In this essay, we focus on the moral justification of a highly controversial measure to redress medical braindrain: the duty to stay. We argue that the moral justification for this duty lies primarily in the fact that medical students impose high risks on their fellow citizens while receiving their medical training, which in turn gives them a reciprocity-based reason to temporarily prioritize the medical needs of their fellow citizens.
ABSTRACTOne of the characteristics of the relationship between the developed and developing worlds is the ‘braindrain’– the phenomenon by which expertise moves towards richer countries, thereby condemning poorer countries to continued comparative and absolute poverty. It is tempting to see the phenomenon as a moral problem in its own right, such that there is a moral imperative to end it, that is separate from any moral imperative to relieve the burden of poverty. However, it is not clear (...) why this should be so – why, that is, there is a moral reason to stem the flow of expertise in addition to seeking to improve welfare. In this paper, I examine three explanations of the putative moral aspect of the braindrain. (shrink)
According to the braindrain argument, there are good reasons for states to limit the exit of their skilled workers (more specifically, healthcare workers), because of the negative impacts this type of migration has for other members of the community from which they migrate. Some theorists criticise this argument as illiberal, while others support it and ground a duty to stay of the skilled workers on rather vague concepts like patriotic virtue, or the legitimate expectations of their state (...) and co-citizens. In this article, on the contrary, we suggest that the liberal conception of states’ legitimate political authority demands, and not just permits, that developing states from which migration of skilled workers occurs set up contractual mechanisms. These mechanisms will ensure that state-funded training in the health sector is provided against a commitment on the part of future professionals to reciprocate with their services for the benefits obtained. If one of the conditions for the state to maintain legitimate political authority is to provide basic services such as healthcare to its subjects (while respecting at the same time their autonomy and freedom), then this is what developing states affected by the braindrain ought to do. What we call the authority-based approach to the braindrain also helps to clarify the obligations that other states have not to interfere with these contractual mechanisms when they exist, and not to profit from their absence. Inspired by FIFA’s legal instruments of training compensation and solidarity mechanism for the transfer of players, we conclude by suggesting a plausible global policy to complement this authority-based approach. (shrink)
Theorists concerned about the distributive effects of skilled emigration (braindrain) often argue that its harmful effects can be justly mitigated by restricting emigration from sending countries or by limiting immigration opportunities to receiving countries. I raise moral and practical concerns against restricting the movement of skilled migrants and contend that conceptualizing the moral issue in these terms leads theorists to neglect the moral salience of institutions that determine the distributive effects of migration. Using an analogy to skilled (...) migration in a domestic context, I argue for locating braindrain in a more holistic, institutional context that includes the reform of global institutions and of policies affecting migration. (shrink)
There is a consensus that the effects of medical braindrain, especially in the Sub-Saharan African countries, ought to be perceived as more than a simple misfortune. Temporary restrictions on the emigration of health workers from the region is one of the already existing policy measures to tackle the issue—while such a restrictive measure brings about the need for quite a justificatory work. A recent normative contribution to the debate by Gillian Brock provides a fruitful starting point. In (...) the first step of her defence of emigration restrictions, Brock provides three reasons why skilled workers themselves would hold responsibilities to assist with respect to vital needs of their compatriots. These are fair reciprocity, duty to support vital institutions, and attending to the unintended harmful consequences of one’s actions. While the first two are explained and also largely discussed in the literature, the third requires an explication on how and on which basis skilled workers would have a responsibility as such. In this article, I offer a vulnerability approach with its dependency aspect that may account for why the health workers in underserved contexts would have a responsibility to attend to the unintended side effects of their actions that may lead to a vital risk of harm for the population. I discuss HIV/AIDS care in Zimbabwe as a case in point in order to show that local health workers may have responsibilities to assist the population who are vulnerable to their mobility. (shrink)
The metaphor of “care drain” has been created as a womanly parallel to the “braindrain” idea. Just as “braindrain” suggests that the skilled migrants are an economic loss for the sending country, “care drain” describes the migrant women hired as care workers as a loss of care for their children left behind. This paper criticizes the construction of migrant women as “care drain” for three reasons: 1) it is built on sexist (...) stereotypes, 2) it misrepresents and devalues care work, and 3) it misses the opportunity for a theoretical change about how skills in migration contexts can be understood. (shrink)
In her debate with Michael Blake, Gillian Brock sets out to justify emigration restrictions on medical workers from poor states on the basis of their free-riding on the public investment that their states have made in them in form of a publicly funded education. For this purpose, Brock aims to isolate the question of emigration restrictions from the larger question of responsibilities for remedying global inequalities. I argue that this approach is misguided because it is blind to decisive factors at (...) play in the problem of medical braindrain and consequently distorts the different responsibilities this problem generates. Brock’s strategy, if successful, would effectively lead to punishing emigrating workers from poor states for the free-riding and exploitation that is committed by affluent states – which is a counter-intuitive result. (shrink)
