Human Conscience and Patient Autonomy
December 1, 2015
This weekly series of posts is from Dominican Friars Health Care Ministry of New York, a ministry of the Province of St. Joseph centered at St. Catherine of Siena Priory in New York, NY. Reflections on Ethics, Faith & Healthcare Human Conscience and Patient Autonomy By Fr. Jonah Pollock, O.P., S.T.L., Associate Director, Dominican Friars Health Care Ministry of New York Conscience, according to St. Thomas Aquinas, is the act of the human intellect by which “we judge that something should be done or not done” (Summa Theologiae I, q. 79, a. 13). This judgment is to be based on our knowledge of what is right and wrong for us to do, knowledge that we acquire both from our natural God-given ability to discern right from wrong (natural law) and from the truth about right and wrong that God has revealed to us through Scripture and Tradition (divine law). When we make correct judgments of conscience and act accordingly, we participate in God’s wisdom and act in accord with God’s will. Pope Saint John Paul II has referred to this human participation in the law of God as participated theonomy (Veritatis Spendor 41). In a similar vein, the Second Vatican Council document Gaudium et Spes calls conscience “man’s most secret core and his sanctuary. There he is alone with God whose voice echoes in his depths” (Gaudium et Spes 16). When we act according to correct judgments of conscience, we act from the depth of who we are as free persons who are at once masters of our own acts and children of our heavenly Father. A person’s conscience is to be respected and protected as an essential element of that person’s human dignity. Barring exceptional circumstances, no one should compel another person to act against his or her conscience. A person’s conscience is his or her honest judgment about what is right and wrong to do. To act against one’s conscience is to do what one honestly thinks to be wrong. For that reason, conscience is said to be binding. Everyone is morally bound to do what he or she think is right. Even if someone is in fact wrong, that person is bound to do what he or she honestly thinks is right. This doesn’t mean that a person who follows his or her errant conscience is necessarily excused from guilt. Such a person may or may not be morally responsible for the wrong he or she does, depending on whether that person should have known better. We are duty bound to follow our consciences, but we are also duty bound to form our consciences. Errant judgments of conscience are without excuse if we have not make an honest effort to discover what is truly right and good. According to the Catechism of the Catholic Church, “Conscience must be informed and moral judgment enlightened” (1783). The duty of formation of conscience is a prerequisite for living a morally upright life. At the same time, “The education of conscience is a lifelong task” (CCC 1784) that we are to engage in with the help of parents and teachers, with the benefit of experience and moral maturity, guided by the light of God’s Word and the authoritative teaching of the Church. Such an education leads a person to authentic virtue and the freedom to act with excellence in concert with the Divine Wisdom “whose voice echoes in his depths.” This understanding of human conscience is the basis for correctly understanding and applying what bioethicists have called the Principle of Autonomy, by which they mean “the right to make moral decisions that affect oneself” that are “free from interference by others” (Ashley, deBlois, and O’Rourke, Health Care Ethics 5th ed., 257). In the medical context, the right to autonomous decision making is seen as belonging primarily to patients. Patients should be free to make decisions about their own health care without interference from others. This right can be seen to be both based on and limited by a Catholic understanding of human conscience. The right of a patient to autonomous decision making is founded on their right to follow their conscience. To make judgments of conscience and act on them is to exercise the rationality and self-determination that are at the core of human dignity and is a participation in the wisdom and freedom of God. To prevent a human person from following his or her conscience is therefore to prevent that person from exercising the aspects of his or her personhood that are most authentically human and most approximately divine. Such restriction of personal freedom is usually oppressive and generally to be avoided. A patient’s autonomy is limited, however, by the involvement of other human beings in that patient’s care. Doctors, nurses, and family members have consciences too. Those who approve, perform, or consent by proxy to a course of action desired by a patient cannot set their own consciences aside. These people are bound by the same duty as the patient both to form and follow their consciences. They, no less than the patient, must follow their honest judgments about what should be done, and thus remain true to their own dignity as autonomous human beings and children of God. Editor: Fr. Jonah Pollock, O.P. Mailing Address: 411 E. 68th St., New York, NY 10065
Image: William Holman Hunt, Morning Hunt, 1866.