Stem cell tourism is a small but growing part of the thriving global medical tourism marketplace. Much stem cell research remains at the experimental stage, with clinical trials still uncommon. However, there are over 700 clinics estimated to be operating in mostly developing countries – from Costa Rica and Argentina to China, India and Russia – that have lured many patients, mostly from industrialized countries, driven by desperation and hope, which in turn continue to fuel the growth of such tourism.While (...) much research has focused on such dimensions as the promotions that allow such businesses to make their services known, media coverage, some patient research, and regulatory conditions for developing country clinics, little attention has been paid to the non-affected members of the general population, the future potential users of such services. This empirical study based on five focus group discussions with a diverse group of healthy adults in a Canadian city, explored participant views of patients who use stem cell tourism services, the likelihood they would avail themselves of such services if they were to suffer similar illnesses, and the conditions under which they might do so, and the impact that admonitions and advice from international expert bodies might have on their decisions. Our findings suggest that these healthy adults are sympathetic to the drivers of hope and desperation, and, despite cautions about research limitations, may seek such treatments themselves under similar conditions. These findings are discussed in the context of the policy and ethical issues raised by this form of medical tourism. (shrink)

A subcategory of medical tourism, reproductive tourism has been the subject of much public and policy debate in recent years. Specific concerns include: the exploitation of individuals and communities, access to needed health care services, fair allocation of limited resources, and the quality and safety of services provided by private clinics. To date, the focus of attention has been on the thriving medical and reproductive tourism sectors in Asia and Eastern Europe; there has been much less consideration given to more (...) recent ‘players’ in Latin America, notably fertility clinics in Chile, Brazil, Mexico and Argentina. In this paper, we examine the context-specific ethical and policy implications of private Argentinean fertility clinics that market reproductive services via the internet. Whether or not one agrees that reproductive services should be made available as consumer goods, the fact is that they are provided as such by private clinics around the world. We argue that basic national regulatory mechanisms are required in countries such as Argentina that are marketing fertility services to local and international publics. Specifically, regular oversight of all fertility clinics is essential to ensure that consumer information is accurate and that marketed services are safe and effective. It is in the best interests of consumers, health professionals and policy makers that the reproductive tourism industry adopts safe and responsible medical practices. (shrink)

Culture is a key resource for tourism. Any destabilisation of a local culture makes a destination less attractive for visitors. It is therefore in the interest of tour providers to protect and re-stabilise culture. There is great need for such efforts with regard to indigenous cultures, which are endangered worldwide. In this chapter, it is being elaborated why tourism needs to employ policies that ensure the maintenance of indigenous cultures. In their idiosyn-cratic physical appearance, which, in tropical areas, is (...) often unclothed, indigenous persons would have a slim chance to be acknowledged as citizens. This situation contrasts sharply with some basic claims of the global culture. (shrink)

Reproductive tourism is a manifestation of a larger, more inclusive trend toward globalization of capitalist cultural and material economies. This paper discusses the development of cross-border assisted reproduction within the globalized economy, transnational and local structural processes that influence the trade, social relations intersecting it, and implications for the healthcare systems affected. I focus on prevailing gender structures embedded in the cross-border trade and their intersection with other social and economic structures that reflect and impact globalization. I apply a social (...) connection model of responsibility for unjust outcomes and consider strategies to counter structural injustices embedded in this industry. The concluding section discusses policy reforms and proposals for collaborative action to preclude further injustices and extend full human rights to all. (shrink)

The article is a presentation and analysis of the main provisions of 16 works of the world's leading experts on religious tourism and pilgrimage, published in a special issue of the International Journal of Religious Tourism and Pilgrimage. 2020. Vol.8. This special issue was dedicated to the impact of the COVID-19 pandemic on religious tourism, and in particular pilgrimage, in the world. Religious tourism has a strong socio-cultural potential and demand - it is the value status of any person who (...) feels the need for cultural, religious and recreational facilities important for spiritual, ideological and physical existence. It is also the availability of opportunities to meet the social and cultural needs of people in tourism services, because it has such a socio-cultural characteristic as a social practice that changes a person and positions him in the social space. Religious tourism became in the XXI century. significant, socially significant phenomenon. But the current pandemic has dealt a very painful blow to the entire tourism sector of the world economy, including religious tourism. Under the influence of the pandemic, the country banned pilgrimage. So the question arose: what's next? Is there a radical transformation of the religious life of mankind, including religious tourism? Isn't this the beginning of the end of religions, as some sociologists of the past predicted? This article is devoted to finding answers to these and other, no less complex, questions. The author set a goal - based on the analysis of the latest research on the impact of the COVID-19 pandemic on religious tourism to identify and present those important points that are already relevant for religious tourism in Ukraine, as well as those that are just beginning to appear and will be relevant in the post. -pandemic era. In almost all articles of this Special Issue, the authors emphasized that religious tourism and pilgrimage are very sustainable and will meet the challenges posed by the pandemic. The question for the religious tourism and pilgrimage industry is how they will develop and transform new approaches that will help the growth strategies of key stakeholders. However, due to pandemic restrictions, it may not be possible to resume travel to holy sites and pilgrimage sites and trails without the assistance of national governments, international agencies, and relief organizations. Thus, the authors predict that the religious tourism industry will face very difficult circumstances in the near future. All articles in the special issue of this journal express extremely relevant, deep and valuable opinions of scientists, which make us all think about what lessons Ukraine should learn about religious tourism, and in particular pilgrimage, and what should be its state policy and public opinion in this regard. further. And the author in the conclusions expresses her point of view on the content of these lessons, based on the views set out in this article of the world's best experts in religious tourism and pilgrimage. (shrink)

