The Linacre Quarterly

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Freedom of Conscience in Ethical Decision Making

Fr. Juan Vélez

To cite this article: Fr. Juan Vélez (2009) Freedom of Conscience in Ethical Decision Making, The
Linacre Quarterly, 76:2, 120-132, DOI: 10.1179/002436309803889232

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 Freedom of Conscience in Ethical
Decision Making*

by
Fr. Juan R. Vélez, M.D.

Fr. Juan R. Vélez G. is a priest of the Prelature of Opus Dei who resides in
Los Angeles. He holds a doctorate in dogmatic theology from the University
of Navarre. He has a medical degree, also from the University of Navarre,
and was previously board certified in internal medicine. In addition to bio-
ethics, his interests include the life and works of John Henry Cardinal New-
man. He can be reached at jrvg98@gmail.com.

Abstract
The freedom of conscience of health providers (physicians, pharma-
cists, and institutions) has been consistently defended by United States
law. In the last few years the freedom of these health providers to act in
line with their conscience has been challenged by abortion advocates.
The current United States administration wishes to weaken this free-
dom by reversing a recent ruling of the Department of Health and Hu-
man Services, which stipulated that institutions receiving federal funds
must express their compliance with non-discrimination laws. A person’s
moral conscience makes practical judgments founded on binding ob-
jective moral norms. For this reason each person is bound to obey his
conscience and should have the freedom to do so without discrimina-
tion. Physicians and other health-care providers should not be deprived
of these legitimate rights.

* The author wishes to thank and acknowledge the editorial help of Professor Bar-
bara H. Wyman, instructor of English and Latin at McNeese State University, Lake
Charles, Louisiana.

The Linacre Quarterly 76(2) (May 2009): 120–132.

© 2009 by the Catholic Medical Association. All rights reserved.
0024-3639/2009/7602-0003 $.30/page.

120 Linacre Quarterly

 Introduction
During the last quarter of the twentieth century a serious misunder-
standing of the nature of moral conscience and of its prerogatives has be-
come widespread. Conscience considered as a purely subjective judgment is
frequently invoked to justify wrongful actions. At the same time, the right to
act according to the moral conscience based on objective moral norms has
rightly been defended by many. The attempt to protect the right to act ac-
cording to one’s conscience has resulted in various legislations in the United
States. However many professionals are not aware of their legal protection,
and these very laws are discredited by groups advocating the right to abortion.
Most professional bodies have codes of ethical behavior, such as the
Hippocratic Oath, which dates from antiquity. These codes are founded on
the conviction that there are actions which are intrinsically good, which
should be fostered, and others which are intrinsically evil, which should
never be allowed. Underlying these ideas is the understanding that human
work has an ethical dimension because it is work carried out by a free human
agent. This free agent, the human, chooses to commit or omit actions which
lead to his human flourishing and conformity of his life to its ultimate end.
Human actions entail free decisions concerning ends and means. These
actions have an ethical dimension because they concern making right choic-
es based on the analysis of the nature of acts and the intentions and circum-
stances that are involved. In making decisions a physician applies his knowl-
edge of science to a concrete end which a given action seeks. Through con-
science—conscientia in Latin, literally “with knowledge”—a person tries to
order his choices according to the demands of the laws of human nature. The
habit of prudence, or right judgment, does not create the goodness or evil of
an action. It helps a person to recognize that goodness or evil, whether as an
end or a means to an end. An important dimension of professional work is
growth in the exercise of virtues. Among these virtues, prudence stands out
as key to right judgment.
This notion of practical judgment of the mind was developed in Chris-
tian thought which formulated the principle that each person must act ac-
cording to a well-formed conscience. In other words, it is not sufficient to
act merely by one’s likes and opinions under the name of “my conscience.”
A person’s conscience must be well formed with respect to the primary and
secondary principles of natural law. Conscience is not justification for any
behavior. Instead, conscience is the application of lasting truths to choices
about human behavior.
In the nineteenth and twentieth centuries a false notion of conscience
developed based on subjective relativism. The idea that man should not be

