While MSF cannot work directly in Syria, it has collected testimonies from wounded patients treated outside the country and from doctors inside Syria.  The testimonies, collected from several people from various parts of the country, point to a crackdown on the provision of urgent medical care for people wounded in the ongoing violence in Syria.  

“In Syria today, wounded patients and doctors are pursued and risk torture and arrest at the hands of the security services,” said Marie-Pierre Allié, MSF president. “Medicine is being used as a weapon of persecution.”

Most of the wounded do not go to public hospitals for fear of being tortured or arrested. When a wounded person is admitted to a hospital, a false name is sometimes used to hide his or her identity.  Doctors sometimes provide a false diagnosis to help patients elude security forces, who search for patients with wounds consistent with those sustained in protests and demonstrations. People have suffered grievous injuries, including from shrapnel and from bullets that apparently explode on impact.  The testimonies recount instances of people shot by snipers.

“It is critical that the Syrian authorities reestablish the neutrality of healthcare facilities,” said Marie-Pierre Allié. “Hospitals must be protected areas, where wounded patients are treated without discrimination and are safe from abuse and torture, and where medical workers do not risk their lives by choosing to comply with their professional code of ethics.”

The injured are largely treated in clandestine treatment facilities by doctors trying to fulfill their commitment and duty to provide medical assistance. Improvised health clinics have been established in apartments, on farms, and elsewhere. Simple rooms outfitted as makeshift operating theatres, known as “mobile hospitals,” are used for surgical procedures.  Hygiene and sterilisation conditions are rudimentary and anaesthesia is in short supply.  Furthermore, the mere possession of drugs and basic medical materials, such as gauze, is considered a crime.

“The security services attack and destroy the mobile hospitals,” said a doctor who requested anonymity. “They enter houses looking for drugs and medical supplies.”

Security is the key concern for doctors working in the parallel underground networks. In the prevailing climate of terror, treatment must be provided rapidly since medical workers and patients must constantly change location to avoid detection. 

“We are constantly being pursued by the security forces,” said another physician. “Many doctors who treated wounded patients in their private hospitals have been arrested and tortured.”

It is extremely difficult for the clandestine health workers to treat major trauma cases and provide post-operative care. Additionally, they cannot obtain blood from the central blood bank, which is controlled by Syria’s Ministry of Defence — the only blood supplier in the country.

Only a few wounded patients have managed to find refuge in neighbouring countries, where they can receive proper—albeit delayed—medical care.   

“I was wounded in the thigh and the soldiers caught me,” recounted a patient treated by MSF. “They beat me on the head and on my wound, but I managed to get away with help from people in the neighbourhood. In the end, I found someone who could treat me — a nurse, not a doctor. He didn’t even have anaesthetic.”

Under the current circumstances, MSF’s assistance to Syrians requiring medical care is limited.  For months, MSF has been seeking official authorisation to aid the wounded in Syria, so far without success. The organisation is treating patients outside Syria and is supporting doctors’ networks inside the country, through the provision of medicine, medical supplies, and surgical and transfusion kits.   

Source: member // Medecins Sans Frontieres – UK 

Yet people can, and often do, behave in very different ways.

A news search for the words “hero saves” will routinely turn up stories of bystanders braving oncoming trains, swift currents and raging fires to save strangers from harm. Acts of extreme kindness, responsibility and compassion are, like their opposites, nearly universal.

Why are some people prepared to risk their lives to help a stranger when others won’t even stop to dial an emergency number?

Scientists have been exploring questions like this for decades. In the 1960s and early ’70s, famous experiments by Stanley Milgram and Philip Zimbardo suggested that most of us would, under specific circumstances, voluntarily do great harm to innocent people. During the same period, John Darley and C. Daniel Batson showed that even some seminary students on their way to give a lecture about the parable of the Good Samaritan would, if told that they were running late, walk past a stranger lying moaning beside the path. More recent research has told us a lot about what happens in the brain when people make moral decisions. But are we getting any closer to understanding what drives our moral behavior?

Here’s what much of the discussion of all these experiments missed: Some people did the right thing. A recent experiment (about which we have some ethical reservations) at the University of Chicago seems to shed new light on why.

Researchers there took two rats who shared a cage and trapped one of them in a tube that could be opened only from the outside. The free rat usually tried to open the door, eventually succeeding. Even when the free rats could eat up all of a quantity of chocolate before freeing the trapped rat, they mostly preferred to free their cage-mate. The experimenters interpret their findings as demonstrating empathy in rats. But if that is the case, they have also demonstrated that individual rats vary, for only 23 of 30 rats freed their trapped companions.

