Conscience Sensitive Medical Education

Abstract

Medicine is a moral enterprise, and young people who enter professional school are presumed to be morally astute, as well as intellectually capable. Thoughtful students quickly grasp the fact that what we can do in medicine usually outpaces the consensus of what we ought to do, and one of the earliest questions these students ask is how they should go about honoring their individual consciences in the face of patients, peers or teachers who profess divergent values, or request services that jar the young professional’s sense of ought-ness. Medical educators readily acknowledge the need, indeed the moral requirement, to teach ethics, but struggle to ascertain the most effective, efficient and compelling way to present the material and engage the moral reasoning of students who are already inundated with basic and advanced science studies (Self & Baldwin, 1994). Students appreciate hearing about case stories, but do not want much in the way of philosophical theory. Most students at our institution have backgrounds in biology or chemistry; few have taken any courses in literature, philosophy, religion, ethics or other humanities. The handful of lectures and small-group case-based discussions related to ethical dilemmas in medicine offered in the curriculum are helpful, but often fail to prepare the young physician adequately for a life in which moral questions daily will present themselves. We are piloting an approach to moral teaching in medicine based on an examination of conscience formation and functioning, and the understanding of the intersection of personal conscience with professional medical and ethical values. We believe that conscience theory and language may be a useful addition to the traditional approaches to dilemma resolution that involve principles, theories, and case based reasoning. In this paper we will explore traditional ethical resolution methods, give a brief history and overview of Conscience Theory, and then show through case example how using Conscience Theory may allow a richer examination of the most poignant and troubling dilemmas physicians face.