Health-worker migration, commonly called "medical brain drain", refers to the mass migration of trained and skilled health professionals from low-income to high-income countries. This is currently leaving a significant number of poor countries, particularly in sub-Saharan Africa, with critical staff shortages in the healthcare sector. A broad consensus exists that, where medical brain drain exacerbates such shortages, it is unethical, and this review presents the main arguments underpinning this view. Notwithstanding the general agreement, which policies are justifiable on ethical grounds (...) to tackle brain drain and how best to go about implementing them remains controversial. The review offers a discussion of the specific ethical issues that have to be taken into account when deciding which policy measures to prioritise and suggests a strategy of policy implementation to address medical brain drain as a matter of urgency. (shrink)

In this article, we defend a normative theory of prenatal equality of opportunity, based on a critical revision of Rawls's principle of fair equality of opportunity . We argue that if natural endowments are defined as biological properties possessed at birth and the distribution of natural endowments is seen as beyond the scope of justice, Rawls's FEO allows for inequalities that undermine the social conditions of a property-owning democracy. We show this by considering the foetal programming of disease and the (...) possibility of germ-line modifications. If children of lower socioeconomic background are more likely to develop in a poor foetal environment and germ-line enhancements are available only to the rich, initial inequalities between the rich and the poor would grow, and yet FEO would be satisfied. In order to avoid the problem, we propose a revised FEO principle omitting any reference to the comparison of natural endowments. Our revised FEO requires that institutions mitigate social class effect from reproduction and gestation to the greatest extent compatible with parental freedoms and the value of the family. (shrink)

© 2016 Informa UK Limited, trading as Taylor & Francis Group. David Miller’s political philosophy of immigration employs two complementary argumentative strategies to challenge open border theories. The first strategy is to defeat the principled case for open borders, such as the global equality of opportunity argument for more lax immigration control. The second strategy is to establish the democratic community’s prima facie right to determine the shape of its future, including membership and the right to exclude. First, I argue (...) that Miller’s conception of global equality of opportunity is overly narrow and that his objections to the principle, to the metric and to what counts as feasible political action misfire against other, more plausible, accounts. Second, I argue that his democratic interpretation of collective self-determination does not solve the pressing question concerning the morally justified scope and content of self-determination and the moral limits of the right to exclude. I conclude by questioning Miller’s general strategy: whether theories of immigration should be engaged in an exercise of shifting the burden of proof between open and closed borders. By contrast, I argue that a more desirable task for the political philosophy of immigration is to find ways in which the joint requirement of global equality of opportunity and collective self-determination can be coherently upheld. (shrink)

Michael Blake holds that liberal states are precluded from introducing compulsory medical service to improve access to health care under conditions of critical health worker shortage. "Emergency circumstances" are the only exception when the suspension of liberty may be justified. I argue that there are three problems with Blake's emergency justification of compulsory service. First, his concept of emergency is vague. Second, his account does not really rely on emergency as much as liberty. Third, his conception of permissible restrictions of (...) liberty is too narrow. I argue that liberties may be limited to some degree, temporarily, for the sake of attaining the capacities necessary for the exercise of liberties and for safeguarding the social conditions of the right to health. I conclude that in poor societies, temporarily delaying emigration through a highly qualified compulsory medical service can sometimes be justified. (shrink)

The concept of voluntariness permeates the ethics and politics of migration and is commonly used to distinguish refugees from migrants. Yet, neither the precise nature and conditions of voluntariness nor its ethical significance for migrant rights and state obligations has received enough attention. The articles in this collection move the debate forward by demonstrating the complex ethical judgments involved in delineating voluntary from forced migration and in drawing out its political and institutional implications. In addition to highlighting the interplay between (...) the voluntary and nonvoluntary elements of migration over time and across different sites of the migration journey, they provide a nuanced account of the various conditions of voluntariness and they challenge common ideas about its normative political consequences. (shrink)

