Dominating all bioethics discussions this week was the passage of President Obama’s healthcare bill. Although everyone agrees that American healthcare needs to be fixed, a chasm separated Democrats and Republicans, progressives and conservatives, pro-life and pro-choice, over whether the 2,300 page bill will do the job.

Those whose focus was universal medical cover were delighted. "It's a fundamental ethical issue of the highest order," said Eric Meslin, director of the Indiana University Center for Bioethics in Indianapolis. "This is why many of us went into bioethics in the first place -- because we were concerned about fairness and access and the role of medicine in caring for patients." More than 46 million Americans are currently uninsured and this bill will cover 31 million of them. The practice of denying coverage to anyone with a "pre-existing medical condition" or rescinding coverage when a patient gets ill will also stop.

The Obama administration claims that the scheme will actually lower the overall cost of the healthcare bill. Writing in the BMJ, Gavin Yamey, of the Global Health Group, University of California San Francisco, declared that “It more than pays for itself, partly through new taxes on high cost insurance plans and on wealthy Americans”. But its critics worry that it will bankrupt the US.

The bill was nearly derailed because pro-life politicians and lobby groups objected to provisions which funded abortion and threatened the freedom of healthcare workers to conscientiously object. But at the 11th hour President Obama stitched up a deal with dissident Democrats. He promised an executive order which decrees that federal funds would not be used for abortion services (except in cases of rape or incest, or when the life of the woman would be endangered). However, this did not satisfy the critics. They pointed out that an executive order was a band-aid solution which could easily slip off.

As usual, on this issue, bioethicists were divided between those who thought abortion was not worthy of discussion and those who thought, in the words of Pope Benedict to the US Ambassador to the Vatican, there is “an indissoluble bond between an ethic of life and every other aspect of social ethics.”

Although the bill is being described as "the civil rights act of the 21st century" it makes like even harder for the millions of illegal immigrants in the US. After abortion, this was one of the main objections of the Catholic bishops: “many immigrant workers and their families could be left worse off since they will not be allowed to purchase health coverage in the new exchanges to be created, even if they use their own money.”