"Why does there have to be an end to life? When Im gone, will anyone remember me or care? For how long? For how long will there be human beings at all, anywhere? Wont it all eventually turn to dust? In the longest view, does anything I or any of us do in life really matter?" These questions dwell in the silent and shadowy depth of the modern soul. They usually go unasked, let alone answered. Most of us are far too busy to take time out of the day for idle musing about the meaning of it all. But a profound and unprecedented revolution in the nature of human existence is about to overtake us and we may no longer be able to afford the luxury of being consumed by the urgent matters of daily living. Technology is giving our species capacities that our ancestors could not have imagined and that we ourselves are only beginning to grasp. We have barely begun to ask ourselves what criteria should be included in decisions about the cost and availability of life-saving, life-altering, and life-extending technologies, and whether there are ultimate practical limitations to such technologies in economies that are tied to broad cultural values. But even before we tackle these issues, we have work to do. Our struggle with the more basic questions of existence may be the first step in managing the tidal wave of change that is looming.