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, A Catholic would be guilty of formal cooperation in evil, and so unworthy to present himself for Holy Communion, if he were to deliberately vote for a candidate precisely because of the candidate’s permissive stand on abortion and/or euthanasia. When a Catholic does not share a candidate’s stand in favor of abortion and/or euthanasia, but votes for that candidate for other reasons, it is considered remote material cooperation, which can be permitted in the presence of proportionate reasons. The need for a sufficient proportion of good effects in order to tolerate the evil effects using the Principle of Double Effect must be distinguished from the condemned moral theories of consequentialism and proportionalism. Popular especially among European and American theologians after Vatican II, they argued that in determining moral lawfulness the end (intention) could justify an otherwise evil act (proportionalism), or, the foreseen good effects could justify an action that previously has been judged to be morally evil. These theories denied that any act was intrinsically evil by its object alone, apart from its intention and circumstances. Even abortion, contraception, adultery and other intrinsic evils, which the entire moral tradition has condemned, could, in some cases, be morally good by reason of their intention or consequences. Pope St. John Paul II, in his Encyclical Veritatis Splendor, specifically condemned these theories.