Abstract
Over the last decade a group of moral philosophers concerned with medicine have argued, some stridently, that conscience has no place in the conscientious practice of medicine. And yet, it is hard to separate conscience from conscientiousness. This paper reviews and critiques the argument against conscience and the assumptions underlying it. It argues that it is often difficult to separate conscience, a moral perspective on appropriate practice, from the clinical knowledge and experience that practitioners possess and patients do not. The result is not paternalistic although it challenges the assumption that the patient in distress often knows best. The focus in this paper shifts from simple autonomy as a reflexive rule to the social and broadly clinical context in which decisions about procedures like abortion and medically assisted death are made.