Before the spirits visit Scrooge, he is busily working when men stop by to collect charity for the poor. Scrooge dismisses their efforts and refuses to contribute to the cause, telling the men that he cannot afford to make "idle people merry." Scrooge believes that the poor deserve their situation, assuming that they refuse to work hard. He tells the men that he already pays for them to be contained in "prisons" and "workhouses," and he refuses to contribute anything more.

Tiny Tim breaks through Scrooge's cold and indifferent heart and stirs within him feelings of true empathy. In this young boy, Scrooge sees the real face of poverty, and it conflicts with the stereotypes he has previously held. This innocent and thoughtful child clearly doesn't deserve the fate of prisons or workhouses, and Scrooge's attitude is transformed by observing the way Tiny Tim interacts with his father and his family.

When Scrooge asks the spirit whether Tiny Tim will live, he learns that the little chair in which the boy sits will soon be vacant if the future remains "unaltered." Scrooge protests, begging the spirit to tell him that the child can be spared. He is disheartened to hear his previous words about the poor parroted back to him:

What then? If he be like to die, he had better do it, and decrease the surplus population.

Tiny Tim presents the humanity of poverty, and Scrooge is "overcome with...grief" to think that Tiny Tim might die because of poverty. Scrooge has direct influence over this situation as the employer of Tiny Tim's father, Bob Cratchit.

After the final visit by the spirits, Scrooge becomes a direct influence on Tiny Tim's life and health, becoming known as a "second father" to the young boy. As a result, the boy does not die, proving that Scrooge's transformation has a profound impact on the life of this innocent boy.

Scrooge's stony heart is positively melted by the thought of Tiny Tim's death. That a man who's earned the deserved reputation of a heartless, mean old skinflint should respond like this is an indication of the profound effect that his visits by the various ghosts have had upon him.

The Ghost of Christmas Present, who appraises Scrooge of Tiny Tim's possible death, has had a particularly powerful effect on the old miser. He's shown Ebenezer the grim reality of poverty in London that rich people like himself prefer to ignore. Previously, Scrooge was always so callous when it came to those less fortunate than himself. When two charity collectors came to him for a contribution, he sent them packing with a lecture about the surplus population and how prisons and workhouses were appropriate places for the poor.

However, now that he's seen the reality for himself, he's experienced an almost Damascene conversion to the cause of philanthropy. The prospect of Tiny Tim's imminent death makes Scrooge face his social responsibilities. It also strikes a chord of humanity that we never even thought existed. Scrooge's instinctive reaction to what he sees at the Cratchit house is to hope that Tiny Tim's life will be spared.

Although Scrooge has undoubtedly been strongly influenced by the ghostly visitations, his response to Tiny Tim's possible demise appears to come from deep within his soul, a place that for years has been contaminated by greed and misanthropy. This makes his heartfelt reaction all the more remarkable.

When the Ghost of Christmas Present takes Scrooge to Bob Cratchit's lowly household during Christmas to show him how the poor family celebrates the holiday, Scrooge is enchanted by Tiny Tim and his meek, innocent nature. Despite his frail appearance and limited physical strength, Tiny Tim is a remarkably enthusiastic, compassionate child who brightens the day with his positive energy.

After Tiny Tim remarks, "God bless us every one!," Scrooge asks the Ghost if Tiny Tim will live. The Ghost responds by telling Scrooge that, if things do not change, he sees a vacant seat at the table with an unused crutch in the near future, which indicates that Tiny Tim will surely die. Scrooge reacts with a passionate plea by saying:

No, no . . . Oh, no, kind Spirit! say he will be spared. (Dickens 56)

Scrooge desperately wishes for Tiny Tim to survive and is ashamed about his previous callous comments regarding the "surplus population." Scrooge has been moved by witnessing Tiny Tim's innocent spirit and is beginning to experience a dramatic transformation.

The Ghost of Christmas Present shows Scrooge the Cratchit family's present Christmas and predicts that future holiday celebrations will be minus Tiny Tim.  The boy will die if the Cratchit family's life does not change in the future. 

Scrooge is enchanted by Tiny Tim. The author tells us that he looks at him throughout this visit.  He doesn't take his eyes off the small boy who loves life, even in his physically disabled condition.  Scrooge is a miserable and lonely man who has everything compared to the Cratchit family, yet he is fascinated by Tiny Tim's simple joy.

 "I see a vacant seat," replied the Ghost, "in the poor chimney-corner, and a crutch without an owner, carefully preserved. If these shadows remain unaltered by the Future, the child will die.'' (Dickens) 

"No, no,'' said Scrooge. "Oh, no, kind Spirit! say he will be spared.'' (Dickens) 

"If these shadows remain unaltered by the Future, none other of my race,'' returned the Ghost, "will find him here. What then? If he be like to die, he had better do it, and decrease the surplus population.''  (Dickens)

Scrooge hung his head to hear his own words quoted by the Spirit, and was overcome with penitence and grief.  (Dickens)

In the above passages, Scrooge is deeply saddened by the possibility of Tiny Tim's death.  He feels ashamed by his words that are thrust back at him by The Ghost of Christmas Present. 

In this scene, Scrooge shows sincere grief for the Cratchit family and remorse for his past ways. Witnessing the absence of Tiny Tim at the next Christmas gathering helps him make the connection between his present acts and their imminent consequences. He implores the Ghost to intervene.

When he wakes up from his vision, Scrooge is a changed man. He is overjoyed to learn that it is really not too late and immediately goes about helping others, and in particular the Cratchit family. Both his deeds of charity and his inner joy are clear signs he is a different Scrooge from the "Bah! Humbug" one at the beginning of the story.