The Bioethics of Ballot Initiatives
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There are 26 US states that allow citizen-initiated ballot measures, and they often center on ethically charged issues like abortion, assisted suicide, or even legalizing recreational marijuana. 2024 saw a record 10 state ballot initiatives concerning abortion and one on assisted suicide. Since the 2022 US Supreme Court Dobbs decision that reversed the infamous Roe v. Wade abortion ruling, seven different state ballot initiatives have been won by the pro-abortion side. This has even occurred in states that normally vote conservatively in national elections. Kansas and Kentucky residents, for instance, rejected ballot initiatives to restrict abortion.
Pro-Lifers with substantial experience in running and winning ballot measure campaigns on issues like same-sex “marriage” pointed out how the pro-life side of the ballot campaigns failed spectacularly to understand the special dynamics of these votes. Brian Brown proposed that winning required a different approach, including better professional campaign leadership and raising more money to be at least competitive with the vast sums the pro-abortion side was pouring into these political fights. Thankfully, this advice was heard in some places.
In Florida, the pro-abortion side outspent pro-lifers by a factor of 9 to 1, and their Amendment 4 would have created a state constitutional right to abortion. The vote needed a 60% supermajority, and the pro-life coalition that included Governor DeSantis, the Florida Conference of Catholic Bishops, and other groups made good use of ethical arguments in their winning campaign. Florida Family Action used the following message: “The sponsors of this extreme amendment want to legalize abortion up to the moment of birth and to repeal all limitations and regulations on abortion — even safety regulations that protect women — because they want to make Florida the home of late-term abortions in the Southeast.” Despite being outspent $118 million to $12 million, the 2023 Florida law that protects preborn human life after a fetal heartbeat can be detected, generally at 6 weeks of pregnancy, remains on the books.
In South Dakota, Constitutional Amendment G, that would have re-established the Roe v. Wade regime of legalized abortion, thankfully failed. The current law prohibits all abortions with an exception for the life of the mother. Winning in Florida and South Dakota showed that when the pro-life side marshals the right approach to these campaigns and messaging, they can win. Heartbreakingly, Missouri failed by only 51% to retain pro-life laws that protected preborn life with a few small exceptions. West Virginia voted by a similarly small majority to enshrine in their state constitution a strong prohibition on assisted suicide.
Clearly there is no ethical dilemma involved in voting against measures that would expand abortion access or in favor of bans on assisted suicide, but Nebraskans did face a hard choice. There, two different measures were on the ballot. Initiative 439 would have codified in the state constitution a "fundamental right to abortion until fetal viability, or when needed to protect the life or health of the pregnant patient." At the same time, Initiative 434 proposed to prohibit abortions after the first trimester, except for medical emergencies or cases related to rape or incest. This would codify in the state constitution the 2023 state law that banned abortion after 12 weeks of pregnancy with exceptions for saving the life of the mother, serious threats to the physical health of the mother, and if the pregnancy was a result of rape or incest.
The NCBC received a consult call from a Nebraskan pro-lifer who felt conflicted. She knew 434 had been introduced to blunt support for 439, but both initiatives allowed abortion and neither made the pro-life situation objectively better. Pope St. John Paul II had written about pro-life voting in his encyclical letter Evangelium Vitae:
In the case of an intrinsically unjust law, such as a law permitting abortion or euthanasia, it is therefore never licit to obey it, or to take part in a propaganda campaign in favour of such a law, or vote for it.
A particular problem of conscience can arise in cases where a legislative vote would be decisive for the passage of a more restrictive law, aimed at limiting the number of authorized abortions, in place of a more permissive law already passed or ready to be voted on. Such cases are not infrequent. It is a fact that while in some parts of the world there continue to be campaigns to introduce laws favouring abortion, often supported by powerful international organizations, in other nations — particularly those which have already experienced the bitter fruits of such permissive legislation — there are growing signs of a rethinking in this matter. In a case like the one just mentioned, when it is not possible to overturn or completely abrogate a pro-abortion law, an elected official, whose absolute personal opposition to procured abortion was well known, could licitly support proposals aimed at limiting the harm done by such a law and at lessening its negative consequences at the level of general opinion and public morality. This does not in fact represent an illicit cooperation with an unjust law, but rather a legitimate and proper attempt to limit its evil aspects.
I quote at length from St. John Paul II because it illustrates the difficult moral discernment required in such cases. Different situations and legislative proposals have in fact frequently caused strong disagreements in the ranks of pro-lifers.
Nebraskans could have, of course, ethically voted against both initiatives. Nevertheless, Initiative 434 passed with 55% support and 439 was rejected by a majority of voters. The tactic of preventing passage of a more extreme abortion legalization measure by proposing a lesser evil worked. It did, however, create problems of conscience for many Catholics. A more ethical strategy for stopping abortion on demand would have been preferable.
Joseph Meaney received his PhD in bioethics from the Catholic University of the Sacred Heart in Rome. His doctoral program was founded by the late Elio Cardinal Sgreccia and linked to the medical school and Gemelli teaching hospital. His dissertation topic was Conscience and Health Care: A Bioethical Analysis. Dr. Meaney earned his master’s in Latin American studies, focusing on health care in Guatemala, from the University of Texas at Austin. He graduated from the University of Dallas with a BA in history and a concentration in international studies. The Benedict XVI Catholic University in Trujillo, Peru, awarded Dr. Meaney an honorary visiting professorship. The University of Dallas bestowed on him an honorary doctorate in Humane Letters in 2022.