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When worlds intersect: practical and ethical challenges when caring for international patients in the NICU

Journal of Perinatology volume 35, pages 982–984 (2015)Cite this article

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Pediatric health care has become increasingly globalized, even in the neonatal intensive care unit (NICU).1 Health-care teams from industrialized countries frequently provide pediatric care in poorer resource settings. Conversely, families sometimes travel across the globe to pursue specialized medical care for their infant or child that is otherwise unavailable in their country of origin, including neonatal intensive care.1, 2, 3, 4 Worldwide, over the past 2 decades there has been a rapid increase in ‘medical tourism’ or ‘international medical travel’ (IMT). Improved access to health-care information online and lowered transportation costs have contributed to an increase in IMT.5 Recognizing entrepreneurial opportunity, health-care institutions have also started to actively recruit patients outside their domestic markets.6

Opportunities for high quality pediatric care through IMT can be extremely beneficial for some patients and families. They may receive a diagnosis formerly not known to them or a treatment becomes available which substantially improves the quality of life or is even curative. For other patients and families, however, such opportunities may lead to sub-optimal outcomes, posing unique practical and ethical challenges. Differences in culture, language and values can all contribute to potential miscommunication and misalignment of expectations, possibly leading to disappointment, frustration or even moral distress for all parties involved. Such cross-cultural challenges are not unique to international patients, but can be compounded by additional factors, including unfamiliarity with the US health-care system, misaligned expectations and great distances away from home without necessary support systems.

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Acknowledgements

We would like to thank members of the International Office, Interpreter Services, Social Work Department, Chaplaincy and the Ethics Advisory Committee at Boston Children’s Hospital for their invaluable input during PERCS Rounds, as well as Robert Truog, MD and Deborah White, RN for thoughtful review.

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Author notes

  1. T Langer and C L Cummings: These authors are co-first authors.

Authors and Affiliations

  1. Institute for Professionalism and Ethical Practice, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    T Langer & E C Meyer

  2. Children’s Hospital, Helios Centre Wuppertal, Witten/Herdecke University, Witten,, Germany

    T Langer

  3. Division of Newborn Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    C L Cummings

  4. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    E C Meyer

Authors
  1. T Langer
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  2. C L Cummings
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Correspondence to C L Cummings.

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The authors declare no conflict of interest.

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Langer, T., Cummings, C. & Meyer, E. When worlds intersect: practical and ethical challenges when caring for international patients in the NICU. J Perinatol 35, 982–984 (2015). https://doi.org/10.1038/jp.2015.106

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