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I think he certainly does recognize what he is doing. He laments his situation quite a few times during the story. In Act 5 sc 3, Macbeth seems to understand that he really has become a horrible person.
And that which should accompany old age,
As honor, love, obedience, troops of friends,
I must not look to have, but, in their stead,
Curses, not loud but deep, mouth-honor, breath
Which the poor heart would fain deny and dare not.