David E. DeCOSSE & Thomas A. NAIRN, OFM, eds. Conscience & Catholic Health Care: From Clinical Contexts to Government Mandates. Maryknoll, New York: Orbis, 2017. Pp. 200 and Index.  $ 35, pb. ISBN 978-1-62698-212-3. Reviewed by Nathan R. KOLLAR, St. John Fisher College, Rochester, NY 14618.


Today the proclamation that you are following your conscience seems to be an unassailable declaration that no law or established custom should stop you from doing what you declare conscious-guarded.  Among many Roman Catholics one’s conscience is oriented toward obeying unquestioned moral laws derived from the unchanging moral doctrine declared by the hierarchy.  God’s voice, your conscience formed by the hierarchy, tells you what is right or wrong.  Consequently Little Sisters of the Poor will not sign government documents dealing with contraception; many doctors in Catholic hospitals will not abort a fetus to save a mother’s life, and many nurses in Catholic hospices will do nothing to hasten an individual’s death.  Catholics follow their conscious knowing that their eternal life depends upon it – no matter who and how much others may suffer.

Conscience & Catholic Health Care following the tradition set by Conscience and Catholicism: Rights, Responsivities, and Institutional Responses (2016) clearly and expertly sets this understanding of conscience within the entire Catholic tradition.  It does so in fourteen essays which review the different understandings of conscience within that tradition, provide a context for understanding past and present understandings of conscience and does so while keeping in mind the everyday work world of those providing health care in our Catholic facilities.

The following are some ideas that are elaborated upon in these essays: The necessity of taking into consideration all the consciences involved in decision making (reciprocity of consciences); that formation of conscience challenges us to creatively become a responsible moral agent; that conscience is the whole act of a whole person and thus “… a moral and spiritual entity representative of the deepest meaning of a person”; that actions dependent upon conscience are also, in their own way, statements of a moral truth – many times inherently connected  to moral doubt in which epikeia and skepticism play a vital role; that we should be aware of the possible conflict between the  individual conscience, the patient, and the institutional conscience (the health care system); that  one’s conscience is inherently social, participating in an essential  aspect of human nature,  thus the actions forthcoming from our conscience easily participate in the sins inherent in every culture – conscience is not a “pure” as some proclaim;  that  conscientious objection to  what one considers sinful in a culture presupposes a willingness to accept the consequences of such objection (e.g. jail);  that when our moral claim of conscience turns into a court case the necessity to translate that claim into legal language is a significant change of context;  formation of conscience is essential as our culture increases its technological tools and decreases its aid to the poor and needy; that formation of conscience must include how our individual acts are shaped by our biases.

There are several checklists in the essays which help us form our own and others’ conscience; one is that offered by  Paris and Moore as a list of  questions  for assessing the validity of claiming conscientious objection and  three others offered by Carol Taylor who, as any good teacher, lists the significant terms for discussing conscience and morality, how to get the faculty involved in conscience formation, and the necessary questions to ask of our pedagogies in helping form the conscience of our students.

Repetition is a natural consequence of compilations such as this and certainly exists in this text. At the same time it is interesting to read the variety of ways conscience is understood and distinguished from each other as presented by each author.  This is a valuable book,  one that enables the reader to understand the diversity of views within a unity of faith and moral understanding. If you have not been updated on “conscience” in the Roman Catholic tradition this is a must read.