Several factors will combine to chart the future of healthcare and the ethical dilemmas surrounding it. Most of these are inevitable dilemmas that patients, doctors, voters, hospitals, medical companies, NGOs and governments will all need to deal with; no group will be able to single-handedly direct them.
The key factor is simple economics. Increasingly sophisticated medications and surgeries are available, with even more promising areas, such as tailored gene therapy, on the horizon. The main question is whether wealth should determine who has access to these. Should wealthy individuals have access to more medical care than poor ones? Should the children of poor families, or people clustered in poor countries die prematurely or being permanently harmed by diseases that medicine can cure?
This leads to a second problem of how one estimates the costs and benefits of a treatment. For example, if a treatment has a cost of $200,000 and has been shown to result in a 5 percent increase of 2 additional weeks of life, is it worth the money? While cost-benefit analysis seems heartless, since health care funding is not unlimited, does it make sense to spend money on two weeks of additional life for a terminal patient for money that could, for example, save the lives of 5,000 children through vaccination? Especially as biotechnology and gene therapies develop, the cost of leading edge medical technology is increasing astronomically, and presents important questions about how we value life in economic terms.
Finally, we have the question of technology being able to prolong physical life in quite extreme cases, such as extremely premature babies, or the very frail elderly suffering from dementia and other incurable diseases. Thus we will be increasingly confronted with questions not of whether we can save lives, but whether we should.