The immigration debate in political theory has produced a series of accounts that justify the state’s right to exclude potential immigrants, where the right of self-determination figures prominently. We challenge two prominent accounts of the self-determination-based right to exclude and defend a circumscribed right to exclude and a corollary duty to admit immigrants, based on our ‘people relationship goods’ account of self-determination. Our conception reconciles the moral claims of global opportunity migrants with the well-being and non-alienation interests of the locals. (...) It therefore provides a principled answer to the philosophical question underlying pressing political conflicts today, namely what is the permissible scope of exclusion by self-determining political communities, in light of weighty global moral demands of inclusion. (shrink)

Inequality causes a variety of social ills, which give egalitarians reasons for concerns of justice. In particular, inequality is deemed to undermine people’s fundamental moral capacity of self-respect. In this paper, we explore the complex relationship between inequality and self-respect from a philosophical and an empirical angle, arguing that a theory of justice should take both into account. To this purpose, we first clarify the normative objection to inequality from the alleged erosion of self-respect. Then, we elaborate on empirical findings (...) showing the crucial role that ‘relative deprivation’ plays in the causal mechanism that connects inequalities to the erosion of self-respect. We conclude that this role is best understood in philosophical terms as a form of deprivation that affects thesignificance that people attach to the value of the choices they make. (shrink)

ABSTRACT One of the most ambitious and sophisticated recent approaches to provide a theory of global health justice is Sridhar Venkatapuram's recent work. In this commentary, we first outline the core idea of Venkatapuram's approach to global health justice. We then argue that one of the most important elements of the account, Venkatapuram's basis of global health duties, is either too weak or assumed implicitly without a robust justification. The more explicit grounding of the duty to protect and promote health (...) capabilities is based on Martha Nussbaum's version of the capability approach. We argue that this foundation gives rise to humanitarian duties rather than duties of justice proper. Venkatapuram's second argument from the social determinants of health thesis is instead a stronger candidate for grounding duties of justice. However, as a justificatory argument, it is only alluded to and has not yet been spelled out sufficiently. We offer plausible justificatory steps to fill this gap and draw some implications for global health action. We believe this both strengthens Venkatapuram's approach and serves to broaden the basis for future action in the area of global health. (shrink)

Multidimensional theories of well-being are locked into a debate about value judgment. They seek to settle which dimensions should matter for measurement and policy, and, more importantly, on what grounds to decide what should matter. Moreover, there is a gulf between theory and practice, given that measurement and policy are rarely rooted in a coherent ethical framework. Our paper engages in the debate concerning the legitimate grounds for selecting dimensions. Combining Amartya Sen's capability approach and John Rawls’ method of political (...) constructivism, we explore whether the constitution and its public culture can be used as an ethically sound informational base for selecting dimensions, and if so, why. We apply this ‘constitutional approach’ to the Italian case with the aim of deriving a set of publicly justifiable dimensions of well-being. It is a long-standing Constitution with broad public consultation at its base, which still enjoys a wide consensus. We seek to show why there is a need for more ethically sound methodological approaches to measuring well-being, pointing out the advantages of the constitutional approach, and how it may enrich the work of practitioners engaged in the policies of well-being. (shrink)

European Journal of Philosophy, Volume 30, Issue 2, Page 503-514, June 2022.

One of the most ambitious and sophisticated recent approaches to provide a theory of global health justice is Sridhar Venkatapuram's recent work. In this commentary, we first outline the core idea of Venkatapuram's approach to global health justice. We then argue that one of the most important elements of the account, Venkatapuram's basis of global health duties, is either too weak or assumed implicitly without a robust justification. The more explicit grounding of the duty to protect and promote health capabilities (...) is based on Martha Nussbaum's version of the capability approach. We argue that this foundation gives rise to humanitarian duties rather than duties of justice proper. Venkatapuram's second argument from the social determinants of health thesis is instead a stronger candidate for grounding duties of justice. However, as a justificatory argument, it is only alluded to and has not yet been spelled out sufficiently. We offer plausible justificatory steps to fill this gap and draw some implications for global health action. We believe this both strengthens Venkatapuram's approach and serves to broaden the basis for future action in the area of global health. (shrink)