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We want to help: ethical challenges of medical migration and brain waste during a pandemic
  1. Elizabeth Fenton1,
  2. Kata Chillag2
  1. 1Bioethics Centre, University of Otago, Dunedin, New Zealand
  2. 2Department of Public Health, Davidson College, Davidson, North Carolina, USA
  1. Correspondence to Dr Elizabeth Fenton, Bioethics Centre, University of Otago, Dunedin, New Zealand; elizabeth.fenton{at}


Health worker shortages in many countries are reaching crisis levels, exacerbated by factors associated with the COVID-19 pandemic. In New Zealand, the medical specialists union has called for a health workforce emergency to be declared, yet at the same time, many foreign-trained healthcare workers are unable to stay in the country or unable to work. While their health systems differ, countries such as New Zealand, the USA and the UK at least partially rely on international medical graduates (IMGs) to ensure access to health services, particularly in underserved communities. This paper focuses on the challenges faced by many IMGs, particularly those that constrain their capacity to live and work in the countries that rely on their skills. These challenges give rise to two ethical problems. First, they represent a failure of reciprocity towards IMGs; second, they represent a source of harm, both to IMGs themselves and to communities whose healthcare service depends on contributions made by IMGs. We argue that brain waste and disvaluing the contributions of IMGs and other foreign-trained health professionals have significant costs for maintaining a functional healthcare system, costs which must be adequately recognised and counted.

  • ethics
  • health workforce
  • policy

Data availability statement

This analysis was part of a larger study. Data from that study are available on request.

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Data availability statement

This analysis was part of a larger study. Data from that study are available on request.

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  • Contributors EF and KC conceptualised the paper and are responsible for overall content. EF drafted the manuscript with significant contributions and critical revisions from KC. The final version of the manuscript has been reviewed and approved by all authors.

  • Funding This analysis was part of a larger study funded by the Greenwall Foundation.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.