Organ availability for transplantation has become an increasingly complex and difficult question in health economics and ethical practice. Advances in technology have seen prolonged life expectancy, and the global push for organs creates an ever-expanding gap between supply and demand, and a significant cost in bridging that gap. This article will examine the ethical implications for the nursing profession in regard to the procurement of organs from an impoverished seller’s market, also known as ‘Transplant Tourism’. This ethical dilemma concerns itself (...) with resource allocation, informed consent and the concepts of egalitarianism and libertarianism. Transplant Tourism is an unacceptable trespass against human dignity and rights from both a nursing and collective viewpoint. Currently, the Australian Nursing and Midwifery Council, the Royal college of Nursing Australia, The Royal College of Nursing (UK) and the American Nurses Association do not have position statements on transplant tourism, and this diminishes us as a force for change. It diminishes our role as advocates for the most marginalised in our world to have access to care and to choice and excludes us from a very contemporary real debate about the mismatch of organ demand and supply in our own communities. As a profession, we must have a voice in health policy and human rights, and according to our Code of Ethics in Australia and around the world, act to promote and protect the fundamental human right to healthcare and dignity. (shrink)

The use of organs obtained from executed prisoners in China has recently been condemned by every major transplant organization. The government of the People's Republic of China has also recently made it illegal to provide transplant organs from executed prisoners to foreigners transplant tourists. Nevertheless, the extreme shortage of transplant organs in the U.S. continues to make organ transplantation in China an appealing option for some patients with end-stage disease. Their choice of traveling to China for an organ leaves U.S. (...) transplant programs with decisions about how to respond to the needs of patients who return after transplantation. By discussing two cases that raised this dilemma, we argue for upholding medicine's commitments to traditional principles of beneficence and nonjudgmental regard in sorting out the policies that a transplant program should adopt. We also explain how position statements that aim for the high ground of moral purity fail to give appropriate weight to the needs and suffering of present and future patients in the U.S. and in China. (shrink)

Medical tourism is a practice, whereby individuals travel across national borders with the intention of receiving medical care. Medical tourists are motivated to travel abroad by a number of factors, including the affordability of care abroad, access to treatments not available at home, and wait times for care at home. In this article, we share the findings of interviews conducted with 32 Canadian medical tourists with the aim of developing a better understanding of medical tourism, the ethical issues it raises (...) for public health within Canada and other source countries for medical tourists, and to identify research gaps and policy responses to this practice. While patient and academic perspectives overlap in several regards, we suggest areas in which academic consideration of the ethical issues raised by medical tourism can be informed by patient perspectives. (shrink)

This book provides a detailed insight into the amalgamation of the healthcare and hospitality sector, which brought forward the concept of healthcare tourism or medical tourism. There have not been comprehensive resources in this particular area. The available quality resources focus on the Western world. Countries like India are an upcoming and one of the most favored destinations for medical tourism, and this trend is going to increase exponentially in the coming years. This book is developed in a very simple (...) and lucid manner to enable even a layman to grasp the key components of the healthcare and hospitality sector at different levels and gradually link it to the present scenario where factors like accreditation, health insurance, corporatization, and public policy make an impact. Scholars in these sectors attempt to provide the recent trends and prospects supported with updated information. Therefore, it can solve the problem of a single source of detailed information relevant to different yet interconnected industries with a focus on developing countries. (shrink)

While the clinical promise of much stem cell research remains largely theoretical, patients are nonetheless pursuing unproven stem cell therapies in jurisdictions around the world—a phenomenon referred to as “stem cell tourism.” These treatments are generally advertised on a direct-to-consumer basis via the Internet. Research shows portrayals of stem cell medicine on such websites are overly optimistic and the claims made are unsubstantiated by published evidence. However, anecdotal evidence suggests that parents are pursing these “treatments” for their children, despite potential (...) physical and financial risk. Physicians are in a unique position as they can be expected to be involved in, or privy to, such decisions. In this paper, we consider what duties physicians may have toward minor patients whose parents/guardians wish to engage in stem cell tourism on their behalf. We use the Canadian perspective to address the broadly relevant issues raised by this trend. (shrink)

Social sustainability is in its early stages in hospitality and tourism supply chains, especially in developing countries. This research draws on institutional and stakeholder theories to identify the adopted social sustainability practices in Egypt and to determine the factors affecting their implementation. A mixed-method research approach is followed involving interviews of hotel managers and a literature-based questionnaire answered by a total of 187 practitioners from hospitality and tourism supply chains in Egypt. The interviews revealed that social sustainability practices in the (...) two hotels' supply chains are adopted but limited to legal requirements and brand policies. Statistical analysis indicated that local suppliers boost the adoption of social practices. All the studied barriers show very weak correlation with the adoption of social sustainability practices; according to the interviews, this does not imply barriers inexistence, but rather reflects lack of awareness regarding social rights in a culture that tend to preserve social conservatism. The enablers explained significant variations in many social sustainability practices (53 out of 62). This study is unique since it offers a novel approach by linking institutional and stakeholder theories to recognize weaknesses in tourism supply chain social sustainability, thereby providing directions for the future design of sustainable tourism policies. (shrink)

