Case Study   Tom is a 3-year-old boy who is being flown to the United States from a small village i

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Case Study


Tom is a 3-year-old boy who is being flown to the United States from a small village in Nigeria to correct a birth defect, spina bifida occulta. The flight and surgery were arranged through a local church missionary group whose members travel to underserved regions worldwide.


One of the missionary group’s members is a pediatric neurosurgeon who arranged for the surgery to be conducted at a large metropolitan hospital where he is chief of surgery. The surgery will be performed at no cost from either the physician or the hospital. The hospital’s immediate postoperative follow-up care and inpatient rehabilitation will also be provided by the hospital at no cost to the patient or his family.

The nursing staff at the hospital have begun to refer to these types of patients as “medical tourists” because they fly in and then leave to go back to their countries. Most nurses believe that they have the same responsibilities for care when treating foreign nationals without immigration status in the United States.

However, one of the nurses, Becky, strongly believes that these “medical tourists” are using resources that could be much better used for the underserved in the United States. She often expresses her opinion whenever the opportunity arises. She is on the hospital’s Policy and Procedure Committee. She has been insisting that these foreigners be required to provide proof of sufficient medical coverage and ability to pay before undergoing treatment in her hospital. She quotes many studies that show that the U.S. healthcare system has a difficult time providing adequate services to a large portion of its population. She stresses that even the Affordable Care Act has no provision for the care of noncitizens.

She also notes that there seems to be no one responsible for long-term care when these patients return to their country of origin. Often they live in poverty in their rural villages, where there is an underdeveloped healthcare system. Who will provide for Tom’s future care? What if he has a shunt placed to treat increased intracranial pressure, a common complication of the surgery, by draining the excess cerebrospinal fluid? Who in his village knows enough to provide care if the shunt becomes blocked? Small villages in the rural areas of Nigeria lack even basic sanitary conditions and qualified health care providers.

Critical Thinking Questions

How do you feel about expending limited resources on those who are not U.S. citizens and live in other countries when they cannot afford their care? Do you agree with Becky or the other nurses? Why?
Should the hospital concentrate on allocating its resources to U.S. citizens, the population for which they are most responsible?
What ethical principles are involved in limiting care to foreign nationals without insurance? What if they did have insurance or a source of funding that could pay for their care?





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