Examining the Consequences of ACOG's Definition of Conscience

In the last blog post we examined the definition of conscience promoted by the Committee of Ethics of the American College of Obstetricians and Gynecologists. When we compare their description to the definition taught by the Catholic Church, we notice that they have many similar points, but one major difference. The definition of conscience proposed by ACOG does not even mention an objective moral law as a norm for conscience. The next logical (and common) question is, so what? This blog article will examine the consequences of understanding conscience according to ACOG’s definition, using the very opinion statement published by that committee. We’ll first explore the committee’s examination of what makes a judgment of conscience valid. We’ll then look at the importance of their implication that the judgment of conscience is not inviolable. Finally we’ll see that their definition of conscience opens the door for tyranny.

Click here to read the first blog article in this series

Click here to read about the Catholic Church's teaching on conscience at the Abbey

According to ACOG’s definition of conscience, a judgment of conscience is only valid to the extent that

1. the underlying values “constitute a core component of” one’s identity


2. the a person has deeply reflected on the issue at hand


3. the person is likely to feel guilt, shame or loss of self-respect by performing the act in question (2).

Notice once again that all of these conditions for an authentic judgment of conscience are subjective. None of them appeal to an objective norm of right and wrong. The committee on ethics goes on to say that a claim to conscience is not genuine if it is a mask for personal distastes, based on discriminatory attitudes, based on self-interested motives, and influenced by social pressures.

On one hand, these statements seem reasonable. We need to deeply reflect on matters of conscience, make sure our decisions are not being unreasonably influenced by social pressures, biases or distaste and be careful that we are not being selfish. However, the list of qualifications offered by ACOG begs the question, “on what is an authentic judgment of conscience based?” ACOG does not satisfactorily answer this question. They seem to offer these possibilities:

1. Social considerations


2. Patient desire


3. “Professional standards”


4. Scientific integrity (at least this one appeals to something objective)

Their first basis for a legitimate judgment of conscience seems to contradict their own qualification that an authentic judgment of conscience should not be influenced by social pressure: “In some circumstances respect for conscience must be weighted against respect for particular social values.” The second basis seems to contradict good medical practice – if the moral conscience of the practitioner cannot contradict the wishes of the patient why is thre need for a medical consultant? Medical care simply becomes another consumer-provider market relationship. We’ll talk about the other conditions in a future blog article. However, the first condition is a major concern for this article.

What is the consequence of ACOG's qualifications for an authentic judgment of conscience? For ACOG, the judgment of one's conscience is not inviolable. If the moral conscience is not inviolable, neither is our right to form our own character and moral destiny. By ACOG’s own logic, personal integrity must sometimes be sacrificed for social standards. In fact, if conscience is a personal feeling and if a medical professional's conscience opposes social "moral norms," "professional standards" or a patient's desire, it would actually be selfish for a medical professional to follow her conscience! Specificallly, ACOG’s statement says, “Although respect for conscience is a value, it is only a prima facie value, which means it can and should be overridden in the interest of other moral obligations that outweigh it in a given circumstance” (2). In one statement, ACOG has relegated judgments of conscience to just one value among many, and must be subverted by moral norms imposed - not by objective truth but by social and "professional" norms created by those in power!

The imposition of a moral choice on an individual conscience (not to be confused with the attempt to rationally convince someone of the rightness of a moral decision) is called tyranny. If ACOG's definition is widely accepted, the individual right to form is own character and determine his own destiny will be usurped by those in social and political power. If conscience must be weighed against social values, then society controls the individual. ACOG itself proposes certain moral assumptions that they claim must be accepted (based on what?). The most egregious include their assumption that because the life of an unborn baby is "debated," it can not be a professional consideration and that the life of the mother must always be placed above the life of the fetus (as if one life should be valued over another).

Our experience of the last century has revealed the fickleness of social standards. Society bases its standards on political majority, media propaganda, and immediate self-interest. For this reason, philosophers from Plato to Saint Thomas Aquinas to John Locke to Thomas Jefferson have stressed the need for guidance of objective standards that transcend the whims of the people (Jefferson did not believe these standards should be enforced by the federal government, but he did believe they needed to be in place). According to ACOG's arguemnt, the personal conscience of the abolitionist should have been sacrificed to the social standard that accepted slavery. The German dissenter during Hitler's reign should have been silenced in the face of the social standard that accepted the values of the Third Reich.

By defining conscience only as a personal judgment without any reference to an objective moral law, ACOG robs the moral conscience of its importance and purpose. ACOG then subverts moral conscience even further by subordinating it to the whims of society and those in power who set medical professional standards.