Churchill Larry R
Perspect Biol Med. 2019;62(3):519-526. doi: 10.1353/pbm.2019.0030.
There is much to admire in Lauris Kaldjian's explication of conscience and its uses for medical practitioners. Yet his claim that conscience is the final and best assessment of moral judgments is flawed, because it diminishes the influence of moral reasoning that balances and often corrects conscience. Skepticism about conscientious judgments is an important feature of ethics. Kaldjian's close linkage of conscience with moral integrity blunts the necessary recognition that one's conscience can be mistaken. His defense of physician refusals to refer patients gives insufficient weight to the idea that patients' actions in seeking services may also reflect conscientious judgments. Analyses of cases near the end of this essay present no problems with respecting physicians' conscientious refusals to provide services themselves, but they also mostly leave moral room for physicians to make referrals. Examination of these cases suggests other ways to resolve moral conflicts than recourse to one's conscience.
劳里斯·卡尔吉安对良知及其在医学从业者中的应用的阐释有许多值得赞赏之处。然而，他声称良知是道德判断的最终且最佳评估这一观点存在缺陷，因为它削弱了平衡并常常修正良知的道德推理的影响力。对出于良知的判断持怀疑态度是伦理学的一个重要特征。卡尔吉安将良知与道德正直紧密联系起来，削弱了人们对自己的良知可能出错这一必要认识。他对医生拒绝转诊患者的辩护没有充分重视这样一种观点，即患者寻求服务的行为也可能反映出于良知的判断。本文结尾处对案例的分析在尊重医生出于良知拒绝亲自提供服务方面不存在问题，但它们大多也为医生进行转诊留下了道德空间。对这些案例的审视表明，除了诉诸良知之外，还有其他解决道德冲突的方法。
