When Conscience Meddles with Ethics

Article excerpt

Abstract

The right of conscience is the right of an individual to refuse to do something requested by another on the basis of a deeply-held moral belief. Although debates over rights of conscience in medicine have focused on controversial questions at life's margins, the physician's exercise of conscience also extends to many other areas of care. Conscience is at the heart of the medical profession's commitment to honesty, compassion, and taking responsibility to prevent harm. Conscience in obedience to truth is the bedrock on which rests the moral integrity of the physician, which is essential to the patient's trust.

Objections to a medical professional's right of conscience have been based on flawed reasoning. The argument that physicians should provide any medical service that is legal upon request jeopardizes the moral integrity of the physician who is required to implement interventions he believes to be harmful to patients. Whereas the patient's right to refuse a treatment is nearly inviolable, a patient's right to demand a specific treatment is subject to physician discretion. To compel the physician to act in violation of his or her conscience would be to require that professional to become complicit in an action that he or she believes to be harmful or immoral.

The philosophical appeal to moral relativism is also flawed, because to insist that there is no universal standard of morality in medicine is to assert a truth claim that itself is not empirically verifiable. The absence of consensus on moral issues, on which conscientious people may disagree, does not establish that there exists no truth to be found on those issues. Differing views on ethical dilemmas are inevitable in a pluralistic society and should be welcomed as opportunities for dialogue and discovery. Moreover, to consider the patient's moral beliefs to be worthy of respect rather than arbitrary is to acknowledge the validity of moral beliefs.

Neuroscience, while not possessing a complete theory of conscience, has mapped brain regions underlying moral reasoning. Conscience, which has both innate and cultivated aspects, involves empathy, social awareness, reasoning, memory, and assessment of anticipated consequences. The cognitive capacities that enable conscience are essential to human interactions and growth in wisdom. They are also imperfect. An individual professional's conscience is answerable to the professional community, to humanity, and to God.

Medicine strives for a higher moral standard than can be codified in law, rationalized by philosophy, or pictured by brain scans. Abstract disciplines are detached from the patient as person, but medicine cannot be morally neutral. Medical care is actively concerned with human health and need. The practice of medicine is not merely an exchange of information or a technical procedure but is first and foremost a moral endeavor. The conditions at the bedside - the fact of illness, the act of profession, the provision of medicine - define the healing relationship, where patient and physician partner together as moral agents for the patient's benefit. Preservation of the moral integrity of the medical profession is in everyone's interest.

God has given everyone a conscience. - Dietrich Bonhoeffer1

Dissent can be most inconvenient, especially when a lone voice impedes a welldevised plan. Might dissent at times be a moral imperative? Authorized programs, legally-sanctioned policies, or ethically-endorsed guidelines sometimes draw lines that conflict with the deeply-held beliefs of part of the community. They may conflict with the values of a minority, or they may compromise the values of a majority for the sake of an ostensibly greater good. When such conflict moves from discussion and debate to requiring people to act in violation of their most deeply-held moral principles, dissenters may appeal to conscience to justify their nonparticipation.

Conscience, according to the Oxford English Dictionary, is "the sense of right and wrong as regards things for which one is responsible; the faculty or principle which pronounces upon the moral quality of one's actions or motives, approving the right and condemning the wrong. …