May 2009 121

tied down to moral norms of behavior, but should be able to act freely fol-
lowing his own desires and passions has become common. According to this
way of thinking, conscience is severed from reason, and personal freedom is
made absolute. Conscience equals feelings or at most preference. The per-
son separates his choices and decisions from references external to himself.
He becomes the center of his own moral universe and acts as if his freedom
were absolute.
Conscience and Freedom
Today the question must be asked: What is meant by the term “con-
science,” and why should a person be bound to act by his conscience? First,
it must be understood that conscience is not a feeling. With the use of reason,
a person arrives at moral decisions that are not superficial choices which
wax and wane as do feelings. The moral conscience is a person’s judgment
about a given action’s ordering to man’s ultimate end based on the person’s
knowledge of the action, its end, and circumstances. Each person draws
from various sources for this knowledge, such as common sense, basic sci-
ence, history, law, experience, and religion.
The moral conscience is considered the proximate norm of conduct
because it is the immediate source of information guiding human actions.
It directs human actions so that a person can transcend his animal instincts
and human inclinations. A person’s conscience is rightly considered sacred
because conscience allows man to exercise reason, which is a spark of divine
intelligence.
John Henry Newman, in the nineteenth century, defended the objective
and sovereign character of the conscience. He described divine law as, “the
rule of ethical truth, the standard of right and wrong, a sovereign, irrevers-
ible, absolute authority in the presence of men and angels.”1 Man’s participa-
tion in this divine law is called natural law. Newman explained that this law,
as apprehended in the minds of individual men, is called “conscience;”
and though it may suffer refraction in passing into the intellectual me-
dium of each, it is not therefore so affected as to lose its character of
being the Divine Law, but still has, as such, the prerogative of com-
manding obedience.2
Since the judgment of conscience is a judgment about how an action
conforms or does not conform to natural law, then, it is obligatory to follow
that judgment, that is, to act according to one’s conscience. The act of the
moral conscience is an efficacious practical judgment. Without conscience
a person would doubt even the smallest decisions. Although there are per-
sons who have a “doubtful conscience” which renders them unable to decide
upon actions easily, this is the exception. A well-formed conscience is effec-

122 Linacre Quarterly

tive because it makes practical judgments with relative ease or after seeking
necessary advice.
Great respect is due to a person’s moral judgment because without this
respect a person would be deprived of the freedom to choose what he consid-
ers to be a good and true end or a proper means to that end. To compel a per-
son to act against his conscience is to do violence to that person. In matters
of great importance, such as sexual morals, respect for human life, and the
practice of religion, this violence is even graver and therefore more repug-
nant. For these reasons, the right to freedom of conscience is fundamental
and has always been honored.
In the United States respecting a person’s conscience in matters of
the unborn has been protected by legislation for the last thirty years. This
right, manifested as the respect due a physician’s professional and moral
judgment, dates back to the First Constitutional Amendment’s protection
of freedom of speech and exercise of religion. On December 18, 2008, the
Department of Health and Human Services (HHS) issued a rule reaffirming
already protected freedoms, reaffirming the rights of health professionals
and institutions providing health care to be free from discrimination, and
ensuring protections already implemented under federal statutes since the
1970s.
Almost immediately following the Roe v. Wade ruling in 1973, a bi-
partisan Congress passed the Church Amendments. Still in effect today, they
state that public officials may not require individuals or entities that receive
certain public funds to perform abortion or sterilization procedures if such
performance would be contrary to individual religious beliefs or moral con-
victions.3 A decade later, Congress has reasserted this protection through
the Danforth Amendment to the Civil Rights Restoration Act of 1988. Since
then, bipartisan majorities continued to extend the freedom of conscience
protection through the Omnibus Consolidated Rescissions and Appropria-
tions Act of 1996, as well as the Balanced Budget Act of 1997.4
In November 2007, the Committee on Ethics of the American Col-
lege of Obstetricians and Gynecologists (ACOG) issued a document, “The
Limits of Conscientious Refusal in Reproductive Medicine.”5 This docu-
ment recommended that physicians who object to abortion or contraception
must refer patients desiring such services to other providers. They may not
argue or advocate their views on these matters though they are required to
provide prior notice to their patients of their moral commitments; and, in
emergency cases or in situations that might negatively affect the patient’s
physical or mental health, they must actually provide contraception and/or
perform abortions.

