Medical tourism has been one of the greatest hot spots for the past few years. While it has given many people the opportunity of enhancing their quality of life, it has also brought up many ethical pressing issues. These ethical issues mostly arise within the stakeholders who are greatly affected by the results of medical tourism. One of the major concerns in North America is the long waitlist of organ and tissue transplants along with the costs that go along with the surgery. Many individuals are in need for organs such as kidney, liver or pancreas to enhance their quality of life but there is also an increase in the number of individuals needing transplants in order to survive and live. The number of North Americans needing transplants is increasing day by day but the availability of organs cannot fill the gap. This is what leads many people to leave Canada or the United States to take part in organ transplant abroad. This is a sector of medical tourism that has brought up many ethical and political issues for stakeholders. Among them I will argue that the most important issue within medical tourism is transplant tourism.
The policies and practice of medical tourism can affect stakeholders internally and externally. The internal category consists of the country in which citizens reside in and the laws and regulations. The external categories are the destination medical tourist countries that individuals are traveling to for treatment. These stakeholders range from hospitals, physicians, facilitators, brokers, insurance companies, governments and patients themselves in many cases. As the awareness of medical tourism has increased, so has the popularity of investment and political issues. Much of these issues arise from the difference of health care regulation and the management of patients participating in medical tourism around the world. However, what patients do not realize is the potential impact they may have on their home country and their health system by traveling abroad for treatment.
A major stakeholder that is usually affected by a policy or practice like medical tourism are physicians. There are many cases in which citizens of United States or Canada leave for abroad treatment only to return back to their home country and get further care. Many time citizens usually opt for procedures and techniques in foreign countries that may be illegal in the patient’s home country or in both the home country and the destination countries (Rothenberg, S. L.). In the case of transplant tourism though, there is a higher burden on the physicians in North America (Testa, G., & Angelos, P). Individuals who choose to take part in transplant tourism are in high risk of gaining other health complication. They can range from acquiring infectious diseases, to the extreme of needing re-transplantation (Testa, G., & Angelos, P). Physicians are placed in a difficult position as the return of patients from foreign countries with medical complications can cause economical and ethical burden in their home countries. Many times, it can cause home country patients to be deprived of an organ transplant when a donor organ was transplanted to a returning transplant tourist in emergency need of a second surgery (Testa, G., & Angelos, P).
Secondly, other major stakeholders that are affected by the practice of medical tourism are hospitals. These medical facilities are a business of its own in terms of employment. Hospitals hire hundreds of nurses, physicians, caretakers, and janitors to maintain the quality of health care. The more patients decide to go overseas for treatment, the less funds hospitals will have to keep their health care facility running. Amongst that reason, many of the hospitals in the Unites States are research based hospitals that are working towards new treatments and discoveries day by day. The ethical issue arises when patients decide to go overseas and deprive US hospitals of revenue’s that they use to subsidize research facilities, and care for the poor (Rothenberg, S. L.). This in turn increases the risk of the global market of privatization and diminishment of public health care (NaRanong, A., & NaRanong, V.). Hospitals in destination countries are also being affected by this industry and have brought up broader ethical issues. Some argue the policy of medical tourism has led to a deepening of inequality which is already apparent in the foreign health care system (NaRanong, A., & NaRanong, V.). In Thailand, for example, citizens of the country had stated that the physicians have become so busy with foreign patients that they are having difficulty getting care (NaRanong, A., & NaRanong, V.). These citizens feel as if they are second to the international patients and don’t receive the appropriate care they are entitled for at the hospitals due to bed shortages, or the cost of treatment cannot be afforded by the locals (NaRanong, A., & NaRanong, V.). This becomes an ethical liability to the destination country as they start giving higher priority to foreign patients who are willing to pay for services. In terms of equality, it does not seem appropriate to give foreign patients treatment when the countries own health care system is not properly established.
Lastly, governments are the stakeholders that are affected the most by medical tourism whether the outcome is positive or negative. Governments of both home country and destination countries are affected by the decisions made by patients, physicians and other health care professionals (Rhodes R., & Schiano, T). Rules and regulations of health care are different in the countries around the world hence so are the treatments and services offered. Certain countries offer procedures and treatments that may not be available in North America or can be illegal. If a complication were to arise from these treatments, it would be difficult to solve the situation since the treatment was not approved by state governments of the country. In terms of transplant tourism, United States has strict guidelines regarding transplant, organ procurement, and organ allocation. These are all regulated by the United Network of Organ Sharing (UNOS) (Rhodes R., & Schiano, T). Each type of organ has different rules governing the allocation but it is based on four criteria’s: urgency, need, tissue match/organ compatibility and time on the list (Rhodes R., & Schiano, T). Even though these criteria’s are being regulated and the patients needed transplants are being prioritized, there is still a waitlist gap that needs to be filled (Rhodes R., & Schiano, T). This is the main reason why many patients go abroad for treatment only to come back to the United States and have the health care refuse them (Rhodes R., & Schiano, T).