For centuries pilgrimages are present in Christianity. For Catholics, the importance of devotions and visits to the Marian sanctuaries is indisputable. The number of visitors and pilgrims to these temples make the local economy an important destination of religious tourism. In order to understand the economic determinants of religious tourism, two sanctuaries were studied, namely, Aparecida and Fatima. Given the large collection of statistical information of the Portuguese Sanctuary, it was verified through the Vector Autoregressive model that Gross Domestic Product (...) and Unemployment have a causal unidirectional relation with the pilgrimages. The Autoregressive Distributed Lag model revealed that an increase in Gross Domestic Product and international arrivals in the short term positively impacts the number of pilgrims. Through the Ordinary Least Squares regression, significant statistical relationships between climatic factors and visitors in the Sanctuary of Fatima were found. The Seasonal Autoregressive Integrated Moving Average forecast method was applied to the number of monthly visitors to the Sanctuary of Aparecida and to the number of pilgrims in the Sanctuary of Fatima, the results show a strong seasonality and that the first and last months of the year are periods of low demand. The results of this study allow a new look at religious tourism in the Marian context, the empirical results allow those responsible for establishing public policies, tourism agents and the administration of the Sanctuaries to direct their actions. Measures planned and executed jointly between the various agents can benefit residents, visitors, pilgrims, the tourism sector, the local economy and the Sanctuaries themselves. (shrink)

Sustainable tourism is essential to improving the preservation of cultural property since it encourages ethical travel, helps local communities, and raises money for conservation initiatives. It guarantees the preservation of cultural treasures for future generations while promoting awareness and appreciation of them. In this paper, the relationship between sustainable tourism practice, environmental policies, tourist education, community involvement, tourism revenue allocation, and cultural heritage preservation were evaluated using structural equation modeling (SEM) analysis. Five hypotheses were developed and the dataset (...) includes 232 respondents. A systematic questionnaire with a Likert scale rating was used to evaluate the data. As a result, latent construct validity and reliability were examined, and the structural model evaluated the connections between the constructs in the context of the suggested hypotheses. The structural model revealed that EP, STP, and TE are positively connected to the CHP, providing support for hypothesis 1: Cultural Heritage Preservation and Sustainable Tourism Practice (CHP→STP) and 3:Cultural Heritage Preservation and Environmental Policies (CHP→EP) are well supported and show no significant changes to enhancing heritage preservation. (shrink)

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding (...) of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy. (shrink)

Next SectionReproductive medical tourism is by some accounts a multibillion dollar industry globally. The seeking by clients in high income nations of surrogate mothers in low income nations, particularly India, presents a set of largely unexamined ethical challenges. In this paper, eight such challenges are elucidated to spur discussion and eventual policy development towards protecting the rights and health of vulnerable women of the Global South.

Source: Author: Ahamed Lebbe Mohamed Aslam Nowadays, policy makers believe that the tourism is a positive tool for economic growth of nations because which helps to economies of countries by several ways. In Sri Lankan experience it was not statistically confirmed. The aim of this study was to test the nexus between the tourism earnings and the gross domestic product in Sri Lanka. To test this nexus this study used time series data during the period of 1970 to 2014, and (...) employed the multiple regressions model. In this study, the gross domestic product in constant price was used as dependant variable and exchange rate, foreign remittance, tourism earning, and inflation rate were considered as independent variables. Based on the regression outcomes, this study found that the tourism positively maintained the nexus on the gross domestic product in Sri Lanka at five percent significant level. ]]>. (shrink)

This paper explores the notions of hope and how individual patient autonomy can trump carefully reasoned ethical concerns and policies intended to regulate stem cell transplants. We argue that the same limits of knowledge that inform arguments to restrain and regulate unproven treatments might also undermine our ability to comprehensively dismiss or condemn them. Incautiously or indiscriminately reasoned policies and attitudes may drive critical information and data underground, impel patients away from working with clinical researchers, and tread needlessly (...) on hope, the essential motivator of patients, advocates and researchers alike. We offer recommendations to clinicians and health care providers to help balance the discourse with individuals seeking treatment while guarding against fraud, misconception, and patient harm. (shrink)

Amongst the latest, and ever-changing, pathways of death and dying, “suicide tourism” presents distinctive ethical, legal and practical challenges. The international media report that citizens from across the world are travelling or seeking to travel to Switzerland, where they hope to be helped to die. In this paper I aim to explore three issues associated with this phenomenon: how to define “suicide tourism” and “assisted suicide tourism”, in which the suicidal individual is helped to travel to take up the option (...) of assisted dying; the legality of assisted suicide tourism, particularly in the English legal system where there has been considerable recent activity; and the ethical dimensions of the practice. I will suggest that the suicide tourist—and specifically any accomplice thereof—risks springing a legal trap, but that there is good reason to prefer a more tolerant policy, premised on compromise and ethical pluralism. (shrink)

This paper explores the notions of hope and how individual patient autonomy can trump carefully reasoned ethical concerns and policies intended to regulate stem cell transplants. We argue that the same limits of knowledge that inform arguments to restrain and regulate unproven treatments might also undermine our ability to comprehensively dismiss or condemn them. Incautiously or indiscriminately reasoned policies and attitudes may drive critical information and data underground, impel patients away from working with clinical researchers, and tread needlessly (...) on hope, the essential motivator of patients, advocates and researchers alike. We offer recommendations to clinicians and health care providers to help balance the discourse with individuals seeking treatment while guarding against fraud, misconception, and patient harm. (shrink)