May 2009 123

 Although one may think that this position does not violate a physi-
cian’s freedom of conscience because in most cases it does not force him to
perform an abortion, it obliges him to refer someone to a physician who will
perform an abortion. For physicians who oppose abortion as a serious viola-
tion of natural law, a referral of a patient to a physician who will perform an
abortion is a serious matter that he cannot do without violating his own con-
science. But in some cases the recommendations suggest a greater violation
of a provider’s beliefs when it states: “In an emergency when referral is not
possible or might negatively affect the a patient’s physical or mental health,
providers have an obligation to provide medically indicated and requested
care regardless of the provider’s personal moral obligations.”6
Furthermore, ethicist Chris Kaczor points out that ACOG has in the
past argued against gag rules that prohibit free communication between
physicians and patients when dealing with insurance companies and fed-
eral family-planning guidelines.7 Now, however, ACOG recommends gag
rules for physicians who wish to explain to their patients why they do not
advise certain reproductive treatments which they think are harmful to their
patients.
Most people agree that autonomy, or freedom, is important for the ex-
ercise of any profession. If the autonomy of a physician or a pharmacist is
removed, harm would be done just as if a women’s autonomy in making
reproductive decisions was removed. If it is agreed that women have the
right to make reproductive decisions, then we should also recognize that
health-care providers have the same right of autonomy. If women are not to
be forced to act against their best judgment, then physicians, pharmacists, or
health-care institutions should be treated likewise.
In light of conflicting moral judgments, it seems reasonable to accept
J. Stuart Mills’s idea in his book On Liberty that a person should grant ev-
eryone the same amount of liberty that is compatible with defending his own
liberty: “The only freedom that deserves the name, is that of pursuing our
own good in our own way, so long as we do not attempt to deprive others of
theirs, or impede their efforts to obtain it.”8 Love and respect for freedom is
something that strikes a deep cord in the heart of Americans throughout his-
tory. The right to act according to one’s informed judgment of conscience is
an essential manifestation of freedom. When a person’s right to act accord-
ing to his conscience is removed, his freedom is curtailed, and more so when
it involves serious matters.
The federal health-care conscience provision clauses were enacted and
repeatedly reaffirmed to protect physicians and other health providers from
discrimination in hospitals and agencies receiving federal funds when these

124 Linacre Quarterly

persons do not wish to perform abortions, sterilizations, and other proce-
dures that are contrary to their religious or moral beliefs. These provisions
prohibit termination of employment or other privileges as well as prohibiting
discrimination in hiring or internships.
The Health Insurance Portability and Accountability Act of 1996
(HIPAA) stipulated that the federal government will not license institutions
that require the performance of induced abortions or training to perform
abortions for physicians in post-graduate positions. The Weldon Amend-
ment of 2008 stipulates that government agencies will not receive funds if
they exclude health-care entities or health-care providers who do not per-
form, pay for, or refer persons for abortion.
One of the last acts of the Bush Administration was the issuing of a
rule prepared by Michael Leavitt, secretary of HHS in December 2008.9 This
rule defines certain key terms of the previous federal regulations without
denying services that federal law allows or without expanding the entities
that are subject to the conscience clauses. The purpose of the Department
of Health and Human Services rule is also to clarify and reaffirm existing
federal law; to provide some important points about discrimination, and to
promote greater awareness of these regulations. It requires that recipients
of departmental funds certify their compliance with statutory requirements.
The text of the rule states:
As noted in the preamble to the proposed rule, the department is con-
cerned about the development of an environment in sectors of the
health-care field that is intolerant of individual objections to abortion
or other individual religious beliefs or moral convictions. Such devel-
opments may discourage individuals from entering health-care profes-
sions. Such developments also promote the mistaken belief that rights
of conscience and self-determination extend to all persons, except
health-care providers.10
The right to act according to one’s conscience is recognized for all citizens.
Soldiers are explicitly granted this right. Health-care professionals and pro-
viders are entitled to the same basic right as others. However, some groups
and patients wish to deny health providers these basic rights. Health provid-
ers should have discretion with regard to what they consider good for their
patients. They cannot be obliged to relinquish their medical and moral judg-
ments. That would be tantamount to making a physician or a pharmacist like
a “vending machine” that dispenses what he is told to dispense.
The Health and Human Services rule affirms,
The doctor-patient relationship requires a balancing of interests. The
patient has an interest in obtaining legal health-care services—and, in
the context of federally funded health-care programs, an eligible patient