This paper proposes a novel use of tax policy to address one of the most pressing issues arising from economic globalization and international migration, that of “braindrain” – in particular, the migration of certain skilled and highly trained or educated professionals from less and least developed countries to wealthy “western” countries. This problem is perhaps most pressing in relation to doctors, nurses, and other medical professionals, but exists also for teachers, lawyers, economists, engineers, and other highly skilled (...) or trained professionals. While there have been other proposals in the past to use tax policy to address braindrain (most famously versions of the so-called “Bhagwati Tax”, a form of exit tax), in this paper I provide an account of and justification for using tax credits, modeled loosely on the foreign tax credits U.S. citizens receive in certain situations for taxes paid in other countries. My proposal avoids several of the pitfalls of other methods of using tax policy to ameliorate the harms of braindrain, as it does not subject people from the developing world to potentially onerous double taxation, and does not depend on sophisticated tax collection capabilities within developing countries, capabilities which are often lacking. Additionally, my proposal also leads to fewer morally problematic restrictions on the liberty of citizens of less and least developed countries than do non-taxed based alternative proposals, such as temporary bans on migration. While the proposal cannot hope to completely solve the problems that arise in relation to braindrain – no approach can do this – it does provide a straightforward way to ameliorate the problems that arise from it without placing significant financial or liberty burdens on already less advantaged people from the developing world. -/- (This paper may be downloaded for free from the link to my SSRN page below). (shrink)
This article focuses on two questions regarding the movement of persons across international borders: (1) do states have a right to unilaterally control their borders; and (2) if they do, are migration arrangements simply immune to moral considerations? Unlike open borders theorists, I answer the first question in the affirmative. However, I answer the second question in the negative. More specifically, I argue that states have a negative duty to exclude prospective immigrants whose departure could be expected to contribute to (...) severe deprivation in their countries of origin. Countries have a right to unilaterally control their borders, but their exercise of this right is constrained by the demands of morality. (shrink)
This chapter criticizes policies that aim to restrict the emigration or immigration of skilled workers, analyzes the ethics of recruitment, and proposes basing an ethics of skilled migration based on the violation of negative duties not to uphold unjust institutions.
In this paper I first argue that when answering the question of whether or not governments may restrict emigration, Brock and Blake are staking out positions not astronomically far from one another. Despite the ostensibly large philosophical gap between the two, both think that certain governments may restrict emigration when such restriction is agreed to in a morally binding contract. Secondly, both authors think that there are specific “circumstances” or “conditions” under which a contract that restricts emigration can be morally (...) binding. This second part of the paper will pose some questions that explore these various circumstances or conditions. The ultimate aim of the paper is to help point the debate in the right direction so as to further develop an answer to the question of whether or not governments may restrict emigration. (shrink)
This article considers one seemingly compelling justification for immigration restrictions: that they help restrict the braindrain of skilled workers from poor states. For some poor states, braindrain is a severe problem, sapping their ability to provide basic services. Yet this article finds that justifying immigration restrictions on braindrain grounds is far from straightforward. For restrictions to be justified, a series of demanding conditions must be fulfilled. Braindrain does provide (...) a successful argument for some immigration restrictions, but it is an argument that fails to justify restrictions beyond a small minority of cases. (shrink)
Recent reports published by the United Nations and the World Health Organization suggest that the braindrain of healthcare professionals from the developing to the developed world is decimating the provision of healthcare in poor countries. The migration of these key workers is driven by a combination of economic inequalities and the recruitment policies of governments in the rich world. This article assesses the impact of the healthcare braindrain and argues that wealthy countries have a (...) moral obligation to reduce the flow of healthcare workers from the developing to the developed world. (shrink)
In Debating BrainDrain, Gillian Brock and Michael Blake both draw on a liberal moral- political foundation to address the issue, but they come to different conclusions about it. Despite the common ground of free and equal persons having a dignity that grounds human rights, Brock concludes that many medical professionals who leave a developing country soon after having received training there are wrong to do so and that the state may place some limits on their ability to (...) exit, whereas Blake infers that there is neither any wrongdoing on their part, nor rightful restrictions placed on them. In this article, rather than sort out which has the better interpretation of what liberalism entails, I consider the medical braindrain in light of an alternative normative framework, one informed by ideals of communion salient in the sub-Saharan moral tradition. I argue that a principle of prizing communal relationships more naturally entails Brock's conclusions than does her appeal to liberalism. (shrink)
