About Neera Bhatia, Children’s Medical Tourism Research Network
Dr Neera Bhatia is an Associate Professor in the School of Law, Deakin University, Melbourne, Australia. Her research interests are in end-of-life decision making for critically ill infants and children, organ donation, voluntary assisted dying, and emerging health and reproductive technologies. She teaches Health Law in the undergraduate and postgraduate programs. Neera actively engages with the wider community as an expert commentator in the media on topical issues in health law. She sits on several clinical ethics committees.
About Giles Birchley, Children’s Medical Tourism Research Network
Dr Giles Birchley is a research fellow at the Centre for Ethics in Medicine at the University of Bristol, UK. He has a research interest in the ethical and legal aspects of healthcare decisions made for and by adults and children who presumptively lack full decision-making competence. Giles is a co-investigator on the “BABEL” collaborative project, funded by the Wellcome Trust “BABEL” that focuses on this area. He is a member of the Royal College of Paediatrics and Child Health Ethics and Law Advisory Committee, representing the Children’s Ethics and Law Special Interest Group.
About Children’s Medical Tourism Research Network
The Children’s Medical Tourism Research Network was founded to bring academics, clinicians and healthcare providers together to develop research into Children’s Medical Tourism, defined as “the bi-directional movement of children (less than 18 years of age) to and from a country to seek advice, diagnosis and treatments”. Children’s medical tourism has the potential to widen the choices of treatment available, spur innovation and contribute to economic growth. Yet it also raises medical, ethical, economic, regulatory and legal issues. These hamper child medical tourism’s legitimacy and development into a trusted avenue of healthcare provision. By bringing together an international group of researchers and stakeholders, the network aims to understand and address the challenges of children’s medical tourism.
The Children’s Medical Tourism Research Network has received AHRC funding.
Drs Giles Birchley (University of Bristol, UK) and Neera Bhatia (Deakin University, Australia) have recently won two years of funding from the UK Arts and Humanities Research Council to develop the Children’s Medical Tourism Research Network.
The network, which has been informally meeting since 2021, brings together researchers and other interested parties to understand children’s medical tourism from an international perspective in order to pose inclusive solutions to the challenges that come with this area of practice.
Medical tourism is the phenomenon where people travel across international borders for medical treatment. Although we use the name for the network, and the word ‘tourism’ may suit the marketing of healthcare travel as something that can be combined with a holiday, ‘medical tourism’ may be badly named.
Research in the UK – where official statistics show around 0.25 million residents travel abroad for treatment each year – shows that it is only dental tourists who are likely to combine their treatment with a holiday, and most medical tourists feel they travel for treatment out of necessity.
Children’s medical tourism is part of the same phenomenon, but, unlike its adult counterpart (which has been the subject of thousands of pages of research), children’s medical tourism has only been studied a handful of times. Very few of these studies have generated empirical data that could be of use to health planners, institutions and policy-makers.
One major motivation for the network is therefore exploratory – we think it will be helpful in all sorts of ways to find out more about children’s medical travel.
There are general issues attached to medical tourism regarding choice, equity, public health and exploitation; medical tourism provides choice to patients and provides them with access to therapies that may be scarce in their country of origin, but this choice is not equitable and many people are too poor to benefit.
Indeed, medical travel can increase local scarcity by sucking funds and skills from local healthcare providers. These are public health risks, and they are compounded by the risks of international contagion due to medical travel, where patients are vectors transporting rare diseases from one country to another, and the contributions to the global climate emergency of an industry that depends on mass international transport.
Finally, healthcare is an expert field where a good deal of trust is placed in expert institutions to deliver quality therapies. This places patients at risk of exploitation by the unscrupulous.
Children’s medical tourism has its own take on these problems, and raises some unique issues. Children are especially valued within global society, and the bond between parent and child is unique. The strength of this bond can mean that parents are in an especially vulnerable position when looking for medical treatments for their child.
Parents who might not consider treatment abroad for their own healthcare, or have the means to do so, may be attracted to children’s medical tourism; few people are as motivated as parents of sick children.
Parents may be left destitute to raise funds for treatment, and parents who have low incomes in their country of origin are especially at risk. At the same time parents may be at risk of exploitation by unscrupulous institutions, and inequalities between countries means that many children are simply priced out of international healthcare.
Concern about protecting children also means that children are among the few types of patients travelling across borders that national laws are usually interested in as patients. While many wealthy countries are erecting barriers to migration at present, special restrictions already apply to children travelling for female genital cutting (FGC).
Other medical interventions may not be legally proscribed in the same way as FGC, but when children are involved they are more likely to generate negative public sentiment and headlines if they are seen as putting children at harm.
Finally, like all medical questions involving children, there is a tension between honouring the wishes of parents and an independent view of what is physically best for the child from a medical point of view. This tension becomes especially strong where medical advice differs between distant institutions or when parents are seeking a treatment that is not generally medically recognised.
Children’s medical tourism is undoubtedly a valuable part of a good global children’s healthcare system, and the way these issues are resolved will vary from one society to another. Yet because medicine is both a truly global institution and an inexact science, there is the possibility of conflict and disagreement. Parents and children must navigate this difficult landscape and require institutions and information sources they can trust.
National laws and policies must be drafted with an understanding of their international impact. Our global research network is beginning to work on these and other issues, and we hope to develop frameworks that help children’s medical tourism to work as best it can as a global good.
To do this work well the Children’s Medical Tourism research network needs the voices of different stakeholders to make sure it considers all viewpoints and interests. Do please get in touch if you want to be a part of our work.
Giles Birchley ([email protected])
Neera Bhatia ([email protected])