Ethical and legal implications of the risks of medical tourism for patients: a qualitative study of Canadian health and safety representatives’ perspectives

Abstract

ObjectivesMedical tourism involves patients’ intentional travel to privately obtain medical care in another country. Empirical evidence regarding health and safety risks facing medical tourists is limited. Consideration of this issue is dominated by speculation and lacks meaningful input from people with specific expertise in patient health and safety. We consulted with patient health and safety experts in the Canadian province of British Columbia to explore their views concerning risks that medical tourists may be exposed to. Herein, we report on the findings, linking them to existing ethical and legal issues associated with medical tourism.DesignWe held a focus group in September 2011 in Vancouver, British Columbia with professionals representing different domains of patient health and safety expertise. The focus group was transcribed verbatim and analysed thematically.ParticipantsSeven professionals representing the domains of tissue banking, blood safety, health records, organ transplantation, dental care, clinical ethics and infection control participated.ResultsFive dominant health and safety risks for outbound medical tourists were identified by participants: (1) complications; (2) specific concerns regarding organ transplantation; (3) transmission of antibiotic-resistant organisms; (4) (dis)continuity of medical documentation and (5) (un)informed decision-making.ConclusionsConcern was expressed that medical tourism might have unintended and undesired effects upon patients’ home healthcare systems. The individual choices of medical tourists could have significant public consequences if healthcare facilities in their home countries must expend resources treating postoperative complications. Participants also expressed concern that medical tourists returning home with infections, particularly antibiotic-resistant infections, could place others at risk of exposure to infections that are refractory to standard treatment regimens and thereby pose significant public health risks.

Determinants of medical tourism destination selection process

“…However, MTC is not without substantial risks such as unsafe practices by foreign professionals and facilities, poor and substandard quality of services, risk of travelling after a surgery, transmission of antibiotic resistant organisms that may be prevalent in foreign countries, discontinuity of medical documentation, minimal legal recourse, and difficulty of after-care coordination once the patient returns home (Center for disease Control, 2013;Crooks et al, 2013).…”

Orthopaedic medical tourism

“…However, this issue may be able to be mitigated through use of modes such as telemedicine. Furthermore, patients may be provided with incorrect, ambiguous or, at the very least, non-comprehensive information electronically about their destination facilities, which also undermines informed consent (Crooks et al, 2013;Mestrovic, 2014).…”

“…English may not be spoken at many of the surgical centres located abroad, and patients from the United States would also be likely to face communication barriers and have limited health literacy in those settings, creating another important ethical concern (Crooks et al, 2013). Finally, if patients are harmed or undergo undue complications or negligent care during their surgeries abroad, they may or may not have the ability to pursue legal action to obtain reparations (Mestrovic, 2014).…”

A Cautionary Tale: The ‘New’ Medical Tourism Industry in Argentina

“…As Smith et al (2009) have indicated, in non-accredited facilities, the doctor's responsibility ends when the patient leaves the clinic, and follow-up care is not always considered a part of the treatment sought abroad. This is an important issue to consider because previous research in other medical tourism destinations has pointed to multiple cases of postoperative or postprocedure complications and, in some instances, antibiotic-resistant infections that must be dealt with by medical staff in the tourists' country of origin when they return (Connell 2013;Crooks et al 2013;Hall and James 2011).…”