Bound by a common profession and motivation to heal, physicians still can be moral strangers. Some physicians exercise claims of conscience to avoid participating in interventions such as abortion and physician-assisted suicide that violate their deeply held values or religious beliefs. Disagreements about these interventions transcend beliefs and values; they embody different conceptions of the goals of medicine and the meaning of conscience itself. This month’s authors seek to understand claims of conscience more fully and find ways for physicians to act in good conscience without alienating or abandoning those who seek care.
Protecting one’s moral integrity may require a conscience clause that protects positive conscience claims by permitting individuals to perform actions that are otherwise prohibited by legal or institutional rules.
Equating conscience with clinical judgment challenges the way that ethics is marginalized in medical education. Ethics is simply an account of what good medical practice looks like in particular situations.
Margaret Little, PhD and Anne Drapkin Lyerly, MA, MD
Society is best served by an approach to conscience that combines a progressive understanding of patients’ needs, a nuanced determination of when those needs translate into claims, and a limited role for conscientious refusal.