Confronting the possibility of a worldwide flu pandemic has a way of throwing some of our most enduring health care quandaries into sharp relief. How can we distribute limited resources equitably and morally? How do we balance care for the individual and care for the community when they are in conflict? How much power should medical staff have to weigh the merits of individual cases when allocating scarce resources such as ventilators? How much autonomy can individuals be allowed if their decisions (such as a healthcare providers refusing to be vaccinated) can have serious impact on others? These become more than academic debates — they become policy, which then becomes reality for medical staff.
 Executives in four different ELCA-affiliated health care systems consider what ethical issue confronts them most directly and how they reach their decision. All relate to the ELCA’s social statement on health and health care: Caring for Health: Our Shared Endeavor. Each one chooses a different approach — even faced with the same disease, institutional, legal and social realities mandate different concerns.
 The common concern of all four health care systems is succinctly summarized by Donald Steiger: “…it is essential to recognize that we inevitably move from a normative orientation around individual patient care to a more communal/public health focus. The overriding concern is for the common good.” Lutheran Medical Center, for example, seeks to apply standards for ventilators based purely on clinical criteria for recovery. In caring for the elderly, The Evangelical Lutheran Good Samaritan Society recognizes their need for autonomy and social interaction, yet must subordinate these needs to the needs of the community. Alegent Health Care engaged in planning using up-do-date information about outbreaks in order to serve the community with vaccines. Advocate Health Care sought to be a partner to its communities and congregations through dissemination of information and engagement of particular constituencies. The four articles by executives in health care organizations all present the reader with vivid pictures of the reality of planning for an epidemic. Planning for an epidemic begins with the understanding that the first concern has been redirected to caring for the common good.
 Dare I draw an analogy to the concerns of health care reform? Those who fight for universal care most fiercely see an emergency in which we have to shift our focus from the individual to the common good. Others are not convinced that this is an appropriate shift to articulate, never mind set in the stone of policy. Robert Francis, working in the ELCA’s Washington office, recently published a wise and interesting account of what mainline Protestant advocacy offices have said about healthcare reform. What we learn this month from our colleagues “in the trenches” at healthcare organizations is that every decision requires attention to the inherent limits and realities of a given situation. May our elected representatives remember this principle as they seek to institute health care reform.