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Hard choices: who lives, how, and who decides? The ethics of making national policy.

Technological advances in medicine and biomedical research have been both exhilarating and depressing. They have heralded prolonged life and with it a moral dilemma regarding the quality of that life. These moral issues are relatively trouble-free on the individual level; however, they become extremely problematic when a policy must be developed which will affect the lives of thousands or millions of people. The persistent problem which is likely to haunt us for decades is the question of allocation of our health care resources--should these health care resources be rationed, and if so, by whom.