Monday, September 15, 2008

She Wants a Job? Well, She's a Victim, and Should Work For Fellow Victims Instead

This basically sums up (admittedly, with editorialization) the suggestions made by Lawrence Gostin, Law Professor at Georgetown, in an article titled "International Migration and Recruitment of Nurses: Human Rights and Global Justice"in the April 16, 2008 issue of Journal of American Medical Association (Subscription required. Yes, I catch up late).

Due to our country's nursing shortage, U.S. hospitals actively recruit and sponsor worker's visas for nurses who were trained in foreign countries. This represents a considerable opportunity for many health care workers to improve their family's lives, but also a problem for developing countries that face their own (significantly larger) nursing shortages. While Mr. Gostin recognizes freedom of migration as a human right, he volunteers such nurses as martyrs for the ailing people in their own countries, which require "the human resources necessary to ensure the right to health care for their populations."

If maintaining human resources is a required component of respecting civil rights, who logically must be impinging on these rights by reducing the human resource pool? Presumably, workers themselves, who, while choosing to improve their own lives, neglected their "responsibility to contribute to the public's health, safety, and welfare of their home country." Of course, the U.S. is not left off the hook either for this "global injustice." Our country's hospital administrators and bureaucrats are admonished for informing people about better opportunities, as "advocates for global health call active recruitment in low-income countries a crime."

Such criminal behavior does not stem from providing too many perks or incentives to to workers to stay in this country, offers that would certainly aggravate global nursing disparities. Rather, Mr. Gostin, somewhat incoherently, believes that the U.S. contributes to the problem by victimising the nurses, "luring them with misleading promises, and threatening [them] with deportation if they break their contract." Is it a crime to sponsor people to stay here or a crime to prevent them from staying too long?

Nursing is probably one of the most grueling, difficult jobs available, and it is probably hardest for foreign workers, who besides dealing with language or cultural barriers, tend to work for the poorest hospitals. However, if abuse is as pervasive as Mr. Gostin suggests (before he advocates for state laws to prevent discrimination, poor and unsafe working conditions, unequal pay and treatment, as well as other perceived injustices), why would it constitute such a threat to send such workers home? Shouldn't it be a blessing to release people from their shackles? And if people are so desperate to stay here, despite all of the employment regulations that hospitals seem to violate, wouldn't increasing incomes and improving working conditions for nurses only discourage them from returning home, which is Mr. Gostin's goal? After all, Mr. Gostin believes that we have a responsibility to place incentives for workers to "stay at home, or return home after visiting abroad."

Mr. Gostin somehow believes that, if we increased benefits, we'd snatch up fewer foreign workers, who, now flooded with cash, would desire to return home. I'm skeptical. Guarantees of minimum salaries and expansions of benefits would only provide a new flood of nurses, astute enough to apply for entry to this country, whether or not we banned "active recruitment."

Mr. Gostin's fundamental problem is that he struggles to portray both the workers, as well as the people they "neglect," as victims. He also attempts to condemn the United States for offering too many opportunities, as well as too few (or at least for not long enough). Presumably, every inconsistency could be untangled if we assume that all of the hospitals systematically break promises or contracts made at time of recruitment. However, even if we did assume ubiquitous deceptive and exploitative behavior, this would not explain why most workers strongly prefer to stay and work in the U.S.

By designating aggressors and victims for a hodge-podge of perceived, and often contradictory, indiscretions, Mr. Gostin hinders advancement of his central goal, which is presumably to increase the number of health care workers in developing countries. Additionally, so long as people "owe" services, simply because they possess skills and others have needs, whenever such people forge their own paths, choose their own options, and advance their own values, they, according to Mr. Gostin's reasoning, inevitably contribute to violating others' human rights.

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