Ethical Considerations for Medical Travel

Rick Johnson, for HealthLeaders Media , June 3, 2008

With all the attention it gets, medical tourism might seem like an entirely new concept. Although the idea of U.S. residents seeking services outside the States is relatively novel, destination hospitals have long received patients from places like Latin America, the Middle East, Europe, and more recently Asia.

As medical travel has gained acceptance and the industry begins to take off, the debate over its ethics also gains momentum. In my last column, I discuss whether U.S. healthcare organizations will explore ways to collaborate or compete with global destination hospitals. In a public comment, one reader appears to take offense to the notions I forwarded in the story, and in this online posting the reader raises many of the ethical dilemmas associated with medical travel.

With 150,000 Americans traveling abroad for medical care last year, according to Josef Woodman, author of Patients Beyond Borders: Everybody's Guide to Affordable, World-Class Medical Tourism, the global healthcare industry should consider ethical matters with care as it seeks to further develop inroads into first-world countries.

Woodman joined three others from the medical travel industry for a panel discussion at Harvard Medical School on the ethical issues of medical tourism. The conversation was wide-ranging and focused more on medically necessary procedures rather than cosmetic procedures that account for more than half of the industry's services.

Maggi Grace, a consultant with BestMed Journeys and author of State of the Heart: A Medical Tourist's True Story of Lifesaving Surgery in India, put a human face on the issue by telling her first-hand account of traveling with her partner, Howard Staab, to India to repair a mitral valve in his heart. Grace made the case that the U.S. health system doesn't provide enough for the uninsured and has in effect forced people like Staab to seek alternatives outside the States.

At the same time, Grace questioned whether the citizens of India are receiving "compromised care" because healthcare resources are being diverted to medical travelers. This is perhaps the toughest ethical issue for the medical travel industry.

Another panelist, I. Glenn Cohen, JD, assistant professor at Harvard Law School, said that he considered "brain drain," a term for the practice of developed countries recruiting clinicians from underdeveloped countries, as a greater ethical dilemma for global healthcare than private hospitals providing medical travel services.

David Boucher, president and chief operating officer for South Carolina-based Companion Global Healthcare, was also on hand to outline how U.S. insurers are entering into global healthcare. The idea that insurers are working with employers to explore cost-savings options through medical travel didn't sit well with some of the Harvard faculty in attendance.

During the Q&A session, Arnold Relman, MD, professor emeritus of medicine and of social medicine at Harvard Medical School and the former editor of the New England Journal of Medicine, was on hand to question why American providers should support the expansion of medical tourism at the cost of neglecting problems within the U.S. healthcare system. He described the need for Americans to access medical travel as a failure of the U.S. system and suggested that by accommodating the middle-class, who can afford access to procedures abroad, the medical tourism industry is reducing the political pressure on policy makers.

In sum, the panelists responded that they believe medical travel will continue to expand and shouldn't be ignored by U.S. healthcare providers and organizations. Woodman pointed out that he didn't think it possible to stop the trend of medical travel and global healthcare and said that as a component of overall healthcare, medical travel could force changes to the healthcare system.

Other topics—such as medical travel's influence on the continuum of care, destination hospitals providing services that are illegal in home countries, and malpractice mitigation—were touched upon. It's no surprise that global healthcare faces numerous ethical issues.

At the same time it's unreasonable to expect any industry to solve all possible ethical issues on the front-end of globalization. In the history of globalization, what industry has indisputably succeeded navigating the minefield of multicultural ethical considerations? Unlike some other industries, global healthcare seems to have at least a solid understanding of the potential impacts of its expansion. I'm not saying all have been overcome, but they have been identified and can now be addressed.

But more ethical problems that we have yet to imagine will be discovered along the way. What will be telling is the willingness of industry players to engage in candid public dialog about these issues.

With the industry is still in its infancy, I believe that as global healthcare evolves, it will find ways over time to resolve ethical concerns, provide more healthcare options to those in need, and help to further develop emerging countries. I'm sure we'll also uncover unethical medical practices—just as we do in developed nations—but I hope these will be the rare exceptions.

Time will tell, but perhaps more readers could enlighten us with their thoughts. As always, feel free to leave a public comment using the tool below or send me an e-mail.

Rick Johnson is senior online editor of HealthLeaders Media. He may be reached at
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