The Physician's Conscience and Virtue in Defending the Right to Life and Human Dignity

Abstract

Through the cultivation of virtues and the development of a deeply reflective and well-formed conscience, physicians can uphold patients’ dignity and safeguard the sanctity of life amid the ethical dilemmas arising from continuous advancements in medical techniques and procedures, guided by both medical expertise and moral wisdom grounded in truth.

Introduction

The principles articulated by the Magisterium of the Catholic Church on bioethics and medicine are clear: the right to life and respect for human dignity from conception to natural death. However, as medical advances continue to evolve across all fields and are applied in clinical practice, new ethical dilemmas emerge, particularly in areas such as reproductive health, the mother-fetal relationship, the beginning and end of life, and therapeutic obstinacy. While the general principles and guidelines provided by the United States Conference of Catholic Bishops in the Ethical and Religious Directives for Catholic Health Care Services are well-established, real-life situations often present complexities that go beyond these directives.

Though we may desire clear guidelines or a step-by-step approach for every clinical scenario faced by physicians and patients, this is unrealistic, as each patient presents a unique clinical reality with distinct circumstances. While bioethics committees play a crucial role, they are typically reserved for particularly complex cases. In practice, physicians often encounter ethical dilemmas that require timely resolution in the best interest of the patient (Burke 1980, 124–65).

This is why the development of virtuous physicians, guided by conscientious judgment, is essential for optimal healthcare and professional growth. Physicians must cultivate creativity and resourcefulness—qualities vital for practical wisdom when facing challenges. They must also learn to make sound judgments based on truth and apply them to each patient's unique situation, all within a trusting physician-patient relationship that upholds human dignity and the right to life.

Principles of the Right to Life and Human Dignity

When the Magisterium of the Catholic Church addresses bioethics or medicine, it does so based on the Christian understanding of human life and dignity. The Church teaches that human dignity is inherent in every person, as each individual is created in the image and likeness of God (Genesis 1:26-27). This dignity is not earned or conferred, but is intrinsic to every human being from the moment of conception. Every person possesses equal value and dignity, regardless of status, race, sex, or circumstance. The Catholic Church emphasizes that this dignity requires respect and protection for every individual (Second Vatican Council 1965b, 12; John Paul II 1995, 2; Congregation for the Doctrine of the Faith 1987, 1). The Magisterium also upholds that human life is sacred from conception to natural death, grounded in the belief that life is a gift from God and that each person has a unique purpose and value. Protecting life is seen as a fundamental moral obligation for both individuals and society (Second Vatican Council 1965b, 27, 51; John Paul II 1995, 2; Congregation for the Doctrine of the Faith 2008, 4).

These teachings can be understood through reasoning, study, and reflection. The Catholic approach is not based solely on faith, nor does it dismiss the rational justification of values and norms. Rather, religious faith sharpens reason, enabling individuals to respect the reality they believe is created by God and to integrate scientific facts with principles of faith (Hernandez-Ojeda and Requena 2024, 47–60). When human reason seeks truth in these matters, it must listen respectfully to the insights of the Catholic Church. This interplay between faith and reason is especially relevant in the moral life of Catholic physicians, particularly in their clinical practice, where conscience and virtue shape ethical decision-making.

Conscience and Virtue in the Moral Life of the Physician

According to Aquinas (1994, q.16, a.1), synderesis is the habit of practical reason by which one understands the first principles of natural law—namely, to do good and avoid evil. Infallible and steadfast in its inclination toward the general good, synderesis provides a necessary foundation in medical ethics for addressing complex ethical dilemmas.

A physician's conscience applies these universal principles to specific situations, seeking ethical truth in particular medical contexts. Conscience renders a judgment regarding the decision to act or refrain from acting, understood primarily as the rational assessment of an action—whether it should be done, omitted, or whether it has already been done or omitted. (Lodovici 2020, 53–60).

The judgment of conscience evaluates the morality of a medical act based on the knowledge the physician actually possesses. In doing so, it relates directly to the truth of the action, aiming to determine whether the chosen course aligns with moral principles and the ultimate good of the patient (Sulmasy 2008, 135–49).

Human freedom is rooted in natural inclinations toward truth, goodness, beauty, social life, the preservation of human beings, and the gift of life. These inclinations serve as foundational principles for moral judgment when reason is applied to specific actions. They correspond to the synderesis principle—“Good is to be done, and evil is to be avoided”—which guides the judgment of conscience. Therefore, freedom is the capacity to act in accordance with truth and goodness, a capacity given to us as a seed that develops progressively.

