Conscience and Integrity
When an individual makes a conscientious refusal to perform a certain action, she does so because she believes that to perform that action would be to contradict her core moral beliefs (Wicclair 2011: 4-5) or her religious faith and would go against what her conscience is “telling” her to do. When an individual listens to her conscience, she is responding to a moral judgement and/or feeling that urges her to act or discourages her from acting. Most people are familiar with this feeling, though it is hard to pinpoint exactly what the conscience is and how exactly it relates to whether an action is (or would be) right or wrong. Hill describes the conscience as a “capacity, commonly attributed to most human beings, to sense or immediately discern that what he or she has done, is doing, or is about to do (or not do) is wrong, bad and worthy of disapproval” (Hill 1998: 14). It is most common for the conscience to be referred to in the context of wrong action, as Jenkins explains: “We hear a great deal about a ‘bad’ or ‘guilty’ or ‘nagging’ conscience, and about ‘pangs’ with which conscience afflicts us when it is ‘hurt’ or ‘outraged’. We hear very little about a ‘good’ conscience. This indicates that conscience is peculiarly alert to human malfunctioning” (Jenkins 1955: 261-2). When the good conscience is referred to, it is as a wholesome entity or is described as having an absence of negative properties. As Childress puts it, “often the good conscience is described by nouns such as ‘peace’, ‘wholeness’ and ‘integrity’ or as adjectives such as ‘quiet’, ‘clear’, ‘clean’ and ‘easy’” (Childress 1979: 318).
Despite the sometimes powerful “gut feeling” that an (in)action would be wrong (or right), the conscience is not generally considered by philosophers to be a reliable and definitive indication of what is in fact right and wrong (see Childress 1979; Hunter 1963; Sulmasy 2008). Indeed, one’s conscience can be desensitised over time by consistent wrongdoing, which implies it is a poor evaluator of whether an action is right or wrong.
The moral judgements of the conscience are not solely based on feelings or intuitions; a conscientious refusal is often the result of careful, rationalised thought. This intellectual aspect of moral judgement may make it easier to understand, challenge, persuade or dissuade someone from the position she holds, but it does not necessarily make her conscience a more reliable indicator of what is in fact right or wrong. Individuals with equally strong conscientious positions can hold opposing views, again implying the conscience is not a reliable epistemic tool.
Even though the conscience gives an unreliable indication of whether an action would be morally permissible, a person’s appeal to her conscience remains morally valuable because the conscience represents an individual’s commitment to doing what is right. This is captured in Sulmasy’s definition of conscience, which is perhaps the clearest and most fitting among the various definitions in the literature, and will be adopted for the remainder of this chapter:
(1) a commitment to morality itself; to acting and choosing morally according to the best of one’s ability, and (2) the activity of judging that an act one has done or about which one is deliberating would violate that commitment. (Sulmasy 2008: 135)
Importantly, it is this commitment that matters when a conscientious refusal is honoured. In this way, the conscience clause has little to do with the particular procedure to which the individual is objecting; rather, it is in place partly to respect the individual’s integrity. Take the example of pharmacists supplying EHC. In several countries, including the USA, the pharmacy profession as a whole supports the view that supplying EHC in certain circumstances is morally permissible but allows conscientious refusals. The fact that an individual pharmacist’s conscience tells her that it is not morally permissible does not in itself persuade the profession that the practice is wrong. Rather, the conscientious refusal is honoured in part because the profession respects the pharmacist’s commitment to morality. The profession accepts that for some individuals, the act of supplying EHC would be a breach of this commitment and would violate their integrity.