Comment

Comment by Sunset Dental Cancun on October 13, 2011 at 2:39pm

This is an excellent thread, This belief is the core of our clinic, i am glad we have found you Professor Green.

Comment by Renee-Marie Stephano on October 18, 2010 at 5:48pm

I agree ethics is a very large issue in medical tourism. We have been considering the arguments both ways on whether the MTA should establish a position on all of these issues. We have a position that patients traveling for organ transplants should be providing their own donors. The other issues warrant discussion and I am open to hear diverse opinion on the suggested approach for the MTA both pro and con in taking such positions.

Comment by Dr.Ayyappan on January 24, 2010 at 2:19pm

hats off Professor Stephen Green.

Comment by Professor Steve Green on August 5, 2009 at 4:30pm

What represents an ethical hospital or clinic?

The following is a suggested list of ethical standards that an ethically sound healthcare-providing establishment should perhaps be considering adhering to.

The following principles are seen as fundamental to acceptable patients care.


1) Do the right thing
2) Do the thing right
3) Always put the patient first
4) Transparency and openness are the best disinfectants
5) Is your hospital the right place for it to be done?
6) Is that professional the right person to be doing it?
7) Be prepared to listen to constructive criticism and act upon it
8) Maintaining confidentiality of a patient’s data is vital
9) Always follow the principle of genuine informed consent

Please commend and suggest amendments etc. as necessary.

Please read on

- The hospital’s missions statement and/or charter contains a clear commitment that the hospital, including staff members and other healthcare professionals providing services within the hospital, will expect to conduct all its activities in an ethically sound way

- The hospital has lay people, as well as professionals, sitting on relevant committees within the hospital, and their views are taken into account

- The hospital has an appropriately qualified and constituted advisory committee to deal with issues within the hospital related to ethics and probity, including transplantation-related and fertility work

- The hospital does not deny patients treatment exclusively on the grounds of race, gender, religion, culture or disability

- The hospital has a commitment to ensuring confidentiality of information related to all individual patients, including any staff members and other healthcare professionals providing services within the hospital who themselves become patients of that same hospital

- The hospital has a robust commitment in place to ensure that there is appropriate chaperoning when patients undergoes physical examination

- The hospital has a robust system in place to ensure that hospital staff and other healthcare professionals providing services within the hospital have adequate and documented appropriate police checks prior to commencing work within the hospital so as to ensure that they are have no criminal record of relevance to their duties (e.g. Criminal Records Bureau (CRB) screening in the UK)

- The Hospital has a firm commitment and a robust system in place to ensure that the hospital staff and other healthcare professionals providing services within the hospital are dealt with appropriately should the situation in the preceding paragraph change while they are associated with the hospital, and there are mechanisms to ensure this.

- All hospital staff and other healthcare professionals providing services within the hospital endorse and display a robust commitment to adhere to the appropriate codes of ethics published by the local relevant controlling bodies (e.g. the local medical council, nursing council etc.)

- The hospital itself displays a robust commitment to ensuring that all hospital staff and other healthcare professionals providing services within the hospital endorse and display a robust commitment to adhere to the appropriate codes of ethics published by the local relevant controlling bodies (e.g. the local medical council, nursing council etc.)

- All advertising, public relations, & internet activities by and in the hospital, and by the hospital staff and other healthcare professionals providing services within the hospital, conform with locally-published legal and ethical codes, with local advertising standards and with internationally accepted norms

- The hospital, all hospital staff, and all other healthcare professionals providing services within the hospital do not condone or endorse a system of paying people to donate bodily organs or tissues for the purpose of transplanting them into other people (or offering other inducements)

- Clinical governance, audit, and relevant education and training relevant to all fields of clinical activity are in place

- Medical ethics, and discussion of, is a routine part of the on-going training and educational programme for all hospital staff and other healthcare professionals providing services within the hospital

