New ethical guidance on medical tourism was adopted this week at the American Medical Association’s (AMA) Annual Meeting to help physicians understand their fundamental responsibilities when interacting with patients who seek or have received medical care outside the U.S.
Every year, American patients cross borders to receive treatments and procedures outside the United States. Despite this growing trend, many aspects of medical tourism confound core ethical expectations regarding patients’ rights, including informed consent, continuity of care, and access to medical records. Issues of safety and quality can loom large, especially when traveling for care that is unapproved or legally or ethically prohibited in their home system.
Many returning medical tourists do not have records of the procedures or medications they obtained while abroad, or contact information for the foreign health care professionals who provided services. Medical tourists often need to secure follow-up when they return, even if only to monitor the course of an uneventful recovery. Patients who develop complications may need extensive follow-up care when they return home.
“When asked to make right what went wrong as a result of medical travel, physicians can be confronted with a problematic position when they lack vital information to guide follow-up care,” said AMA Immediate Past Chair Patrice A. Harris, M.D. “The AMA’s new ethical policy will help guide physicians on the implications of medical tourism and their responsibilities with patients.”
Among the key points of the new guidance, individual physicians should:
- Familiarize themselves with issues in medical tourism to help support informed consent;
- Help patients understand the nature of risks and likelihood of benefits, especially when patients desire an unapproved therapy;
- Advise patients who consult them in advance whether the physician is willing to provide follow up care;
- Offer their best professional guidance, as they would for any care decision; and
- Respond compassionately to requests for follow-up care from returning patients who had not consulted the physician before seeking care abroad, and carefully consider the implications before declining to provide nonemergent follow-up care.
The new ethical policy provides companion guidance to AMA principles adopted in 2008 on medical tourism, which call for all medical care outside of the U.S. to be voluntary. The AMA principles address financial incentives, insurance coverage for care abroad, and the use of internationally accredited institutions. The principles also urge coordinated follow-up care, a transfer of medical records that adhere to HIPAA requirements, and the tracking of safety and quality data for procedures performed outside the U.S.