Informed nondissent: an underutilized tool for the NICU context

Informed nondissent is a form of shared decision-making in which clinicians provide a medically appropriate recommendation while observing for explicit objection, rather than requiring affirmative agreement. This approach emphasizes transparency, clinician responsibility, and the opportunity for dissent. Clinicians and parents in the neonatal intensive care unit (NICU) are frequently tasked with values-based, emotionally charged goals-of-care decisions for critically ill newborns with poor prognoses. When NICU parents indirectly express readiness to change goals of care without explicitly verbalizing it, prudent use of informed nondissent can improve alignment between parental values and goals and clinical care, prevent decisional conflict, and decrease moral distress. In this paper, we critically examine the benefits of informed nondissent and offer practical guidance for its effective application within NICU shared decision-making. We address its potential pitfalls, emphasizing that informed nondissent must be applied carefully to preserve parental authority and maintain parental ability to participate in decision-making.