This doctoral thesis within applied ethics consists of four articles together with a cover essay. All articles concern the ethics of skilled health worker emigration from under-served and resourcepoor regions, often referred to as ‘medical brain drain’. Methodologically, the thesis utilizes normative ethical theory to analyse the justifiability of temporary or long-term emigration restrictions, such as compulsory health service programmes, that are employed by developing countries with the aim of safeguarding their needs for health care provision. Such programmes restrict the mobility of individual health workers and give rise to conflicts between different types of rights and interests.

The ethics of skilled worker emigration warrants an exploration of the ethical implications of such restrictive programmes for different stakeholders, such as the under-served countries and health workers; and a clarification of the rights and duties of the concerned parties. This thesis provides a thorough analysis and clarification of such rights restrictions and offers theoretically and empirically grounded recommendations as to how they ought to be managed. Rights theory and accounts of individual responsibilities are employed to assess the acceptability of restrictive health service programmes.

In brief, the thesis (a) discusses the conditions under which individual health workers may have responsibilities to attend to the basic health needs of a population, (b) explicates the rights at stake such as the freedom of movement and the right to exit, (c) offers insight into what it means to restrict one’s right and its implications and (d) suggests ways for conflicting rights and interests to be balanced and resolved. Taken together, the thesis presents a nuanced approach towards individual responsibilities in under-served contexts and an improved understanding of the right to exit as well as the implications of restricting the right. The thesis also contributes to the ethics of skilled worker emigration with a discussion on the responsibilities of skilled workers when the other parties do not fulfil their fair share of responsibilities.

Denna avhandling i tillämpad etik består av fyra artiklar jämte en längre introduktion. Samtliga artiklar behandlar etiska aspekter på emigrationen av högutbildad vårdpersonal från utvecklingsländer och resursfattiga regioner, ett fenomen som ofta beskrivs som medicinsk kunskapsflykt (Medical Brain Drain). Utifrån normativ etisk teori analyseras i vilken utsträckning, om alls, utvecklingsländers ansatser att säkerställa nationella vård- och omsorgsbehov med hjälp av begränsningar av vårdpersonals mobilitet kan anses vara etiskt försvarbara. I avhandlingen analyseras också olika intressenters skyldigheter och rättigheter utifrån teorier om ansvar och rättigheter. Det gäller bland annat frågan om sjukvårdspersonalens individuella ansvar att stanna i hemlandet för att tillgodose grundläggande vårdbehov hos befolkningen.

Avhandlingen bidrar med ett klargörande av (i) argument för och emot begränsningar av vårdpersonals rätt att lämna landet, (ii) relaterade rättighets- och intressekonflikters natur och (iii) teoretiskt förankrade rekommendationer för hur denna typ av konflikter bör hanteras. Avhandlingen synliggör etiskt relevanta följder av obligatoriska vårdprogram för olika intressegrupper (stakeholders) som stater, vårdgivare, vårdpersonal och vårdtagare, liksom vilka rättigheter och skyldigheter som står på spel, som exempelvis rätten att fritt lämna sitt land och rätten till grundläggande hälso- och sjukvård. Sammantaget bidrar avhandlingen med en grundlig analys av skäl för och emot begränsningar av den fundamentala men sparsamt analyserade mänskliga rättigheten att lämna det egna landet.

One of the ways to address the effects of skilled worker emigration is to restrict the movement of skilled workers. However, even if skilled workers have responsibilities to assist their compatriots, what if other parties, such as affluent countries or source country governments, do not fulfil their fair share of responsibilities? This discussion raises an interesting problem about how to think of individual responsibilities under partial compliance where other agents (including affluent countries, developing states, or other individuals) do not fulfil their fair share of responsibilities. What is fair to expect from them? Taking health worker emigration as a case in point, I discuss whether the individual health workers’ fair share of responsibilities to address basic health care needs decreases or increases when the other parties do not fulfil their share. First, I review the responsibilities that different stakeholders may hold. Second, I argue that there are strong reasons against increasing or decreasing health workers’ fair share of responsibilities in a situation of partial compliance. I also argue that it is unfair for non-complier states to enforce health workers to fulfil their fair share or take up the slack.

Compulsory (health) service contracts have recently received considerable attention in the normative literature. The service contracts are considered and offered as a permissible and liberal alternative to emigration restrictions if individuals relinquish their right to exit via contract in exchange for the state-funded tertiary education. To that end, the recent normative literature on the service programmes has particularly focused on discussing the circumstances or conditions in which the contracts should be signed, so that they are morally binding on the part of the skilled workers. However, little attention is devoted to the relevance of the right to exit for the debate on compulsory service programmes. In this paper, I argue that even if the service contracts are voluntary, and thus the would-be medical students voluntarily relinquish their right to exit, the reasons behind the right should be taken into account for the contracts to be morally valid. A clear understanding of the right to exit is a must in order not to breach its basic components and for the service contracts to be morally binding. To that end, I provide two accounts of the reasons to value the right to exit by presenting Patti Lenard’s discussion of the right and by reconstructing James Griffin’s account of human rights. I conclude by offering brief ethical considerations for compulsory health service programmes grounded in the reasons to value the right to exit.

The contributors to this issue offer applied critical and normative perspectives on central, yet overlooked, ethical aspects of migration management with a certain cosmopolitan lance in some capacity. However, cosmopolitanism might mean different things for transnational migration. It can refer to “political cosmopolitanism” that provides the reasons for why there should be certain global institutions governing migration. It can also refer to “moral cosmopolitanism” that simply represents a moral concern for individual rights and interests first and foremost (Caney 2005). Cosmopolitanism can also work as a lens that is based on a scepticism towards using the nation-state as the ultimate unit or locus of analysis. These perspectives are not mutually exclusive, and the contributions in this special issue accommodate a form of cosmopolitan outlook or stance to some extent in their discussion on migration management practices.

Den här rapporten analyserar kortfattat Joseph H. Carens senaste bok, The Ethics of Immigration. Den inledande delen av dokumentet berör de grundläggande principerna från boken och hur Carens härleder sin utvärdering av olika immigrations och integrations principer från Ius Soli inom ett liberalt demokratiskt ramverk. Den andra delen behandlar bokens huvudsakliga metodologiska område, detta är den dualistiska strukturen Carens använder och hur den ska bli förstådd med hans givande bidrag. Slutligen kommer dokumentet undersöka den milda anti-cosmopolitan attityden Carens håller och dess implikationer.

This study is devoted to the ways and means to justify a ‘more’ cosmopolitan realization of certain policy implications, in the case of immigration. The raison d’être of this study is the idea that the contemporary debate over open borders suffers from indeterminate discussions on whether liberal states are entitled to restrict immigration. On the other hand, most of the liberal cosmopolitan accounts neglect the detrimental consequences of their open borders argument – which take it as a means to compensate people in need –, such as brain drain and the effects of brain drain on the opportunity sets of members of sending countries. Therefore I offer a moral cosmopolitan account of immigration which takes the interests of would-be immigrants, the residents in receiving, along with the residents in sending countries in respect to their opportunity sets because of the way arbitrary border control represents the inequality of opportunity. I do not provide a well-formed immigration policy here, yet I believe the account provided here is more feasible in considering phenomena such as brain drain.