The on-going row between medical bodies and hospitals in Canada over medical tourism is escalating. Ontario could be vulnerable to legal challenge because of medical tourism. Allowing international patients to pay for health care sets Ontario up for a challenge by Canadians who want to do the same. Doris Grinspun of the Registered Nurses’ Association of Ontario, says the practice of some hospitals accepting foreign patients for profit may lead to demands by Canadians to be allowed to pay for private medical care. If Ontario fails to order all hospitals to cease accepting any medical tourists immediately -the nursing union threatens a court challenge over the right to pay out-of-pocket for health care. Inbound medical tourism in Canada is particularly sensitive in certain provinces that do not allow either private healthcare or private health insurance. Medical tourism is a threat to public healthcare because it creates a double standard that could see well heeled Canadians demand to pay out-of-pocket to jump the queue and get quick treatment. The court threat is not as idle as it may sound. In September, British Columbia is headed to court on a legal challenge over patient access to private surgery centres. The union threat is that the legal costs to hospitals and government will more than offset any income they make from a small number of medical tourists. Health Minister Eric Hoskins says international patients can be treated in Ontario hospitals only if zero public dollars are used, domestic patients are not displaced, and any monies made are reinvested into improving care for Ontarians. Hoskins promises a ministry review to look at ways to strengthen the current rules of the universal public health care system. So far in 2014 Sunnybrook Hospital has treated three foreign patients for cancer, two from the Caribbean and one from Europe. At the University Health Network, 75 international patients have been treated; 31 from Libya and the rest from the Caribbean, Middle East and Africa. Dr. Nizar Mahomed of UHN International has defended medical tourism on the basis that what the University Health Network is doing is not medical tourism, but providing care to people who cannot get it at home. Patients from Libya were wounded in that country’s civil war and that their care at UHN is paid for by the Libyan government. The nurses are far from convinced by the statements of politicians or hospitals and argue that treating people from overseas is medical tourism, wherever they come from or why. A head to head clash between the three is now inevitable.