Dr.

Acevedo

Med Ethics: Conscience

PRINCIPLE OF A WELL-FORMED CONSCIENCE (Informed Conscience) The moral precepts as objective norms of morality can be compared to signposts and markers on the road, which indicate the direction the traveler must take in order to reach his goal. Conscience are guides on our journey in our lives Directs us to the right path to our goals Voice speaking to man which is himself

STANDARDS OF MORALITY Some norms or standards of acting are followed Norms of moral actions are highly necessary if people have to live in peace, order and Harmony. Morality => Peace, Order and Harmony Two norms or standards of moral and ethical actions recognized and understood in Bioethics o Natural Law o Conscience CONSCIENCE Subjective norm of morality Maybe erratic and prone to miscalculations Based on human intellect, which is imperfect, therefore prone to errors As judgment of intellect, it makes declaration of o Truth and Untruth o Goodness and Badness o Actions he wants to pursue o Thoughts he wants to believe May be affected by o Family o Environment o School o Church o Individuals own biases Narrowness of experience or outlook Moral obligations CONCEPT AND NATURE OF CONSCIENCE Heteronomous conscience o Normative ethics o Focused on Laws and obligations Commands and prohibitions o No room for evaluation on decisions

Concept of conscience in theology o Judgment of reason whereby general norms of the moral law are applied to a concrete action A person is about to perform or has performed, telling the person what his obligation is here and now or judging his past acts. o St. Augustine and the Franciscan School The place of the innermost encounter between God and man, and therefore the voice of God. The persons most secret core and sanctuary. The spark of the soul; the peak of the soul. Recent theologians of the Franciscan school That faculty which makes known to man his moral obligations and urges him to fulfill them. Second Vatican Council

The most secret core and sanctuary of the human person. Conscience as subject to being

If Life is self-realization then, Conscience is subjectoriented

must do Autonomous conscience o Subjective o Ignores law o Determines right and wrong by itself
Robin Hood? Steal from the rich give to the poor - Stealing is bad but they think its for the good of the people because they give the money to the poor.

But if the ultimate end of man is the glory of God, the building of His kingdom of justice and peace and the further unfolding of the work of creation, then conscience appears to be object-oriented. o If Life is for the glory of God, then Conscience is object-oriented As a Practical Moral Judgment Concept of the Dictate of conscience o Conscience is an ultimate, practical judgment on the morality of a concrete action, commanding to do what is good and to avoid what is evil. o Conscience is the meeting point of the MORAL LAW, objectively and universally valid and the INDIVIDUAL PERSONALITY. OTHER DEFINITIONS 1. Refers to the inner sense of right and wrong in moral choices, as well as to the satisfaction that follows action regarded as right and the dissatisfaction and remorse resulting from conduct that is considered wrong. 2. The CAPACITY TO MAKE PRACTICAL JUDGMENT in matters involving ETHICAL ISSUES. The capacity cannot be delegated to anyone else or to any institution. 3. An ultimate practical judgment on the morality of a concrete action, commanding to do what is good and to avoid what is evil. 4. 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. When man listens to his conscience, the prudent man can hear God speaking. SHOULD A MAN FOLLOW HIS CONSCIENCE BE IT RIGHT OR WRONG? St. Thomas Aquinas: Every conscience, whether right or erroneous, whether with regard to acts which are evil in themselves or acts which are indifferent, is obligatory, so that he who acts against his conscience does wrong. YOU MUST FOLLOW YOUR CONSCIENCE! HOW DO WE FOLLOW OUR CONSCIENCE? Follow the law o But legality doesnt always mean morality Legalizing abortions Follow your cultural beliefs o Limited when people become aware of equality rights Jehovahs Witness against blood transfusion Muslim women death punishment for commission of adultery Follow your feelings

CONCEPT OF CONSCIENCE From Holy Scriptures Old Testament Hellenistic origin o Syneidesis (Democritus) Part of conscience of passing judgment on acts already performed o Judgment of conscience is the voice of god (Job) o Later translated to Conscientia by Cicero New Testament Paul o Universal endowment of every man in which he judges his deeds and omissions

So if you judge your own actions, you have a conscience

As a Moral Faculty Views outside of Christian Theology o Seneca Holy spirit dwelling in man, an observer and watcher of good and evil in us o Kant Consciousness of an interior court of justice in man o Freud Superego Kind of superstructure of the ego The Persona o Jaspers

