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Stuhmcke A. Reflections on autonomy in travel for cross border reproductive care. Monash Bioeth Rev 2021; 39:1-27. [PMID: 33453036 DOI: 10.1007/s40592-020-00125-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2020] [Indexed: 11/27/2022]
Abstract
Travel for reproductive health care has become a widespread global phenomenon. Within the field, the decision to travel to seek third parties to assist with reproduction is widely assumed to be autonomous. However there has been scant research exploring the application of the principle of autonomy to the experience of the cross-border traveller. Seeking to contribute to the growing, but still small, body of sociological bioethics research, this paper maps the application of the ethical principle of autonomy to the lived experience of infertile individuals who cross borders for reproductive care. It examines their choices as patient, consumer and traveller. It suggests that their experience evidences a contradictory autonomy, which offers them both choice and no choice in their final decision to travel. The paper argues that this lack of meaningful autonomy is enabled by a medicalised framework of infertility which prioritises technology as the cure to infertility. This both shapes expectations of infertile individuals and limits their options of family creation. Ultimately, the paper suggests that sociological bioethics research shows that the liberatory credentials of technology should be questioned, and identifies that this field demands greater scholarly attention.
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Affiliation(s)
- Anita Stuhmcke
- Faculty of Law, University of Technology Sydney, Sydney, Australia.
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Jackson C, Snyder J, Crooks VA, Lavergne MR. Exploring isolation, self-directed care and extensive follow-up: factors heightening the health and safety risks of bariatric surgery abroad among Canadian medical tourists. Int J Qual Stud Health Well-being 2019; 14:1613874. [PMID: 31084487 PMCID: PMC6522967 DOI: 10.1080/17482631.2019.1613874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This article explores first-hand accounts of Canadian bariatric patients' experiences of seeking and obtaining weight loss surgery abroad through the practice of medical tourism. While researchers have identified many of the challenges and associated health and safety risks imposed on patients by engaging in medical tourism generally, little is known about the specific challenges experienced by Canadians seeking bariatric surgery abroad. METHOD To better understand these challenges, we conducted thematic analysis on interviews conducted with 20 former Canadian bariatric tourists. RESULTS Our analysis illuminated three key challenges Canadians face in obtaining bariatric care: (1) stigma and isolation from friends, family and medical professionals; (2) self-directed navigation of domestic and destination health care systems; and (3) challenges with obtaining adequate follow-up care in Canada. CONCLUSIONS While these challenges identified by participants may occur in other forms of medical tourism, it appears that these challenges are occurring simultaneously in cases of bariatric tourism by Canadians. These challenges appear to work in conjunction to heighten the health and safety risks potential Canadian bariatric tourists may be exposed to. Unless structural changes occur to increase domestic availability of bariatric surgery, Canadians are likely to continue seeking this care abroad.
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Affiliation(s)
- Carly Jackson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Jeremy Snyder
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Valorie A. Crooks
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | - M. Ruth Lavergne
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Medical Tourism and Postoperative Infections: A Systematic Literature Review of Causative Organisms and Empiric Treatment. Plast Reconstr Surg 2019; 142:1644-1651. [PMID: 30489537 DOI: 10.1097/prs.0000000000005014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Medical tourism has become increasingly globalized as individuals travel abroad to receive medical care. Cosmetic patients in particular are more likely to seek surgery abroad to defray costs. Unfortunately, not all procedures performed abroad adhere to strict hygienic regulations, and bacterial flora vary. As a result, it is not uncommon for consumers to return home with difficult-to-treat postoperative infections. METHODS A systematic literature review of PubMed, Ovid, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases was performed to assess the microbiology patterns and medical management of patients with postoperative infections after undergoing elective surgery abroad. RESULTS Forty-two cases of postoperative infections were reported among patients who underwent elective surgery abroad. Most cases were reported from the Dominican Republic, and the most common elective procedures were abdominoplasty, mastopexy, and liposuction. Rapidly growing mycobacteria such as Mycobacterium abscessus, Mycobacterium fortuitum, and Mycobacterium chelonae were among the most common causes of postoperative infection, with M. abscessus involving 74 percent of cases. Most cases were treated with surgical débridement and a combination of antibiotics. Clarithromycin, amikacin, and moxifloxacin were the most common drugs used for long-term treatment. CONCLUSIONS When encountering a patient with a history of medical tourism and treatment-refractory infection, rapidly growing mycobacteria must be considered. To increase the likelihood of yielding a diagnostic organism, multiple acid-fast bacilli cultures from fluid and débridement content should be performed. There has been reported success in treating rapidly growing mycobacterial infections with a combination of antibiotics including clarithromycin, amikacin, and moxifloxacin.