- The hospital has a transparent policy for the publishing of collective data related to patient safety and well-being (e.g. infection control, complaints-related data, mortality data etc.), and makes this data available in the public domain

- The hospital’s system for consenting patients for surgery and other procedures are robust, and inclusive of a commitment to providing all patients with appropriate information in a way that is comprehensible to them

- There is a commitment by the hospital, by all hospital staff, and by all other healthcare professionals and workers providing services within the hospital, to risk management and reduction within the hospital through the use of a robust “whistle-blowing system”, with appropriate safeguards also being in place

- Charges made by hospitals for any healthcare and related services they provide should be made clear in advance of treatment being started. They should be transparent and easily comprehensible, and with no hidden extras

- The billing of patients for services rendered by the hospital should be transparent and should contain a full and complete explanation of all charges made

- Staff are appointed to posts within the hospital on the basis of an open interview, with appropriate representation on the appointing committee including lay representation

- The hospital has a robust policy and system in place to ensure openness of competition and equality of opportunity with people applying for a staff post within the hospital (and for all other healthcare professionals applying to provide services within the hospital) and appointments are made on the basis of ability, regardless of race, gender, disability, or personal connections

- The hospital pays appropriate regard to making all facilities and services within the hospital available and accessible to disabled staff and patients
- The hospital has a robust commitment in place to ensure that complaints made by patients and their carers are dealt with fairly and efficiently, and the senior management are involved in the process

- All hospital staff, and all other healthcare professionals providing services within the hospital carry appropriate indemnity, so as to ensure that that professional has access to ethical guidance when necessary, and any patients who takes legal action against that person, and is successful, can and will be appropriately remunerated as and when necessary (e.g. Medical Protection Society, Medical Defence Union)

- The hospital carries appropriate insurance cover to ensure that any patients who takes legal action against the hospital and are successful can and will be appropriately remunerated as and when necessary

- The hospital has a policy of apologising to patients when appropriate


More controversially perhaps

- Cognisant that a patient should always be looked after by the best quality staff available, the hospital, all hospital staff, and all other healthcare professionals providing services within the hospital do not engage in the paying of commissions to or “fee splitting” with fellow professionals specifically to attract referrals to their own hospital or parent organisation, or to their own specific clinic

- The results of independent external quality assessment, including accreditation, are published publicly and non-selectively so that patients can make up their own minds about the quality and safety standards in a particular hospital

Comment by Professor Steve Green on July 30, 2009 at 1:52pm

Dear all,

The existence and role of the Ethics Committee in a Hospital or Clinic

An accreditation scheme should pay serious attention to the way ethical issues are dealt with by hospitals and clinics. For example, the possession of an ethics committee by a hospital seeking accreditation is a requirement for the Trent Accreditation Scheme. The precise way a hospital or clinic deals with an ethically sensitive matter is not the issue - what is vital is that a hospital or clinic recognises and flags up those issues which require ethics-orientated assessment and the generation of a policy to deal with them, and has a robust system in place to do this.

The appropriate make-up of committees involved in ethics-orientated deliberations is worthy of mention. There is a useful comment in a paper by Dr Henry B. Dinsdale MD on the "Canadians for Health Research" web site - this refers to expected standards of practice in the USA, Europe and Australia.

"U.S. recommendations suggest that Resarch and Ethical Boards (REBs) should have five or more members, including at least one scientist, one non-scientist and one person not affiliated with the institution. The REB should include people knowledgeable in the law and standards of practice and professional conduct. Special memberships are advocated for handicapped or disabled concerns, if required by the protocol under review.

The European Forum for Good Clinical Practice (EFGCP) suggests that REBs include two practicing physicians who share experience in biomedical research and are independent from the institution where the research is conducted; one lay person; one lawyer; and one paramedical professional, e.g. nurse or pharmacist. They recommend that a quorum include both sexes from a wide age range and reflect the cultural make-up of the local community.

