This morning’s Sunday School session was the last in a series on bioethics, and Sandy, a nurse practitioner who is part of the Clinic's Ethics team, led the end of life decisions discussion.

As Sandy spoke of the kind of health care rationing that may become more common as the culture (and economics of health care) change, I looked around the room. Tom was sitting in the front row, the mentally challenged man I had the privilege to drive to church this month. Our conversation this morning had been, as usual, labored and slow, as he explained to me some plan of his to try to go to Super Target by himself instead of with “the group”. He lives in a group home in a neighborhood just a mile from my house, and he has often spoken of some programs that he goes to, but I have so much difficulty understanding his very careful speech that I really don’t know how large an accomplishment this trip may be—or if it is even a reasonable goal for him to pull off by Wednesday or Thursday, his target dates.

As I continued considering others in the class, I saw a person with multiple schlerosis, a relatively healthy woman nearing 90, and the husband of a 60s something woman who just this week had angioplasty. Another husband was there without his wife, as she is facing surgery this week for an ongoing medical problem with some neurological involvement. And there I was, still recovering from the heightened asthma complications brought on by the flu of a couple of weeks ago. Sandy spoke of the problems possible with any huge disease outbreak such as the anticipated bird flu epidemic (“not if, but when,” she assured us). “I can tell you definitively,” she stated. “There will not be enough nebulizers to go around in any such event. Rationing will have to occur.”

Rationing that will begin with us, or at least some of us. We had discussed the current national health service guidelines in Britain that do not pay for dialysis or coronary bypass for any patient over 65, and I thought of the Oregon guidelines for some of their state medical assistance procedures. But somehow it seems that most of these kinds of discussions end up always making us think of what other people will be affected, not that we ourselves may be the ones who are turned away from treatment.

And these are the “easy” discussions, the ones that still talk about dividing up the rich American pie of health care and benefits. But there was that article in the Star Tribune that spoke of the extremely drug resistant TB that has now spread outside South Africa into the rest of that troubled continent, threatening hundreds of thousands and even millions more people. There are the ongoing problems of infant deaths due to malnutrition and bad water and lack of immunizations that still trouble much of the world, and the fistulas that leave hundreds of thousands of young girls in undeveloped countries as pariahs subject to great pain and early death, for want of very basic prenatal care.

Our discussion closed with a reminder that we as Christians have “hope,” even when the medical prognosis is hopeless., and we spoke of needing to explore further how we as a church as well as individual Christians can reach out to the hurting, the dying, the frightened, and offer this real and everlasting hope to them. But then , the session was over, and the exploration of this topic must be held to another time. I only pray that I will be able to continue this conversation with others and that we are able to begin thinking in terms of becoming a hopeful people, sharing that hope of the gospel to those who need it most.