The Role of Conscience in Medical Ethics

Abstract

There are a number of areas of applied philosophy where the idea of conscience enjoys pivotal importance. In political philosophy, one may debate whether elected representatives, say in Parliament, have a duty first and foremost to vote in accordance with their individual conscience, or the manifesto they were elected on, should there be a conflict; in warfare it is debated whether soldiers should follow their conscience in disobeying orders they consider to be immoral; in business it is debated whether employees’ primary loyalty should be to their employers or to their conscience, in cases where employees suspect abuses are taking place. But, at least in the public mind, it is probably in health care that issues of conscience are most clearly apparent. Examples of doctors or nurses who refuse to assist in abortion, because it goes against their conscience, or of health care professionals who break the law on euthanasia or assisted suicide because they feel prompted to do so by their conscience, are all too easy to find. But what exactly is the appeal to conscience, and what authority should it have? When, if ever, should provisions for conscientious objection be made? In this chapter I shall explore the logical structure of appeals to conscience, and then ask how appeals to conscience are best analysed in medicine and nursing.