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The article ‘The active recruitment of health workers: a defence’ by Hidalgo1 discusses a highly interesting and relevant topic. It provides, in clear language, a mix of ethical arguments and empirical data, which are used to assess the validity of two arguments that are invoked by some who claim that the active recruitment of health workers from poor countries is morally impermissible. However, the article has two main shortcomings: (1) the analysis is too narrow (perhaps because the author has focused only on arguments that can be found in the literature rather than also identifying and considering additional conceivable arguments); and (2) various elements of the analysis are problematic.
The analysis is too narrow
If the question is whether promoting a ‘medical brain-drain’ from poor to rich countries is morally acceptable, then it is not only the actions of the persons soliciting relocation and those considering relocation that need to be considered. Within the status quo and mores of a free market society, these actors may very well be perceived as innocent—it may be the actions of others who maintain the status quo that may be at fault, if fault there is. Consider the question: is it acceptable to sell your slave (a) to anyone, or (b) only to someone who will be kind to her? This invites only the answers (a) or (b). A potentially unacceptable starting point is presumed to be acceptable. The same problem arises, to some extent, with this article.
The emigration of medical professionals clearly falls into two categories (neither addressed as such in the article): (a) where the country's investment in training the professional is adequately returned through payments by the emigrant to the state—that is, a state of affairs possibly more likely to exist with nurses and other carers who are not so costly to train; and …