May 2009 125

 may have the right to obtain certain health-care services from certain
entities. This must be balanced against the statutory right of the pro-
vider in the context of a federally funded entity to not be discriminated
against based on a refusal to participate in a service to which they have
objections, such as abortion. As stated above, Congress recognized
those provider rights in several statutes.11
The Department of Health and Human Services wishes to include reference
to non-discrimination provisions in the earlier Church Amendments and in
certifications of existing and potential recipients of department funds ac-
cording to the Weldon Amendment. In addition it seeks to provide enforce-
ment of the departmental statutes. The rationale is a clear and just one: Ev-
ery professional, not only medical ones, expects respect for his professional
autonomy. No one should dictate what decisions he makes if he abides by
general standards of safety and good medical care. Some will object that
abortion and sterilization are part of standard professional care and that no
one will be forced to practice these. But isn’t this discrimination against
medical professionals?
Chris Kaczor has argued that any discrimination against health-care pro-
fessionals or providers who do not practice abortions or sterilizations would
in fact be compounded by the fact that those health professionals who are
less likely to practice abortion or sterilization are already minorities, namely
Latinos, Blacks, and conservative Catholics or Evangelical Christians.12
If government or professional societies dictate what is medically good
and morally acceptable to health-care professionals whose own conscience
indicates otherwise, especially in the highly controversial matter of abortion,
one could envision grave abuses. For instance, if doctors’ conscience rights
were removed in Africa, many doctors could be forced to perform female
genital mutilation. In the United States execution of prison inmates is some-
thing repugnant to most physicians, but if conscience rights were removed,
physicians could be forced by law to assist in the execution of prisoners. One
could also imagine physicians and other health professionals being obliged
to participate in military acts of torture against their judgments of conscience
under the obligation of a committee report.
In addition to respect for the professional autonomy of physicians and
pharmacists, the moral autonomy of these professional should also be re-
spected. Part of respect for a person is respect for his ethical judgments,
and the same applies to health professionals. Although people may have
different values, a doctor should respect a patient’s moral values. Likewise
health-care professionals should not be forced to do what they find morally
objectionable. The supposed right to abortion has eroded respect for the right
to act in conscience.

