Prescription for Hypocrisy: The Tough Ethics of International Doctor Migration

December 10, 2009

The British Medical Association just released a new statement on the international migration of health workers. Sadly, it repeats a common, self-contradictory, profoundly unethical position on international high-skill migration.It starts off well. The Association states that “every health professional has a right to migrate to seek work wherever they wish for professional or personal reasons”, and thus “measures to restrict the movement of health personnel may be unethical.” How magnanimous for a professional guild to seemingly favor competition from abroad!But they don’t mean it. The British Medical Association directly advocates measures that restrict doctor migration, measures that it has just declared unethical: The statement congratulates Britain for moving toward “self-sufficiency” in health professionals. Leaders of the Association frequently advocate “self-sufficiency”.Why does “self-sufficiency” restrict movement? The Association’s own statement explains exactly why:

“In the past decade a number of new medical schools have been established in the UK, which has led to greater self-sufficiency in medical staffing and resulted in a reduced reliance on doctors from outside the EEA [European Economic Area]. Opportunities for employment for doctors from outside the EEA are therefore likely to be limited.”
In other words, measures to fill professional jobs in Britain with nice British people make it more difficult for professionals from developing countries and elsewhere to access those jobs -- regardless of how qualified they are. This doesn’t “restrict the movement” of doctors willing to waste their education and drive taxis, but it certainly “restricts the movement” of doctors who wish to exercise their profession.The Association’s position is closely analogous to insisting that black doctors have a right to seek any job they want, but urging white people to fill physician jobs with other white people so that those jobs are not available to black doctors. There are two reasons for this analogy. First, no one born outside Europe chose to be born outside Europe, just as no one born black chose to be born black. Second, being born outside Europe is irrelevant to one’s ability to deliver health care, just as being born black is irrelevant to one’s ability to deliver health care. I am not at all saying that working to limit a person’s professional employment opportunities because of where they are from is the same thing as racism, but rather that it shares abhorrent, unethical traits with racism.“Self-sufficiency” is not the proper goal of any country, in any field, for “self-sufficiency” is synonymous with zero migration. If there ever existed a world in which zero migration was desirable, it is gone forever.I find it baffling that the British Medical Association is willing to publicly advocate a position that it has plainly described as unethical. At least they are honest. Making lofty affirmations on ethics is easy; dropping isolationist, nativist policies is not. I have treated these and other issues related to high-skill migration in a recent non-technical paper.


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