Persons with serious and disabling medical conditions have traveled abroad in search of stem cell treatments in recent years. However, weak or nonexistent oversight systems in some countries provide insufficient patient protections against unproven stem cell treatments, raising concerns about exposure to harm and exploitation. The present article, the first of two, describes and analyzes stem cell tourism in Russia and India and addresses several scientific/medical, ethical, and policy issues raised by the provision of unproven stem cell-based treatments within them. (...) The distinction between treatment based on proven clinical research and "innovative treatment" is addressed and the authors conclude that the innovations at issue constitute neither. Regulatory measures need to be developed or strengthened in accord with internationally accepted standards in such countries to protect those seeking stem cell treatments. (shrink)

I. Glenn Cohen’s Patients with Passports: Medical Tourism, Law, and Ethics offers a thorough examination of the growing practice of medical tourism, the legal regulations governing it, and the many ethical issues it raises for policy-makers, health care providers, and prospective medical tourists. Demonstrating mastery of the relevant literatures in the social sciences, law, ethics, and political philosophy, Cohen provides a comprehensive overview of the current practice of medical tourism, and offers well-argued, sensible policy advice to guide its reform. Cohen’s (...) book is a significant achievement of interdisciplinary scholarship and is essential reading for scholars and policy-makers. Medical... (shrink)

This paper researches and analyzes the evaluation of the competitiveness of ice and snow tourism, uses the improved fuzzy neural network algorithm to process the system flow diagram of ice and snow tourism development through the function and characteristics of the power system of ice and snow tourism, and finally selects more than 40 indicators of the three subsystems of resources, economy, and culture. Based on the construction of cloud fuzzy neural network model, the above method is used for experimental (...) comparison analysis, and experiments are conducted through University of California Irvine dataset and engineering examples to compare with the traditional cloud model, fuzzy neural network, and BP neural network to analyze the operation efficiency, accuracy rate, and several rules of the algorithm. Through the experimental comparative analysis, the cloud fuzzy neural network can fully take into account the randomness and fuzziness of the data, optimize the generation of cloud rules, avoid multidimensional rule disasters, and ensure the operational efficiency of the algorithm; the accuracy rate of the algorithm is improved relative to that of the traditional technology, and it applies to a variety of datasets. And the software is used to test the ice and snow tourism industry system dynamics model to realize the correctness and robustness testing of the model. After the constructed model can reflect the real situation within the error range, the final policy simulation of the model is carried out. (shrink)

'Trade in Health is a timely reflection on the interface of economics with the ethics and public policy facets of the international movement of patients. Health issues such as these are at the forefront of modern political economy."National" health is increasingly less so. Reisman's previous scholarship in this area is brought to bear in an insightful and eminently readable and engaging fashion. In an area where uncovering the facts is more difficult than "decyphering the Dead Sea Scrolls", such a reflective (...) work on the critical aspects of political economy helps to fill a void in considering whether such trade is likely to be in the interests of patients, nations and the global community. In addition to the rosy picture of healthy and wealthy tourists having a sojourn for medical care during a vacation, Reisman is not afraid to tackle the thorny issues concerning trade in organs, eggs and even death, in this sobering and comprehensive volume. It is a rare skill to bring the luminaries of Smith, Marshall, Mill and Confucius to bear on such a contemporary tale! International travel by patients is at the nexus of a revolution in global health. It is driving and affecting aspects of foreign investment, health worker migration and e-health provision. Reisman skilfully links these foundations of health care, and as such provides critical text for consideration by those seeking to build and strengthen future health systems. Trade in Health is an excellent overview. It provides critical insights for those new to the area as well as new information and challenges for those of us involved for a number of years.' - Richard Smith, Professor of Health Ssytem Economics and Dean of Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK. Once exports and imports meant agriculture and industry. In the global economy and the electronic age, trade is also expanding into the service sector. This timely book closely examines trade in health. It documents the growth of a cross-national service that in the past was mainly consumed at home. Following from his highly successful book Health Tourism, Professor David Reisman offers a comprehensive and searching multidisciplinary account of the way in which medical services, patients, capital and professionals are making up a global healthcare economy that crosses borders. He reflects on their pursuit of lower prices, better quality and a differentiated product, and suggests that public policy is essential if the ethical capital of interdependent societies is not to be eroded by the international market in health and care. Written in a concise and lucid form, this original book will be of great interest to all people interested in the internationalization of health care. Combining theory and empirical evidence from economics, tourism and medical care, scholars involved in health policy and social administration will find much of significance in this authoritative study. (shrink)

Purpose: The main aim of this study was to examine the influence of organizational culture on strategy implementation in Kenya Government Tourism Agencies. Materials and Methods: The study used a positivist approach research philosophy. The research designs employed in this study were explanatory and descriptive research designs. The study population comprised of the tourism industry. The study included the ministry of tourism itself since it is the parent ministry that regulates and oversees the operations of the tourism agencies to give (...) a total of 10 areas of study. A sample of 327 was achieved based on the following formula. This study used primary data. The study used questionnaires and interview guides to collect both qualitative and quantitative data. Quantitative data was analyzed through scientific methods using the statistical package for social sciences (SPSS version 22) while qualitative data was analyzed thematically. The descriptive statistics was first used to analyze the demographic factors of the respondents using frequencies and charts. Inferential statistics such as correlation and multiple linear regression analysis were used to test the relationship among the variables as per the study hypothesis. Findings: The culture of an organization was found to play a critical role in implementation of strategies and consequently realizations of set objectives and profits in organizations. Organizational norms, ethics, employee training and organizational climate are very key in achieving success while implementing strategies. Implications to Theory, Practice and Policy: It is recommended that organizations (tourism industry) create strategy implementation promoting culture, culture of timeliness, innovative culture, ethics and one which promotes team spirit. These aspects of culture need to be reinforced and strengthened to ensure implementation of strategies is smooth and quick enough. This study thus bridges the gap between theory and practice, offering a nuanced understanding of the interplay between organizational culture and strategy implementation in a critical sector for Kenya's economy. (shrink)

