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Costly genetically engineered therapies, which threaten to cripple the health care industry economy and undermine the common good if applied indiscriminately, loom on the horizon. The spectrum of applicable candidates include moribund nursing home patients at the end of life. They will be fair game for therapy that will ultimately send them back to nursing homes to return later with the same condition. 'Quality of life' assessments that limit patient autonomy may be forced as a result. Discussants from South Africa, New Zealand, and the USA suggest methods to deal with this issue in a just and ethical framework.

Ethics roundtable: Using new, expensive drugs.