An Examination of ACOG's Definition of Conscience

In November, 2007, the American College of Obstetricians and Gynecologists (ACOG) Committee on Ethics wrote Committee Opinion Number 385, "The Limits of Conscientious Refusal in Reproductive Medicine." In this opinion, the Committee on Ethics undertook to define conscience, and then to place limitations based on this definition on when a health care provider can refuse to provide "treatment" based on conscientious objection.

Their definition of conscience runs like this: Conscience has been defined as the private, constant, ethically attuned part of the human character. It operates as an internal sanction that comes into play through critical reflection about a certain action or inaction. The committee also says, "Ethical decision making in medicine often touches on individual's deepest identity-conferring beliefs about the nature and meaning of creating and sustaining life." They stress the relationship between conscience and personal integrity: "According to this definition, not to act in accordance with one's conscience is to betray oneself - to risk personal wholeness or identity."

There are some good points of this definition.

• The Committee on Ethics seems to respect the conscience and to give it appropriate weight of importance, especially in its acknowledgement that following one's conscience is a key part of "personal wholeness or identity."
• Conscience is a key part of the human character. The choices that we make define our character, and our conscience helps us make those decisions and is also formed by those decisions as part of our character.
• The Catechism of the Catholic Church says about conscience, "Moral conscience, present at the heart of the person, enjoins him at the appropriate moment to do good and to avoid evil. It also judges particular choices, approving those that are good and denouncing those that are evil" (CCC 1777). That sounds pretty close to the "intenral sanction" in the ACOG definition.
• The Catechism also says, "Conscience is a judgment of reason whereby the human person recognizes the moral quality of a concrete act that he is going to perform, is in the process of performing, or has already completed" (CCC 1778). That sounds close to ". . . that comes into play through critical reflection about a certain action or inaction." In fact, this is part of the definition of conscience that many Catholics ignore today. Conscience is a critical reflection - an exercise of reason. It is not just a "little voice" that tells us what is right and wrong, although the Holy Spirit certainly speaks to our conscience, and part of our conscience is made up of synderesis, the natural moral law that is an inherent part of human nature and is therefore obvious to every human being. However, the primary function of conscience is moral reasoning.
• Finally, the CCC says, "His conscience is man's most secret core and his sanctuary" (1776). This aspect of conscience will actually compose the central argument of the ACOG statement on the limitations of conscience. It is true that the conscience is an intensely personal aspect of the human character. It resides in the heart, the center of our being, where it pulls together all of our human faculties and where our personality meets the Holy Spirit.

The ACOG Committee gets part of the definition of conscience correct, and that gives their statement a certain weight of authenticity. However, their definition omits a crucial aspect of conscience. One cannot speak of conscience as a process of moral reasoning without acknowledging objective truth. What is there to reason about if objective truth does not exist? The Catechism of the Catholic Church repeatedly stresses the relationship between moral conscience and the objective moral law:

• "Deep within his conscience man discovers a law which he has not laid upon himself but which he must obey. Its voice, ever calling him to love and to do what is good and to avoid evil, sounds in his heart at the right moment. . . . For man has in his heart a law inscribed by God" (CCC 1776)
• "It bears witness to the authority of truth in reference to the supreme Good to which the human person is drawn, and it welcomes the commandments" (CCC 1777).
• "It is by the judgment of his conscience that man perceives and recognizes the prescriptions of the divine law" (CCC 1778).
• "Conscience is a law of the mind; yet [Christians] would not grant that it is nothing more" (CCC 1778).

The ACOG Committee on Ethics completely ignores the objective moral law in their definition of conscience. To them, the personal nature of conscience naturally means that conscience is private and subjective.

The consequences of this mistaken definition of conscience are striking, even in the conclusions the Committee on Ethics draws in this opinion.

The authenticity of conscience can be assessed through inquiry into 1) the extent to which the underlyling values asserted constitute a core component of a provider's identity, 2) the depth of the provider's reflection on the issue at hand, and 3) the likelihood that the provider will experience guilt, shame or loss of self-respect by performing the act in question. It is the genuine claim of conscience that is considered next, in the context of the values that guide ethical health care.

Notice that all three of these earmarks of "authentic claims to conscience" are completely subjective. By relegating the claims of conscience to personal and subjective decisions, the Committee on Ethics can summarily dismiss these claims - which is exactly what they do in the rest of the opinion, as we shall see in the next post.