Hidalgo offers a novel and interesting defence of the active recruitment of health workers by organisations based in the developed world.1 His conclusions are highly controversial and run directly counter to those drawn by a large number of bioethicists, empirical researchers and national and international organisations interested in the issue of health worker migration.The debate about the effects of the migration of healthcare professionals began in earnest in the 1970s. During this decade a number of researchers argued that migration flows (...) from the developing to the developed world were detrimental to poorer countries and suggested that policies ought to be put in place to both retard the flow of migration and compensate countries for the negative effects of any ongoing migration.2 However, some researchers have recently argued that the migration of healthcare workers has many positive effects.3 This is because migration encourages human capital investment, leads to large scale flows of remittances back to source countries, encourages the transfer of knowledge, innovations and best practice, and improves trade relations. Clemens even argues that the net effects of migration are positive—which implies that the so called …. (shrink)

Many organisations in rich countries actively recruit health workers from poor countries. Critics object to this recruitment on the grounds that it has harmful consequences and that it encourages health workers to violate obligations to their compatriots. Against these critics, I argue that the active recruitment of health workers from low-income countries is morally permissible. The available evidence suggests that the emigration of health workers does not in general have harmful effects on health outcomes. In addition, health workers can immigrate (...) to rich countries and also satisfy their obligations to their compatriots. It is consequently unjustified to blame or sanction organisations that actively recruit health workers. (shrink)

This paper evaluates an argument for immigration restrictions that appeals to the costs that immigration imposes on the citizens of a recipient state. According to this argument, citizens have associative duties to protect each other’s interests, immigration can damage these interests in certain cases, and the associative duties between compatriots justify immigration restrictions in these cases. Call this: the partiality argument for immigration restrictions. I argue that the partiality argument is unsound. Immigration restrictions violate negative duties to refrain from interfering (...) with people’s liberties and these duties silence compatriots’ associative duties to one another. Furthermore, I argue that compatriots lack associative duties to one another in virtue of the fact that the relationships between compatriots reliably cause injustice to outsiders. (shrink)

Hidalgo1 argues that, contrary to widespread belief, active recruitment of health workers ‘generally refrains from enabling harm or facilitating wrongdoing’. In this commentary, I argue that the case is not yet convincing. There are a number of problems with the argument, only some of which I can sketch here. These include: Hidalgo gives an insufficient account of the relevant harms that are inflicted when healthcare workers emigrate. Relatedly, he does not take account of the underlying causes of migration and what (...) might assist in remedying the situation. He thus fails to catalogue a wide range of losses that are born when health workers emigrate from developing countries and fails to appreciate how his recommendations undermine some of the constructive initiatives that might assist poor, developing countries. Hidalgo misrepresents the situation in developing countries, incorrectly describing government funding of tertiary education as some kind of gift, rather than an investment in creating important human capital to provide for citizens’ needs, which can mean that fair returns on investment are quite justified. With the correct descriptions in place, the grounding for various duties to reciprocate is rendered secure. There are some important problems with the empirical studies cited such that they do not provide support for Hidalgo's argument.I begin with the case for . There are large disparities in life prospects between developing and developed countries. Indeed, this wide disparity is one of the main reasons healthcare workers want to leave in the first place. If that is the main reason healthcare workers seek to exit, it is not insignificant what would address the causal, underlying problems. How do we promote prosperity in developing countries? A lively debate on this topic flourishes. However, one factor that has widespread support from all sides of the debate is that the quality of …. (shrink)

Hidalgo's paper is a clear and powerful contribution to a topic of ongoing concern.1 It should be taken seriously by anyone who worries that there is something seriously wrong with the flow of medical expertise from the poor countries of the South to the rich countries of the North because it forces open the question of just what that wrongness is supposed to be. Being unable to identify the moral problem about migration will not make the problem about poor health (...) in the South go away, of course: and it might be that, if we are genuinely concerned to keep expertise in the South, we simply have to face up to the possibility of subsidising the wages …. (shrink)

This brief commentary reappraises the issue of emigration of physicians from developing countries to developed countries. A methodological framework is developed for assessing the impact of physician emigration on population health outcomes. The evidence from macro and micro studies suggest that developing countries especially in sub-Saharan Africa would benefit from regulating physician emigration because the loss of physicians can lower quality of healthcare services and lead to worse health outcomes. Further discussion is contained in an e-letter: http://jme.bmj.com/content/early/2013/05/30/medethics-2013-101409/reply.