MEDICAL crowdfunding has seen a huge growth in the last five years not only in India but the world over. The rising, prohibitive cost of healthcare – especially when it involves hospitalization and treatment of rare diseases – has triggered this global phenomenon. But does crowdfunding for medical expenses raise ethical issues?

Of course, in India, poor access to healthcare is a well known malaise – 55 million Indians were pushed into poverty in 2011-12 due to out-of-pocket medical expenses according to a 2018 report by Public Health Foundation of India. This fact alone often forces patients and their families to raise funds for medical treatment they cannot afford. If this provides adequate funds to improve the health outcomes of patients from underprivileged backgrounds, it should be a good thing.

But, raising funds for medical expenses online is not the purview of the poor alone. People from varied socio-economic backgrounds turn to medical fundraising sites such as GiveIndia to pay exorbitant hospital bills.

In fact, medical crowdfunding can in itself be viewed as discriminatory as it is not something that can be done by those with little access to or knowledge of the digital world and no social networks to whom they can turn to when they need financial help for medical treatment. Patients from economically disadvantaged families have to be fortunate enough to find themselves in a hospital that is collaborating with medical fundraising sites to avail the benefits of this growing trend. Besides, crowdfunding for medical expenses usually cover costs of private healthcare rather than give back the costs borne by the public healthcare system.

There is another issue – the ‘crowd’ itself or donors who want to help the needy to access healthcare they require, often for urgent medical interventions like transplants, chemotherapy, paediatric emergencies or complications of rare diseases. Out of the hundreds of appeals on social media and web-based ads, how does the donor choose which patient is most worthy of their benefaction?

Many contributors are drawn to the visual appeal of the medical fundraising campaigns that they see online. Others are moved by the storytelling skills of the fundraiser. But is that fair? Should financial help for medical treatment be available only for those patients who are photo-friendly or whose tale of dire need and suffering catches people’s imaginations and arouses more sympathy? Shouldn’t funding for healthcare emergencies be equitable and if necessary prioritised according to the urgency and severity of the case rather than be based on its popularity with netizens?

Also, at a time when tech giants such as Facebook and Google are under scrutiny for impinging on people’s privacy, crowdfunding for medical expenses requires almost full disclosure of the patient’s details including their name, medical condition, family status, etc so that a compelling, believable story can be woven for ‘the crowd’. And long after the fundraising is over, all the data of the patient and their families remain online, freely available to the public. Is that ethical?

There are other issues such as safety and efficacy concerns of the medical procedures being offered by private healthcare providers to patients whose families are desperate to cling on to any hope for their loved one’s survival. So they may agree to treatments that have not been tested or are even fraudulent. And what happens to the funds raised if the patient dies before they can be used?

But in a country like India, where the wealth and health care gap is a grim reality for millions, the ability to raise funds for medical treatment from an online community of contributors comes as a boon to many. So despite concerns about the ethics of medical crowdfunding,  it is here to stay for the foreseeable future.