The causes of the difference in their behavior must lie in the rats themselves. It seems plausible that humans, like rats, are spread along a continuum of readiness to help others. There has been considerable research on abnormal people, like psychopaths, but we need to know more about relatively stable differences (perhaps rooted in our genes) in the great majority of people as well.

Undoubtedly, situational factors can make a huge difference, and perhaps moral beliefs do as well, but if humans are just different in their predispositions to act morally, we also need to know more about these differences. Only then will we gain a proper understanding of our moral behavior, including why it varies so much from person to person and whether there is anything we can do about it.

If continuing brain research does in fact show biochemical differences between the brains of those who help others and the brains of those who do not, could this lead to a “morality pill” — a drug that makes us more likely to help? Given the many other studies linking biochemical conditions to mood and behavior, and the proliferation of drugs to modify them that have followed, the idea is not far-fetched. If so, would people choose to take it? Could criminals be given the option, as an alternative to prison, of a drug-releasing implant that would make them less likely to harm others? Might governments begin screening people to discover those most likely to commit crimes? Those who are at much greater risk of committing a crime might be offered the morality pill; if they refused, they might be required to wear a tracking device that would show where they had been at any given time, so that they would know that if they did commit a crime, they would be detected.

Fifty years ago, Anthony Burgess wrote “A Clockwork Orange,” a futuristic novel about a vicious gang leader who undergoes a procedure that makes him incapable of violence. Stanley Kubrick’s 1971 movie version sparked a discussion in which many argued that we could never be justified in depriving someone of his free will, no matter how gruesome the violence that would thereby be prevented. No doubt any proposal to develop a morality pill would encounter the same objection.

But if our brain’s chemistry does affect our moral behavior, the question of whether that balance is set in a natural way or by medical intervention will make no difference in how freely we act. If there are already biochemical differences between us that can be used to predict how ethically we will act, then either such differences are compatible with free will, or they are evidence that at least as far as some of our ethical actions are concerned, none of us have ever had free will anyway. In any case, whether or not we have free will, we may soon face new choices about the ways in which we are willing to influence behavior for the better.

Peter Singer, a professor of bioethics at Princeton University and a laureate professor at the University of Melbourne, is the author, most recently, of “The Life You Can Save.” Agata Sagan is a researcher.

Obama implores Congress not to “gut” investments in research, so American can maintain its spot as a world leader in medical innovation. That line will earn applause from the pharmaceutical and medical device industries, but it won’t be enough to deliver a health care economy that delivers a “fair shot” to everyone.

The president held out the continued possibility of saving health care costs with Medicare reform. “As I told the speaker this summer, I’m prepared to make more reforms that rein in the long term costs of Medicare and Medicaid, and strengthen Social Security, so long as those programs remain a guarantee of security for seniors,” Obama said. “But in return, we need to change our tax code so that people like me, and an awful lot of members of Congress, pay our fair share of taxes. Tax reform should follow the ‘Buffett Rule’:  If you make more than $1 million a year, you should not pay less than 30 percent in taxes.”

And he rebutted Republican accusations that his signature 2010 health reform law amounts to socialized medicine. “I’m a Democrat. But I believe what Republican Abraham Lincoln believed: That government should do for people only what they cannot do better by themselves, and no more,” he said. “That’s why our health care law relies on a reformed private market, not a government program.”

Obama makes it clear that he sees the giant health care sector as a place ripe for jobs growth. The American Association of Medical Colleges projects a shortage of 90,000 doctors over the next 10 years. It’s more than double that for the nursing industry, where the American Nursing Association sees a potential shortage of 260,000 nurses by 2025. These shortfalls will only be worsened as an additional 30 million people get health insurance under the 2010 health reform law.

But a national workforce commission established under the health care law has been chronically underfunded by Congress. The training programs that will be needed to fix these shortages have a slim to little chance of getting any funds. Appropriators have no room to give precious federal dollars to new programs while they are slashing old sacred cows in the austere spending environment that has reigned on Capitol Hill since Republicans took the House in 2011.

And while investments in research are nice, what medical device companies want even more is for Congress to take back a $20 billion tax it imposed on the industry to help cover the cost of the health reform law. Stephen Ubl, president of Advamed, a medical device lobbying association, says the tax is already causing layoffs.

Obama doesn’t get a break from hospitals either. The American Hospital Association says a coming 2 percent cut to Medicare and other cuts will cost them 278,000 jobs as revenue drops from Medicare and Medicaid. In the health care world, federal funds are the spigot for job creation, and no State of the Union speech is going to change the spending environment on Capitol Hill.

