Balancing autonomy against conscience

With conscientious objection emerging as a surprise bioethical headline over the past month, it turns out that the President’s Council on Bioethics is preparing for a white paper on this very topic. Council chair Edmund Pellegrino prefaced testimony from some prominent ethicists on September 11 and 12 wtih an explanation of the scope of the Council’s study: "In light of the growth and emergence and almost absolutization of patient autonomy, how are the two to be balanced? And what is the present status, both legally and morally, of the sanctity of the human conscience? Should the health professional be morally neutral…?"

The first to speak was Father John Paris, a bioethicist from Boston College. His speech outlined the notion of conscience as a fallible but generally reliable interpreter of immutable moral truth in Catholic thought from the New Testament to Thomas Aquinas to the Second Vatican Council. Exasperated by Father Paris’s theological emphasis, Council member Alfonso Gomez-Lobo interjected that conscience can be defended "can be defended on purely rational grounds". To which, without any apparent irony, Father Paris replied that Yes, Thomas Aquinas would agree with that.

The next speaker was Anne Drapkin Lyerly, a bioethicist with the American College of Obstetrics and Gynecology. She was critical of doctors who refuse to do abortions or supply emergency contraceptives, and refuse to refer as well. She was roasted by Council member Robert P. George, a professor at Princeton, for promoting a "my way or the highway" view medical ethics.

The next speaker was Howard Brody, of the University of Texas Medical Branch, who sternly criticised the Catholic view of conscience. He preferred to see conscience as keeping faith with special moral mentors – with colleagues, in the case of healthcare workers. The rights of conscience should never trump the needs of patients, in his opinion.

Finally, Farr Curlin, of the University of Chicago, criticised what he termed the "patient sovereignty model" promoted by the previous two speakers. In his view, if doctors always acceded to patients’ requests without reference to their consciences, the outcome will be less than ideal. "Patients gain technicians, it seems to me — technicians who are committed to cooperation, and they lose healers committed to health. They gain control over physicians, but thereby divest physicians of responsibility. As a result, physicians can wash their hands of patients’ decisions so long as the physician gives accurate information and provides technically proficient health care services."

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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