W10- Physician Brain Drain Eyal & Hurst/ Hidalgo

Question 1

Physician brain drain international problem

Answer 1

the emigration/ immigration of medical professionals away from the country of citizenship/ where they were education- drain from where they are most needed leaving a severe shortage

Question 2

Brain drain domestic problems

Answer 2

from rural to urban areas in the same country even in AUS

Question 3

Why do they migrate?

Answer 3

1. Huge difference pay/ working conditions
2. Don’t have the resources in country of origin to do what they were trained to do
3. Safety/ better facilities for research

Question 4

Key ethical questions

Answer 4

1. Should developed countries restrict health care workers from entering?
2. Should developing countries allow their medical professionals to seek employment abroad?

Question 5

Positive duties

Answer 5

assert that we must do something ie we might have a positive duty to benefit someone

Question 6

Negative duties

Answer 6

assert that we must refrain from doing something ie we must not harm others of interfere with corresponding rights – eg not interfere with right of freedom of movement

Question 7

PBD issue

Answer 7

physicians immigrating to richer countries (for higher salaries etc) threatens access to medicines, vaccination + health care in resource poor settings.
dev world- fewer amount of physicians exacerbates child + maternal morality and hinders treatment of AIDS wants to find a way to combat shortage of physicians diminish brain drain

Question 8

Eyal and hurst argument

Answer 8

• In resource poor countries “locally relevant medical training” (teaching about local endemic diseases + practice in scarcity conditions) + training in rural communities + admitting rural students preferentially – could help improve retention

Question 9

Locally relevant training

Answer 9

1. Make graduates less attractive for western employers by making their skills more relevant for work in under resourced areas and less relevant for work in the private sector in the Western world.
2. Align gradates expectations with actual practice diminishing burn out
3. Enhance the professional prestige of local practice
4. Hold rotations in + recruit applicants from rural areas
   Create local career development options that attract health workers to stay with the potential for new career options

Question 10

Eyal and hurst objections

Answer 10

1. To implement this reform would be to prevent students + physicians from excising their freedom of movement preventing their autonomy?
2. To force medical students to stay and work in local needs areas is illiberal
3. if we force people to stay where they are and they aren’t fulfilled with the amount they are earning – they may be pressured to engage in illegal surgical activities potentially harming more people by engaging in illegal activities

Question 11

Eyal and Hurst Rebuttals

Answer 11

1. illiberal solution may be justified as it is in aim of saving lives of many individuals which should be the primary concern – to become a medical physician is to help others. If you make the decision to become a doctor – you are making a decision to take on that role- they accept and comply
2. rather than forcing people to stay, they could be allowed to work overseas on the condition of returning to help the local poor regions (can be a condition upon graduation?) international shift work

Question 12

Hidalgo argument

Answer 12

1. restrictions on the immigration of health workers are unjust even if it results in bad health outcomes for people in poor countries
2. restrictions on immigration of health workers are only permissible if that recipient state’s positive duties to prevent health related harms to sending countries, outweigh their negative duties to respect the liberties of health workers
3. immigration restrictions that aim to decrease medical migration are unjust
4. immigration restrictions coercively interfere with occupational liberty

Question 13

Positive/ negative duty

Answer 13

1. Positive Duty: The duties to provide aid or support to other people
2. Negative Duty: are duties to abstain from harmful intervention or interferences

Question 14

Hidalgo obejctions

Answer 14

1. Perhaps clinicians have a moral duty to help people in their countries to provide healthcare
2. Medical emigrations sometimes result in severe harms; maybe countries taking in emigrating doctors could determine har,
3. Contractual Account: If the country provides costly benefits for the clinician then it may be more acceptable

Question 15

Hidalgo rebuttal

Answer 15

1. clinicians have occupational liberty and they shouldn’t be forced to stay somewhere if they don’t want to – might diminish their motivation cant put a restriction on where people work
2. Breaches freedom of movement (civil and political right)
3. Unequal distribution of opportunities for students