The Dark Side of Medical Tourism?: End of Life Choice, Human Trafficking, and Organ Transplants

Introduction: Trends In The ‘Dark’ Medical Tourism Market

Traditionally, healthcare is disease oriented, rather than health oriented. Health orientated healthcare is focused mainly on behavior and lifestyle issues. In the medical model of disease, patients are usually not held responsible for the genesis of their illness. When a person becomes ill, the medical judgment implies that they cannot be blamed for their condition. This model goes on to specify that reactive treatment and care are appropriate and morally desirable (the medical treatment model). But the World Health Organization (WHO) has defined healthcare as “a process of enabling people to increase control over and to improve their health.” The strategy behind this notion is to relate personal choice and social responsibility in health to the creation of healthy environments, and to encourage positive personal health behaviors within these. However, current medical treatment arguments are not concerned with what individuals have done, but rather with how to repair the damage that resulted, and how they will behave in the future (Engelhardt, 2013).

A very great difficulty for the medical treatment model is that the financial burden of medical care expenses is increasing rapidly in many countries. Much of this rise in the cost of care can be attributed to advances in medical technology, but there is also a changing disease pattern at work too; 63% of all deaths worldwide currently stem from non-communicable diseases often requiring surgery (NCDs - chiefly cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes; WHO, 2013). When these changing patterns conflict with local legal or healthcare structures, and shortages of the resources needed to solve some of them (replacement organs primarily), there rises the opportunity for criminal involvement and ethical disputes in the healthcare system (Scheper-Hughes, 2000; Denier, 2008; Neoh, 2014). Medical tourism can offset some of these issues, but paradoxically has contributed to some of them also. This chapter examines 3 major issues in medical tourism impacted by this situation that are being discussed at the time of writing: End of life choice, trafficking in human bodies and body parts, and organ transplants.