MEDICAL EDUCATION Conscience as Clinical Judgment: Medical Education and the Virtue of

The degree to which “conscience ” should guide physician practice has been frequently debated in recent years within medicine, bioethics, and health policy circles [1-3] and has found new life in the debate about various “conscience protection ” rules issued by the G. W. Bush and Obama presidential administrations. In these debates, physician “conscience ” has been invoked in the medical literature almost exclusively in cases in which physicians attempt to avoid or to decline participation in practices or procedures that they find morally objectionable, often because such practices violate the physician’s religious or cultural practices. In this debate, “conscience ” is therefore often associated with religious belief or, at least, with deeply held “values ” of the physician in question [4, 5]. Medical educators and physicians, however, do not typically invoke the language of “values ” or “conscience ” in the context of ordinary medical practice: decisions, for example, about whether to prescribe a benzodiazepine for an anxious patient or an antibiotic for an upper respiratory tract infection are framed as a matter of “clinical judgment ” but rarely as a matter of “values ” or “conscience. ” As a result, it is easy t