Medical technology is having major effects on health care decision making at the patient-physician interaction, community-health care institution, and society-national government levels. This impact is characterized by three processes—diffusion of decision making through the increase of possible alternatives, the relinquishing of part of the role of decision maker to others in the health care system, and the shift of some of the decision making process onto the object (patient or community) of that decision. These processes are having their most pronounced effect at the national government level where decisions regarding the allocation of limited societal resources are often made without sufficient weight being given to the intended or negative consequences of specific technologies or to their external and opportunity costs, since these may not be the concern of powerfully organized special interest groups. We recommend that if national decision making is to represent societal choices, mechanisms such as technological review panels and public notification forms, must be established for ferreting out relevant social, economic and ethical considerations early in the development of a technology and disclosing these to the public.
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