Perspect Biol Med 2019 ;62(3):414-433
While conscience in medicine has been a source of debate for decades, the role of conscience in medical training remains largely unexamined. Insofar as conscience is addressed, trainees are typically urged to avoid practices that will conflict with their internal moral codes, refer to practitioners who will provide such practices, or even consider leaving the profession. This essay considers Lauris Kaldjian's articulation of two rival definitions of conscience: conscience as mere private and idiosyncratic moral belief, or conscience as a fundamental capacity for moral reasoning, akin to good clinical judgment. The authors propose that these definitions reflect two rival conceptions of medicine-medicine as product, or medicine as moral practice-and argue that the latter definition is vital to understanding both the purposed nature of medicine and the role of the conscience within that purpose. The authors conclude that because medicine is fundamentally moral and the conscience is the capacity for moral reasoning, medical education is essentially a training in conscience. Therefore, neglecting or disparaging conscience in medical training will have serious consequences for the future of trainees and the practice of medicine alike.