2020 Visions: Long View of a Changing World.

The twenty-first century will be the European century, not the Pacific century, according to 2020 Visions. As nations merge to form megastates -- " massive confederations with many common economic rules, synchronized foreign policies, and joint military forces" -- Europe will become a "continental

The European megastate, like other megastates around the world, will not be as centralized as the United States is, "but will fall somewhere between Canada and the current European Economic Community in degree of central power."

The authors predict, "Within large nations, power will decentralize, with such former nations as Scotland or the Basque provinces gaining at least as much power as U.S. states."

2020 Visions was written by economist-futurist Richard Carlson, president of Spectrum Economics, Inc., in Mountain View, California, and Bruce Goldman, editor and manager of the Portable Stanford Book Series. Their collaboration results in a readable and plausible view of the years ahead. Chapters cover a range of topics, from housing and education to politics and demography.

The chapter on health care is particularly strong, vividly showing how advancing medical technology will pose increasingly agonizing dilemmas for society. For instance, the soaring costs of prolonging the lives of the very elderly will soon become unacceptable to society, but refusing them treatment that could preserve their lives for additional weeks, months, or possibly years is equally unacceptable to many people.

"The premier ethical quarrel of the coming decades -- How much medical care is enough for this 'old old' population? -- will make the abortion issue seem like a playground argument," Carlson and Goldman warn.

All developed nations now face the same challenge to some degree: "Traditional health care has become too expensive for any current healthcare system, whether fully nationalized or private," the authors state. As a result, health care must evolve toward changing people's behavior in order to forestall health-care problems and toward efficient rationing when expensive therapies are indicated.

One growing problem posed by modern medical technologies is that more people suffering from genetic defects will survive to reproduce, thus increasing the genetic burden for the future. The rising expense "will fuel serious proposals for legitimizing eugenics to protect against the increase of fatal genes in the population," according to Carlson and Goldman.

The use of tissue from aborted fetuses is currently highly controversial in the United States, and the government has withdrawn financial support for using fatal tissue in research. "Fortunately for the victims of such maladies as Parkinson's disease, other counties are proceeding with this research," note the authors.

A bigger stumbling block is that abortion will become technically outmoded, thanks to better birth-control and abortion pills. So by the year 2010, the authors expect, "fetuses will need to be deliberately grown as donors to meet the demand."