Tuesday, February 26, 2008

Doctors, but Not of Philosophy

Very casual empiricism leads me to conclude that doctors have a greater urge toward collectivism than almost any other profession. The Lancet, one of the world's oldest and most prestigious medical journals, has an editorial arguing that rich countries should be prevented from soliciting doctors, nurses and pharmacists in poor ones, because of the impact on health care in the latter (free registration required):

If there is any hope of strengthening the workforce capacity in poor countries every possible local and international solution should be seriously considered, no matter how aspirational. Demanding that rich countries stop actively recruiting from poorer nations remains a viable option. The human resources crisis may be undoubtedly complex but this still does not obscure right from wrong. Richer countries can no longer be allowed to expoit (sic)and plunder the future of resource-poor nations.

The Lancet, according to its fans, plays an outsize role in such questions:

The Lancet has always promoted debate and set the agenda.

"One of its greatest editors Robbie Fox, who was editor from 1944 to 1964, was well known for doing that."

He added: "It is especially relevant in the internet age in which we live.

"In many ways it makes more sense to publish data on the internet, where it is freely available to everyone, than a journal.

"And if that is so, it is clear the role of journals is much more about interpreting the information."

So what exactly is the "right and wrong" of this question? A pure utilitarianism, focused on the here and now, could suggest restricting the ability of wealthy countries to recruit professionals form poor ones, even if the shortage is caused by incentives not fully appreciated. A health-care worker in Malawi probably adds considerably more years of good health at the margin than one in London.

But of course that kind of primitive static utilitarianism (ignoring the question of trying to improve health care in the exporting countries, e.g. through greater economic growth, which I have never known the Lancet to argue in favor of) is not the only issue in question. As free men and women, health professionals have a right to emigrate if they are made better off. I have heard an editor of The Lancet recognize this and say he is not arguing for a ban on hiring foreigners in wealthy countries, just for recruitment by them. But this is simply an argument for the right to keep these professionals in ignorance of these opportunities. If they have a right to leave, they have a right to learn about opportunities leaving presents them with, and restricting recruitment is a limiting (through increasing their costs of doing so) of their ability to solicit the information that will help them make a better decision. I reluctantly conclude that this is a cheap substitues for moral reasoning, in which the authors are mad at the right people (rich governments and their big pharmacy chains) and don’t want to be caught on the wrong side of the rich/poor divide. For an example of this kind of thinking see the assertion by Amir Attaran in The Globe and Mail that companies should actually be criminally prosecuted for such recruitment:

"I don't have any difficulty saying that it would be lovely and I would prefer to live in a world where it were criminal," said Dr. Attaran, who teaches in the University of Ottawa's Institute of Population Health and the faculty of law.

"But their argument is that already customary international law tells us that this recruitment should stop ... That is an incorrect understanding of what customary international law is."

Dr. Attaran co-authored an article published in January by the Canadian Medical Association Journal that denounced Shoppers Drug Mart for recruiting in South Africa.

Prof. Attaran, like most residents of Canada, is himself a descendant of an immigrant. One wonders how his ancestors would've reacted to a similarly Draconian crackdown against employers who sought to recruit them way back when. The essence of sound moral reasoning is the ability to extend the rights you enjoy to others in analogous circumstances.


Anonymous Anonymous said...

Just wanted to say thanks, Evan. I read your posts with much appreciation and always learn something from them. Looking at your lack of commentors, it strikes me that you're not so much under appreciated as under acknowledged. Keep up the good work.

8:00 PM  

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