Trading life-saving meds for cash highlights the relationship between employment and eligibility requirements for programs such as the AIDS Drug Assistance Program (ADAP) or HIV/AIDS Services Administration (HASA), as some HIV-positive individuals have to choose between holding a job and keeping benefits from these types of assistance programs. It also raises the question of how advocates can help people living with HIV better understand their options when receiving health care, so that they won’t feel pressured to partake in illegal activity.

The Uptowner reported:

Street sales have been particularly noticeable near uptown subway stations for more than six years, according to Dr. Michael Mowatt-Wynn, the president of Precinct 33’s Community Council. Prescription painkillers are prevalent, but the most popular drugs aren’t addictive and don’t produce any kind of high: HIV antiretroviral medications. …

[...] “I saw a mother with children in tow, no more than 5 or 6 years old,” Mowatt-Wynn says. “She was selling her HIV medicine, saying she needed to get food for her children. So she was basically selling herself. It’s a form of medical prostitution — that’s what we call it.”

In other countries, HIV medication is expensive and uncommon, making it a lucrative product for the black market. Buyers stand around the more popular uptown subway stations as if it’s a full-time job. From 9 to 5 Monday through Friday, they’re buying prescription medication from people who will use the proceeds to buy food, pay bills or fuel an addiction. Pharmacists then buy and repackage the drugs so they’ll sell for higher prices and ship them to countries with high demand, like the Dominican Republic and Mexico, [Pablo] Colon [the senior HIV counseling and treatment specialist at the New York City HIV organization Iris House] says.

According to The Uptowner, as a way to deter these sales, the “council and [33rd] precinct have instituted new policies to try to reduce the drug trade, placing cameras on lampposts at the most popular subway stations and stationing patrol officers nearby.”

City Limits also reported on the same issue:

… [A] bill sponsored by New York Sen. Kemp Hannon and passed by the Senate in June could close that gap if approved by the assembly this year.

The bill identified an “exploding black market in non-controlled substance medications,” including AIDS medications that are either sold to pharmacies or shipped overseas. Under the bill, first degree “criminal diversion of prescription medications and prescriptions” moves from a C felony (with likely maximum jail time of five to 15 years) to a B felony, for which the maximum is eight to 25 years.

Pharmacists play a crucial role in the trafficking as well. Ms. Cruz, who has sold her medications in the past, provided City Limits with the following scenario:

The HIV [positive] patient calls to let the pharmacist know in advance that it’s not really the pills he or she is interested in buying, but something else. Upon arrival at the pharmacy, the pharmacist scans the barcode on the bottle of pills, and then hands over a plastic bag filled with a few hundred dollars, instead of the medication.

The pharmacist can then sell the pills back to drug dealers or ship them directly overseas.

Have you ever considered selling your AIDS meds to make ends meet?

[Editor's note: Sadly, Pablo Colon passed away on Dec. 30, 2011, at the age of 49.]

Warren Tong is the associate editor for TheBody.com and TheBodyPRO.com.

Life Technologies Corp., a Carlsbad, Calif., genomics company, plans to introduce Tuesday a machine it says will be able to map an individual’s entire genetic makeup for $1,000 by the end of this year. Moreover, the machine and accompanying microchip technology, both developed by the company’s Ion Torrent unit, will deliver the information in a day, the company says.

 If Life Technologies delivers on the claim, it would likely make the company the first among a group of rivals racing to produce a $1,000 gene map. The current cheapest sequencing costs about $3,000 and takes a week.

The goal, triggered in part by an initiative launched by the U.S. government’s National Human Genome Research Institute in 2004, already has resulted in a dramatic cost reduction in sequencing all three billion units of DNA, known as base-pairs, that make up the human genetic code.

Scientists say that breaking the $1,000 barrier—roughly the price of an MRI test—will accelerate an already fast-moving transformation in genetic discovery and drug development.  Some experts believe a person’s genetic code eventually will be used routinely to guide prevention and treatment of illnesses throughout life.

Drug companies increasingly are identifying gene variants that they can target with drugs. And geneticists are identifying more and more diseases that result from a mutation in just one gene.

The hope is that mapping variations in the entire human genome can speed up or improve disease diagnosis and aid in developing more medical treatments targeted to patients with a specific genetic makeup.

Genomic information also may give individuals information about their risk for a common disease and predict how one will respond to particular medications or environmental exposures, such as radiation from medical tests, according to the U.S. Department of Energy Genome Programs.

