Debates within the medical profession are looking at who should live..and who should be allowed to face death when the next big flu pandemic strikes. Here’s what the medical profession is facing: An influenza of unknown characteristics…a six-month minimum delay in developing a vaccine even after the characteristics are determined…a vaccine supply that can protect only one in five citizens…When will a pandemic be publicly declared? What individual rights will be affected when it happens? How can a profession that focuses on preserving life decide to write off some people? Vice President Michael Brannigan with the Center for Practical Bioethics in Kansas City says that last point is a critical issue because the professional is a dual agent whose primary obligation is to the individual patient but whose additional obligation is to the larger community. The issue is complicated because the Spanish Flu pandemic of 19-18 attached healthy people more than it attacked those usually considered at-risk….and some epidemiologists think the Avian Flu will resemble the Spanish Flu. In that pandemic, the people most at-risk were healthy people. Brannigan says that creates the question of whether those who stand a chance to live a longer life span should receive vaccine rather than those who are most at risk–namely, the elderly, those with multiple health conditions, and young children. He says the issue of allocating scarce resources is not new—-althought he scope of the potential problem is. The federal department of health has issued a set of recommendations for rationing vaccine if there is a pandemic. But it suggests each state have its own recommendations…and guidelines might differ from hospital to hospital, community to community. In the end, he says, there might be little uniformity in practices—except that doctors ultimately will have to decide who gets protected…and who doesn’t….from whatever…whenever.