An effect can be tolerated without being willed by its agent; for instance, a mother's exhaustion from tending her sick child. A bad effect is not imputable if it was not willed either as an end or as a means of an action, e.g., a death a person incurs in aiding someone in danger. For a bad effect to be imputable it must be foreseeable and the agent must have the possibility of avoiding it, as in the case of manslaughter caused by a drunken driver. The directness meant in this principle refers to causality, not time. In the Catechism’s example the same action which provides care for the child also causes the harm to the mother. In the use of medicine or radiation for treatment, the bad effects often occur before the good of health is attained. Yet, in both cases, the effects proceed as directly from the cause.   This is the principal of proportionality. It forbids the toleration of effects that are not seriously proportionate to the good effects that are expected from the action. Establishing a just wage for workers is desirable by Catholic social teaching. However, this good effect can never be proportionate enough to compensate for the evil of abortion, the attack on marriage and family, or the loss of religious freedom (the Non-Negotiables). These are categorically and qualitatively different goods. Therefore, a basket of non-negotiables improving the quality of life of hundreds of millions cannot justify the toleration of the killing of one million human beings annually through abortion. This is an absurd calculus, that those who employ it would reject if applied in many historical contexts in which millions were killed to achieve economic and other political objective. The Nota Bene of then Joseph Cardinal Ratzinger at the end of his July 2004 letter to the U.S. Bishops on "Worthiness to Receive Holy Communion" is often cited in a proportionalist fashion to equate a basket of lesser issues with the greater and essential issues. He wrote,