From this perspective, divine and natural law are not merely sets of imposed obligations but gifts that invite a response of love. Morality, therefore, is rooted in the greatness of love rather than strict legalistic obedience (John Paul II 1993, 11). While law is necessary to guide moral considerations—especially in the early stages of moral growth—it ultimately serves to develop the initial capacity for freedom. Moral law comes from above but aligns with our natural inclinations toward truth, goodness, and our innate sense of God and others. It reflects what we perceive in our conscience when we hear the voice of God (Second Vatican Council 1965b, 16).

However, law and conscience alone are not sufficient to fully develop our ability to act according to truth and goodness; the cultivation of virtues is essential for directing our natural inclinations. Virtue is like the talent of an artist or the skill of a craftsman, providing clarity and energy that enhance our ability to act. It nurtures our natural inclinations toward truth and goodness, empowering us to achieve excellence for ourselves and others. This virtue-based morality is not solely the product of human effort; it is also a gift from God, both infused and acquired, passive and active. All virtues form a cohesive whole, like the body with its various members and organs, working together when we perform concrete acts.

In this regard, medicine is often referred to as the art of healing, a phrase that captures the intricate blend of scientific knowledge and humanistic care inherent in medical practice. While medicine relies heavily on empirical data, research, and technological advancements, it equally depends on the intuitive and compassionate aspects of caregiving, with a focus on human dignity. Medicine is not solely a science; it is also an art. This art involves connecting with patients on a personal level, understanding their fears, concerns, and hopes (Curlin and Tollefsen 2021, 85–92).

The art of medicine also entails navigating ethical dilemmas and complex decision-making processes in healthcare. Physicians must weigh the benefits and risks of treatments, consider patients’ values and preferences, and sometimes make difficult choices under pressure. The ability to make these decisions thoughtfully and ethically is a hallmark of the art of medicine.

Therefore, we can distinguish two types of judgments, both originating from the same person (Aquinas 1947, II-II, q.47–56). The first is the judgment about the medical act itself—whether it has already been performed or is yet to be done. This judgment evaluates the moral quality of the act based on the physician's existing knowledge and convictions. While it has a strong cognitive aspect, it is not merely an abstract conclusion; it is a concrete, practical judgment made by the physician in light of their moral understanding and insight. This judgment is not infallible and is referred to as the judgment of conscience.

The second type of judgment concerns the actual decision the physician makes about what action to take. This is known as the judgment of choice or prudential judgment. Unlike the judgment of conscience, this judgment involves shaping a medical action that does not yet exist; it requires creativity and practical deliberation. Here, the physician draws from the knowledge and moral insight gained through the judgment of conscience. Though both are practical and specific, the judgment of choice also engages the physician's emotional state—including desires, fears, and preferences—which can significantly influence the final decision.

Consider, for example, a case in which the judgment of conscience leads a physician to advocate for a palliative care approach for an elderly patient with terminal cancer. The judgment of choice then determines the best course of action. The physician must develop an individualized care plan, selecting medications based on the patient's specific symptoms, overall health condition, and the preferences of both the patient and their family. This decision-making process also requires attention to factors beyond the patient's clinical needs, such as the financial feasibility of treatments, the family's ability to provide support, and the accessibility of care—for example, the distance to a medical facility. Thus, prudential judgment enables the physician to discern, deliberate, and choose the most appropriate means to achieve the end determined by the judgment of conscience.

It is within this framework that we encounter prudence and understand its role and relationship to conscience. Like all virtues, prudence requires external support from mentors, authorities, or other intermediaries, especially in its early stages (Aquinas 1947, I-II, q.24 a.9). The gradual formation of prudence enriches conscience, providing it with a firm grounding and clearer distinctions between good and evil, as well as between obligatory and prohibited actions.

To develop prudence, habitual practice in deliberation and action is essential. Prudence does not operate in a purely syllogistic or abstract manner; rather, it involves the art of discernment and deliberation, selecting the appropriate means to achieve a given end. This is why prudence is crucial in medical ethics, where physicians constantly face complex, context-specific decisions.

Among the virtues, prudence holds a central and guiding role in the medical profession. It is indispensable not only for determining the right course of treatment for each patient but also for fulfilling the physician's deeper vocation: to live a morally integrated and meaningful life. Aristotle called this virtue phronesis (Aristotle 2014, NE 1105–1106), or practical wisdom—the capacity to discern and pursue the good in concrete circumstances. Prudence bridges intellectual virtues, such as science and art (which aim at truth), with moral virtues like temperance, courage, and justice (which form good character). It enables physicians to recognize when their actions may deviate from their ultimate purpose and to respond with appropriate and virtuous means.

As the governing virtue, prudence shapes and orders all other virtues, ensuring their proper application in specific situations. It provides the ability to weigh ends and means, align actions with the purpose of human nature, and orient one's choices toward moral truth. At its core, prudence is rooted in the universal precept: “do good and avoid evil.” For physicians, it enables sound and ethical decisions even amid uncertainty, always guided by what is right and good (Pellegrino and Thomasma 1993, 82–89). A lack of prudence is not merely a technical or intellectual shortcoming—it is a moral failing. While unintended mistakes in complex medical contexts are not necessarily moral faults, a failure to discern and execute the good reveals a deficiency in virtue and a shortfall in moral excellence.