The article reveals some approaches to the notion of the balance between “life and work”. There are given constituents of the notion “work and life”, also we offered basic orientations of policy in achievement the correspondent balance, analyzed possible consequences of establishment/violation for a person or business, in particular for enterprises in the tourism and hospitality sphere. There are given and analyses survey results of the specialists in tourist enterprises concerning the balance between working and free time. Several kinds (...) of organizational culture are outlined and given monitoring results on these kinds in tourist agencies of Dnipropetrovs’k and Dnipropetrovs’k region. We determined that adherence of the employees of recreational enterprises to their working places depends on their awareness of the possibility in achievement in the working place the balance between working and free time. Secondly, we found out that employer’s help was more important than family support as to reducing stress and leveling industrial conflicts. Thirdly, there exist significant dependence between employee turnover in tourist and some other enterprises and unbalancing between «public» and «individual». There is emphasized the role of organizational culture in finding the compromise between public and private, and given recommendations as to its reinforcement. (shrink)

The analysis of the operation of tourism companies will provide valid information for the design of policies to reactivate the tourism industry, which has been strongly affected during the pandemic generated by COVID-19. The objective of this paper is to use soft computing techniques to analyse tourism companies in Ecuador. First of all, dimensionality reduction methods are applied: principal component analysis, isometric feature mapping and locally linear embedding, on data of tourism enterprises in Ecuador for the year 2015. In (...) addition, to verify the trend of operational variables, the data of tourism companies in Ecuador in 2019 and 2020 are analysed with dimensionality reduction methods that improve the interpretation by minimizing the loss of information. The data sets are analysed with k-means, k-medoids and Hierarchical Clustering, generating groups according to similar characteristics. The optimal number of clusters is determined with the following: Elbow Method, Silhouette Coefficient, Davies-Bouldin Index and Dunn Index. In addition, an analysis of the operation of tourism companies in the year 2020 concerning previous years is included. The study allows exploring Soft Computing techniques to identify important information for the definition of strategies that contribute to an effective reactivation of the tourist industry of Ecuador. (shrink)

This paper examines the effect of the image of destinations on the wage income of resident households, and the corresponding income inequality, from a novel perspective. This work uses China’s excellent tourism city image program, which is an urban planning policy implemented by the central government across cities to enhance the image of the city destination in the minds of tourists, and then promote tourist motivation and local tourism development to assess the effect on household wage income and its (...) distribution. Results show that the program significantly increases household wage income by increasing employment opportunities, promoting business and population agglomeration, and improving urban infrastructure. Additionally, the image of the city destination promotion causes an increase in income inequality among households. (shrink)

Individuals are at risk of acquiring untreatable agents of infection when they travel to countries where antibiotic-resistant agents of infection are prevalent, and particularly when they travel for healthcare. Uncertainty with respect to the overall political and economic consequences seems to underlie the reluctance of public health authorities to issue relevant travel advisories. The conditions of choice, the act of choice and the consequences of choice can each be a primary focus of ethical appraisal of public health policy. The ‘value (...) of choice’ account provided by Scanlon draws attention to the value of the choices that individuals are given, and the potential for reasonable rejection of policies that do not give adequate emphasis to the conditions of individual choice. There is both instrumental and symbolic value in informing people of the risk of acquisition of antibiotic-resistant microbes associated with health tourism. We cannot reasonably reject a principle of actively informing unless there are insurmountable countervailing reasons. These reasons should be explicit and subject to review. If health tourism is a concern then we might also consider how best to facilitate alternative choices. (shrink)

Despite the wide and daunting array of cross-cultural obstacles that the formulation of a global policy on advance directives will clearly pose, the need is equally evident. Specifically, the expansion of medical services driven by medical tourism, just to name one important example, makes this issue urgently relevant. While ensuring consistency across national borders, a global policy will have the additional and perhaps even more important effect of increasing the use of advance directives in clinical settings and enhancing their effectiveness (...) within each country, regardless of where that country's state of the law currently stands. One cross-cultural issue that may represent a major obstacle in formulating, let alone applying, a global policy is whether patient autonomy as the underlying principle for the use of advance directives is a universal norm or a construct of western traditions that must be reconciled with alternative value systems that may place lesser significance on individual choice. A global policy, at a minimum, must emphasize respect for patient autonomy, provision of medical information, limits to the obligations for physicians, and portability. And though the development of a global policy will be no easy task, active engagement in close collaboration with the World Health Organization can make it possible. (shrink)

Despite the wide and daunting array of cross-cultural obstacles that the formulation of a global policy on advance directives will clearly pose, the need is equally evident. Specifically, the expansion of medical services driven by medical tourism, just to name one important example, makes this issue urgently relevant. While ensuring consistency across national borders, a global policy will have the additional and perhaps even more important effect of increasing the use of advance directives in clinical settings and enhancing their effectiveness (...) within each country, regardless of where that country's state of the law currently stands. One cross-cultural issue that may represent a major obstacle in formulating, let alone applying, a global policy is whether patient autonomy as the underlying principle for the use of advance directives is a universal norm or a construct of western traditions that must be reconciled with alternative value systems that may place lesser significance on individual choice. A global policy, at a minimum, must emphasize respect for patient autonomy, provision of medical information, limits to the obligations for physicians, and portability. And though the development of a global policy will be no easy task, active engagement in close collaboration with the World Health Organization can make it possible. (shrink)

