One difficult question that lurks in the background of the health care debate is whether there is a point at which life itself becomes artificial. That is, after a person has passed the point at which they would be able to stay alive without constant medical care, does the value of their life change? Is there a point at which the medical obligation to that life – specifically, to save it – changes? Or if medical science can provide a solution, is the society obligated to offer that solution regardless of its complexity or its cost? Are there gradations of what one might consider artificial? Certainly there is a difference between someone with advanced terminal cancer who is on life support and would die without the machines and someone with diabetes who would die without periodic insulin shots. There is a difference between someone who requires part-time senior home care and someone who needs thousands of dollars worth of medical attention every day. Do we draw a line? Where do we draw it? And, perhaps most importantly, who holds the pen?