 
a commitment to persuasion through rational, argumentative discourse. 

6. Conclusion 

IfFogelin is right, then it is possible for people to disagree deeply on a whole variety 
of issues, including the bioethical debates illustrated so tragically by the case of Terri 
Schiavo. But the prospect that a clash of opposing views might be so deep as to be 
rationally irresolvable can, I think, have little practical effect on the efforts of disputants 
who, quite properly, continue to proffer reasons and develop arguments in the 
hope that they may move each other to a mutually acceptable position on the 
problem that divides them. 



Knowing when Disagreements are Deep 77 

Notes 

I A summary of the ASBH Report appeared in Aulisio et al. (2000) and Aulisio et al. (2003). 
2 For history and analysis ofthe Schiavo case, see In Re: Guardianship of Schiavo 780 So. 2d 176 
(2001); In Re: Guardianship of Schiavo 792 So. 2d 551 (2001); and Annas (2005). 
3 See Annas (2005). 

References 

American Society for Bioethics and Humanities. 1998. Core Competencies for Health 
Care Ethics Consultations. Glenville, IL. 

Annas, George. 2005. '''Culture of Life' Politics at the Bedside: The Case of Terri Schiavo," 
New England Journal of Medicine, Vol. 352, Apr. 21: 1710-1715. 

Aulisio, Mark P., et al. 2000. "Health Care Ethics Consultation: Nature, Goals, and 
Competencies," Annals of Internal Medicine, Vol. 133, No.1, July: 59-69. 

Aulisio, Mark P., et al. 2003. Ethics Consultation: From Theory to Practice. Baltimore: 
The Johns Hopkins University Press. 

Fogelin, Robert: 1985 "The Logic of Deep Disagreements," Informal Logic, 7.1: 1-8. 
Reprinted in Iriformal Logic, 25.1 (this issue): 3-11. 

Grady, Denise. 2005. "The Hard Facts Behind A Heartbreaking Case," New York Times, 
June 19, Section 4. 

Hopfensperger, Jean. 2005. "Schiavo Family Unswayed by Autopsy's Conclusions," 

Minneapolis Star Tribune, June 17. 

David M. Adams 
Department of Philosophy 

California State Polytechnic University, Pomona 
Pomona, CA 91768 

dmadams@csupomona.edu