Superhighway patrolman

•Chronic disease management needs to change to become sustainable in the future.•Technology will permit self-management of disease and the tracking of individuals.•Both examples will pose ethical dilemmas for the government and society as a whole.•These ethical concerns should be considered now to influence the debate.•Family bonds and social networks will (hopefully) continue to provide cohesion in society.

This fictional prototype explores two of the future's major societal challenges: the delivery of healthcare to an increasingly ageing society; and the policing of a society, in which digital surveillance may predominate. It contrasts the author's vision of what life could be like in the United Kingdom in a decade's time (just as he contemplates retirement) with the simpler values of the 1980s, when he began his postgraduate career. The lyrics of the poignant 1982 Bruce Springsteen song, “Highway Patrolman” are used to bridge the epochs1. The prototype relocates the two main ‘middle-America’ characters, brothers Joe and Frank Roberts, in London in the year 2025. Much has already changed politically and socially in ‘Western societies’ in the intervening period up to 2012, driven by the inexorable advances of technology. As further scientific advances drive us to an anticipated paradigm change,2 one can only speculate on how society will advance, posing serious ethical dilemmas. Many of the changes will be positive. However, the story explores the potential negative consequences to the ageing population, in what appears to be a successful economy. Although somewhat pessimistic in outlook, a hopeful conclusion is that the ‘ties that bind’ will still predominate.