In chapter 4 of Practicing Medicine and Ethics: Integrating Wisdom, Conscience, and Goals of Care, Lauris C. Kaldjian explores three interweaving dimensions of conscience in the contemporary world: moral cognition, moral emotion, and moral motivation. In chapter 5, “The Authority, Fallibility, and Reach of Conscience,” he then goes on to look at three other important features of conscience.
First of all, Kaldjian looks at the authority of conscience, which he recognizes from the outset as being somewhat paradoxical. On the one hand, conscience claims authority, yet on the other hand, it can lead the individual to erroneous conclusions which, on the face of it, would appear to call into question the very authority of conscience.
Yet as Kaldjian goes on to reflect, conscience's vulnerability to error does not in any way damage its moral authority. This is because conscience enjoys the authority it has due to its significance for the individual, irrespective of any rational validity it may have for others. Ultimately, the moral significance of conscience lies in the fact that it is independent of other persons, relating as it does to a person's moral freedom and dignity.
Though the moral conscience of the individual is rightly protected in liberal democracies, one should still recognize the dangers inherent in attributing self-justifying qualities to it. The moral authority exerted by the individual conscience doesn't entitle anyone to disregard sources of moral truth external to the individual.
Yet this is a very real danger, especially in an increasingly secular society where the old sanctions of religion no longer enjoy the same degree of authority that they once had. Without these external sanctions in place, moral individualism can all too easily degenerate into a willful disregard of social responsibilities. This is an example of what the Canadian philosopher Charles Taylor calls the individualism of self-fulfillment, a debased form of the moral ideal that is so much concerned with the self and its needs that it disregards our ties to others.
Having established that the self-justification of the moral conscience is problematic, Kaldjian turns to the fallibility of conscience and its moral authority. As he reflects, the moral validity of conscience is all too often prone to errors of fact, reasoning, and moral perspective. This is by no means a merely academic concern. As Kaldjian points out, Nazi war criminals such as Himmler and Eichmann carried out their barbarous acts with a clear conscience, sincerely believing that they were doing their duty.
In the medical field, which is of course especially relevant to the book as a whole, the fallibility of conscience is a live issue, one that affects medical professionals virtually every day of their working lives. In the clinical context, a deceived conscience is a particular danger, leading some physicians to rationalize or even deny moral conflicts of interest that may arise from their work. An example given by Kaldjian is that of their dealings with pharmaceutical companies.
In such cases, it is all the more important that there are codes of medical ethics in place that provide a source of external moral standards to supplement, and in some cases correct, the moral authority of the individual conscience. This is because there is always a clear distinction to be made between the individual authority of the conscience and its fallibility. Whereas the former is related to the freedom and dignity of the individual, the latter arises from the inherent weaknesses of human nature, not to mention the power of self-deception. Simply put, just because individual conscience has moral authority, it doesn't mean that it's infallible. Any discussion on the subject of the authority of moral conscience that doesn't take into account this basic insight is liable to be deficient.
Finally, Kaldjian goes on to discuss the normative reach of conscience, that is to say, the extent to which the normative influence of the moral agent should be expected to reach. In other words, we need to address the question as to the moral relevance of the individual's conscience to other people.
In a previous section of the chapter, Kaldjian had examined how the conscience is formed through an extensive process of social interaction. Far from residing purely within the individual, moral conscience, therefore, has an inescapably social dimension, which provides the basis for a meaningful normative reach beyond the individual.
Recognizing the normative reach of conscience beyond the individual and towards society allows the moral agent to develop a respect and an understanding of other people and their own moral viewpoints. The social formation of conscience provides an opportunity to see ourselves as others see us, to realize that we are not at the center of our own moral universe, isolated from others and safely cocooned inside our own individual consciences.
Adopting such a perspective also allows us to ground our moral conclusions on much firmer ground. If we realize that moral conscience has a normative reach beyond the narrow confines of ourselves, we are much more likely to justify our conclusions on objective moral grounds that apply not just to ourselves but to others as well. In Kantian terms, this means that the reasons and conclusions of the individual conscience have the potential to be universalized, to apply to everyone, irrespective of their individual circumstances. Or, as Blustein has it, if a person's conscience entails moral reasoning, it has universalizable implications.
Although conscience may well have implications that are unique to me and which do not have the same moral force on others, that doesn't mean to say that they have no implications for others at all. If we recognize the inherently social nature of the formation of conscience and that conscience involves moral reasoning, then we cannot avoid the conclusion that the normative reach of conscience extends beyond the particular and the individual to the general and universal.