Whole-genome sequencing—as opposed to identifying just a subset of genes suspected of being linked to an illness—allows scientists to look broadly across all genes for mutations that are associated with diseases.

This “broad net” approach is particularly useful when researchers don’t have a good sense of which genes might be involved in a disease and may identify a novel drug target, said Richard K. Wilson, director of the Genome Institute at Washington University in St. Louis.

Eventually, if people can be sequenced early in life to learn about health risks, such as aneurysms or early-onset heart attacks, they may be able to take preventive drugs or boost the monitoring of their health, Dr. Wilson said.

With single-gene conditions such as sickle-cell disease, sequencing the whole genome could be useful in identifying “modifier” genes that work with the primary mutation to make a disease more or less severe, Dr. Wilson added.

But understanding how genes work together to cause a condition or to develop a treatment will require extensive laboratory research far beyond merely analyzing the genome, said Karen Kaul, a molecular pathologist at NorthShore University HealthSystem in Evanston, Ill., and spokeswoman for the American Society for Clinical Pathology.

“We are just beginning to scratch the surface about what [genomic] changes are clinically relevant,” she said. “I think we have to be realistic and a little cautious” about current genomic information.

Completion of the Human Genome Project in 2003—which for the first time mapped the human genome—created high expectations that a stream of new drugs would soon flow out of pharmaceutical labs. When that didn’t happen, skeptics questioned the value of the effort.

But in the past year or two, drugs based on genomic information have begun to reach the market.

Still, the wider availability and lower price of sequencing raises the question of how to convert the flood of genetic data into useful information for drug development and treating patients.

“We can sequence the genome for dirt cheap,” said Eric Green, director of the NHGRI, “but we don’t know how to deal with the data. We’ve got to work on that.”

Whether Ion Torrent actually hits the $1,000 target by year’s end won’t be known until the machine and its accompanying technology are delivered and tested by top sequencing centers. Some earlier promises to hit less ambitious price targets by industry participants have failed to meet deadlines or pan out.

Just four years ago, Knome Inc. of Cambridge, Mass., introduced the first commercial human genome, priced at $350,000. Until recently, the high cost largely has limited sequencing to a handful of people, including the late Apple Inc. chief executive, Steve Jobs, according to a recent biography of him by Walter Isaacson.

Even now, only an estimated 1,800 whole genomes have been sequenced using high-quality technology, according to the National Human Genome Research Institute.

Current machines marketed by Illumina Inc. of San Diego, the market leader in sequencing devices, can decode an entire human genome in about a week for about $3,000.

In the wings, said Jeff Schloss, a program director and technology expert at NHGRI, are newer approaches to sequencing that could help drive the price of a genome down to $100.

Jonathan Rothberg, founder of Ion Torrent, is unveiling the machine Tuesday at the annual J.P. Morgan Healthcare conference. It will cost $149,000. The announcement comes amid challenging times for sequencing companies despite the rapid leaps in technology as restraints in government and academic research budgets and the uncertain economy have damped sales of big-ticket sequencers.

“It’s tremendously concerning that at the same time policymakers and law enforcement professionals are waging a war on the growing prescription drug crisis, new super-drugs could well be on their way, flooding the market,” said Sen. Charles Schumer, D-N.Y. “The FDA needs to grab the reins and slow down the stampede to introduce these powerful narcotics.”

A message seeking comment from the Food and Drug Administration was not immediately returned Friday.

The Associated Press reported last month about addiction experts’ fears over four drugs being tested that contain a more powerful version of one of the nation’s most abused painkillers — hydrocodone.

Schumer is particularly concerned about legalizing the drugs for prescriptions because they would be prized commodities in the black market.

Experts say painkiller addiction has been driven partly by a loophole in the 1970 Controlled Substances Act that classified pure hydrocodone — a super painkiller — as a strictly controlled Schedule II drug. But the law put combination products, such as pills containing hydrocodone and acetaminophen, into the less strict Schedule III.

Because of the loophole, patients can refill a prescription for a hydrocodone-acetaminophen drug like Vicodin up to five times. A prescription for a similar oxycodone product, such as Percocet, can be filled only once. Critics say the loophole has flooded American medicine cabinets with hydrocodone.

In 1999, the Drug Enforcement Administration and FDA began reviewing whether they should reschedule hydrocodone combination products. But an AP review of regulatory documents and court filings shows the agencies have repeatedly passed the rescheduling study back and forth, with no final decision made.

A New Year’s Eve robbery at a Long Island pharmacy netted prescription painkillers and cash and left the robber and a federal agent dead. In June, four died in another Long Island pharmacy robbery in which 11,000 hydrocodone pills were stolen.

