My kids received the 140th and 141st doses of flu mist distributed by the Bradford Regional Medical Center during an H1N1 vaccination clinic Monday. We arrived half an hour early for the noon start; it would take nearly three hours to make our way to the actual vaccination treatment room and another 20 minutes of observation to assure there would be no ill effects. We walked away with verification of the first dose and instructions to get another within 28 days.

It was a beautiful day, sunny and warm, with just the faintest edge of fall. The line was orderly, even when it stretched from the outpatient-services lobby through the length of the parking lot and snaked down the sidewalk. No one wanted to wait three hours, but there was no cutting in line; I didn't see a temper flare.

My kids -- who can ask 90 times how much longer a 60-minute church service will last -- waited patiently, and most kids did. Some preschoolers dug in the mulch and swung around the swaying trunks of the ornamental trees, but, at an age when checkout lines can last an eternity, the orderliness was remarkable.

How democratic, I thought. The clinic was free and open to anyone in the priority categories designated by the Centers for Disease Control. We arrived, lined up and received a number. Fair and square.

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So why did I feel progressively unsettled? Why did my mind take me back to the exercise in ethical decision-making which inevitably finds its way into high schools and youth groups? Remember, the one where the group must deliberate how to allocate life-saving treatment to the teenager, the young single mother of three, the productive executive and the convict. And here I was in a line, not in a thought experiment, about which parents could protect their kids from a virus that has killed 1,000 otherwise healthy children at last report.

When I looked around, the answer was clear: lots of stay-at-home moms who could excuse their children from school at noon, parents with jobs in the exempt category where a lunch hour turned to three is no big deal. We were people likely to get the newspaper and read about the clinic and the limited supply of vaccine.

But in an environment of scarcity, what other option did the medical center have? A free clinic, first come, first served: It's the greatest good to the greatest number -- utilitarianism, pure and simple.

The CDC does the work of determining which groups would derive the greatest good from the vaccine -- in the case of H1N1 it is pregnant women and children from 6 months to 24 years of age -- and the greatest number is determined by supply-chain logistics. Bradford got a little over 500 doses.

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The next morning, I compared notes with a co-worker and mother of two. We shared blended feelings of relief and guilt. Thank goodness our kids have at least some protection. We've felt little bodies burning with fever as if it raged through our own bodies; we've sponged cool water and held cold compresses on our kids' foreheads through interminable nights. So we jumped at the opportunity to vaccinate ourselves against the powerlessness of a parent with sick children, and now hope against hope that the vaccinations work.

Yet where, we wondered, were the kids who are most vulnerable?

Ours is not an affluent community; the ratio of low-income families is above the state average and there's a public-housing complex less than a mile from the free clinic. The correlation between poverty, poor health outcomes and access to care is well-established, and there are plenty of kids breathing second-hand smoke day in and day out whose nutrition is sub-par, who will fall further behind if they miss a week of school with the flu. What system of vaccination would be fairer?

I heard on the Buffalo news that New York implemented a lottery system to determine in which schools flu vaccine would be offered to all students. Other states are distributing supplies to areas identified by epidemiologists as most affected. Yet advocates of personal responsibility have no problem with the system we accessed -- one in which those with the initiative to seek care receive it.

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So, no easy answers. In a climate where health-care reform dominates the public discourse, I'm reminded that the hardest questions are probably not economic or logistical or even scientific, but fundamentally philosophical. And these ethical dilemmas perpetuate more questions than answers, as we press on, each with our own personal version of the question, "Now what will I have to do to get the second H1N1 doses for 140 and 141?"

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