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Béland D, Zarzeczny A. Medical tourism and national health care systems: an institutionalist research agenda. Global Health 2018; 14:68. [PMID: 30012218 PMCID: PMC6048823 DOI: 10.1186/s12992-018-0387-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 06/29/2018] [Indexed: 11/10/2022] Open
Abstract
Although a growing body of literature has emerged to study medical tourism and address the policy challenges it creates for national health care systems, the comparative scholarship on the topic remains too limited in scope. In this article, we draw on the existing literature to discuss a comparative research agenda on medical tourism that stresses the multifaceted relationship between medical tourism and the institutional characteristics of national health care systems. On the one hand, we claim that such characteristics shape the demand for medical tourism in each country. On the other hand, the institutional characteristics of each national health care system can shape the very nature of the impact of medical tourism on that particular country. Using the examples of Canada and the United States, this article formulates a systematic institutionalist research agenda to explore these two related sides of the medical tourism-health care system nexus with a view to informing future policy work in this field.
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Affiliation(s)
- Daniel Béland
- Johnson Shoyama Graduate School of Public Policy, 101 Diefenbaker Place, Saskatoon, SK S7N 5B8 Canada
| | - Amy Zarzeczny
- Johnson Shoyama Graduate School of Public Policy, 101 Diefenbaker Place, Saskatoon, SK S7N 5B8 Canada
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Armas A, Meyer SB, Corbett KK, Pearce AR. Face-to-face communication between patients and family physicians in Canada: A scoping review. PATIENT EDUCATION AND COUNSELING 2018; 101:789-803. [PMID: 29173960 DOI: 10.1016/j.pec.2017.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/07/2017] [Accepted: 11/16/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Patient-provider communication is critical in primary care. Canada's unique health system, population distribution, and cultural context suggest there is value in addressing the topic in the Canadian context. We conducted a scoping review to synthesize recent Canadian literature to inform practice in primary care settings and identify research agendas for patient-provider communication in Canada. METHODS Using Arksey and O'Malley's framework we searched four literature databases: Medline, Web of Science, CINAHL and EMBASE. We extracted 21,932 articles published between 2010 and 2017. A total of 108 articles met the inclusion criteria. The articles were analyzed qualitatively using thematic analysis to identify major themes. RESULTS Four major themes were identified: information sharing, relationships, health system challenges, and development and use of communication tools. CONCLUSION Our review identified a need for Canadian research regarding: communication in primary care with Aboriginal, immigrant, and rural populations; the impact of medical tourism on primary care; and how to improve communication to facilitate continuity of care. PRACTICE IMPLICATIONS Challenges providers face in primary care in Canada include: communicating with linguistically and culturally diverse populations; addressing issues that emerge with the rise of medical tourism; a need for decision aids to improve communication with patients.
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Affiliation(s)
- Alana Armas
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Kitty K Corbett
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Alex R Pearce
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Caulfield T, Zarzeczny A. Curbing transplant tourism: Canadian physicians and the law. CMAJ 2016; 188:935-936. [PMID: 27270121 DOI: 10.1503/cmaj.160497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Timothy Caulfield
- Health Law Institute, Faculty of Law (Caulfield), University of Alberta, Edmonton, Alta.; Johnson Shoyama Graduate School of Public Policy (Zarzeczny), University of Regina, Regina, Sask.
| | - Amy Zarzeczny
- Health Law Institute, Faculty of Law (Caulfield), University of Alberta, Edmonton, Alta.; Johnson Shoyama Graduate School of Public Policy (Zarzeczny), University of Regina, Regina, Sask
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Caulfield T, Duijst W, Bos M, Chassis I, Codreanu I, Danovitch G, Gill J, Ivanovski N, Shin M. Trafficking in Human Beings for the Purpose of Organ Removal and the Ethical and Legal Obligations of Healthcare Providers. Transplant Direct 2016; 2:e60. [PMID: 27500253 PMCID: PMC4946496 DOI: 10.1097/txd.0000000000000566] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/18/2015] [Indexed: 11/25/2022] Open
Abstract
Physicians and other health care professionals seem well placed to play a role in the monitoring and, perhaps, in the curtailment of the trafficking in human beings for the purpose of organ removal. They serve as important sources of information for patients and may have access to information that can be used to gain a greater understanding of organ trafficking networks. However, well-established legal and ethical obligations owed to their patients can create challenging policy tensions that can make it difficult to implement policy action at the level of the physician/patient. In this article, we explore the role-and legal and ethical obligations-of physicians at 3 key stages of patient interaction: the information phase, the pretransplant phase, and the posttransplant phase. Although policy challenges remain, physicians can still play a vital role by, for example, providing patients with a frank disclosure of the relevant risks and harms associated with the illegal organ trade and an honest account of the physician's own moral objections. They can also report colleagues involved in the illegal trade to an appropriate regulatory authority. Existing legal and ethical obligations likely prohibit physicians from reporting patients who have received an illegal organ. However, given the potential benefits that may accrue from the collection of more information about the illegal transactions, this is an area where legal reform should be considered.