If the pure hydrocodone drugs are approved, Schumer wants a “robust post-market surveillance” of the drugs as they are marketed, advertised and sold.

To begin with, I hope most of us would agree that conscience is not the proverbial angel on my shoulder, the antagonist of the little devil who whispers temptations in my ear perched on my other shoulder.  Yet, while most of us have progressed beyond this childish understanding of conscience, I fear that a large percentage of Catholics still labor under some form of misconception about the nature of moral conscience.

Allow me to suggest that most if not all of those problematic notions about conscience—having trickled down to us historically from different schools of moral philosophy, psychology and related fields—generally fall into one of the following broad categories:

(a) Conscience as emotive response. On this view, conscience is nothing more than an emotive response conditioned over time by genetic factors, environment and other socializing factors, in addition to psychological forces deep at work in our own psyche.  So conceived, conscience—particularly when manifested as guilt—is to be overcome or ignored or otherwise harmoniously integrated into our own everyday life in a way that it does not become an obstacle to our “life style choices,” “values,” “self-projects,” and so on.

(b) Conscience as built in moral guidance system. Here, conscience is understood to be a kind of natural faculty or power. Some depict it as the very voice of God who, through conscience, can guide our actions directly.  If not so depicted, it is presented as at least responding to the external dictates of moral authority in the manner of an internalized moral GPS: “do this,” “avoid that,” “too much more and you will cross the line,” and so on.

(c) Conscience as moral sense. A third misconception, presents conscience as a kind of intuition which simply cannot be accounted for or explained in terms of human reasoning. Sometimes called the “moral sense,” conscience, from this viewpoint, must be developed much like developing the ability to judge a good wine, pick a winning race horse, assess a person’s character, or keep a group of school children well behaved and attentive.

(d) Conscience as moral opinion. Finally, a fourth misconception presents conscience as simply that process by which I give consideration to moral matters and come up with my best judgment—essentially my opinion—about what I, or others, ought to do or not do.  When I am convinced of this judgment, it enjoys primacy over all other moral points of reference, trumping any other considerations. As such, my “judgment of conscience”—that is, my best formed opinion on the moral matter at hand—is infallible and absolute:  my conscience is my moral compass, period.2

Now, some readers might be surprised by my suggestion that none of these definitions is a good fit for the notion of conscience that has come down to us from the NL tradition. That will become apparent as we work our way toward the tradition’s understanding of conscience by briefly critiquing each of the misconceived notions in (a) through (d).  To be sure, a point of agreement between these versions of moral conscience, and that proposed by the NL tradition, is that conscience is something very personal, whose locus is to be found within the realm of one’s own personal subjectivity. Beyond that common element, however, we have some strikingly diverse conceptions of what moral conscience actually is, each emerging from its own unique intellectual history.

To begin, I will discard notion (a) as grossly inadequate. Notwithstanding the importance of psychology and upbringing in the overall task of conscience formation, this account of conscience is highly problematic from the moment we consider how poorly it accords with our shared human experience of moral obligation. While the experience of conscience can indeed be accompanied by emotional responses (both positive and negative, both guilt at doing wrong, and delight at doing good), moral conscience itself is not simply reducible to emotional responses. Furthermore, we must reject the negativity of this notion of conscience. The NL tradition conceives of conscience as a profound aid to a healthy and fulfilling existence, not as an onerous quirk of human psychology that one must essentially learn to ignore.

