Freedom of Conscience in the Practice of Medicine

John B. Shea
August: 2002
Reproduced with Permission

The Catechism of the Catholic Church states that … "Conscience is man's secret core, his sanctuary … a judgment of reason by which the human person recognizes the moral quality of the concrete act … The dignity of the human person implies and requires uprightness of moral conscience."1 At the United Nations Organization the international community has respected the freedom of conscience and religion.2 It has also acknowledged that the basis for doing so is the dignity of the human person, acting freely "according to the imperatives of conscience."3 The Catholic Church teaches that each person, on the basis of his personal convictions, is led to recognize and follow religious or metaphysical concepts involving his whole life in regard to fundamental choices and attitudes.4

The Attack on Conscience

Until approximately forty years ago, a Catholic physician, nurse, or other health care giver encountered little moral difficulty or opposition in the practice of medicine. The Hippocratic tradition, which was widely respected and followed throughout western society, treated the patient with the proper respect and was coherent with the natural law and Catholic moral teaching. Hippocrates, a Greek physician, born in 460 B.C. had written in his magnum opus, 'Epidemics' … "As to diseases, make a habit of two things, - to help, or at least to do no harm."5 This was translated by a Roman physician, Galen (129-210 A.D.) as "Primum non nocere." Hippocrates, in his famous Hippocratic Oath, had also stated … "I will give no deadly medicine to anyone if asked, nor suggest any such counsel; in like manner, I will not give a woman an abortive remedy." When the Roman empire converted to Christianity, the temples, where much of medicine was practiced, became churches. The physicians were now Christians, and they followed faithfully in the footsteps of Hippocrates and Galen in that they treated those in their care with consideration and respect. Today, however, the society in which the Christian finds himself, has radically changed.

In 1960, the U.S. government approved the use of the first oral contraceptive. By 1970, contraceptive sterilization was common, and by 1969, Canada and many other governments in the western world had legalized abortion. These changes ushered in a era of moral collapse, so that today we are engulfed in a medical maelstrom of abortion, sterilization, contraception, in vitro fertilization, embryonic stem cell research, eugenics, and euthanasia. There has been a particularly devastating impact on women, children, the unborn and the elderly. It has also adversely affected the spiritual life of the nations. The freedom of conscience of physicians, nurses, pharmacists, technicians and social workers is under fierce and relentless attack, and this assault has come from many directions. The U.S. Supreme Court has deprived the unborn child of any right to life. Canada has no law in regard to induced abortion, and the only countries which still prohibit abortion are Ireland and Malta. It is of interest to note that these two countries also have the lowest maternal death rate. Throughout the world most medical schools give training in these atrocities, which are promoted vigorously by governments and non-governmental organizations at the United Nations, and by the U.N. organization itself, in which those interested in world population reduction have great power and influence.

Hospital Mergers

According to the Catholic Health Association, 620 Catholic hospitals in the U.S. constituted 11% of all hospitals and 17% of all services. For the past 10 years, because of skyrocketing costs in relation to revenues for services, a growing number of secular hospitals have formed partnerships or mergers with Catholic hospitals. The rate of these mergers tripled between 1997 and 1998. The American Catholic bishops in the year 2001 issued ethical and religious directives for Catholic health care services. Directive number 69 states that "If a Catholic health care organization is considering entering into an arrangement with another organization that may be involved in activities judged morally wrong by the Church, participation in such activities, must be limited to what is in accord with the moral principles governing cooperation." Directive number 71 states that "The possibility of scandal must be considered when applying the principles governing cooperation." The catechism of the Catholic Church says "Scandal is an attitude or behaviour which leads another to do evil." (no. 2284): "Anyone who uses the power at his disposal in such a way that it leads others to do wrong becomes guilty of scandal and responsible for the evil that he has directly or indirectly encouraged." (no.2287). One can only hope that our Catholic hospitals are acting in accordance with these directives.