126 Linacre Quarterly

 Right to Abortion
Western culture has lost respect for human life and has become a cul-
ture of death. In most countries of Europe and Northern America, abortion
and euthanasia are considered respectful options for women and health pro-
viders. The innocent child in the womb is considered an intruder and a men-
ace. His human rights and society’s rights are completely disregarded. This
situation is the end result of a subjective and absolute notion of freedom and
an evisceration of the concept of conscience, which always should have a
reference to natural law.
When a prohibition on the sale of contraceptives was struck down as
unconstitutional in Griswold v. Connecticut (1965), a mistaken right to pri-
vacy was invoked which began a process of privatization of morals. This
notion of a private morality was expanded by the United States Supreme
Court in Roe v. Wade (1973), the decision that created a constitutional right
to abortion. It removed the rights of a child in a mother’s womb and of soci-
ety’s right to protect its unborn members.
Years later, in Planned Parenthood v. Casey (1992), the federal courts
developed the idea of an absolute moral universe when its majority decision
enshrined a person’s right to decide what is good and what is wrong inde-
pendently from universal moral standards. Since then abortion has become
the most important right. Properly speaking it is the “right to choose abor-
tion.” This supposed right is invoked to kill innocent children and promote a
culture of selfish hedonism and parental irresponsibility.
The new administration under President Obama wishes to decrease the
rights of health-care providers and institutions that refuse to perform abor-
tions and provide contraception. It has announced that it will revise the HHS
rules issued by the Bush Administration. One must ask what is the reason for
revision of these rules? The most probable reason is that right to abortion has
become the reigning right that must be defended at all costs. This so-called
right not only removes the right to life of unborn children, it now threatens to
remove the rights of conscience of health-care providers who are easily open
to discrimination for their ethical behavior in refusing to practice abortion or
prescribe contraception.
The logic that any medical procedure that is technically possible is
therefore legitimate has resulted in the creation and destruction of countless
human embryos by clinics performing in vitro fertilization (IVF). A count-
less number of these embryos are aborted in the practice of IVF. The abor-
tion of these embryos has become a means to an end. Since abortion is a
“right” then the practice of IVF, which includes numerous abortions, is also

May 2009 127

considered a “right.” When implanted embryos do not abort spontaneously,
the unwanted fetus can be destroyed by a “selective reduction.”
Two recent notorious cases in California illustrate serious flaws in phy-
sicians’ use of conscience. In one case a fertility physician performed IVF on
a single mother of six children and implanted eight human embryos into the
woman.13 Subsequently, the woman gave birth to octuplets. This mother’s
life and the life of the children were placed at risk. The single mother now
has fourteen children to care for without a husband. The physician should
have objected to the patient’s request, but did not.
Another case regarded a woman’s petition for artificial insemination.14
In this case a woman who is a lesbian sued a fertility specialist who chose
in conscience not to perform artificial insemination out of religious motives.
In a lawsuit a court awarded for the plaintiff against the physician for unjust
discrimination. In this case the physician’s right to act according to his judg-
ment of conscience was found to be discriminatory, and he was punished.
In both cases, women demanded treatments that they had no right to
receive. In the first case, the woman received treatment because of her capri-
cious use of freedom and a physician’s reprehensible moral judgment. In the
second a woman was awarded the right to the treatment she demanded at the
cost of the physician’s right of conscience.
The Christian and Conscience
Since conscience is not an arbitrary decision reached in an isolated
self-referential manner, but the result of prudent choice made within the con-
text of established moral and social norms, it is necessary to form the con-
science to be able to make correct judgments. Otherwise a person’s moral
conscience remains in ignorance and makes erroneous judgments.15
Divine revelation aids Christians in the formation of their consciences.
The Sacred Scriptures and the Tradition of the Church are a sure guide for
moral actions. Moreover, the Church is the authentic interpreter of the Scrip-
tures and Tradition, and its teaching has a binding character on conscience.16
Over the ages, and especially during the twentieth century, the Magisterium
of the Church has addressed difficult moral questions, particularly in the face
of constant medical and scientific developments. A Catholic professional is
obliged to form his criteria based on the universal teaching of the Church.
Christ asks him to act with an “obedience of faith” in matters of faith and
morals that the ordinary or extraordinary Magisterium teaches.17 Far from
restricting his freedom of judgment, the Church thus helps her children to act
with greater ease and certainty in choosing actions that are good and avoid-
ing those that are evil.