Notion (b) is often taken to be the true NL, or Catholic, understanding of conscience.  This notion entails a kind of legalism, however, and the least imprecise sense that conscience—whether innate or internalized through experience—is like an interior voice that would direct our every action, understood by some to be the voice of God himself (or the Holy Spirit) speaking interiorly. While it is true that the Vatican II document, Gaudium et Spes, speaks of conscience as our “secret core” and our “sanctuary” where we are “alone with God” whose voice “echoes in [our] depths,” such metaphors must be properly understood. While the Holy Spirit certainly can, and does, speak through a correct judgment of conscience, conscience cannot simply be reduced to “the voice of God.” As we will explain just ahead, conscience can in fact err, a reality that notion (b) fails to countenance. Notion (b) also inaccurately depicts  conscience as a kind of separate faculty of the soul, a notion which needs a some considerable specification.  That notwithstanding,  notion (b) falls very short of the mark. It presupposes that the moral life is tantamount to the following of norms of external norms. The Catholic tradition has consistently indicated the dangers of such a legalistic understanding of the moral life, which can easily stunt human moral growth, lead to scrupulosity, moral shallowness, misplaced rigidity, and imprudence in making moral judgments. As such, notion (b) constitutes an impoverished notion of what the NL tradition has genuinely maintained. is a sort of angelic voice distinct from our own reasoning which comes, as it were, from outside us, even if we hear it in our heart; it is generally trustworthy, but we must decide to obey it or not. There is more than a hint of this at several points in our theological tradition. But whatever these texts mean, they clearly do not mean a divine or diabolical voice intrudes into our ordinary reasoning processes, commanding or complaining, a rival with our own moral thinking… Were conscience really a voice from outside our reasoning it would play no part in philosophy and there might be some kind of double truth in the moral sphere. Late scholastic voluntarism and post-scholastic legalism took moral theology down just such a blind alley. [The Church’s] Magisterium became the satellite navigator and the role of conscience was to hear, interpret and obey. Many contemporary theologians and pastors are heirs to this. For some the solution to the crisis of moral authority is to keep calling for submission to the navigator. Moral tax lawyers, on the other hand, try to find ways around the moral law, or ways to “sail as close to the wind as possible” without actually breaking the moral law. Can you do a little bit of abortion or embryo experimentation or euthanasia without breaking the moral law?” (Op. cit).543

Notion (c), though very popular over the past hundred years or so, and enormously influential, is also problematic. Consider, among other things, that notion (c) leaves no room open for appeal to objective criteria on which basis I could challenge someone’s “moral sense.” A member of a Sudanese Janjaweed militia might argue a few years back that his moral sense indicated that dark-skinned African inhabitants of the Darfur region should be exterminated. Preferably, we would want a theory of moral conscience that leaves us grounds to challenge such a claim. Notion (c) does not afford us that, however. This notion presupposes, moreover, that morality is essentially something lying outside the bounds of our use of reason, and that conscience is quite literally non-rational—hardly the notion of conscience we discover in the NL tradition.76

Notion (d) requires more sustained consideration for the several valid elements it contains, for its degree of overlap with the NL notion of conscience, and for the predominance of this view, including the remarkable degree of confusion such a view has engendered, especially among Catholics.  I would go so far as to assert that notion (d) is, by and large, a kind of default understanding of conscience in our contemporary culture.  Its highly problematic reduction of conscience to the level of moral opinion, however, sets it deeply at odds with the perennial Catholic, natural law understanding of conscience.

In the NL tradition, conscience is understood to be a judgment emanating from human reason about choices and actions to be made, or accomplished, or already opted for and performed. Conscience judgments will become manifest in our personal lives to the degree that conscience has been developed. Conscience can be antecedent (while my willing has not yet settled on an option); it can be concomitant (presenting itself in the very act of choosing); or it can be consequent (presenting itself after I have settled on an option).8

Antecedent conscience presents itself as a judgment with regard to the pending choice to accomplish, or a refraining from committing a possible action, the consideration of which is the result of our deliberation process. Through deliberation, we come up with options.  We may be leaning toward choosing one of those options, when that judgment becomes interiorly manifest: “this option is good,  I may go ahead with it; this other option is wrong, I must shun it and refrain from choosing it.” In the virtuous individual, who finds herself deliberating about a morally objectionable course of action, the judgment of conscience will make itself present, then and there, and direct her not even to consider such possibilities, suspending that part of her deliberation process.9

Aquinas held that conscience, in the strict sense, was as an act of human reason—called a judgment—following upon, and concluding, a time of deliberation.  In this sense, I like to explain conscience as the interior resounding of reason. Conscience is reason’s awareness of a choice, or an action’s harmony or disharmony, with the kind of behavior which truly leads to our genuine well-being, and flourishing.

If our choice or action is not in accord with the judgment of a rightly formed and active conscience, then that judgment will linger in our conscious awareness, presenting itself as a felt disharmony between the choice, and the moral norm (and corresponding virtue), being violated. While such felt disharmony is indeed of an emotive nature (e.g. a healthy emotional guilt), the judgment of conscience remains something distinct and irreducible to the negative feeling which happens to accompany it.10

While the experience of conscience is, indeed, something intimate and personal, the NL tradition holds that conscience will always require points of reference which can be acquired through education and moral training. These points of reference are normally embodied in moral norms; the habitual living out of behaviors in accord with those norms is called virtue. Both the norms, and the virtues, become guides to conscience.  The virtues and norms reflect what the tradition holds to be reasonable human behavior; that is, human behavior in accord with the genuine and true manner of human flourishing and happiness intended by the Creator.  Some of those norms are so basic that they are accessible to all sane human beings: do no harm to the innocent; treat others as you would have them treat you; do not commit adultery.  Other norms and virtues deal with more specific aspects of the moral life.

