Whether an action should be classified as an instance of formal or remote material cooperation is often decided after the fact, by what we take antecedently to be illicit or licit.
Formal cooperation in evil, the moralists hold, is illicit; thus, if we think it would not be illicit to do something that involves some kind of cooperation in evil, we must find a way to classify it as material. Yet it would be desirable to have some kind of independent test or justification.
In the case at hand, suppose that President Obama is re-elected, and the HHS mandate survives legal challenges, at least until the so-call “safe harbor” provisions expire: what then? If to comply with the mandate constitutes formal cooperation in evil, then a Catholic institution simply must not comply, even shutting its doors if necessary to avoid complying. As I said in my previous post, doing so would not be “civil disobedience” but simply “we must follow God rather than man”—and trust in God that everything will work out as a result. But it seems almost incredible that Catholic universities and hospitals might simply have to shut their doors. So one very much wants to find that the cooperation would be only material, and remote (and therefore it would be licit if the conditions governing double effect were satisfied, as it seems they would).
But is there an independent test or justification for this finding? I gave in my previous post various considerations which, in my opinion, tilted the other way. I noted that my fellow Academician, Fr. White, along with Rusty Reno, in a First Things treatment of the mandate, had apparently not even thought it necessary to justify their explicit supposition that the cooperation was material. However, the estimable Jeff Mirus has in a recent piece given some considerations for that conclusion. How do these stand?
One might wonder first how the case should be approached. For example, should we look for the safest course; to avoid the worst outcome if we are wrong; to avoid expense and trouble unnecessarily; or something like that? Since to cooperate formally is sin, should we presume that cooperation is formal unless we can be shown otherwise? These are interesting questions. The only thing that Mirus writes along those lines, revealing his approach, is this:
In the absence of a contrary declaration by the Magisterium of the Church (to which I would submit immediately), it seems clear to me that the purchase of health insurance which includes some elements of immoral coverage is a matter of remote material cooperation with evil
One wonders whether a bishop’s declaration would be enough. Also, are there really no competing considerations or arguments for the opposite conclusion, and, if there are, wouldn’t one want to have a sense of how they might be answered before simply accepting what “seems clear”? That is, is it only ecclesiastical authority, not any authority of reasoning or reasons, that needs to be taken into consideration on the other side?
I will say only this much under this head: in matters of compliance with a despotic and coercive civil authority, an initial step of formal cooperation, however slight, is exceedingly dangerous, as history has shown.
For example, Dr. Leo Alexander in 1946 published in the New England Journal of Medicine a famous study, "Medical Science under Dictatorship," in which he posed the question: why had German doctors capitulated completely to the Nazi regime, but the Dutch doctors had not? He concluded that it was because the Dutch doctors never took that first, small step of (as we should call it) formal cooperation.
What was that step? The German occupiers of Holland asked the physicians there to begin including as part of every medical exam some certification of their patients’ ability. The certification was designed to be so bland as to appear completely innocuous, but the Dutch doctors recognized it for what it was, namely, as a very slight step in the direction of cooperating with the program of sending unfit persons off to extermination camps. So what did they do? They met together and jointly decided to close all of their medical practices rather than comply— in response to which the Nazis sent hundreds of them away to death camps. A severe and brutal retribution: and yet, according to Dr. Alexander, if the Dutch doctors had acted differently, they would likely have been bullied and forced along the same path that the noble German medical profession ended up following:
It is obvious that if the medical profession of a small nation under the conqueror’s heel could resist so effectively, the German medical profession could likewise have resisted, had they not taken the fatal first step. It is the seemingly innocent step away from principle that frequently decides a career of crime.
I propose the comparison simply to show that it is necessary to be confident that the cooperation would not be formal.
