Forum on Public Policy 1 Nurses and Conundrums of Conscience

There is controversy today concerning conscience, conscientious objection, and health care professionals. Nurses reportedly have said that they are expected to “set aside ” or “deaden ” their conscience to work in health care. Given the morally serious work that nurses do, this expectation is puzzling and concerning. It suggests a misunderstanding of the meaning of conscience, a conundrum which could be contributing to the persistent problem of nurses ‟ moral distress and to the chronic shortage of nurses. This conundrum may be confounding efforts by society to formulate coherent policy on conscience and conscientious objection by health care professionals. In this essay I offer reflections on various understandings of conscience as they relate to nurses. I suggest that when conscience is conceptualized in terms of relativism and subjectivism, setting aside one‟s conscience may seem possible and even understandable in a morally pluralistic society. However, conscience may not be entirely subjective or relative but, rather, deep-seated and grounded in objective moral norms, and, as a result, it is difficult to completely ignore one‟s conscience and troubling to act contrary to it. Because persons of good will may disagree in their conscientious judgments, tolerance, or mutual respect for conscience, is needed. Thus, reasoned discussions are necessary to formulate policy on conscientious objection that is coherent, morally defensible and avoids misunderstandings. It is my hope that this essay contributes to the discussion and to clearing up the conundrums