Therefore, the coordination of conscience and prudence forms the foundation of creativity in a wise and virtuous physician when making choices, particularly in medical challenges or moral dilemmas. The truly virtuous physician is often adaptable, able to respond to challenges in innovative ways. However, creativity must be understood correctly: there is no place in morality for inventing moral norms. The idea that moral norms are created as one progresses through life is mistaken. This does not mean that creativity has no place in applying moral norms to action. Life demands creative responses to situations as they arise, particularly with the continuous advancement of medical techniques and procedures.

Truly virtuous individuals recognize challenges and respond to them, while others either fail to perceive these challenges or, if they do, fail to respond. While moral norms exclude erroneous actions, they generally do not prescribe specific positive actions (Lodovici 2020, 53–60). The active agent—truly free, responsible, and grounded in truth—must be capable of inventiveness in action. Moreover, a mature physician must manage any resistance to responsible action, whether arising internally or influenced by societal pressures.

This connatural knowledge is possessed by the wise physician, who seeks to enhance the quality and excellence of actions. Wisdom enlightens conscience, helping it discern conformity with moral law and its obligations, extending beyond mere legal requirements. A virtuous physician possesses a type of knowledge that perceives truth beyond civil law and can make medical decisions that best serve the patient, grounded in respect for life and human dignity—even when civil laws fail to uphold these principles.

This deep moral insight is not acquired instantly but requires a well-formed conscience, shaped by the virtues—especially prudence—which guide moral reasoning in medical practice.

Virtue in the Formation of the Physician's Conscience

The collaboration between prudence and conscience is the most effective approach to understanding conscience formation and ensuring its fidelity to truth. When we speak of the formation of conscience, we refer to the development of the knowledge by which a physician reflects on the morality of their actions. It is not simply theoretical knowledge about good or evil, nor is it about objectifying one's moral identity. Merely hearing or reading that stealing or killing is wrong, or that the Church or the State condemns it, is insufficient. For these truths to become part of the physician's moral knowledge, they must transform into personal convictions.

The formation of moral knowledge in a physician's life involves both internal and external factors (Bellocq 2024, 528–53). Internal factors pertain to how the physician receives and processes what they learn—such as their dispositions: whether they are superficial or reflective, open to advice from authoritative figures or closed to others’ opinions, and whether they seek guidance to clarify their conscience amid moral doubts or neglect such efforts. Good will plays a crucial role in shaping a physician's moral knowledge, with moral habits being the most influential factor.

Since ethical reflection begins with the physician's reflection on the kind of person they wish to become, and the virtues needed to reach that goal, the best way to form conscience is by cultivating virtues. The mere imposition of rules or the simple transmission of information, no matter how detailed, cannot effectively form conscience if the physician does not perceive it as good for themselves or their patients. This depends more on personal dispositions and virtues than on the logical strength of reasoning, as it pertains to practical knowledge. The more virtuous a physician is, the more naturally they align reasonable propositions with their own convictions. Consequently, the more virtuous the physician, the greater the harmony between moral knowledge and concrete choices.

Achieving harmony between the physician's judgment of conscience and the moral order it serves requires a well-formed conscience to guide action correctly. Differences in judgment may arise from theoretical ignorance, such as a lack of education or study in a specific area, or, more often, from practical ignorance—stemming from a lack of virtue, which distorts the understanding of good and evil (Aquinas 1947, I-II, q.76, a.1). For instance, despite knowing that abortion is the killing of an innocent human being, a physician's defective moral habits may prevent them from recognizing that unconditional respect for life, even that of an embryo, is essential to living a good life. Practical ignorance, at the root of a defective conscience, cannot be resolved by information alone; it requires growth in virtue until moral principles become natural to the physician's disposition, enabling them to live accordingly.

Therefore, the formation of conscience is fundamentally the cultivation of the physician's moral identity, shaped by distinct yet interconnected virtuous traits. This process involves knowledge that guides moral understanding and forms the basis for conscientious deliberation. Such knowledge includes convictions developed through persuasive argumentation, teachings, codes of conduct, advice from authorities, values from one's reference group, inherited wisdom, collective imagination, reflective study, and personal life experiences.

Conscience and Virtue in Creative Physicians’ Moral Decision-Making

As moral knowledge evolves, it shapes the convictions that influence a physician's conscience, reinforcing their moral identity and guiding their ethical decision-making. It reflects the moral understanding the physician holds at a given moment. While conscience formation can be complex, the key element remains the physician's moral character. The more cohesive the physician's virtues, the less likely their judgment and actions will be inconsistent. A well-formed conscience aligns with the virtuous ends the physician has adopted, guiding their choices and actions in harmony with these values.