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Affiliation(s)
- Timothy Caulfield
- Health Law Institute, University of Alberta, University of Alberta, Edmonton, Canada
| | - Wilma Duijst
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mike Bos
- Eurotransplant International Foundation, Leiden, The Netherlands
| | | | | | | | - John Gill
- University of British Columbia, Vancouver, BC, Canada
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Piccoli GB, Sacchetti L, Verzè L, Cavallo F. Doctor can I buy a new kidney? I've heard it isn't forbidden: what is the role of the nephrologist when dealing with a patient who wants to buy a kidney? Philos Ethics Humanit Med 2015; 10:13. [PMID: 26684455 PMCID: PMC4683780 DOI: 10.1186/s13010-015-0033-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 12/05/2015] [Indexed: 05/08/2023] Open
Abstract
Organ trafficking is officially banned in several countries and by the main Nephrology Societies. However, this practice is widespread and is allowed or tolerated in many countries, hence, in the absence of a universal law, the caregiver may be asked for advice, placing him/her in a difficult balance between legal aspects, moral principles and ethical judgments.In spite of the Istanbul declaration, which is a widely shared position statement against organ trafficking, the controversy on mercenary organ donation is still open and some experts argue against taking a negative stance. In the absence of clear evidence showing the clinical disadvantages of mercenary transplantation compared to chronic dialysis, self-determination of the patient (and, with several caveats, of the donor) may conflict with other ethical principles, first of all non-maleficence. The present paper was drawn up with the participation of the students, as part of the ethics course at our medical school. It discusses the situation in which the physician acts as a counselor for the patient in the way of a sort of "reverse" informed consent, in which the patient asks advice regarding a complex personal decision, and includes a peculiar application of the four principles (beneficence, non-maleficence, justice and autonomy) to the donor and recipient parties.
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Affiliation(s)
- Giorgina Barbara Piccoli
- SS Nephrology, Department of Clinical and Biological Sciences University of Torino, Torino, Italy.
- AOU san Luigi Gonzaga, Regione Gonzole 10, Orbassano, Torino, Italy.
| | - Laura Sacchetti
- EBM Course, Torino Medical School, University of Torino, Torino, Italy.
| | - Laura Verzè
- EBM Course, Torino Medical School, University of Torino, Torino, Italy.
| | - Franco Cavallo
- EBM Course, Torino Medical School, University of Torino, Torino, Italy
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Crooks VA, Johnston R, Labonté R, Snyder J. Critically reflecting on Loh's "Trends and structural shifts in health tourism". Soc Sci Med 2015; 152:186-9. [PMID: 26638803 DOI: 10.1016/j.socscimed.2015.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Valorie A Crooks
- Department of Geography, Simon Fraser University, RCB 6141, 8888, University Drive, Burnaby, V5A 1S6, British Columbia, Canada.
| | - Rory Johnston
- Department of Geography, Simon Fraser University, RCB 6141, 8888, University Drive, Burnaby, V5A 1S6, British Columbia, Canada.
| | - Ronald Labonté
- Faculty of Medicine, the University of Ottawa, Ottawa, Ontario, Canada.
