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In the past century, enormous advances in medical knowledge and technology have aided physicians in the care of patients, with dramatic reductions in morbidity and mortality. As medicine evolves, diagnostic and therapeutic techniques are expanding the human-machine interface and changing the ways medicine is practiced. Looking ahead, medical systems are being developed that require very little direct involvement of physicians. An extreme example is the emergence of "smart" medical systems that are being prototyped for remote harsh environments, including space. Some of the considerations and accomplishments for developing such systems are described in this paper.