Health-worker migration, commonly called "medical brain drain", refers to the mass migration of trained and skilled health professionals (doctors, nurses, midwives) 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.
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 wellbeing. 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.
The paper addresses the problem of justifying ethically sound dimensions of poverty or well-being for use in a multidimensional framework. We combine Sen’s capability approach and Rawls’ method of political constructivism and argue that the constitution and its interpretative practice can serve as an ethically suitable informational basis for selecting dimensions, under certain conditions. We illustrate our Constitutional Approach by deriving a set of well-being dimensions from an analysis of the Italian Constitution. We argue that this method is both an improvement on those used in the existing literature from the ethical point of view, and has a strong potential for providing the ethical basis of a conception of well-being for the public affairs of a pluralist society. In the final part, we elaborate on the implications for measuring well-being based on data, by ranking Italian regions in terms of well-being, and pointing out the differences in results produced by different methods.
In this article, we propose a reconciliation between global equality of opportunity and self-determination, two central and seemingly conflicting principles in the contemporary theory of global justice. Our conception of reconciliation draws on the family-people analogy, following the account of familial relationship goods, developed by Harry Brighouse and Adam Swift, on permissible parental partiality and domestic equality of opportunity. We argue, first, that a plausible conception of global equality of opportunity must be able to distinguish morally arbitrary aspects of nationality that require mitigation from morally permissible ones. Second, we argue that a plausible criterion for the distinction integrates a person’s normative interests over a lifetime: (i) the interests of a child born into societal circumstances that impact her life prospects; and (ii) the interests of an adult citizen in collective self-determination. Third, we outline an account of ‘people relationship goods’, as a principled way to circumscribe the permissible scope of self-determination. Fair global equality of opportunity requires mitigating nationality-tracking inequalities, except those that fall within the permissible scope of collective self-determination.
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