128 Linacre Quarterly

 In an age of marked relativism in which Catholics are often called in-
tolerant for refusing to relinquish their religious beliefs, the Church places
us on guard against a false notion of a moral equivalence among all cultural
beliefs.18 With great concern the Church urges Catholics to defend human
life from the moment of conception to the moment of natural death.
In this context, it must be noted also that a well-formed Christian con-
science does not permit one to vote for a political program or an individual
law which contradicts the fundamental contents of faith and morals. The
Christian faith is an integral unity, and thus it is incoherent to isolate some
particular element to the detriment of the whole of Catholic doctrine.19
Sadly there are many Catholic professionals who do not look to the
Church’s teaching to form the necessary criteria that inform their moral deci-
sions. They fail to accept the Church’s teaching regarding actions that are al-
ways in and of themselves intrinsically wrong. These Catholic professionals
separate the judgment of conscience from truth and objective moral norms.
Pope John Paul II explained in the encyclical Veritatis splendor:
The individual conscience is accorded the status of a supreme tribunal of
moral judgment which hands down categorical and infallible decisions
about good and evil. To the affirmation that one has a duty to follow
one’s conscience is unduly added the affirmation that one’s moral judg-
ment is true merely by the fact that it has its origin in the conscience.20
The Church assists men in avoiding this false exaltation of human freedom,
which makes the individual conscience an arbiter of what is good and what
is evil. However, many Catholics acting in good faith are unaware of re-
cent documents from the Holy See such as the instruction Dignitas personae
which applies truths of moral theology about the sanctity of human life rec-
ognized by the universal Magisterium to concrete medical questions of re-
search with embryonic stem cells and cloning.21
There also good physicians, pharmacists, and nurses who, although
agreeing with the Church’s teaching on moral questions, think that they can-
not “impose” their values on patients. This erroneous way of thinking fails
to understand that the Church proposes the truth; it does not impose it on
anyone. Furthermore Catholic professionals, as acting moral subjects, are
not only entitled to act according to their moral judgment without relinquish-
ing them in the practice of their profession, but are also called by God to be
a guide and example to others in society.
Conclusion
The moral conscience is a practical judgment regarding the conformity
of an action to man’s ultimate end. Respect for conscience is based on man’s
freedom and use of reason. It is a grave injustice against a person’s dignity

May 2009 129

to deprive him of the freedom to act according to his conscience. At the same
time each person has the obligation to form his conscience well through the
study of natural law. For a Catholic the teaching of the Church is a very im-
portant means for ascertaining more easily and without errors the content of
natural law. Therefore, for a Catholic to act in good conscience, he must also
study the Church’s teaching to be able to make the right choices.
In seeking a balance between physician rights and patient rights the
principle of autonomy for both parties must be respected. Doctor Edmund
Pellegrino points out the danger of the current situation where physicians’
professional discretion is trumped by an exaggerated view of patient rights.22
In light of renewed interest on the part of some for Congress to pass the
Freedom of Choice Act (FOCA) that would repeal important rights of health
-care professionals and institutions who do not wish to perform abortions or
sterilizations or provide contraceptives to their patients, the defense of the
above rights and freedom is all the more urgent.
Existing federal laws, and the December 2008 ruling by the Depart-
ment of Health and Human Services, serve precisely to defend the freedom
and rights of physicians, other health professionals, and institutions that pro-
vide medical care. If this freedom and respect is weakened, patients and so-
ciety as a whole will suffer in the end. Should a ruling be passed that would
infringe on persons’ rights of conscience, Catholic professionals would need
to be able to explain more clearly to others the true meaning of freedom of
conscience and to fight even more to defend the right to this freedom. Thus,
Catholics need to study both the true meaning of conscience and its binding
character, in order that they might effect change in these pressing times.

References
1
John Henry Newman, “Letter to the Duke of Norfolk,” in idem, Certain Difficul-
ties Felt by Anglicans in Catholic Teaching, vol. 2 (New York: Longmans, Green,
and Co, 1900), 246, http://www.newmanreader.org/works/anglicans/volume2/glad-
stone/section5.html.
2
Ibid, 247.
3
See 42 U.S.C. § 300a-7(b).
4
See Jodi Feder, “The History and Effect of Abortion Conscience Clause Laws,”
Congressional Research Service, Library of Congress (February 27, 2006), 3, http://
assets.opencrs.com/rpts/RS21428_20060227.pdf.
5
See American College of Obstetricians and Gynecologists, “The Limits of Consci-
entious Refusal in Reproductive Medicine,” ACOG Committee Opinion Number
385, http://www.acog.org/from_home/publications/ethics/co385.pdf (also found at

