The story began with the birth of twin baby girls. Their parents named them Mary and Martha. They were tiny little girls. Their arms and legs were twisted, bodies misshapen. I was only 10 years old at the time, but I was aware that the survival of the twins was unlikely from the beginning. How could they possibly live? Their parents were people of modest means. How would the medical costs be managed? Our whole family was of working class and ordinary means.

Mary and Martha were my first cousins.

Their health was so fragile and compromised that the babies were expected to live only briefly and then die. But they did not die. In time they required institutional care. They were fortunate from the start to have loving attention from their caregivers. The family was vigilant and involved. The girls did not die. They miraculously lived through their teenage years. Then their 20s, 30s, 40s, and 50s.

Along the way they learned simple communication skills. Therapies provided noticeable improvement in their quality of life. They developed a few motor skills, although they were always confined to beds and wheel chairs. Their heads would twist and sway and could not remain stable. But they kept their smiles. They communicated, especially with each other. We are not sure how much they understood. But they showed love and care for each other and for their friends and family.

They loved simple things. Coloring with crayons. Playing with dolls. They enjoyed going on shopping trips with their caregivers. They loved our family reunions. Last year we had a big birthday party for them. They loved parties. Everyone who ever met them loved them! It seemed that despite their profound problems, Mary and Martha enjoyed life. They seemed to be happy in their little universe. And they made all the rest of us happy, too.

Recently, Mary became very ill. Soon she came under the tender care of that wonderful organization, Hospice. Now word has come that Mary has died. She was 59 years old. Family members tried to help Martha understand what had happened. Martha seemed to comprehend the finality of it. She said, "Mary gone?" She patted Mary's hand. She was taken to another room while Mary's body was being removed. She said poignantly, "Mary gone. Mary, don't go."

Later from Martha's room came sounds of Martha throwing things.

We worry now about Martha's future. She and Mary were inseparable all their lives. They seemed almost like Siamese twins. Now Mary is gone. Martha still has a loving, involved family. She has wonderful caregivers. She is 59 years old. And for the moment, as through all these years, she is helped in remaining alive by a great and compassionate nation that has recognized that all life is not necessarily cost-effective.

In America, now the debate rages about how to deal with the cost of health care. About those who are unable to afford health care, some people shout, "Let them die!" With regard to those with profound birth defects, others shout, "Do not let them be born!" Some people argue: "Be sure they get born!" Then when they are born, "If they are too expensive for society to help live, then let them die."

The towering question is, "What does a civilized nation require?" The biggest danger is that we will make our decisions with too little regard for the moral imperatives that we claim to revere.

Harold Bales is a semi-retired Methodist minister who lives in Kannapolis. He's also got a new book out and advance copies are available for sale. For more information, visit www.TheSouthernFriedPreacher.com. Send him an e-mail at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .