Travel for Treatment

Our readings for this week introduced the concept of medical tourism, detailed some of the issues it brings up in certain places, and finally pushed back on the terminology we use to describe it. Throughout each of the pieces we saw themes arise surrounding poverty and the ability to consent, the impact on local healthcare, and the odd relationship between wealthy kidney recipients and their less fortunate ‘donors.’

In their introduction to medical migrations, Roberts and Scheper-Hughes discussed the rise of border crossing for medical reasons. Though sickness originally gave people more freedom to cross borders in search of asylum, the development of germ theory created knowledge about how diseases spread. As a result of this knowledge, border crossing in illness became much more difficult (a quick look at the number of people turned away at Ellis Island makes this clear). Since borders were no longer crossable for those wanting to escape the conditions they believed responsible for their illness, the new impetus for medical travel was strictly treatment seeking. The authors also discuss the relationship of the donor to their body. For many of limited resources, donating an organ is a way to create options for themselves and regain some agency in their lives. This seems to stand in contrast to the typical notion of agency referring to power over how one uses their body. In the case of these donors, they are using their bodies in a way that is presumably not ideal to create agency in other decisions outside of their body. Finally, Roberts and Scheper-Hughes note that medical tourism may seem benign until we take a closer look at the impacts it has on local healthcare. In general, they note that physicians are moving away from work in public institutions for higher paying jobs in private hospitals catering to foreign patients.

Scheper-Hughes piece on the global trafficking of human organs built on her introduction by providing specific examples in different countries. In China and other areas of Asia and South America, the organs of executed prisoners are harvested for sale and transplantation. In times of low organ supply, laws seemed to be more strictly enforced so that more executions provided more organs for sale. While the government’s role in the supply of organs in China was not necessarily surprising given the sources of said organs, I was surprised and confused by Scheper-Hughes argument that, in general, organ scarcity is an artificially created need by those in power in the system. I had a difficult time understanding how exactly this worked and what the impetus may be. The author also discussed speaking to some wealthy organ recipients about their acceptance of the fact that their new organs had come from executed prisoners. How do people reconcile the fact that the organ they have now fully incorporated into their body has come from someone they believe worthless enough to kill for a piece of their body? A similar dissonance in beliefs about value when it comes to personal benefit was brought up in Dr. Song’s piece on biotech pilgrims.

Song discusses the experience of a religious couple very adamantly against abortion. When the husband becomes paralyzed and could possibly benefit from fetal stem cell therapy, they manage to justify the use of a product of a procedure they are deeply against for personal gain, arguing that his use of the cells means the horrible transgression on life didn’t go to waste. What drives these decisions in such contradictory settings? Is it the sheer fact that temporarily changing our morals will benefit us or is there something else going on?