There is a consensus that the effects of medical brain drain, 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)

In a recent paper, Mpofu, Sen Gupta, and Hays attempt to outline the obligations of recruiting high-income countries and would-be emigrant health workers to tackle the effects of mass exodus of health workers from underserved regions. They reconstruct Rawlsian and Kantian global justice approaches to argue for moral obligations of HICs and an individual justice approach to point to non-enforceable social responsibilities of HWs to assist their compatriots. This critical commentary demonstrates that the argumentation within their individual justice approach is (...) problematic on the basis of three reasons: their discussion under-theorizes and undervalues individual rights and more specifically the right to exit, their argumentation in the latter part, even if problematically, does rather point to moral obligations in lieu of social responsibilities of HWs, and they overlook many other important freedoms, interests, and values pertinent to the issue of retention. (shrink)

This study is devoted to the ways and means to justify a ‘more’ cosmopolitan realization of certain policy implications, in the case of immigration. The raison d’être of this study is the idea that the contemporary debate over open borders suffers from indeterminate discussions on whether liberal states are entitled to restrict immigration. On the other hand, most of the liberal cosmopolitan accounts neglect the detrimental consequences of their open borders argument – which take it as a means to compensate (...) people in need –, such as brain drain and the effects of brain drain on the opportunity sets of members of sending countries. Therefore I offer a moral cosmopolitan account of immigration which takes the interests of would-be immigrants, the residents in receiving, along with the residents in sending countries in respect to their opportunity sets because of the way arbitrary border control represents the inequality of opportunity. I do not provide a well-formed immigration policy here, yet I believe the account provided here is more feasible in considering phenomena such as brain drain. (shrink)

This chapter explores the anti-colonial narrative potential of certain works of cinema taking Aguirre, the Wrath of God and Caché as a case in point. To do so, this chapter first and mainly draws upon the theoretical and normative lens put forward by Gayatri Chakravorty Spivak on the representation of the colonized other and her resulting political and intellectual call for self-reflection on one's privileged Western intellectual positioning. This lens has many normative implications for the ways in which the colonized (...) subject and colonial history are discussed and represented. The partial lack of representation of the colonized other in Aguirre, the Wrath of God leaves the subjectivity of the colonizer in crisis and madness. Second, the narrative of Caché is explored and it is suggested that it resembles the rhetoric of Foucauldian disciplinary power of surveillance turned upside-down thus enforcing the complicit of colonialism to question her privilege. (shrink)

This doctoral thesis within applied ethics consists of four articles together with a cover essay. All articles concern the ethics of skilled health worker emigration from under-served and resourcepoor regions, often referred to as ‘medical brain drain’. Methodologically, the thesis utilizes normative ethical theory to analyse the justifiability of temporary or long-term emigration restrictions, such as compulsory health service programmes, that are employed by developing countries with the aim of safeguarding their needs for health care provision. Such programmes restrict the (...) mobility of individual health workers and give rise to conflicts between different types of rights and interests. -/- The ethics of skilled worker emigration warrants an exploration of the ethical implications of such restrictive programmes for different stakeholders, such as the under-served countries and health workers; and a clarification of the rights and duties of the concerned parties. This thesis provides a thorough analysis and clarification of such rights restrictions and offers theoretically and empirically grounded recommendations as to how they ought to be managed. Rights theory and accounts of individual responsibilities are employed to assess the acceptability of restrictive health service programmes. -/- In brief, the thesis (a) discusses the conditions under which individual health workers may have responsibilities to attend to the basic health needs of a population, (b) explicates the rights at stake such as the freedom of movement and the right to exit, (c) offers insight into what it means to restrict one’s right and its implications and (d) suggests ways for conflicting rights and interests to be balanced and resolved. Taken together, the thesis presents a nuanced approach towards individual responsibilities in under-served contexts and an improved understanding of the right to exit as well as the implications of restricting the right. The thesis also contributes to the ethics of skilled worker emigration with a discussion on the responsibilities of skilled workers when the other parties do not fulfil their fair share of responsibilities. (shrink)