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Med Ethics: Conscience

Feelings belong to the domain of emotions or passions. They are erratic and can change depending on how the swing of moods presents itself to the person. Hence, judgment based on feelings is highly unstable and can hardly be relied upon Follow your religion o The language of God is always love and peace. But the language of those who kill in the name of God is hatred and violence. Thus religious beliefs can be distorted by man due to his concupiscence, greed and pride PRINCIPLE OF A WELL-FORMED CONSCIENCE (Informed Conscience) This principle states that o To have a good judgment of conscience, one is obliged to form it diligently in accordance with some reasonable processes so that one arrives at a right moral decision. Conscience judges a concrete act as good or evil in accord with a norm of morality given to it. This norm is NATURAL LAW. Well-formed Conscience

DIVISIONS OF CONSCIENCE Levels of conscience

To attain the true goals of human life by responsible actions, in every free decision involving an ethical question, one is morally obliged to do the following: o Inform himself as fully as practically possible about the facts and the ethical norms. Knowledge of the Ethical principles is necessary. o Form a morally certain judgment of conscience on the basis of this information o Act according to this well-formed conscience; o Accept responsibility for his actions. Thus, to follow ones conscience is properly to follow ones well-formed conscience.

Qualities which refer to Freedom Qualities which refer to Objective Value Qualities which refer to Moral Attitude Qualities which refer to Degree of Certitude

Levels of conscience

Morality always involves a choice in arriving at a moral decision: 1. There are many alternative means to a goal, some of which are clearly in-appropriate, but often many are appropriate, each with its advantages and disadvantages; 2. It is possible for people to reconsider their goals and to redefine or even alter them in view of some higher goal. Man has the right to act in conscience and in freedom so as personally to make moral decisions. He must not be forced to act contrary to his conscience, nor must be prevented from acting according to his conscience. EDUCATION OF CONSCIENCE The education of conscience is indispensable for human beings who are subjected to negative influences and tempted by sin to prefer their own judgment. The education of conscience is a life-long task. From the earliest years, it awakens the child to the knowledge and practice on the interior law recognized by conscience. Prudent education teaches virtue; it prevents or cures fear, selfishness, and pride, resentment arising from guilt, and feelings of complacency, born of human weakness and faults. The education of conscience guarantees freedom and engenders peace of heart.

Antecedent judgment on morality of an action and the obligation to perform or omit it is passed o Judging the act before doing it o Commands, exhorts, permits, forbids Concomitant the actual awareness of being morally responsible for the goodness or the badness of a particular act which we are carrying out o Judging the act while doing

Consequent if it evaluates a deed already done or omitted o Judging the act already done Qualities which refer to Freedom of Action

Free one is able to assume a personal moral stand with regard to a particular action in a way that is unhindered, in order to answer for that particular action or attitude

Unfree Ones moral attitude or responsibility for a particular action is hindered by some obstacles such as fear or anger Qualities which refer to Object of Value Right agrees with the objective norms of morality. It judges conscience as morally right or wrong, in accordance with fact, that is, when it judges as good that which is really good and as evil that which is really evil. What is morally good, however, must not necessarily be morally right, and vice versa. o If the act itself is obviously good or bad

Killing is bad, so you should not do it

Informed conscience needs knowledge of the facts and of the law, but it also requires a disciplined or virtuous affection for what will truly satisfy our needs in an integral manner.

Erroneous conscience that is not true. There is lack of conformity between the objective values and the moral demands that go with them and ones subjective moral perceptions, discernment, dictates, and decisions in the habitual or actual levels of conscience. Either vincibly or invincibly. o Killing is bad, but killing a dictator maybe good o Vincibly erroneous erroneous through the agents fault. This is culpable, because with some good will its error could be corrected. This cannot be followed as a legitimate rule of action Insufficient grounds, to judge a thing Slightly evil, when actually it is gravely evil To be lawful, while in fact it is unlawful and sinful This is considered as vincibly erroneous o Invincibly erroneous erroneous without the knowledge or fault of the agent. Inculpable, since the person has no awareness of the possibility of error. The invincibly erroneous conscience must be

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Med Ethics: Conscience

followed just the same as a certain conscience which is right. Qualities which refer to Moral Attitude Learn the facts about the medical condition 2. Determine in accord with and objective value system the needs and rights of the people involved ii. Make and carry out decision in accordance with this information Knowledge of the factors involved is not enough to make a rational decision. This must be supported by a free will and a healthy emotion. 1.

