Follow up on the ethics of nurse recruitment from developing countries

A couple of posts back, the topic was the launching of a new ethics code, namely the Voluntary Code for the Ethical Recruitment of Foreign-Educated Nurses to the United States. The code is a response to the well-documented 'brain drain' of nurses from developing countries. In that post, I expressed some skepticism in regard to the code's enforceability and potential impact. Given that recruiting foreign-educated is interesting for powerful agencies in the United States from a cost-benefit perspective, why would they sign onto to Code and hold to its guidelines?

In a letter last Sunday to the Washington Post, Samuel Witten, Acting Assistant Secretary of the
Bureau of Population, Refugees and Migration within the US Department of State gives a flavor of the government's view of the Voluntary Code. Witten states that the Voluntary Code has noble ideals and makes some good points. But the point of the letter is to express one basic complaint: according to Witten, the Code " ... discourages U.S. companies from hiring nurses from countries with severe shortages of health workers, implying that a qualified nurse from a developing country has less right to apply for migration than a counterpart in a developed country."

In my reading, the Voluntary Code does not at all deny the right to migration. What it does is embed that right as one consideration among others in a larger context, which also includes the devastating social and health impact of the loss of nurses for developing countries. Its guidelines are the product of careful balancing of divergent concerns and interests. Apparently the US Department of State sees things quite differently: the individual's right to migration is taken to be the chief, overriding consideration in such cases, even when it comes to the poorest countries with the worst nurse/patient ratios.

That standpoint about 'individual rights' is convenient: it maintains the status quo in regard to the brain drain of medical human resources from developing countries to more affluent ones. The US Department of State is apparently much more concerned with US capacity to cheaply meet nursing care demands for its aging population than it is for the fate of health care and health in general in some of the poorest countries in the world. I suppose this is to be expected, but it is depressing nevertheless.

***Many thanks to Kristen Rosengren at AcademyHealth, who alerted me to Witten's letter in the Washington Post. AcademyHealth was one of the agencies involved in the writing of the Voluntary Code and is, as it describes itself, ". . . the professional home for health services researchers, policy analysts, and practitioners, and a leading, non-partisan resource for the best in health research and policy."