The 1996 Australian Health Ethics Committee recommendations were entitled, "Membership Generally of Institutional Ethics Committees". They suggest a chairperson be preferably someone not employed or otherwise connected with the institution. Members should include a person with knowledge and experience in professional care, counselling or treatment of humans; a minister of religion or equivalent, e.g. Aboriginal elder; a layman; a laywoman; a lawyer and, in the case of a hospital-based ethics committee, a nurse."

While this refers to research and ethical committees, exactly the same issues are encountered when a hospital or clinic are contemplating introducing a new drug or a new procedure to their panoply of activities (e.g. transplantation, stem cell therapy, fertility therapy), and it would seem "ethical" for this process to include a plurality of views and inputs to the dialogue, and certainly not just those of medical enthusiasts and/or marketers. Accordingly, the need for lay (i.e. non-healthcare) views to be sought out and taken into account during this process is, in my humble view, vital.

Yours aye

Comment by Mubbashir on July 29, 2009 at 5:28am

Thank you very much, Dear Dr Sanjiv Malik, I think, every medical tourism professional must view these two presentation to build proper insight into this. I have few comments, but reserve for some other time. I am sure that businesses, healthcare and divinity (fear of God) when combine, then only Medical Tourism can come into existence. What I have felt till now, its more of business, rather then any healthcare in Medical Tourism at large.
Best wishes and best regards
Mubbashir

Comment by Dr Sanjiv Malik on July 29, 2009 at 3:18am

Dear Mubbashir,

Thanks for confirming that you got the presentation.

Comment by Mubbashir on July 29, 2009 at 2:06am

Dear Dr Sanjiv Malik,
Greetings from Kuala Lumpur.
Please share with us all, here. Its very simple, just go to www.slideshare.com and upload your power point presentation, once confirmed uploaded. you can find its EMBED code on the right side of the persentation window at slide share.com and copy the code and paste it here in THIS window.
If you have difficulty in doing it, Please mail me the presentation, at mubbashir9@gmail.com and will upload it and run it here.
Best wishes and regards
Mubbashir

Comment by Dr Sanjiv Malik on July 29, 2009 at 1:03am

I couldnt agree more with Michael . Infact the kidney scams that India has seen definitely are a cause of major concern . The other issue that really needs our attention is the issue of surrogate motherhood. While its a boon for couples having medical problems,affluent couples can hire a womb in developing countries for their comfort. I was not able to upload my presentation on ethical issues. If any one is interested in getting that please email me and i will send it back as an attachment.

Comment by Mubbashir on July 23, 2009 at 9:01pm

Dear Mr Michael D Horowitz, MD, MBA, Thanks for sharing with us, some key features of the report. You have mentioned the negative impact factors, "On the other hand, trade in health services in these countries may compromise the availability and quality of care for the general population, exacerbate the divide between rich and poor, foster a false confidence regarding progress in public health, and create an internal brain drain."
What I feel, though these are important aspects, but no one can deny the changing nomenclature of globalization, no one can refuse to be part of it, at the of its preventing tourism (leading industry in most of the top medical tourism provider countries). What we have to learn is that America developed its healthcare from overseas patients or inbound medical tourism to a good extent. and is still enjoying some large revenues. But they did not good control of rise in healthcare costs. which lead to a divide on the similar lines, which you have mentioned.
What is most important for medical tourism solution providers, that they shall not create a double standard pricing, means, PRICE SHALL REMAIN SAME in PUBLIC AND PRIVATE SECTOR. AND SAME FOR MEDICAL TOURISTS IN PRIVATE SECTOR. KEEP THEIR HOSPITALS IN PUBLIC SECTOR AWAY FROM MEDICAL TOURISM. Countries providing medical tourism will still benefit, from increased influx of revenue both in healthcare and tourism sectors. and snow ball effects of those. And certainly the speed of catching some negative impact will be less.
Thanks again for your enlightening report.
Best regards
Mubbashir

• ‹ Previous
• 1
• 2
• 3
• Next ›
• Page