Clear - a conscience which confidently and freely acts with due regard for perceiving, appreciating and internalizing true values. Lax or dulled - is inclined, on insufficient grounds, to judge a thing o To be lawful, when in fact it is unlawful and sinful o Slightly evil, when actually it is gravely evil o Considered as vincibly erroneous o Compensatory conscience a variety of lax conscience which attempts to conceal a fundamental lack of generosity in the spiritual life which is intended to divert attention from the unwillingness to live up to ones true vocation Strict - shows that the conscience tends to judge obligations too harshly, especially in an excessive legalistic way. Scrupulous - Scrupulosity is the persistent, gnawing, unreasonable fear that one has offended God or is about to do so. The scrupulous person is in constant dread of sin where here is none, or of grave sin where there is only venial sin. St. Francis de Sales points out that scrupulosity have its source in PRIDE. It must be avoided as in lax conscience. Pharisaical - akin to the compensatory Conscience which attaches great importance to small things and makes light of serious matters. Conscience tends to be self-righteous as far as ones own moral evaluation is concerned. Callous - the worst type of conscience because it has no sensitivity to sin, as if the person has no conscience at all. b.

Qualities which refer to Degree of Certitude

Certain Passes judgment without fear or error. An absolutely certain conscience, however can still be erroneous. o A certain conscience must always be obeyed when it commands or forbids. It is the competent and indispensable guide given to man to discern his vocation and moral obligation. Therefore to disobey this faculty is to disobey the moral order, it is to disobey the will of God, and this is sin. o The certainty required for the judgments of conscience generally need not be a strict moral certainty, but a wide moral certainty is sufficient.

Doubtful or Dubious - Uncertain concerning the morality of an action. The agent cannot definitely decide whether the action to be done is good or evil. The doubt may either concern the existence of a law and moral principle or the existence of a fact. o Legal or moral Therapeutic abortion o Factual presence of a cancerous growth in the uterus of a pregnant woman

Strict moral certainty - people will not kill arbitrarily.

Wide moral certainty - physicians will act responsibly & with competence. Must be at least right or at least invincibly erroneous in order for it to be a rule of morality. Invincibly erroneous conscience is also a rule of morality, simply because a man doing this particular action considers it a right moral decision.

Guide for action in Doubtful Conscience 1. In a practical doubt about the lawfulness of an action one may not act. 2. The action must be postponed until certainty can be reached. Practical certainty can be gained directly by solving the doubt through: a. reflection on the case in the light of the general principles b. consultation of experts and pertinent books c. Clarification of the facts, etc. 3. If the doubt cannot be solved directly-but only then-one may attempt to gain practical certainty indirectly by the application of the so-called reflex principles. 4. If there is no time or possibility to solve the doubt, one must opt for the safer alternative, that is, one must favor the alternative which excludes the danger of sin and injustice most certainly. Doubtful or Dubious Conscience: When in doubt about whether a course of action is ethical, give benefit of the doubt to: 1. Existing customs 2. Established and well-known laws 3. Usual way of acting 4. Acceptance of what has already been done: - Codes - Policies - Long experience 5. Reflections 6. Survival

Ethical principle certain conscience must always be obeyed when it commands or forbids. Certainty need not be a strict moral certainty but a wide moral certainty is sufficient Concrete Application of Moral Norm Two different levels of moral certitude 1. Theoretical level of principle and value priorities 2. Practical level of concrete application of principles to particular problems of moral decision Certitude in Ethical Decisions requires: 1. Adequate information 2. Clear understanding of values a. When making personal decisions about health care, one must have the responsibility to follow informed conscience i. Obtain as much relevant information as possible about a situation, both the facts and the objective moral standards (principles) applicable to the situations:

Probable When conscience is doubtful, but grounded upon solid reasons, the agent is said to have a probable opinion. Perplexed The agent is confronted with two alternative precepts and he is afraid of choosing any of the alternatives; a type of erroneous conscience which, in a conflict of duties, fears sin in whatever choice it makes. Classified as an erroneous conscience, because objectively only one of the two conflicting obligations can be binding. It would contradict justice and the wisdom of God if man were

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Med Ethics: Conscience

confronted with two equally binding obligations, of which after all he can fulfill only one. o Example: A resident physician feels obliged by precept of the Church to go to Sunday Mass and bound by charity to report for duty in the hospital because of a critically sick patient, the obligation of charity should be preferred to the obligation of the ecclesiastical precept o Guidelines for action against the latters will. The high probability is that the person contemplating suicide is unable at that moment to make a truly personal decision. However, the help which the doctor or any friend may offer cannot be restricted to saving the biological life; rather, all efforts should be directed towards helping the prospective suicide to find the sense of his life and then arrive at a responsible decision.

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Certain conscience must always be obeyed when it commands or forbids. Certainty needs not be a strict moral certainty but a wide moral certainty is sufficient. Invincibly erroneous conscience must be followed just the same as a certain conscience which is right. The vincibly erroneous conscience, lax conscience, the perplexed conscience and the doubtful conscience cannot be followed as a legitimate rule of action.