| | - Jeremy Snyder
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
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Crooks VA, Li N, Snyder J, Dharamsi S, Benjaminy S, Jacob KJ, Illes J. "You don't want to lose that trust that you've built with this patient...": (dis)trust, medical tourism, and the Canadian family physician-patient relationship. BMC FAMILY PRACTICE 2015; 16:25. [PMID: 25884181 PMCID: PMC4344996 DOI: 10.1186/s12875-015-0245-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/18/2015] [Indexed: 11/30/2022]
Abstract
Background Recent trends document growth in medical tourism, the private pursuit of medical interventions abroad. Medical tourism introduces challenges to decision-making that impact and are impacted by the physician-patient trust relationship—a relationship on which the foundation of beneficent health care lies. The objective of the study is to examine the views of Canadian family physicians about the roles that trust plays in decision-making about medical tourism, and the impact of medical tourism on the therapeutic relationship. Methods We conducted six focus groups with 22 family physicians in the Canadian province of British Columbia. Data were analyzed thematically using deductive and inductive codes that captured key concepts across the narratives of participants. Results Family physicians indicated that they trust their patients to act as the lead decision-makers about medical tourism, but are conflicted when the information they are managing contradicts the best interests of the patients. They reported that patients distrust local health care systems when they experience insufficiencies in access to care and that this can prompt patients to consider going abroad for care. Trust fractures in the physician-patient relationship can arise from shame, fear and secrecy about medical tourism. Conclusions Family physicians face diverse tensions about medical tourism as they must balance their roles in: (1) providing information about medical tourism within a context of information deficits; (2) supporting decision-making while distancing themselves from patients’ decisions to engage in medical tourism; and (3) acting both as agents of the patient and of the domestic health care system. These tensions highlight the ongoing need for reliable third-party informational resources about medical tourism and the development of responsive policy.
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Affiliation(s)
- Valorie A Crooks
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 4X9, Canada.
| | - Neville Li
- Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 4X9, Canada.
| | - Jeremy Snyder
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 4X9, Canada.
| | - Shafik Dharamsi
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Shelly Benjaminy
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Karen J Jacob
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Judy Illes
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Greenfield D, Pawsey M. Medical tourism raises questions that highlight the need for care and caution. Med J Aust 2014; 201:568-9. [PMID: 25390251 DOI: 10.5694/mja14.00471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/29/2014] [Indexed: 11/17/2022]
Affiliation(s)
- David Greenfield
- Australian Institute of Health Innovation, Centre for Clinical Governance Research, University of New South Wales, Sydney, NSW, Australia.
| | - Marjorie Pawsey
- Australian Institute of Health Innovation, Centre for Clinical Governance Research, University of New South Wales, Sydney, NSW, Australia
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Zarzeczny A, Clark M. Unproven stem cell-based interventions & physicians' professional obligations; a qualitative study with medical regulatory authorities in Canada. BMC Med Ethics 2014; 15:75. [PMID: 25315976 PMCID: PMC4203963 DOI: 10.1186/1472-6939-15-75] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/07/2014] [Indexed: 12/02/2022] Open
Abstract
Background The pursuit of unproven stem cell-based interventions (“stem cell tourism”) is an emerging issue that raises various concerns. Physicians play different roles in this market, many of which engage their legal, ethical and professional obligations. In Canada, physicians are members of a self-regulated profession and their professional regulatory bodies are responsible for regulating the practice of medicine and protecting the public interest. They also provide policy guidance to their members and discipline members for unprofessional conduct. Methods We conducted semi-structured telephone interviews with representatives from six different provincial Colleges of Physicians and Surgeons in Canada to discuss their experiences and perspectives regarding stem cell tourism. Our focus was on exploring how different types of physician involvement in this market would be viewed by physicians’ professional regulatory bodies in Canada. Results When considering physicians’ professional obligations, participants drew analogies between stem cell tourism and other areas of medical tourism as well as with some aspects of complementary alternative medicine where existing policies, codes of ethics and regulations provide some guidance. Canadian physicians are required to act in the best interests of their patients, respect patient autonomy, avoid conflicts of interest and pursue evidence-based practice in accordance with accepted standards of care. Physicians who provide unproven treatments falling outside the standard of care, not in the context of an approved research protocol, could be subject to professional discipline. Other types of problematic conduct include referrals involving financial conflict of interest and failure to provide urgent medically necessary care. Areas of ambiguity include physicians’ obligations when asked for information and advice about seeking unproven medical treatments, in terms of providing non-urgent follow-up care, and when asked to support efforts to go abroad by providing tests or procedures in advance that would not otherwise be medically indicated. Conclusions Specific policy guidance regarding the identified areas of tension or ambiguity may prove helpful for physicians struggling with these issues. Further consideration of the complex interplay of factors at issue in how physicians may (should) respond to patient demands related to unproven medical interventions while meeting their professional, legal and ethical obligations, is warranted.
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Affiliation(s)
- Amy Zarzeczny
- Johnson-Shoyama Graduate School of Public Policy, University of Regina, Regina, Canada.
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