Training of Care-givers

The burgeoning public demand for immoral 'services' has placed increasing pressure on universities and medical schools to provide the training necessary to make these 'services' possible. In the case of obstetrics and gynecology, some institutions will not accept candidates for training unless they agree to perform abortions as part of their training. Similar immoral demands are made on student nurses and other care-givers in training. In Canada, some pharmacists are required to prescribe and distribute the morning-after pill, which is an abortifacient. These threats to our rights of conscience are so pervasive that it may not be long before Catholics will not be morally free to enter the medical care giving professions. In the U.S.A., where many jurisdictions are considering making abortion training mandatory - New York City mayor Michael Bloomberg has suggested such a move, and the abortion industry has long lobbied to have every doctor forced to learn how to perform abortion at medical school - there is a clear need for conscience protection for health care workers.

Pope John Paul II has said that the "conflict between social pressure and the demands of right conscience can lead to the dilemma of abandoning the medical profession or of compromising one's convictions." He recommended a middle path, which is that of "conscientious objection which ought to be respected by all, especially legislators."6 Our Pontiff has also taught that "To refuse to take part in committing an injustice is not only a moral duty, it is also a basic human right. Where it not so, the human person would be forced to perform an action intrinsically incompatible with human dignity, and in this way human freedom itself, the authentic meaning and purpose of which are found in its orientation to the truth and the good, would be radically compromised. What is at stake therefore, is an essential right which, precisely as such, should be acknowledged and protected by civil law. In this sense, the opportunity to refuse to take part in the phases of consultation, preparation and execution of these acts against life should be guaranteed to physicians, health-care personnel, and directors of hospitals, clinics and convalescent facilities."7 In his address of June, 2001, to Catholic obstetricians and gynecologists, Pope John Paul stated that "In particular, Catholic universities and hospitals are called to follow the directives of the Church's Magisterium in every aspect of obstetrical and gynecological practice including research on embryos … I trust, that the local churches will give attention to the medical profession, promoting the ideal of unambiguous service to the great miracle of life, supporting obstetricians, gynecologists, and health-care workers who represent the right to life, by bringing them together for mutual support and the exchange of ideas and experiences."8


One factor which has contributed greatly to this rapid moral decline was the invention of a novel ethical theory which bears little relationship to the ethics and morality of the past. It originated by Congressional order with the passing of the National Research Act in 1974. The Act mandated the appointment of a commission which in 1978 produced the Belmont Report. This Report defined three 'ethical principles' … respect for persons (autonomy), justice (fairness) and beneficence. The Belmont ethics was derived from the normative systems of Emmanuel Kant, John Stuart Mill and John Rawls, whose theories fundamentally contradict each other. This ethics did not work in practice because there was no way to resolve the inherent conflicts between these three principles. Furthermore, each of these principles was described as 'prima facie', i.e. no one principle could overrule any of the others. They therefore led to theoretical chaos. How, for example, could a patient claim a right to any or all treatments in the name of autonomy, regardless of cost, or efficacy or fair allocation of resources? Natural law and Divine law were ignored. The good, justice, and autonomy were to be defined and interpreted only by the law of the land.

The problem of getting agreement on ethical issues, which this chaos presented, was claimed to be 'solved' by means of a putative consensus of public opinion. This consensus is achieved by the use of the art of persuasion, or rhetoric. Richard Rorty, the poster boy for modern political philosophy, and an admitted nihilist, holds that there is no such thing as objective moral truth, but nevertheless asseverates that rhetoric has the power to convert our desires into the truth.9 It is this kind of thinking that is used to justify the notion that moral principles could be established by consensus.

The philosophical basis of Belmont bioethics contradicts that on which traditional medical ethics and Roman Catholic ethics are established. Nevertheless, this new 'bioethics' was instantly adopted by the ruling elites of the western world at the United Nations, and also by the academy, the medical and legal professions, diplomats, bureaucrats, and the media throughout the world. It has also been a powerful lever in the hands of those who aim to control and reduce world population.

