Conscience
What?
- Conscience involves a commitment to live morally and a judgment about whether past or proposed actions honor that commitment. It concerns individual decisions and the course of a life.
- Conscience is not identical to intuition, guilt, or satisfaction. Prudence discerns fitting action in a particular situation; conscience assesses fidelity to moral commitments. It requires formation and can be mistaken.
So What?
- Acting against considered moral judgment threatens integrity and a clinician’s sense of purpose. Conscience can also prompt medicine to examine harmful routines and disputed assumptions.
- Disagreement about conscience requires serious attention to patients’ good, access, dignity, and safety. The outline argues that conscience should be followed while stressing the obligation to form it carefully and examine possible error.
Now What?
- Reflect on your actions, motives, and habits. Study difficult questions, seek sound counsel, and test whether your commitments serve the ends of medicine.
- Discuss conflicts in terms of the good of the patient and the responsibilities medicine entails. Ask what counts as care, what harm could follow, and how the patient’s and physician’s convictions can be respected.
Clinical Case (Adapted from The Way of Medicine by Curlin & Tollefsen, 2021)
You are a local primary care physician. Abe Anderson is a fifty-year-old carpenter. He has smoked two packs of cigarettes each day for thirty years. Mr. Anderson has a particularly bothersome respiratory infection, with fever, fatigue, and a hacking cough productive of thick yellow sputum; his wife has persuaded him to see a physician. Mr. Anderson asks for antibiotics. Upon determining that the infection is viral rather than bacterial, you decline to prescribe antibiotics since they will be ineffective against a viral infection and will likely cause adverse side effects for Abe, including potential allergic reactions and loose stools. Mr. Anderson says, “Doc, I value having the antibiotic, even if you do not think it is likely to benefit me. I think it will be good for me, and after all, it is my body and my health we are talking about, right?” He notes that the remote possibility of harm caused by the antibiotics is outweighed by the certain harm of him worrying for days that he might develop bacterial pneumonia, not to mention the cost (another harm) of having to come back to see the physician again if he does.
Discussion Questions
- Should the physician refuse or prescribe in the case as presented? Why?
- How does that choice relate to a commitment to live morally?
- Could guilt follow either decision? What does this reveal about the difference between guilt and conscience?
- If the physician later discovers that the diagnosis was mistaken, how should we assess the original judgment and its outcome?
- If conscience can err, why does the outline argue that it should be followed? What responsibilities does this place on its formation?
- How should moral responsibility be assessed when acting against conscience produces a good outcome, or following it produces a bad one?
Sources
Based on the linked LearnWorlds lessons.
Source outline: Original Drive outline