In writing about abortion and health care reform, I have advocated that whatever legislation is finally approved should be "abortion neutral." Some of the more vociferous members of the pro-life community object to this phrase – and to what it represents – on the grounds that as Catholics we can never be neutral regarding abortion. True enough, but only in one sense. I remain convinced that when abortion becomes the lens through which we see all public policy debates, when it becomes the only issue, then we cut ourselves off from the messy, necessary, complicated, compromising, yet noble task of self-governance to which we are called as citizens. Conversely, if we try and skip past the issue of abortion to reach the Promised Land of Catholic social teaching on the other side, then we cut off that teaching from its roots in our anthropological beliefs about the dignity of the human person. Our commitment to the defense of human life is foundational, but it is not exclusionary.
There appear to me to be twin dangers in this debate. The first is that our concern to reduce abortion will blind us from seeing the good that can be achieved by adopting universal health insurance, indeed that the current health care reform effort may actually help reduce the abortion rate by making pregnancy more affordable for poor women. The reason to be precise in calculating the way the legislation is written is because there are two great goods involved: We cannot cooperate with evil and we must enact universal health insurance. In this free, pluralistic country of ours, there is no way that health care reform can become a vehicle to reduce the abortion rate: too many liberals who support health care also support abortion rights. I think they are wrong. I do not understand how abortion can be seen as health care except in the most extreme cases of a physical threat to the life of the mother. But, I have to concede that abortion is legal, it is covered by some current insurance policies, and that any effort to restrict such coverage as currently exists will kill the chance at health care reform. And, to repeat, universal health insurance is a great good to be achieved, a basic human right currently unmet in our land, an instance of social solidarity of the type advocated by Pope Benedict in his encyclical Caritas in Veritate.
The other danger is that of minimalism. There is a reason that casuistry got a bad name. To use a banal example, wolfing down a burger at one minute past midnight on Good Friday seems to miss the point of the law not to fulfill it. In seeking to define what constitutes formal cooperation with the evil of abortion, and insisting that we can get close to that line but not cross it, are we not inviting a kind of minimalism about the moral life? After all, we are called as Catholic Christians to do more on behalf of justice and love and solidarity than merely to avoid formal cooperation with evil. We are called to holiness, to perfection even. Isn’t there something corrupting about all these careful, precise calculations as to what does, and does not, constitute a federal subsidy and whether or not such a subsidy, if it is indirect, constitutes formal cooperation with evil?
This concern for minimalism is broader than the current debate. I have argued elsewhere that the Church’s natural law theorizing tends to issue in an act-centered morality that invites minimalism. And, I regret that the drafters of the Catechism organized the Church’s moral teachings around the Decalogue rather than the Seven Deadly Sins. The Decalogue has the great advantage of being scriptural, but it fails to capture the psychological aspect of sin the way the Seven Deadly do. You did, or you did not, steal or bear false witness and while there is value in knowing whether you did not did not do these bad things, we humans are crafty at covering our bad deeds with good intentions. The Seven Deadly Sins suggest a more nuanced – and accurate – model, e.g., there is a bit of pride in all of us (perhaps a big bit of pride in those of us who live off of our opinions!), there is a bit of greed and envy and malice in all of us, etc.
In health care, however, both in legislating about it and in administering it, we need casuistry because the questions are complicated and difficult. When my mother was dying, we had to face some of these questions and it was a great comfort to have a Catholic ethics board help us understand the issues. We, as a nation, face some of the complexity of those issues as we consider health care legislation. It is not enough to say, "Oh, we are never neutral on abortion" and then try and defeat any health care bill that does not prohibit the procedure. I think it is reasonably certain that providing health care options to women facing crisis pregnancies is a good thing that will help reduce the abortion rate. The lack of care for forty million of our fellow citizens certainly results in many thousands of unnecessary deaths, and that should concern pro-lifers as well. In this free society of ours where abortion is legal, we cannot force our views on others, we must persuade them. And employing our views to defeat health care reform is not the way to persuade them. We are right to draw lines, and we are right to worry about what happens when we draw lines and scoot up close to them. It is the price we pay for being moral persons.