According to the Belmont principles, consensus can not only define and determine ethical norms, but can also determine how they are to be applied in any given case. Such application is usually achieved by means of word-games … the abuse of language, which is, as Josef Pieper has pointed out, the abuse of power.10 Belmont bioethics claims to be value-neutral, not to lay down rules for others, and yet it is inflicted on the public by means of various spurious forms of 'consensus'. Though consensus is presented as arising from the democratic will of the people, it is in fact concocted by the community of bioethicists themselves. The credentials of this community have been well characterized by bioethicist Dianne N. Irving, who has stated that "Few 'professional bioethics experts', the doctors, researchers, and lawyers who sit on hospital and government bioethics committees, have academic degrees in the discipline, and even for those few who do, there is no uniform or standardized curriculum. Most professors of bioethics don't know the historical or philosophical roots of the subject they teach; the courses vary from institution to institution; there are no local, state or national boards or examinations; and there are no real professional standards. There is not even a professional code of ethics for bioethicists!"11

Belmont bioethics is a 'choice' or 'preference' utilitarianism. Inevitably, it is the 'choices' and 'preferences' of the powerful elite that become, via the manipulative psychological means used by the media, the law of the land. In this way a host of new, often bizarre, 'rights' have become commonplace. They are in no way related to human dignity or human responsibility as seen in the light of the commandments and the natural law. These new 'rights' include such things as … 'reproductive services', (which include abortion and contraception, especially for the poor in underdeveloped countries), in vitro fertilization, embryonic stem-cell research, and increasingly, euthanasia and organ donation.

In regard to organ donation, the organ donor is always assumed to be dead at the time at which organs are harvested, though in many cases, this assumption is in fact, in doubt. Recently added to this list is the bizarre new right to cryogenic suspension after death. Where it suits their purpose, proponents of choice feel free to call live patients 'dead' and dead patients 'live'. Recently, the body of the famous baseball player, Ted William's was placed in liquid nitrogen in order to preserve it, by Alcor Life Extension Foundation in Scottsdale, Arizona. Alcor claims that "Persons in cryonic suspension should be considered potentially 'alive' now and measures must be taken to keep them that way, so that they can become the citizens of the future."

Such bizarre 'rights' are based on the Belmont Ethics which claims to grant the human reason the power to create its own moral laws, and which puts it in conflict with God. This is the old temptation presented to Adam and Eve.

Natural Law

In contrast to secular bioethics, which is based on a consensus of opinions, St. Thomas Aquinas speaks of an Eternal Law, imprinted on all created things by their nature, and by which they achieve their end. Human beings who have reason and free will must use their reason to discover what is best, and must freely choose what reason has so determined. Our inclination to use our reason and free will in this way is called the natural law, by means of which we participate in God's eternal law, and so discover what is good and evil.

The basic commands of natural law include - that we preserve ourselves in being, that we care for our life and transmit life to the next generation, and that we develop our rational and moral capacities by growing in the virtues of the intellect (prudence, art, science) and will (justice, courage, temperance). Mans' infinite capacity for love shows that his proper end is to know and love God.12

Virtues are habits, or stable dispositions, that dispose our faculties to act in a good way, whether in the natural order or elevated to the divine life by grace. They may be acquired by will, or infused - produced by God without human effort through the merits of Christ. The supernatural virtues are, faith, hope and charity - which provide the knowledge, desire, and love of God. A person in the state of grace also receives an infusion of the moral virtues - e.g. prudence, temperance, fortitude and justice.13

Unfortunately, many in the Catholic medical community appear unfortunately to have bought into the Belmont bioethics. This partially explains why they are slow to recognize and to respond to the challenges to conscience that they encounter. There are other reasons. For one thing, scientific changes are complex. For another, there is widespread confusion due to concealment and disinformation in regard to the true scientific facts by the media. Again, in some instances, there may be a lack of moral courage in the face of peer pressure. Many may fear that their careers may suffer if they are not perceived as "team players".

St. Thomas rooted his conception of natural law in an understanding of the universe as caused and cared for by God. We must use our reason to discover what is best for us, to achieve our natural end, to be ultimately happy. We have an infinite capacity to know and love, hence we are destined to know and to love the Infinite Being, God. What natural law allows and commands is not always perfectly obvious in specific instances (the current debate about embryonic stem cell research is a case in point). The particular requirements of natural law may therefore require social and reasoned discourse. This, of course, does not allow human law to be based merely on consensus or decrees of the legislature. Empirical science involves the use of observation, measurement, reasoning and judgment in regard to natural phenomena. It also involves the formation and validation of theories and laws in regard to these phenomena.


