In the film's finale, Hamilton/Tony is wheeled away on a stretcher, presumably to undergo another surgery (once again faking his death). However, it is revealed that "Seconds" who wish for another chance are used as the catalysts (corpses) for a new patient's death. The final shots consist of the camera panning to a hospital light as a drill is pushed into Hamilton's head; two figures walk along a beach.
In the end? In the end, "Mr. Wilson" realizes he never even bothered to dream a dream - the personal consequences of this belated act of insight should make every rational, aging viewer ask... "What do I really want from life?" Stress the first-person 'I". Not what THEY want. What do YOU want???