A number of Catholic theologians have supported the concept of freedom of choice of abortion despite the declarations against abortion by the Vatican. They have argued: 1) It is not always necessary or helpful to support morality by law; 2) There is no national consensus on the question; 3) A law against abortion could not be enforced; 4) It might lead to abortion seems to be medically justified.

*A Well-formed Conscience is one which may be antecedent, concomitant, or consequent and one which is free, righteous, or invincibly erroneous, clear and certain. THE CONSCIENCE OF THE PHYSICIAN VERSUS THE CONSCIENCE OF THE PATIENT.

What would be the proper process to inform ones conscience on these issues? 1. A fully conscious patient refuses a blood transfusion in accordance with the teaching of his religious sect. DECISIONS: o The doctor will abide by the patients request to let him die. If such request is not stated explicitly;

o o

In order for the patient to make a decision with an informed conscience, the physician has to provide himself with the necessary information. If the patient, owing to his age or condition, is unable to judge the situation clearly, the physician has to give adequate information to those who bear responsibility for him. The patient to make a decision with an informed conscience, the physician has to provide himself with the necessary information. If the patient, owing to his age or condition, is unable to judge the situation clearly, the physician has to give adequate information to those who bear responsibility for him. If, for instance, a fully conscious adult patient refuses a blood transfusion in accordance with the teaching of his religious sect, the doctor will abide by the patients request to let him die. If such a request is not stated explicitly, the doctor will prescribe the transfusion in an emergency situation without questioning; he is justified in assuming that a patient wants to be saved by the use of such an ordinary procedure especially if such a restriction has not been unequivocally imposed on the attending physician. Case of a child or a minor: The doctor normally does not need an explicit permission from the family, at least for a life-saving transfusion, and can act on the presupposition mentioned above. If, however, the family has definitively insisted that no blood transfusion be given, the physician will have to distinguish the moral from the legal aspect of the problem. Where-ever there is no legislation, the doctor will also save the life of the child should it be possible. However, when legislation stipulates that the physician must follow the dictates of the family, he will not always be empowered to perform the transfusion. Cases when physician finds himself in disagreement with his patient on some moral principle or its application: A particular human situation wherein, the physician is convinced that sterilization is necessary to ensure the reasonable health or life for the patient, and stability for the family. The patient refuses, because she considers sterilization absolutely immoral. Even if there is justification in the procedure, the doctor is bound to respect the patients decision. The physician has the duty to give his patient proper health care even if morally he disapproves of the life situation in which the patient contacted the illness Example: Patient with STD or AIDS. A woman who committed criminal abortion comes to a physician for professional assistance: Physician is duty-bound to help her. In due time, he may refer to a matter of conscience in so far as this is part of the healing process, or he may urge her, at the proper time, to cooperate in denouncing the criminal so as to avoid harm to other persons. A doctor faced with the case of a suicidal neighbor, has, in conscience, a right or duty to save the life of his neighbor even 2.

The doctor will prescribe the transfusion in an emergency situation without questioning; This is justified in assuming that a patient wants to be saved by the use of such an ordinary procedure especially if such a restriction has not been unequivocally imposed on the attending physician.

Blood transfusion in a child or minor: Decisions: o Doctor normally does not need an explicit permission from the family (considered as a life-saving procedure)

If family has definitely insisted for no blood transfusion, physician will have to distinguish the moral from the legal aspect of the problem. Wherever there is no legislation, the doctor will save the life of the child.

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Just as the doctor has to respect the patients conscience, so does the patient incur the same obligation towards his physician. The patient should never request a treatment which he knows to be against his doctors conscience. In some cases in which the physician has a well-informed and firm conviction that a certain treatment or intervention is both immoral and harmful to the patients well-being, he should expose the facts clearly, including of course the medical and ethical aspects.

QUIZ: Ms. July A. Santos is a nurse who travelled to the USA to work in order to help her family back home. In the hospital where she works, she was asked to help in an abortion procedure, which was legal in US. Now, Ms. Santos is a Catholic who does not believe in the procedure. Her conscience dictates that cooperating in the procedure is cooperating in the killing of the unborn child. Later, she was given instruction that since abortion is legal, she may be committing an illegal act by her uncooperative action and such may cost her job. This bothered her as she may not be able to help her family back home. 1. 2. dilemma? Can Ms. Santos object to the hospital based on the dictates of her conscience? Explain, briefly and direct to the point. What can Ms. Santos conscientiously do to avoid such

Editors notes: Sorry sa lahat ng mga taong nagawan ko ng kasalanan, patawarin niyo na ako. Hi sa mga classmates ko, sana maging close pa tayo ever did I want my class to be closer like a big group of friends and every time I manage to do it. Sana tayo din!

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Dr. Acevedo

Med Ethics: Conscience

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