Cosmopolitan theories share a commitment to ignoring geographic boundaries in the application of moral theory. Such theories come in multiple configurations. For example, Cosmopolitan Utilitarians believe in improving aggregated social welfare, regardless of national boundaries. Also, diminishing marginal utility causes them to argue for maximizing healthcare gains among the poorest. Cosmopolitan Prioritarians do not give equal weight to equal benefits but instead give more weight to benefits to the worse off, which will often include the destination country’s poor. Cosmopolitan Sufficientarians are not concerned with improving the lot of the least well-off or achieving equality per se but instead are concerned with ensuring that individuals do not fall below a particular threshold of what is the “currency” of distribution, including health.
Though Cosmopolitan theories offer a strong case for condemning some forms of medical tourism, they face several problems. First, Cosmopolitans do not rely on causation to ground obligations. The mere fact of the destination country’s citizens’ needs creates the obligation to help. Thus, duties may persist even when medical tourism is eliminated or its harms are remedied. Conversely, if these needs are satisfied, there may be no further obligation to restrict medical tourism even where it diminishes healthcare access for the poor. Second, these approaches also face what I call a “self-inflicted wounds problem” because they do not clearly divide negative effects from medical issues that are within the host country’s control. If the home country’s actions are needed to improve the welfare of the destination country’s poor, the home country should act, even if the wound is partially self-inflicted by the destination country’s failure to regulate. Finally, if one must rely on these theories to convince public policymakers to take action on medical tourism, they threaten to prove too much. Addressing the harms caused by medical tourism is a small drop in the bucket in terms of what these theories would ask us to do to right the balance between developed and developing countries.