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

Abstract

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