Thus, conscience represents the relationship between the physician's virtuous character and the specific acts identified through prudential reasoning. In this context, just law is neither dismissed nor diminished in the pursuit of exceptions. Rather, a virtuous orientation guides the application of law to concrete circumstances, ensuring alignment with moral principles.

The more deeply a physician is trained in virtue, the stronger their commitment to conscience becomes. However, the development of practical wisdom requires experience, and practical wisdom, in turn, guides appropriate action—creating a dynamic, continuous process in which conscience provides direction.

Virtues such as fortitude, temperance, justice, faith, hope, and charity help the physician formulate and adhere to moral principles. The possession of virtue transforms the physician, enabling them to evaluate moral situations correctly (Aquinas 1947, I-II, q.55). For example, a physician with well-developed virtues would not view euthanasia as a compassionate act but rather as a violation of the patient's overall well-being. These moral assessment skills help the physician avoid weakness of will by accurately evaluating situations and determining the best course of action. Conscience plays a crucial role in this process, motivating the physician to strive for moral excellence by focusing on actions that uphold this ideal while avoiding those that detract from it.

A mature conscience not only helps the physician live virtuously but also reinforces virtuous habits over time. It aids in the initial cultivation of virtue and sustains it once achieved, ensuring that moral integrity is preserved. A well-formed conscience continuously guides the morally good physician, ensuring that their behavior remains aligned with ethical principles. Having developed virtues and a mature conscience, the physician becomes a moral authority whose judgment should be recognized and respected. By cultivating virtue and fostering a deeply reflective and responsible conscience, physicians can act in ways that uphold patient dignity and protect the sanctity of life—guided not only by medical knowledge but also by moral wisdom rooted in truth.

Therefore, the cultivation of virtue and a well-formed conscience enables physicians to act with moral integrity. Yet, beyond natural virtues, a physician's character is further shaped by the theological virtues—faith, hope, and charity—which elevate their moral vision and deepen their ethical commitments. When authentically lived, Catholicism shapes a physician's moral choices by providing the foundational worldview and values that guide ethical reasoning.

For example, rather than viewing the physician-patient relationship merely as a legal contract, a business transaction, or a matter of applied biology, a Catholic physician sees it as a covenant of trust. This perspective emphasizes virtues such as trust and selflessness, with legal standards, market values, and scientific objectivity placed under the guidance of moral and theological principles. Similarly, a Catholic physician interprets ethical principles—autonomy, beneficence, non-maleficence, and justice—within this foundational worldview. While autonomy is often understood as unconditional respect for patient choices, a Catholic physician recognizes its limits to prevent harm or preserve their own moral integrity. Likewise, justice, from this perspective, is not solely concerned with equity, merit, or financial capacity but also includes charitable justice, which directly influences decisions regarding resource allocation and patient (Pellegrino and Thomasma 1996, 67–77).

In the Catholic view, human beings are creatures of God, endowed with intrinsic dignity (John Paul II 1995, 34; Second Vatican Council 1965a, 14; International Theological Commission 2022, 16). This understanding opposes any reduction of the physician-patient relationship to a purely commercial or biological interaction. Beneficence demands selfless care, autonomy is never absolute, and justice extends preferential concern to the vulnerable. Suffering, in this view, gains meaning through participation in Christ's Passion, allowing the sufferer to share in Christ's redemptive work and experience spiritual transformation (John Paul II 1984, 26). This perspective rejects utilitarian approaches that devalue human life based on quality or economic worth, emphasizing instead the inherent dignity of every person.

As the highest virtue, charity guides a physician's decisions by prioritizing the well-being of others. It highlights the physician's vocation as a calling to serve with fidelity and compassion, viewing medicine as a path to holiness. A Catholic physician integrates faith and profession, making ethical decision-making an expression of their vocation. Ultimately, the virtuous physician, guided by both natural and theological virtues, exercises moral wisdom in a profession that demands both technical expertise and ethical clarity. In doing so, they uphold the dignity of human life, act as stewards of moral truth, and fulfill their vocation as healers in service to God and others.

Author Biography

Jaime Hernandez-Ojeda is a doctoral student in the Sacred Theology Doctorate program in Moral Theology at the Pontifical University of the Holy Cross in Rome, where he also earned his STB and STL in Moral Theology. Before pursuing theological studies, he obtained an MD and a PhD in Medicine from the University of Barcelona, Spain, and completed a fellowship in Cardiology and Cardiac Electrophysiology at Case Western Reserve University in Cleveland, Ohio. His research interests include conscience and virtue in medical ethics, bioethics, and fundamental moral theology. He also serves as a Roman Catholic priest in the Prelature of Opus Dei in the United States.