Reference to moral norms, and the virtues which embody them, does not have to take the form of a kind of legalism (as represented by notion (b) concerning conscience). Rather, docility to these moral norms, and the acquisition of corresponding virtues, is an expression of healthy, sound, indeed, reasonable living. Now, we are hopefully poised to draw into clearer distinction the difference between mere opinion about moral matters on the one hand, and the genuine judgment of conscience. How would the NL tradition distinguish genuine conscience from mere moral opinion? Consider the following examples of what are arguably the expressions of mere opinions on moral matters:

“If I were Uncle Charlie, I wouldn’t want to be hooked up to that feeding tube; I think we should have the doctors remove it.”

“Whether my college-age kids are sexually active is none of my business.”

“We know what the Church teaches, but my wife and I think contraception is what we need to do right now.”

Again, one could, in good faith, hold any of these determinations to be a sound and genuine judgment of conscience, especially if arrived at after a good deal of deliberation, consultation with friends, even prayer.  They could also be, on the contrary, the articulation of “gut feelings,” and otherwise rather superficial assessments—mere opinion—about what is right for Uncle Charlie, or my kids, or me and my wife. The process here may have been somewhat muddled; there may be an oblique reference to a relevant moral norm, or—as in the third instance—to “what the Church teaches.” But, it also may have been determined, without a great deal of effort in trying to understand Church teaching, before discarding that teaching. Such expressions could also come encased in an impenetrable sense of infallibility: “That’s my judgment, case closed.”

Authentic moral conscience, however, is not merely something that I roll up my sleeves and produce—the product of having weighed my feelings, likes, dislikes, my friend’s opinion on the matter, advice from others, and so on.  While all of this might serve to help me arrive at a genuine judgment of conscience, that judgment—if sound and genuinely proceeding from conscience—will proceed from the core of my being, and will correspond to objective moral norms  anchored in the truth about what perfects us as human persons.  It will be a weighty and carefully distilled judgment of what—given the objective ends of human nature—is reasonably required of me (or someone else) in the present circumstance.

What most often distinguishes genuine conscience, from mere moral opinion, is the role that the virtue of prudence normally plays in arriving at a judgment of conscience. Prudence, as the tradition holds, is right reason applied to practical matters. It is the principal cardinal virtue, and also an infused virtue. In the prudent individual, judgments of conscience will be consistently right. The process of arriving at the judgment of conscience will have a subjective sense of anchoring in moral experience, an habituation to moral determinations of soundness and personal security, which are simply lacking when one is left to come up with mere opinion.11

In the prudent individual, arriving at a right judgment of conscience can at times happen with ease; or in areas of greater complexity, the process will be characterized by caution. The prudent individual is aware that his judgment of conscience could potentially err. So he seeks direction from objective moral norms, and from proven moral guides.  His judgment—when based on those objective points of reference—will have a far greater solidity than a mere opinion about what’s right or wrong in a given situation. One might even discover, upon closer examination, that the authentic judgment of conscience is at odds with one’s opinion, or that in arriving at that opinion, one never made genuine contact with one’s conscience at all!

Granted, it can be hard to distinguish the experience of a certain judgment of conscience from the experience of formulating an opinion. Generally speaking, the latter, even when it is an opinion shared by many people, is nonetheless characterized by that unmistakable taste of subjectivity—it’s my opinion. It can often conceal a lot of vested self-interest. The person clutches to his or her opinion perhaps in a state of interior uncertainty, even turmoil. Opinions are often more the product of emotion, and affective responses, than of sound reasoning. The judgment of conscience, by contrast, is normally characterized by its flavor of objectivity and consistency with moral principle. When that judgment of conscience is certain, it is held with interior serenity, not being swayed by emotion. It can even be embraced independently of one’s own self-interest: think of men and women (Thomas More, Maria Goretti) who have gone to their own deaths out of fidelity to conscience.

To conclude, let’s say a word about the notion of “forming” one’s conscience. The USCCB has written a fine and succinct paragraph about this, especially aimed at Catholics:

The formation of conscience includes several elements. First, there is a desire to embrace goodness and truth. For Catholics, this begins with a willingness and openness to seek the truth, and what is right by studying Sacred Scripture, and the teaching of the Church, as contained in the Catechism of the Catholic Church. It is also important to examine the facts and background information about various choices. Finally, prayerful reflection is essential to discern the will of God. Catholics must also understand that if they fail to form their consciences, they can make erroneous judgments (§17-18).