It can be argued that the Catholic culture in the U.S. and Canada as well as in Europe, has not fully appreciated the importance of science as an intellectual virtue and that our professionals are therefore ill equipped to cope with these complex times. Many Catholics simply do not know that Church teaching forbids in vitro fertilization. Most do not realize that a human being comes into existence at the moment that fertilization begins. The reason? Even though this scientific fact has been established since 1885, and is attested to in the current standard textbooks of human embryology, many so-called 'experts' who have conflicts of interest (obstetricians, pediatricians, and physicians who would wish to see world population reduced) say otherwise. They promote the notion of a "pre-embryo" - that is, an embryo that lacks 'full moral stature' and which does not become a true embryo until its implantation in the uterus at around 14 days after conception. This embryo can therefore, in their mind, be used for research or aborted for the greater good of the majority. This notion that the good of the many trumps the good of the individual is implicit in the Belmont ethic's notion of 'beneficence'. Sadly, many Catholic theologians have accepted this falsehood because they are not scientifically well educated. One simply must get the facts straight before one can solve any problem, let alone a moral problem.

Are our Catholic institutions prescribing and distributing condoms and so-called contraceptive pills and devices? Are they advising people to use contraceptives or to be sterilized? Are they allowing referral for abortion to occur on their premises? Are they allowing organ transplantation before the patient is certainly dead? Are hydration and nutrition being withheld from palliative care patients prematurely, thus hastening the patient's death? Is counseling to use condoms given to patients in order to prevent sexually transmitted disease? On these and many other questions we must examine our conscience. Catholics have a right to know what is going on in our hospitals and other health care institutions.

What Should We Do?

First of all, we must, as Pope John Paul II has repeatedly asked of us, "Be not afraid … put out into the deep." In other words, we must as Dr. Tom Hilgers has said, "encourage the Church to speak out with boldness, the courage of its conviction and the hope that it can be a light to the world in these areas where the Church has for so many years been made to think that it is embarrassingly 'behind the times, naïve and unable to cope with the dimensions of the real world' … and to speak out with confidence in the theology and philosophies that have been expounded from Humanae Vitae through Evangelium Vitae and to speak this from the highest mountain tops and to try to protect Catholics everywhere and those who are not Catholics so that they have access to sound medical care, consistent with their moral beliefs."14

Secondly, in order to play its part as an effective witness to the Faith, and to act as a light to the world, the laity must know the Faith more profoundly and practice it more consistently than ever, and must acquire a working knowledge of the theology, philosophy and science relevant to their particular station in life. In this way, lay Catholics can, in each profession and every calling in life, give a practical living example to others which can be perceived and understood to be a true witness to Christ and the good news of the gospel.


1 Catechism of the Catholic Church. Nos. 1795, 1796, 1780. [Back]

2 United Nations Declaration on Human Rights, Dec. 10, 1948 (article 18): International Covenant on Political Rights of the United Nations on Dec. 16, 1966. (article 18). [Back]

3 Final Act of the Conference on European Security and Cooperation. Aug. 1, 1975. [Back]

4 Freedom of Conscience. John Paul II. Vatican 1980. [Back]

5 Hippocrates, Epidemics. Book 1. Section X1. [Back]

6 Freedom of Conscience, John Paul II. Vatican, 1980. [Back]

7 Evangelium Vitae, Encyclical Letter, John Paul 11, 1995 [Back]

8 Address of John Paul II to Catholic Obstetricians and Gynecologists, (2001). [Back]

9 William A. Frank. Starting Points for Philosophy, History and Metaphysics in Fides et Ratio. Fellowship of Catholic Scholars Quarterly. Vol. 23, no. 2, Spring, 2000, p.18. [Back]

10 Abuse of Language … Abuse of Power Ignatius Press. 1992 [Back]

11 The Impact of International Bioethics on the "Sanctity of Life Ethics", and the Ability of Ob Gyn's to Practice According to Conscience. [Back]

12 Joseph M. Magee Ph.D. [Back]

13 Father John A. Hardon, S.J. Meaning of Virtue in Thomas Aquinas [Back]

14 The Future of Obstetrics and Gynecology: The Fundamental Human Right to Practice and be Trained According to Conscience. MaterCare International (MCI), Rome Papers. [Back]