Not Only the Doctor's Dilemma: The Complexity of Conscience in Medicine

26 Pages Posted: 30 Dec 2012 Last revised: 10 Dec 2014

See all articles by Elizabeth Sepper

Elizabeth Sepper

University of Texas at Austin - School of Law

Date Written: December 30, 2012


In recent years, conscience has become a national catch phrase, invoked regularly in health policy discussions. The word “conscience,” however, often stands in for refusal to deliver abortions or contraception or to remove or withhold life support.

In this talk, I argue that conscience is not so one-sided, nor medical decisionmaking so straightforward. First, medical decisions — especially those involving questions of life and death — inspire divergent moral convictions. Second, medical decisions do not simply implicate conscience for the provider. They should be thought of instead as involving, at minimum, three parties: patients, providers, and institutions. This three-sided relationship complicates moral decisionmaking, with each party asserting potentially conflicting claims.

I contend that in responding to conflicts over medical decisions, lawmakers have overlooked their complexity. As a result, existing legislation undermines conscience, risks harm to patients, and destabilizes ethical decisionmaking within medicine itself. The talk concludes with several proposals to improve the law’s approach to morality in medicine.

Keywords: Medicine, conscientious objection, morality, conscience

Suggested Citation

Sepper, Elizabeth, Not Only the Doctor's Dilemma: The Complexity of Conscience in Medicine (December 30, 2012). 4 Faulkner Law Review 385 (2013), Washington University in St. Louis Legal Studies Research Paper No. 13-03-02, Available at SSRN:

Elizabeth Sepper (Contact Author)

University of Texas at Austin - School of Law ( email )

727 East Dean Keeton Street
Austin, TX 78705
United States

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