Because, if it is, then what is the next step? If a Catholic university can be compelled to offer coverage for contraceptives, on the grounds that preventive and public health require it, then, for instance, can it be compelled to offer contraceptives themselves, on campus? If not, why not? (“Surely it is a grave health risk, with attendant costly consequences, for non-Catholic employees and students, at least, not to have easy access to contraceptives.”) Suppose the next Obama administration says that every employer who offers health insurance must also pay for employee access to clinics that prescribe contraceptives and do abortions—that they an employer must either have such a clinic on site, for large institutions, or provide transportation to such a clinic? Equally good “public health” considerations would recommend such a policy. Since health “insurance,” with the exception of catastrophic conditions, is not really insurance but rather a subsidy, how would this step be different in principle? You see the difficulty.
In any case what does Mirus say to justify the claim that the cooperation is material? He says the following:
Just as we may morally pay taxes even though some tax money is used immorally and we may morally patronize various business which use a portion of their earnings immorally (and in fact this is inescapable in the modern world), so too I believe that if there is no reasonable way to avoid health insurance with some elements of immoral coverage, then it is not immoral to purchase such coverage.
Note that this judgment depends on an evaluation of the remote character of the evil (i.e., only a tiny fraction of the health insurance premium is used to cover immoral procedures, and a direct connection of specific dollars to specific procedures does not exist), the difficulty of avoiding the evil (i.e., the coverage of these immoral procedures is or will be endemic throughout the insurance industry as mandated by the civil government), the impossibility of disentangling ourselves completely from the evils in question, and the responsibility to both ourselves and others, under today’s conditions, to carry health insurance. In my judgment, this situation qualifies as merely remote cooperation with evil which, under typical circumstances, does not involve sin, unless it is desired for its own sake.
That is, he seems to give two reasons:
- Complying with the health care mandate is like paying taxes, because the portion of the expense used for something immoral is slight, and that money is not earmarked specifically for the immoral practice.
- There is no reasonable way to avoid health insurance with immoral coverage.
But the first reason seems to depend on a misrepresentation of the mandate. The mandate is not: the government sets up an insurance plan, and anyone who wants to buy insurance must purchase from this vendor. That is, it is not the imposition of a single-payer plan. Rather, it is a bungled attempt (bungled, because the Democrats really do not understand this kind of thing) to harness private initiative for public purposes. Thus, the mandate is a matter of the government’s dictating (on pain of penalty) the character that a still privately offered health benefit must have.
Perversely the problem would not exist, and would certainly take the form of the remote material cooperation which Mirus believes it is, if Congress had instead rammed through a single-payer health care system. (Indeed, if Mirus were right, then there would be no change, morally speaking, in the transition from our current situation, to a single-payer government-sponsored health plan, when clearly there is.)
The first argument furthermore seems to confuse a slight contribution with a remote contribution. Suppose you are on a jury of 100 jurymen, which is given orders to condemn to death a man known by all to be innocent, on pain of being put to death yourself. It is obvious that everyone else on the jury are cowards and will vote to condemn him. If you vote along with them, your contribution to the man’s execution is exceedingly slight, yet still you cooperate formally in his unjust death.
The second argument seems to confuse institutions with individuals. Institutions can indeed avoid complying: they can refuse to offer health insurance as a benefit and accept any penalties that follow, and as a last resort they can close shop. To say that the cost is so steep that refusing to comply is unreasonable is to beg the question. Any path of action may be compelled. Material cooperation may be compelled, and formal cooperation may be compelled. That not complying has costs which are completely repugnant and grotesquely disproportionate does not establish that the cooperation is material. (Indeed, that it may seem to do so depends upon a fallacy. It is true that: it is a case of licit material cooperation only if the evil that would be avoided is disproportionately large. It is false that: if the evil that would be avoided is disproportionately large, then it is a case of licit material cooperation.)
Set the price for non-compliance high enough, and most persons will do almost anything. Certainly nearly everyone will capitulate in something only slightly evil. Still, we shouldn’t. I don’t like to recall the fact any more than you do, but lots of Christians have been martyred for refusing to do things that have appeared only very slightly evil, if at all.
Again, don’t misunderstand me: I hardly want to argue from “this may be very serious indeed” to “this is very serious indeed.” I simply think that those for whom it is “clear” that this is a case of material cooperation should both give reasons for their view and explain why contrary considerations do not have force.