To the notion that a person must “form” his or her conscience through docility to sound moral guidance, or from example, or from Catholic moral teaching, that person might object, insisting that:  “I have always been taught to ‘follow my conscience’ no matter what others think, including the Catholic Church.”

 Now, the perennial moral principle, directing us to “follow your conscience,” holds true for all persons everywhere.  However—and here are some key details that too often get lost in the exuberance to affirm one’s own judgment—that principle holds true only when it presupposes two things:  (1) that what we’re calling conscience in this case is not just mere moral opinion, and (2) that what we’re calling conscience here presents itself with clarity and certainty (one should not act on an uncertain or doubtful conscience without clarifying the doubt).

In light of the foregoing, it should be clear that this principle is not directing us to “follow your best opinion about what you consider to be right or wrong.” Rather, the principle is directing us to be faithful to the authentic judgment of conscience, arising from within, when (and only when) that judgment is firm and certain: e.g., “I am not in doubt about what I ought to do, and I am not vacillating; rather I perceive interiorly what I ought to do as harmonious with the objective moral order of reality.”

Now, the tradition also holds that moral conscience, although anchored in human reason, is not infallible. Conscience can err. Consequently, one can have a subjectively certain judgment of conscience about moral matters; but it can simultaneously be an erroneous and objectively incorrect judgment. In the latter case, persons working in good faith are normally only aware that their judgment is clear and certain; they are not aware that their judgment is out of sync with objective moral norms. Think for example of the mother who believes, for certain, that she would transgress the moral order in allowing her gravely ill child to receive a blood transfusion; or, the OB/GYN, who is personally opposed to abortion, but judges it a grave omission in failing to perform an abortion on a pregnant fourteen-year-old who is seeking one with parental consent. Such judgments, even though appearing certain, are at odds with the objective moral order.12

This brings us to the question of why conscience must be “formed.” What specifically does the notion of conscience formation—from the Catholic and natural law perspective—entail?  First, conscience formation begins with the deep-seated decision to seek moral truth. One adopts, as a way of life, the habit of seeking out answers to questions about right and wrong, persevering in that quest until one arrives at a state of moral certainty, after having made the most reasonable effort possible to arrive at those answers.  Second, a sound conscience must stand on the firm foundation of integrity, sincerity, and forthrightness.  Duplicity, personal inconsistency, and dishonesty undermine any hope of forming a properly functioning conscience.  Third, conscience formation is sustained by the habit of consistently educating oneself by exposure to objective moral norms, and the rationale behind those norms.

Conscience needs a guide. Catholics, and all people of good will, find that guide in the moral tradition of perennial validity—the natural law tradition—as sustained and enriched by the constant and universal teaching of the Catholic Church. The Catholic who believes that: “The Church can think what it wants on moral matters; and I can think what I want,” may believe this to be an expression of “moral maturity.” In fact, it is the expression of quite unsound reasoning.  Catholic moral teaching is nothing other than the continuation of a tradition of moral thought which extends all the way back to Aristotle, well over two millennia.  The Church’s moral teaching, while certainly enlightened by divinely revealed law, is, at its core, the application of what this tradition has discovered over the centuries about the kinds of behavior that lead us to live genuinely fulfilling, human lives. One does not place oneself at odds with such a tradition lightly.

Consequently, conscience formation requires a habit of on-going self-formation (what we might call moral information gathering) through study, reading, and other types of inquiry. This includes consultation with persons whose moral judgment we know to be sound and in accord with the Church’s moral tradition.  Finally, conscience, if it is to be correct, needs the assistance of the virtue of prudence.  By “prudence,” we mean the virtue as understood within the NL tradition. This should not be confused with timidity, “covering one’s back,” or dissimulation (hiding the truth).

Prudence is the virtue that enables us to discern right moral options in a wide range of practical and complex circumstances. It is prudence which lends immediate guidance to conscience. The prudent individual, in arriving at a judgment of conscience, will do so under the influence of this fundamental virtue. As the Catechism affirms, “with the help of this virtue we apply moral principles to particular cases without error, and overcome doubts about the good to achieve, and the evil to avoid.”  In sum, conscience formation is a life-long project. It is something like playing tennis: if you stop playing long enough, you can lose your backhand. As with an athlete’s body, conscience formation is not a question of getting it in form, once and for all, but of maintaining it in form for a lifetime. It is a project that is foundational for all other life-projects, for a genuinely human existence, and—not to mention—for eternal happiness.1413