There is a recent interest in the ethics of high-skilled worker emigration through which the limitations of the right to exit are discussed. Insightful arguments have been made in favour of the emigration restrictions on skilled workers in order to tackle the deprivations in developing countries. However, there is still a need for clarification on how we can understand, discuss and implement limitations of a right from a normative perspective. Significantly, how we understand the limitation of a right might determine (...) how we approach such limitations – both in terms of the process of assessing the limitations and in terms of their implications. In this paper, I identify two distinct ways to understand limitations of the right to exit with respect to losses associated with health worker emigration, while also pointing to their implications for restrictive policies: as a matter of scope, and as a matter of weight or emergency, which requires a compensatory scheme for the individual right holders. While the emergency restrictions seem to be a point of convergence in the literature, what defines an emergency and the nature of the compensation still warrant exploration. To that end, I also discuss from a normative perspective what might constitute a public emergency that would give states a prima facie prerogative to regulate temporary limitations on the exercise of the right to exit. In addition, I briefly introduce the implications of emergency restrictions, with a particular focus on compensatory schemes for individual right holders. (shrink)

One of the ways to address the effects of skilled worker emigration is to restrict the movement of skilled workers. However, even if skilled workers have responsibilities to assist their compatriots, what if other parties, such as affluent countries or source country governments, do not fulfil their fair share of responsibilities? This discussion raises an interesting problem about how to think of individual responsibilities under partial compliance where other agents (including affluent countries, developing states, or other individuals) do not fulfil (...) their fair share of responsibilities. What is fair to expect from them? Taking health worker emigration as a case in point, I discuss whether the individual health workers’ fair share of responsibilities to address basic health care needs decreases or increases when the other parties do not fulfil their share. First, I review the responsibilities that different stakeholders may hold. Second, I argue that there are strong reasons against increasing or decreasing health workers’ fair share of responsibilities in a situation of partial compliance. I also argue that it is unfair for non-complier states to enforce health workers to fulfil their fair share or take up the slack. (shrink)

The contributors to this issue offer applied critical and normative perspectives on central, yet overlooked, ethical aspects of migration management with a certain cosmopolitan lance in some capacity. However, cosmopolitanism might mean different things for transnational migration. It can refer to “political cosmopolitanism” that provides the reasons for why there should be certain global institutions governing migration. It can also refer to “moral cosmopolitanism” that simply represents a moral concern for individual rights and interests first and foremost. Cosmopolitanism can also (...) work as a lens that is based on a scepticism towards using the nation-state as the ultimate unit or locus of analysis. These perspectives are not mutually exclusive, and the contributions in this special issue accommodate a form of cosmopolitan outlook or stance to some extent in their discussion on migration management practices. (shrink)

Compulsory (health) service contracts have recently received considerable attention in the normative literature. The service contracts are considered and offered as a permissible and liberal alternative to emigration restrictions if individuals relinquish their right to exit via contract in exchange for the state‐funded tertiary education. To that end, the recent normative literature on the service programmes has particularly focused on discussing the circumstances or conditions in which the contracts should be signed, so that they are morally binding on the part (...) of the skilled workers. However, little attention is devoted to the relevance of the right to exit for the debate on compulsory service programmes. In this paper, I argue that even if the service contracts are voluntary, and thus the would‐be medical students voluntarily relinquish their right to exit, the reasons behind the right should be taken into account for the contracts to be morally valid. A clear understanding of the right to exit is a must in order not to breach its basic components and for the service contracts to be morally binding. To that end, I provide two accounts of the reasons to value the right to exit by presenting Patti Lenard's discussion of the right to exit and by reconstructing James Griffin's account of human rights. I conclude by offering brief ethical considerations for compulsory health service programmes grounded in the reasons to value the right to exit. (shrink)