Many western industrialized countries are currently suffering from a crisis in health human resources, one that involves a debate over the recruitment and licensing of foreign-trained doctors and nurses. The intense public policy interest in foreign-trained medical personnel, however, is not new. During the 1960s, western countries revised their immigration policies to focus on highly-trained professionals. During the following decade, hundreds of thousands of health care practitioners migrated from poorer jurisdictions to western industrialized countries to solve what were then deemed (...) to be national doctor and nursing 'shortages' in the developed world. Migration plummeted in the 1980s and 1990s only to re-emerge in the last decade as an important debate in global health care policy and ethics. This paper will examine the historical antecedents to this ethical debate. It will trace the early articulation of the idea of a 'brain drain', one that emerged from the loss of NHS doctors to other western jurisdictions in the 1950s and 1960s. Only over time did the discussion turn to the 'manpower' losses of 'third world countries', but the inability to track physician migration, amongst other variables, muted any concerted ethical debate. By contrast, the last decade's literature has witnessed a dramatically different ethical framework, informed by globalization, the rise of South Africa as a source donor country, and the ongoing catastrophe of the AIDS epidemic. Unlike the literature of the early 1970s, recent scholarship has focussed on a new framework of global ethics. (shrink)

This theoretical study examines the ethics of international nurse recruitment from the conceptual framework of stakeholder interests. It argues that there are stakeholders at individual, institutional, national and international levels, with overlapping but, more often, different or even conflicting interests. Depending on the interests of given stakeholders, different conclusions regarding the ethics of international nurse recruitment may be reached. There is no right or wrong with these varying ethical positions because they reflect different beliefs and philosophies that are not amenable (...) to value judgment. To illustrate and support this line of argument, this article analyzes the underpinnings of two ethical standards published by the International Council of Nurses and the UK Department of Health. In addition, a case study on China augments the argument by demonstrating limitations of the one-size-fits-all approach to the issue. The most important question in understanding and evaluating the ethical standards of international nurse recruitment is to know whose interests they are designed to represent and protect. (shrink)