National, European, and international institutions should implement social policies to help the persons with disabilities. Strategic sectors include education, training, and work, with the equal protection of the laws. In addition, this essay is focused on another crucial “sector" that is part of the primary law, which include tourism along with public transportation and non-discrimination. In conclusion, legislators, and public institutions, as well as transport companies must comply the principles of accessibility, equality, and social justice for the social inclusion (...) of persons with disabilities. (shrink)

This paper explores the notions of hope and how individual patient autonomy can trump carefully reasoned ethical concerns and policies intended to regulate stem cell transplants. We argue that the same limits of knowledge that inform arguments to restrain and regulate unproven treatments might also undermine our ability to comprehensively dismiss or condemn them. Incautiously or indiscriminately reasoned policies and attitudes may drive critical information and data underground, impel patients away from working with clinical researchers, and tread needlessly (...) on hope, the essential motivator of patients, advocates and researchers alike. We offer recommendations to clinicians and health care providers to help balance the discourse with individuals seeking treatment while guarding against fraud, misconception, and patient harm. (shrink)

ABSTRACTDespite the wide and daunting array of cross‐cultural obstacles that the formulation of a global policy on advance directives will clearly pose, the need is equally evident. Specifically, the expansion of medical services driven by medical tourism, just to name one important example, makes this issue urgently relevant. While ensuring consistency across national borders, a global policy will have the additional and perhaps even more important effect of increasing the use of advance directives in clinical settings and enhancing their effectiveness (...) within each country, regardless of where that country's state of the law currently stands. One cross‐cultural issue that may represent a major obstacle in formulating, let alone applying, a global policy is whether patient autonomy as the underlying principle for the use of advance directives is a universal norm or a construct of western traditions that must be reconciled with alternative value systems that may place lesser significance on individual choice. A global policy, at a minimum, must emphasize respect for patient autonomy, provision of medical information, limits to the obligations for physicians, and portability. And though the development of a global policy will be no easy task, active engagement in close collaboration with the World Health Organization can make it possible. (shrink)

Effective stakeholder engagement and inclusive governance are essential for effective and equitable ocean management. However, few cross-national studies have been conducted to examine how stakeholders’ economic and cultural benefit perceptions influence their support level for policies focused on ocean preservation. The current study aims to fill this gap by employing the Bayesian Mindsponge Framework (BMF) analytics on a dataset of 709 stakeholders from 42 countries, a part of the MaCoBioS project funded by the European Commission H2020. We found that (...) economic and cultural benefit perceptions are generally negatively associated with the policy support level. Regarding economic aspects, stakeholders considering transportation and shipping, renewable energy generation, and oil and gas provision as the most crucial benefits their countries’ oceans provide tend to obtain less support for policies focusing on ocean preservation. Meanwhile, for cultural aspects, perceiving recreation and tourism, aesthetic pleasure, mental health and well-being support, and sense of identity provision as the most important benefits provided by the country’s ocean are negatively associated with the policy support level. The perceived economic, cultural, and environmental tradeoffs when supporting policies focused on ocean preservation were discussed. Recommendations for improving the effective management of multi-use marine space are also provided to reduce the perceived competing interests among stakeholders. (shrink)

The study offers new insights by examining the influence of personality traits on tourists' intentions to visit ecotourism sites using the lens of the theory of planned behavior. It also investigates whether environmental knowledge moderates the effect of extraversion, neuroticism, and environmental concern on tourists' ecotourism intentions. We applied structural equation modeling on 350 responses collected through the Amazon M-Turk platform. Results highlight that extroverts are more likely to express ecotourism intentions than neurotic tourists. However, it was also noted that (...) neurotic tourists' intention to visit ecotourism sites could be influenced if their environmental concerns were emphasized. The study offers important new insights to managers, policy-makers, and practitioners about the roles of personality traits, environmental knowledge, and environmental concern vis-a-vis their relative significance in shaping tourists' decision-making and choices for ecotourism sites. As a result, managers/practitioners need to devise specific communication strategies to enhance awareness and a sense of responsibility among neurotic tourists. (shrink)

Counterfactual thinking is presumed to play a preparatory function in promoting people’s behavioural intentions. This study specifically addresses the impacts of COVID-19 severity, tourists’ counterfactual thinking about the pandemic, and tourists’ perceived duty-free consumption value on the effect of a duty-free policy on travel intentions. Four hundred and ten participants took part in this study, which involved a 2 × 2 design. Results reveal the following patterns: compared to the absence of a duty-free policy in tourist destinations, enactment of (...) a duty-free policy leads to stronger visit intentions through greater perceived value and the effect of a duty-free policy on travel intention is moderated by tourists’ counterfactual thinking and COVID-19 severity. (shrink)