Next SectionAccess to medicines, vaccination and care in resource-poor settings is threatened by the emigration of physicians and other health workers. In entire regions of the developing world, low physician density exacerbates child and maternal mortality and hinders treatment of HIV/AIDS. This article invites philosophers to help identify ethical and effective responses to medical braindrain. It reviews existing proposals and their limitations. It makes a case that, in resource-poor countries, ’locally relevant medical training’—teaching primarily locally endemic diseases (...) and practice in scarcity conditions, training in rural communities and admitting rural students preferentially—could help improve retention. Locally relevant training would arguably diminish medical braindrain in five ways. It would (i) make graduates less attractive for Western employers, (ii) align graduates’ expectations with actual practice, diminishing ‘burn-out’, (iii) enhance the professional prestige of local practice, (iv) hold rotations in, and recruit applicants from, rural areas, which is known to improve retention there, and (v) create local career development options that attract practitioners to stay. Such educational reform may raise worries about poor-quality care, breach of the freedom of education and occupation, breach of the freedom of movement, unequal distribution of opportunities among students, hypocrisy and resistance from influential actors. We address these worries. (shrink)
Health-worker migration, commonly called "medical braindrain", refers to the mass migration of trained and skilled health professionals from low-income to high-income countries. This is currently leaving a significant number of poor countries, particularly in sub-Saharan Africa, with critical staff shortages in the healthcare sector. A broad consensus exists that, where medical braindrain exacerbates such shortages, it is unethical, and this review presents the main arguments underpinning this view. Notwithstanding the general agreement, which policies are (...) justifiable on ethical grounds to tackle braindrain and how best to go about implementing them remains controversial. The review offers a discussion of the specific ethical issues that have to be taken into account when deciding which policy measures to prioritise and suggests a strategy of policy implementation to address medical braindrain as a matter of urgency. (shrink)
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 'braindrain', 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)
Braindrain, the migration of skilled labor out of less-developed countries, is an especially acute problem in the medical sector. Countries in the global South face enormous shortages of health-care workers. The most direct solution, to train more doctors and nurses, does not solve the problem because so many of those who are trained move to the global North to take advantage of higher salaries and an improved standard of living. Because we live in a world with porous (...) boundaries and integrated economies, it is incumbent on us to think through questions that arise because of structural factors that benefit the already wealthy and developed economies at the expense of impoverished and struggling economies. Medical .. (shrink)
Unter den Menschenrechten findet sich das Recht eines jeden, den Staat zu verlassen, in dem man geboren ist oder sich gerade aufhält. In jüngerer Zeit wird insbesondere unter Verweis auf verheerende Effekte eines Brain-Drain insbesondere für ärmere Staaten die Frage diskutiert, ob Staaten dennoch das Recht haben, direkte oder indirekte Maßnahmen zu ergreifen, um Personen an der Emigration zu hindern. Der vorliegende Beitrag analysiert die in diesem Kontext vorgebrachten Argumentationen für mögliche Grenzen eines Rechts auf Emigration und die (...) Legitimation staatlicher Gegenmaßnahmen. Die meisten vorgeschlagenen direkten und indirekten Maßnahmen zur Abwehr eines normativ relevanten Brain-Drain werden dabei als Formen der Zwangsausübung als nicht rechtfertigbar zurückgewiesen: Der Brain-Drain ist als Folge gravierender globaler Ungerechtigkeiten einzuordnen, für die die Verantwortung nicht einzelnen Hochqualifizierten aus dem globalen Süden zugeschrieben werden kann, die die Gelegenheit nutzen, ihre individuelle Situation zu verbessern. (shrink)
Patrick J. Carr and Maria J. Kafalas, Hollowing Out the Middle: The Rural BrainDrain and What It Means for America Content Type Journal Article DOI 10.1007/s10806-010-9266-2 Authors Doug Seale, 21 Turner Ridge Road Marlborough MA 01752 USA Journal Journal of Agricultural and Environmental Ethics Online ISSN 1573-322X Print ISSN 1187-7863.
Many of the most skilled and educated citizens of developing countries choose to emigrate. How may those societies respond to these facts? May they ever legitimately prevent the emigration of their citizens? Gillian Brock and Michael Blake debate these questions, and offer distinct arguments about the morality of emigration.
A number of philosophers argue that the earth’s resources belong to every- one equally. Suppose this is true. Does this entail that people have a right to migrate across borders? This article considers two models of egalitarian ownership and assesses their implications for immigration policy. The first is Equal Division, under which each person is granted an equal share of the value of the earth’s natural resources. The second is Common Ownership, under which every person has the right to use (...) the earth’s natural resources, but not the right to exclude others from them. While these models and their associated ideas have a long history within Western political thought, this article will examine them as they are presented by two sets of contemporary philosophers: Hillel Steiner, who defends Equal Division, and Michael Blake and Mathias Risse, who defend Common Ownership. In the case of each model, the article does three things. First, it considers the implications of the model for immigration policy. Second, it defends the model against objections from those defending immigration restrictions. Third, it contends that the model does not go far enough in its opposition to immigration restrictions. More specifically, the article argues that both Equal Division and Common Ownership, as presented by their proponents, fail to respect the claims of people whose interest in the land is not primarily economic. If the earth belongs to everyone equally, then people should not be prevented from pursuing important migratory goals such as family reunification, career development and education. The article concludes with a proposal for com- bining Equal Division with Common Ownership. Under this combined model, peo- ple would be free to migrate across international borders. (shrink)
Several contributions in this book tell of doctors’ increasing emigration from developing countries where they are in critical shortage, especially from the underserved rural and public sectors of countries in sub-Saharan Africa and South Asia. They point out the severe harm from that migration to some of the world’s poorest and sickest populations who have no other doctors to turn to, and gain little from their emigration. Since significant harm to the badly off is bad, decline in that migration is (...) usually a good development. But how to strive to achieve it? (shrink)