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Conscience, As Related To Medical Ethics

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"And always let your conscience be your guide" were the words of Pinnochio's consultant, Jiminy Cricket. Conscience may be defined as a subjective norm of morality, which involves the process of applying and committing to individual knowledge of moral principals and values to specific cases. Even though, according to the Catholic Church, a well-formed conscience should reveal the will of God and be in alignment with church teaching, this is not always the case. Because, with conscience, moral absolutes do not exist, decisions can be made based on purely subjective criteria, which can lead to moral relativism. This issue is currently of great concern to bioethicist; should conscience be the primary guide to ethically-based medical decisions?

When considering ethical values pertaining to medicine, the role of conscience is extremely significant. Contrary to popular belief, an ethically-grounded conscience is much more than Freud's "still small voice" that an individual may hear, but a well-formed conscience is, rather, a pronouncement of inductive reason. In order to have a well-formed conscience, an individual is obligated to inform themselves about ethical norms, incorporate that knowledge into their daily lives, act according to that knowledge, and take responsibility for those actions. Therefore, a mature conscience is formed in dialogue with the sources of moral wisdom, which are tradition, scripture, church teaching, reason and experience (Clark, notes, 2/21).

Historically speaking, conscience in Greek times was only referred to as consequent conscience, which only judged an action previously performed, whereas Paul is believed to first introduce antecedent conscience, which is considered to be a guide for present and future actions. It was not until the medieval times, however, when both concepts were integrated, and conscience was defined as a guide to (antecedent) and judgement of (consequent) actions. Although traditional decision-making involved natural law as the objective norm for conscience, the contemporary conscience now emphasizes the person as the moral agent; conscience is now a "pre-eminently personal thing" (Kavanaugh, Curran 215-18).

There are three dimensions/senses of conscience, and if an individual goes through these senses, then one can affirm a well-formed conscience. Conscience 1 is synderesis, which Thomas Aquinas calls the "habit of first principles". It is above and beyond the other powers in the soul, being reason, spirit, and desire (Curran, 217). Through synderesis, one applies the principle of doing good and avoiding evil. This perception of the good produces Conscience 2, which consults the sources of moral wisdom to determine and consider the relevant facts of the case. This can also be accomplished by consulting authorities relevant to the applied circumstance. According to Gula, one's values can also be incorporated by a vision from an example or role-model, or by a narrative. When this process of reasoning and consideration is completed, Conscience 2 yields to Conscience 3. Conscience 3 is the action of producing a decision and committing to it. If all the relevant facts of Conscience 2 have been genuinely considered, then one can be certain that the decision reached by Conscience 3 is the "only sure guide for action of a free and knowledgeable person". When a conscience is declared well-formed or certain, then one must always follow it. "To violate Conscience 3 is to violate one's own integrity" (Clark, notes, 2/23).

The problem with a well-formed conscience, however, is that it does not guarantee that one is objectively doing the right thing. It only assures that one is acting with integrity and according to one's personal beliefs and values, and is of well-formed character. This is why some individuals see the principle of a well-formed conscience as a way to circumvent moral certitude rather than to encourage it. Even though conscience should be solely based on personal data and conviction, it is often misled by misinformation, distortion, lies, and

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