The US governments set these standards based on safety and quality of life jurisdiction. The government entails that health care facilities research into treatments offered in other countries to prove that they are safe before carrying it out in the United States (Rhodes R., & Schiano, T). Countries such as China have previously attempted to implement agreements with the United States but have been denied because of limitation and standards of American health system. For instance, China asked if American doctors can teach Chinese doctors to appropriately conduct kidney transplant surgeries but United States declined the request due to the organs being extracted from prisoners (Rhodes R., & Schiano, T.). This was declined on the basis of ethical concerns since it would have laid the Chinese system open to corruption by providing incentives to increase the number of executions. The US health care system agreed that it is wrong to do anything that would encourage the corruption of another judicial process (Rhodes R., & Schiano, T.). Other ethical matters that could arise within governments are political circumstances. If medical tourism in another country is encouraged (such as India), it would “severely impact the comparative advantage for the US in the hospital business and cause a loss of reputation and prestige for the US health care system” (Rothenberg, S. L.). This would decrease the immigration of foreign doctors to the US if it became attractive for them to stay in their home countries hence impact the US primary medical care system (Rothenberg, S. L.).
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Ethical issues surrounding transplant medical tourism is increasing as the number of individuals opting for abroad transplants increase. In certain countries such as India, China, Pakistan and the Philippines, there were cases of organs being offered to international patients on basis of them being illegal (Testa, G., & Angelos, P.). For instance, in China, donor organs were often obtained from executed prisoners until laws and regulation regarding prohibition of organ trafficking was placed into effect in 2007 (Rhodes R., & Schiano, T.). Even though this law was implemented it did not explicitly address the issue of executed prisoners (Rhodes R., & Schiano, T.). Other forms of donor organs deal with the illegal purchasing of kidneys, livers, intestines, and tissues from citizens who were considered to be poor (Testa, G., & Angelos, P.). Amongst the trafficking and trading of organs that caused some of the greatest ethical debates within medical tourism, there is also the issue of foreign patients receiving treatment in abroad countries (NaRanong, A., & NaRanong, V.). With any surgeries comes great risks and transplant surgery has some of the greatest risk associated. One of the greatest hazards when it comes to transplant tourism is the risk of acquiring infectious diseases in countries such as Thailand, Indonesia, India, Malaysia, Cuba and Costa Rica (NaRanong, A., & NaRanong, V.). When patients travel abroad, they are already at risk for acquiring infectious diseases because they do not have natural immunity to the foreign country and atmosphere (NaRanong, A., & NaRanong, V.). Although after transplant surgery, patients are weaker than usual because the body needs time to accept the new organ implanted therefor they are more susceptible to infections. If the transplant is done in a foreign country, the individual would have a weak immune system and there is a higher chance of acquiring foreign diseases (NaRanong, A., & NaRanong, V.). There has been much criticism of “organ tourism” that alleges historical evidence of increased morbidity and mortality of patients who have been transplanted with donor organs purchases in foreign countries (Rothenberg, S. L.).
There are many other issues that arise within the sector of medical tourism that can lead to further complications in foreign transplant surgery. For instance, there have been many cases of poor organ matching at which the body has rejected the organ and the individual became further ill (Blackwell, W.). If this was to occur in North America, physicians would attend to the situation right away and solve it to the best of its capabilities because they have a duty to their citizens (Blackwell, W.). Although in a foreign country, the physician does not have to take responsibility to solving the situation. Instead they can ask for more money and still not fulfill the surgical requirements (Blackwell, W.). There is also the issue of quality of substandard surgical techniques and postoperative care. Often different countries would have different guidelines when it comes to surgical tools and cleansing laws. Sanitary is usually a great concern at a foreign hospital and those issues can cause unsuitable surgical environments (Blackwell, W.). Often post-transplant infection can lead to further complications. Another aspect of medical tourism that can become quite difficult is scouting for the best hospitals, clinics and physicians (Rothenberg, S. L.). Many patients who undergo transplant at a foreign hospital usually search for health care professionals online and often many of the sources do not give completely accurate information (Rothenberg, S. L.). Medical tourism facilitators have been implemented to ease the transition into surgery abroad although most of them are not health care professionals themselves and have rarely met the physicians in practice. Also traveling long distance can cause an increase risk of complications. If someone is having a heart transplant, it is strictly enforced that the patient does not travel for some time because the flight itself can cause embolism and lead to further health issues.