BackgroundIn 2004, patient advocate groups were major players in helping pass and implement significant public policy and funding initiatives in stem cells and regenerative medicine. In the following years, advocates were also actively engaged in Washington DC, encouraging policy makers to broaden embryonic stem cell research funding, which was ultimately passed after President Barack Obama came into office. Many advocates did this because they were told stem cell research would lead to cures. After waiting more than 10 years, many of (...) these same patients are now approaching clinics around the world offering experimental stem cell-based interventions instead of waiting for scientists in the US to complete clinical trials. How did the same groups who were once the strongest supporters of stem cell research become stem cell tourists? And how can scientists, clinicians, and regulators work to bring stem cell patients back home to the US and into the clinical trial process?DiscussionIn this paper, we argue that the continued marketing and use of experimental stem cell-based interventions is problematic and unsustainable. Central problems include the lack of patient protection, US liability standards, regulation of clinical sites, and clinician licensing. These interventions have insufficient evidence of safety and efficacy; patients may be wasting money and time, and they may be forgoing other opportunities for an intervention that has not been shown to be safe and effective. Current practices do not contribute to scientific progress because the data from the procedures are unsuitable for follow-up research to measure outcomes. In addition, there is no assurance for patients that they are receiving the interventions promised or of what dosage they are receiving. Furthermore, there is inconsistent or non-existent follow-up care. Public policy should be developed to correct the current situation.ConclusionThe current landscape of stem cell tourism should prompt a re-evaluation of current approaches to study cell-based interventions with respect to the design, initiation, and conduct of US clinical trials. Stakeholders, including scientists, clinicians, regulators and patient advocates, need to work together to find a compromise to keep patients in the US and within the clinical trial process. Using HIV/AIDS and breast cancer advocate cases as examples, we identify key priorities and goals for this policy effort. (shrink)

The problem of the concept of Ukraine’s state economic policy of regulation of human resources international movement in the context of global intellectualization remains topical throughout the existence of Ukraine as an independent state. It should be noted that the favorable geopolitical position of Ukraine provides potential opportunities for the development of both regions and the state as a whole, creates conditions that are associated with the involvement in international migration, tourism and transit and professional processes. Their number increases in (...) modern conditions of globalization development. The analysis of features of Ukraine's participation in the processes of intellectualization of the human resources international movement demonstrates the necessity of developing the state economic policy of the human resources international movement, which would become part of the global space and have certain benefits. (shrink)

Data about flow rate, fishing intensity, and expenditures made by anglers can be used to capture some of the recreational value of waterways in economic terms in a way that avoids a number of the weaknesses of the most commonly used tools such as the contingent valuation method. Furthermore, recreational fishing may spur more economic activity than competing uses of riverine flows such as agriculture. This suggests that potential opportunity cost in regards to recreation ought to be a factor considered (...) in management decisions. (shrink)

Machine generated contents note: Introduction. -- Acknowledgments. -- The Author. -- 1 Ethical Theories and Bioethics in a Global Perspective. -- Theories of Ethics. -- Are Theories of Ethics Global? -- Can Theories of Ethics Encourage People to Do the Right Thing? -- 2 Autonomy and Informed Consent in Global Perspective. -- Ethical Principles and Practical Issues of Informed Consent. -- Does Informed Consent Really Matter to Patients? -- Is Informed Consent a Universal Principle or a Cultural Value? -- 3 (...) Withholding or Withdrawing Treatment and Physician-Assisted Suicide. -- Withholding or Withdrawing Treatment at the End of Life. -- Assisting Patients in Committing Suicide. -- 4 Ethical Issues in Reproductive Health. -- Ethics of Abortion in Different Times, Places, and Cultures. -- Current Ethical Issues in Abortion. -- Assisted Reproductive Technology and Stem Cell Research. -- Emergency Contraception. -- Ethics of Imposing Conditions on Funding. -- 5 Ethical Issues of Female Genital Mutilation. -- The Facts About FGM. -- FGM as a Challenge to Ethical Relativism. -- Ethics of FGM for Adult Women. -- 6 Ethical Issues of Research with Human Subjects. -- Background Information and the Belmont Report. -- Autonomy and Voluntary Informed Consent. -- Beneficence and Cost-Benefit Analysis. -- Issues of Justice and Fairness for Human Subjects. -- 7 The Right to Health Care, and Ethical Obligations to Provide Care. -- Is There an Ethical Right to Health Care? -- Ethical Obligations of Health Care Professionals. -- Ethical Obligations of for-Profit Health Care Providers. -- 8 Ethical Issues in Rationing and Allocation of Limited Resources. -- Levels of Allocating Resources. -- Methods of Rationing Health Resources. -- Comparative Effectiveness Research and Cost-Effectiveness Analysis. -- 9 Ethical Issues of Health Insurance and Health System Reform. -- Ethical Issues in Financing Health Services and Designing Insurance Systems. -- Fundamental Values of Health Systems. -- 10 Ethical Issues in the Movement of Patients Across National Borders. -- Ethical Duties to Provide Health Care to Undocumented Aliens. -- Ethical Issues in Medical Tourism. -- 11 Ethical Issues in the Movement of Health Care Professionals Across National Borders. -- Ethical Issues in the Migration of Health Professionals. -- Proposed Solutions and Their Ethical Implications. -- Fair Treatment of Health Care Workers from Other Countries. -- 12 Corruption and Informal Payments in Health Systems. -- Payment of Informal Fees by Patients and Their Families. -- Is Corruption Bad for Your (and Other People's) Health? -- References. -- Index. (shrink)

Space configuration of industrial heritage sites, which have been adaptively reused, are modeled in the depth map. Simultaneously, by using in-situ observation the actual patterns of pedestrian movement in these sites are captured. Finally, the results of simulated patterns and actual patterns are compared and interpreted. Findings show a notable impact of built heritage on the natural movement's patterns. Consequently, the significance of determinative factors of natural movement in these sites differs from regular sites. Therefore, this exception could develop a (...) tourism policy towards these sites. By acknowledging the fact that the functions of selected case studies are not the same, yet those are the only adaptive reuse practice of industrial heritage in that region. This paper aims to assess the possible impact of built heritage as an influential attraction on distribution patterns of natural movement and develop natural movement theory in these sites. The use of natural movement theory, which provides accurate data that proves the impact of industrial heritage scientifically, is the main indicator of this research. this theory has not been used as an exact tool to identify the behavioral-movement attributes of heritage and needs some consideration to be applied in cultural heritage sites. (shrink)

