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Life Issues Forum

Refusing to Choose
By Richard M. Doerflinger

April 30, 2010
UPDATED

Some teachers like to pose riddles to their students on “lifeboat ethics.” Various members of a ship’s crew – from the captain to a lowly cabin boy -- are drifting at sea in a lifeboat, with limited provisions, and they have to decide which member to kill so the others can survive.

The final situation with health care reform this spring might have been crafted to stump these students. The House of Representatives had passed a reform bill that the Catholic bishops commended for ensuring access to health care for the poor and immigrants, and for respecting longstanding current laws on abortion and conscience rights. But the Senate refused to consider this bill. Instead it approved its own version that was deficient in all these areas, and said: This is our final answer. Due to a change of one Senate seat, that chamber said it no longer had 60 votes to pass any bill with further substantive changes (though it could make purely fiscal changes under a “reconciliation” process requiring a simple majority).

So the final “take it or leave it” bill could be improved on affordability. But it would perpetuate injustices to both legal and undocumented immigrants. It excluded a conscience rights provision that prevents government entities in other federal health programs from discriminating against doctors, nurses and hospitals that don’t provide abortions. It refused accommodations for religious institutions that need to purchase health coverage consistent with their moral values. And it violated the Hyde amendment, which keeps every other federal program from funding elective abortions and health plans that cover such abortions. The federal government would now subsidize plans covering abortion, and require those plans to collect a special fee for such abortions from all purchasers whether they object or not. Finally, the bill appropriated its own new funds from the Treasury that were exempt from the Hyde policy against abortion, including billions of dollars for community health centers serving the poor.

So who would the Catholic bishops throw off the boat? Uninsured citizens, or immigrants and the unborn? The answer was: None of the above. The bishops refused to choose between one moral wrong and another. They reaffirmed that all the human lives at stake are of inestimable worth, and that Congress must pursue reform in ways that do not attack innocent human life, deny conscience rights or ignore immigrants.

Congress did not have the political will to do this, so it passed a law that does many welcome things but is also, as USCCB president Cardinal Francis George said, “profoundly flawed.” Repairing those flaws will take enormous effort in the months and years to come.

Some expected the bishops to give in, to conclude that expanding health care for the uninsured “outweighed” the legislation’s moral flaws. But Catholic moral reasoning doesn’t work that way. As the U.S. bishops explained in their Faithful Citizenship document in 2007, doing good and avoiding evil are equally pressing demands. There is no “ceiling,” no upper limit, to the good we are called to do for the poor and vulnerable, and their needs must never be forgotten. But there is a “floor” to that commitment, beginning with respect for the most fundamental good of the human person, life itself. In particular, we cannot “do good” by expanding direct attacks on innocent human life. The rule for passing health care legislation is the same as the rule for medical ethics generally: First, do no harm.

The bishops surely knew that many would be disappointed, and some would see them as being unrealistic. But sometimes we get to change the world, and occasionally we can only keep the world from changing us. After all the “realists” have spoken, somebody still has to speak up for that cabin boy.

Mr. Doerflinger is Associate Director of the Secretariat of Pro-Life Activities, U.S. Conference of Catholic Bishops. For more information on the bishops’ pro-life activities, see www.usccb.org/prolife and www.usccb.org/healthcare.