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As a human being, we all have the right to live with good health and a comfortable lifestyle. Individuals will go as far as they can to gain their quality of health whether it is receiving medical treatment in their home country or traveling abroad for it. Placing a halt on medical tourism would be impossible to do so but if there were regulation put into place on the way medical tourism is practiced, it would solve many of the ethical issues that stakeholders are having. Solving issues to do with medical tourism would in turn solve the problems with transplant tourism. One method of reform that can be implemented to improve the industry of medical tourism is organizing an international governmental body for accrediting hospitals, physicians and health professionals (Rothenberg, S. L.). By doing so, organization such as WHO which provides guidance health policy frameworks could examine the international hospitals that are top destination countries for health care (Rothenberg, S. L.). Through that, a database of all the hospitals, and physicians that are approved to give medical treatments to their own or foreign patients can be assembled (Rothenberg, S. L.). On a similar basis, there should also be a database of approved treatment and surgical procedures that would be accepted worldwide. This would decrease the amount of disagreements regarding treatment approval (Rothenberg, S. L.).
Another method of reform in medical tourism is to implement agreements with foreign physicians who provide treatment to also provide follow up care using telemedicine (Rothenberg, S. L.). By removing the limitation in the consistency of law and regulations governing the practice of telemedicine, foreign doctors could keep updated with their patients and improve the industry (Rothenberg, S. L.). At the same time, if a patient decided to go overseas for treatment, the home country physician and the destination physician should keep in contact regarding the patient’s situation (Rothenberg, S. L.). It needs to be understood that patients are not demeaning the physicians at their home country but because of health needs, they opt for treatment as soon as they can if they have the opportunity to do so. It is also important to consider the treatments and procedures that are being offered abroad and why they may attract North American patients (Milne, C.). If medical tourism industry is increasing the burden on the United States health care system, then a portion of the finance should be distributed towards researching those services and providing them in the United States (Milne, C.). In terms of transplant tourism, there should be laws regarding national organ sharing so patients don’t need to take part in illegal purchase of organs overseas. This would decrease the amount of organ trafficking and place a national list of organ donors. As of now, organ donation in the United States is left to individual states with no crossover (Milne, C.). This is also the case with Canada, as every province has its own waitlist of donors. Implementing a national list would decrease the amount of people waiting for transplants. By challenging some of the ethical concerns and resolving them as much as possible, stakeholders such as physicians, hospital communities, and the government are less likely to become affected in a negative way. The world should work together in terms of health care and regaining people their quality of life.
To conclude, the industry of medical tourism has brought up many political and ethical issues amongst stakeholders such as physicians, hospitals and governments. These issues are not only taking place in North America but also in destination countries where the health care is not adequately distributed for their own citizens. Much of the ethical situations affect the stakeholders in North America who are burdened with the postoperative results. The best way to improve the industry of medical tourism would be to solve some of the ethical issues as a whole and then progress to individual fields of treatment. By implementing international government bodies that control the industry would not only decrease the amount of ethical issues but also open up the world to international opportunities within health care. It is important to understand that a patient cannot be denied treatment opportunities abroad if they choose to do so but the world can work together to improve medical tourism and to decrease the burden on North American stakeholders.
References
Rhodes R., & Schiano, T. (20120). Transplant tourism in China: a tale of two transplants. The American Journal of Bioethics:AJOB, 10(2), 3-11. Retrieved on Feb 15, 2012
Testa, G., & Angelos, P. (2010). The transplant surgeon and transplant tourist: ethical and surgical issues. The American Journal of Bioethics: AJOB, 10(2), 12-12. Retrieved on Feb 15, 2012
NaRanong, A., & NaRanong, V., (2011). The effects of medical tourism: Thailand’s experience. Bulletin of the World Health Organization, 89(5), 336-344. Retrieved on Feb 15, 2012
Blackwell, W., (2010). Transplant tourism poses ethical dilemma for US doctors. Science Daily. Retrieved Feb 17 2012
Milne, C., (2009). The perils of transplant tourism. Globe and Mail. Retrieved Feb 17, 2012.
Rothenberg, S. L., (2010). Ethical Issues Threaten the Future of the Medical Tourism Sector? Medical tourism magazine. Retrieved Feb 18, 2012
