Tea party groups have pressed him to embrace a controversial strategy: block the spending bill needed to keep the government open past Sept. 30 unless Democrats agree to kill "Obamacare" - even if it means shutting down the government.
They issued a letter last week noting they supported Fitzpatrick and urging him to "back up his words with action."
Democrats, meanwhile, have already made him a top target in 2014 and are salivating at the prospect of his being dragged into a fight that could close the government and leave the GOP saddled with blame for the economic ripple effects.
The liberal group Americans United for Change announced Fitzpatrick would "be slammed" in a media event Friday over the prospect of a shutdown.
The cross-currents have left him contorting.
Early Thursday, he went to the House floor to say Obamacare was "hurting real people in my district . . . and it must be repealed and it must be replaced."
He pointed to a letter from the parent company of Sesame Place telling a constituent a health plan for part-time employees would soon end because it didn't meet the new health law's standards.
But in an interview later Thursday, Fitzpatrick said "shutting down the government is off the table for me," hinting [though not explicitly saying] he won't take the repeal fight so far that it drags the government over the edge.
Fitzpatrick "is like Gumby when it comes to taking a stand on critical issues," said Marc Brumer, a spokesman for the Democrats' congressional campaign arm.
To varying degrees, the dilemma for Fitzpatrick is playing out for other House Republicans from the Philadelphia area.
They represent moderate suburban districts. But the GOP's most conservative elements are steering this fight, and they have demanded a showdown.
The divide was neatly illustrated in a separate House vote Thursday: conservatives pushed through deep cuts to food stamps.
Of 15 Republicans voting against the cuts, four were from the Philadelphia area: Fitzpatrick, Patrick Meehan of Delaware County, and Frank LoBiondo and Chris Smith of South Jersey.
Similarly, most Republicans from the area have bashed Obamacare but said Thursday they didn't want to shutter government.
LoBiondo, for one, was in Congress during the 1995 shutdown, which derailed the GOP and gave new life to then-President Bill Clinton. "He's lived through it before and feels nothing positive comes from it," a LoBiondo spokesman wrote in an e-mail.
Many Republicans agree. Sen Pat Toomey (R., Pa.) has called a shutdown the wrong tactic. Karl Rove made a similar case in an op-ed, and Sen. John McCain (R., Ariz.) said it was "not rational." He added that many of those who want a fight were not in Congress in 1995.
Those urging a standoff say it gives them the best chance to kill Obamacare, or at least stall it.
But those forces don't appear to have a realistic path to victory. Obama has vowed he won't wipe his signature achievement off the books. Senate Majority Leader Harry Reid (D., Nev.) said any Senate bill ending Obamacare would be "dead. Dead."
Some local Republicans have chafed at their colleagues' tactics.
U.S. Rep. Charlie Dent of Allentown called himself "a member of the 'governing wing' of the Republican Party" Thursday in a statement and said voters "did not send me to Washington to shut the government down."
There is one scenario that could quiet the doomsday predictions and provide an escape route for local Republicans.
If the House passes a funding bill Friday with a provision to "defund" Obamacare, the Senate will take up the measure. It will likely approve the short-term spending plan, but leave Obamacare intact - and send that bill back to the House.
At that point, the Obamacare vote behind them, lawmakers in both parties predict the House will soon OK a spending plan to keep the government open, with votes from Democrats and moderate Republicans.
That would allow Fitzpatrick, Meehan, and others to vote to strip Obamacare funding Friday - then later vote to keep the government open.
"I don't think we'll get to a shutdown in the end," Meehan said. "This will give some of the passionate voices in the Senate like Ted Cruz (R., Texas) a chance to prove their muster."
Though Fitzpatrick, Dent, and Meehan said they would vote Friday for the House version that defunds Obamacare, all took pains to say they wanted to move the process along and see what the Senate does. Dent said, "I hope to vote for a compromise bill that keeps the government running."
U.S. Rep. Rob Andrews (D., N.J.) predicted a happy ending after conservatives get an Obamacare vote "out of their system."
But first, he's a featured speaker in Friday's event hammering Fitzpatrick.
Contact Jonathan Tamari at firstname.lastname@example.org or follow on Twitter @JonathanTamari.