The COVID-19 pandemic has deeply influenced the tourism and hospitality industry, and it has also reshaped people’s travel preferences and related behaviors. As a result, how prospective travelers perceive travel constraints and their effects on future travel behaviors may have changed to some extent. Besides, such perception arguably varies across gender. Therefore, this research examines the interplay between travel constraints, gender, and travel intentions for facilitating robust tourism recovery by revisiting the Leisure Constraints Model from a gender perspective. Data were (...) collected through a survey from 357 Malaysian prospective travelers. By conducting path analysis and multigroup analysis, it is found that structural and interpersonal constraints impose indirect effects on travel intentions, and gender moderating the effect of structural cost on intrapersonal constraints and effect of intrapersonal constraints on travel intentions. Based on these findings, this research provides theoretical and practical implications into how to adjust their marketing strategies and travel products during the era of “new normal” for tourism policy makers, destination marketers, and related businesses. (shrink)

The pursuit of unproven stem cell-based interventions is an emerging issue that raises various concerns. Physicians play different roles in this market, many of which engage their legal, ethical and professional obligations. In Canada, physicians are members of a self-regulated profession and their professional regulatory bodies are responsible for regulating the practice of medicine and protecting the public interest. They also provide policy guidance to their members and discipline members for unprofessional conduct.

The emergence of COVID-19 places the economy at risk of recession or worst, depression. A sharp decline in the country’s economic growth is primarily caused by the weak consumption of locals and non-existence of foreign tourists in the country. On the other hand, disruptions of the supply chain in the manufacturing and retails sectors make the situation much worse. With clear uncertainties in mind, government agencies must lay down economic policies, monetary and fiscal, that would boost the confidence of (...) the consumers and producers. Lastly, a clear and coordinated efforts of the national and local government together with economic agencies of the country must be present at this time of the pandemic. (shrink)

This article examines shifts in educational and social governance taking place in Queensland, Australia, through Education Queensland's Industry School Engagement Strategy and Gateway Schools program. This significant educational initiative is set within the context of Queensland's social investment agenda first articulated in its education policy framework, Queensland State Education-2010. The article traces the historic extension of this overarching governmental strategy through establishment of the Gateway Schools concept, brokering state-wide industry-school partnerships with key global players in the Queensland economy. Industry sectors (...) that have formed partnerships in Gateway projects include Minerals and Energy, Aerospace, Wine Tourism, Agribusiness, Manufacturing and Engineering, Building and Construction and ICT, with more industries and schools forecast to join the program. It is argued that this ‘post-bureaucratic’ model of schooling represents a new social settlement of neoliberal governance, which seeks to align educational outcomes with economic objectives, thereby framing the conditions for community self-governance in Queensland. (shrink)

The major part of India’s architectural heritage is to be found in its towns. This paper will, after an historical survey, look at the various agencies that over the last two decades have been concerned with urban heritage, to examine their agenda, and the pressures they face. ‘Heritage cities’ is a term which appears not only in documents of the Archaeological Survey of India and of the Indian National Trust but also, more recently, in statements made by the Ministry of (...) Urban Development, the Government of Delhi in the context of the Commonwealth Games, and the Ministry of Tourism. The paper will discuss ‘preservation’ of facades/interiors of individual buildings, or of precincts, the use/reuse of historic areas/buildings, and the references to history, through commemoration, naming/renaming, erasing. It argues that conservation should be part of a holistic and humane town-planning policy. (shrink)

Public access to the commons is often restricted, thus leading to implicit regulations. This is relevant toward spatial systems, as an important geographical issue is access to various sites over space, and this paper presents varying degrees of accessibility in different places. There is a dialectic struggle to enhance access to the commons as a fundamental right of the public, with the need to balance tourism and recreational uses of coastal resources with conservation and preservation eff orts. This paper will (...) aid policy makers and those concerned with beach access in Connecticut better understand the nature and complexity of how citizens and officials within coastal municipalities have come to perceive, in a collective sense, their beaches/ municipal parks as common property resources to be utilized for recreational purposes while balancing environmental conservation efforts simultaneously. Various legal frameworks, as well as federal and state efforts in coastal zones in key states, in addition to historically recent court cases in Connecticut resulting in legal enhancements toward increasing public access to nonresidents of specific municipalities, have shaped who can and who cannot access the commons. (shrink)

The use of organs obtained from executed prisoners in China has recently been condemned by every major transplant organization. The government of the People's Republic of China has also recently made it illegal to provide transplant organs from executed prisoners to foreigners transplant tourists. Nevertheless, the extreme shortage of transplant organs in the U.S. continues to make organ transplantation in China an appealing option for some patients with end-stage disease. Their choice of traveling to China for an organ leaves U.S. (...) transplant programs with decisions about how to respond to the needs of patients who return after transplantation. By discussing two cases that raised this dilemma, we argue for upholding medicine's commitments to traditional principles of beneficence and nonjudgmental regard in sorting out the policies that a transplant program should adopt. We also explain how position statements that aim for the high ground of moral purity fail to give appropriate weight to the needs and suffering of present and future patients in the U.S. and in China. (shrink)