130 Linacre Quarterly

Obstetrics & Gynecology 110 (2007): 1203–1208).
6
Ibid, 5, recommendation n. 5.
7
Chris Kaczor, “The Pro-Life Doctor, an Oxymoron?” First Things On the Square Blog
(April 8, 2008), http://www.firstthings.com/onthesquare/?m=200804&paged=2.
8
John Stuart Mill, On Liberty, 4th ed. (Longmans, Green, Reader and Dyer, 1869),
27. See also ch. 1, 5–30.
9
Department of Health and Human Services, 45 CFR, Part 88, “Ensuring that De-
partment of Health and Human Services Funds Do Not Support Coercive or Dis-
criminatory Policies or Practices in Violation of Federal Law; Final Rule,” Fed-
eral Register 73.245 (December 19, 2008), http://edocket.access.gpo.gov/2008/
E8-30134.htm.
10
Ibid, 78074.
11
Ibid, 78075.
12
See Kaczor, “The Pro-Life Doctor, an Oxymoron?”
13
Alfred Cioffi, “The Suleman Octuplets and the Immorality of IVF,” National Cath-
olic Bioethics Center News and Events, March 10, 2009, http://www.ncbcenter.org/
details_news.asp?idOfEvent=431; “Octuplets Mom, Nadya Suleman, Under Harsh
Scrutiny but Her Doctor Now Under Investigation,” February 6, 2009, http://com-
monlaw.findlaw.com/2009/02/octuplets-mom-nadya-suleman-under-harsh-scruti-
ny-but-her-doctor-now-under-investigation-.html.
See Jacob M. Appel, “May Doctors Refuse Infertility Treatments to Gay Patients?”
14

Hastings Center Report 36.4 (2006): 20–21.

15
Catechism of the Catholic Church, trans. United States Conference of Catholic
Bishops (Vatican City: Libreria Editrice Vaticana, 1994), nn. 1790–1794. The Cath-
olic Church teaches that no one should act with a doubtful conscience (see CCC, n.
1787). Before acting, a person should overcome reasonable doubt.
16
See Ramón García de Haro, Marriage and the Family in the Documents of the
Magisterium, A Course in the Theology of Marriage, trans. William E. May (San
Francisco: Ignatius Press, 1993), 302–304. In the encyclical Humanae vitae, Pope
Paul VI affirmed the need for obedience to the authority of the Church’s Magiste-
rium and referred to the same teaching by Popes Pius XI and Pius XII.
17
See Rm 1:5.
18
Congregation for the Doctrine of the Faith, “Doctrinal Note on Some Ques-
tions Regarding the Participation of Catholics in Political Life” (November 24,
2002), n. 2, http://www.vatican.va/roman_curia/congregations/cfaith/documents/
rc_con_cfaith_doc_20021124_politica_en.html.
19
Ibid, n. 4.
20
Pope John Paul II, encyclical Veritatis splendor (August 6, 1993), n. 32,
http://www.vatican.va/holy_father/john_paul_ii/encyclicals/documents/
hf_jp-ii_enc_06081993_veritatis-splendor_en.html.
21
Congregation for the Doctrine of the Faith, instruction Dignitas personae (On

May 2009 131

Certain Bioethical Questions; June 20, 2008), http://www.vatican.va/roman_curia/
congregations/cfaith/documents/rc_con_cfaith_doc_20081208_dignitas-personae_
en.html.
22
Dr. Edmund D. Pellegrino argues that patient’s wishes cannot automatically trump
the physician’s competence, discretion, and moral obligations. See Edmund D. Pel-
legrino, “Patient Autonomy and the Physician’s Ethics,” in Annals CRMCC 27.3
(April 1994): 171–173.

132 Linacre Quarterly