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  • BIOETHICS FORUM ESSAY

Conscience: We’re Not Donne Yet

In my senior year of college, I took a course on seventeenth century poetry. The professor had a thing about Stanley Fish. As in, we weren’t supposed to read Stanley Fish, or mention Stanley Fish. This is challenging when the subject is seventeenth century poetry, as Stanley Fish literally wrote the book on John Milton. I don’t remember when I flouted the Fish fatwa. But it was still a thrill to spot Fish’s recent New York Times essay  on conscience clauses and recognize my scholarly obligation to break a commandment, this time in the service of ethics.

I wrote my own dissertation on seventeenth century poetry, and a few months ago I had lunch in Glasgow with my dissertation supervisor. As usual, I brought him up to date on what I’m doing with that literature degree. When I mentioned “conscience clauses,” he was intrigued. During and after the Reformation, to invoke “conscience” in refusing to do something meant something like: “I will not swear that oath.” The options were clear: allegiance to the state through its church, versus fidelity to a different church or creed.

Despite attending both Oxford and Cambridge, John Donne never graduated from university. He was raised Roman Catholic, and could not take the Oath of Supremacy, acknowledging the monarch as head of the church, which was required of Oxbridge graduates.

The consequences of conscientious objection could be much worse. Anabaptists, who refused to practice infant baptism, were persecuted as heretics and traitors by Protestant and Catholic rulers alike: the grimly ironic punishment was often death by drowning. However, my former supervisor immediately saw the problem when I explained how this pre-modern notion of conscience – I cannot do this and simultaneously remain faithful to that, and both actions are theological in some way – turns up in contemporary American debates.

If we decouple “conscience” from its historical context, we miss the fact that formal conscience refusals have tended to involve competing religious truths. How you decided, and how open you were about your decision, could cost you your job, your liberty, or your life, but you understood the category in which you were making your decision as a theological category. Medicine may inspire faith, but it is not the same thing as a state religion.

Stanley Fish is a legal scholar as well as a literary scholar, and he recognizes that defining “conscience” more loosely – as “moral intuition,” or those “secret thoughts” Thomas Hobbes was wary of in public life – has its own long history, but does not solve our contemporary problem. When medical professionals believe that they are being forced to do harm or are prevented from doing good, the ethical solution may not always be the conscience-clause remedy of stepping away from troubling situations.  (As my supervisor pointed out, the notion that virtue lies in keeping one’s conscience clean presumes that it was clean to begin with.)

As the Obama Administration claws back the Department of Health and Human Services policy that made a cudgel out of “conscience” – I will not, and you’d better not, either – we need to keep an eye on this other, more elusive  notion, of “conscience” as free-floating, whatever-you-need-it-to-be refusal. Stanley Fish’s major contribution to literary theory is the idea of “interpretive communities,” that  a text must be considered in relation to its readers, who will read (into) it based on their beliefs and the uses they need to make of this text. The word “conscience,” in a text about medicine – a law, a policy, an op-ed, this essay – has become a kind of text in itself. We may not be sure of what this word means anymore; we’re always sure of what we need it to mean.

Published on: May 7, 2009
Published in: Health Care Reform & Policy

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