Migrant health professionals’ systemic human rights vulnerabilities
| Published date | 01 October 2021 |
| Author | Hugh Breakey,William Ransome,Charles Sampford |
| Date | 01 October 2021 |
| DOI | http://doi.org/10.1111/imig.12816 |
International Migration. 2021;59:197–215.
|
197
wileyonlinelibrary.com/journal/imig
Received: 8 Augu st 2019
|
Revised: 19 November 2 020
|
Accepted: 13 Decemb er 2020
DOI: 10.1111/imig.12816
ORIGINAL ARTICLE
Migrant health professionals’ systemic human
rights vulnerabilities
Hugh Breakey1| William Ransome2| Charles Sampford1
© 2021 The Author s. Internationa l Migration © 2021 IOM
1Institute fo r Ethics, Governan ce & Law,
Law Futures Ce ntre, Griffit h University,
Nathan, Quee nsland, Australia
2School of Phil osophy, Australian C atholic
Universit y, Melbourne, Victo ria, Australia
Correspondence
Hugh Breakey, Inst itute for Ethics,
Governance & L aw, Law Futures Centre ,
Griffit h University, 170 Kessels Ro ad,
Nathan, QLD 4111, Austral ia.
Email: h.breakey@griffith.edu.au
Funding information
Australia n Research Council , Grant/Award
Number: DP160103588
Abstract
This article investigates whether the methods by which
states implement citizens’ human right s poss ess s erious
weaknesses for ensuring mig rant health professionals’
rights. Stemming from the di scipline of normative phil os-
ophy, the moral approach to human rights sees rights as
implemented through multiple waves of duties delivered
by state-managed integrity systems. We argue that this
otherwise compar atively reliable method can fail to deliver
adequate outcomes to m igrant health professionals. The se
professionals can encounter pr oblems stemming from the
following: their lack of poli tical priority as non-citizens; the
challenges to effect ive monitoring of migrant health pr o-
fessional pathways and outcomes; the incapacit y of federal
lawmakers to impact on key polic y levers; the ever-present
threat of “pathways to nowhere”; and state-enabled em-
ployee exploit ation. The findings p rovide a philosophically
grounded fo undation for acknowle dging the human ri ghts
concerns of even high-skilled migra nts, and show why spe-
cial regimes for rights protect ion, facilitation an d monitor-
ing are necessar y for migrant health professionals.
KEYWORDS
ethics, heal th professionals, human r ights, integrity sys tem,
international m igration, migrant prec arity
198
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BREA KEY EtAl.
INTRODUCTION
At first glance, one might suppose that the key human right s problems for migrant health professionals’ (MHPs)
rig hts wi ll be c onst itut ed by th e expl icit and dir ect limit atio ns on th eir en titl eme nts im pose d by des tin ation coun-
tries, suc h as limitations o n receiving welfa re support or o n practising on ly in a particu lar region. Thes e are, no
doubt, imp ortant concern s for working mi grants (Mattila , 2002; Ruhs, 2013). Our focus in this paper, however,
is a differ ent one. We ask: Given th e ways that the moral approach to hum an rights sees human rights a s being best
implemented (by an overa ll system governed by the nation sta te), are MHPs likely to suffer system ic vulnerabilities? By
“systemic vulner abilities,” we mean deleterious im pacts on human rights c aused by deep-seated qualiti es of the
overall politic al-economic system .
As is standard in disciplin e of applied normative philosophy, our method is to employ moral the ory (in this case
the moral approac h to human rights), and apply this theorizing to a complex emp irical situation to deliver a deeper
understa nding of the situation’s ethical challenges and pos sibilities. In the following analysi s, we draw on practical
literature on ri ghts delivery (e.g., by hu manitarians) to extend ph ilosophical theor y by incorporating seven mo des
of rights implement ation. We then apply this approach to the case of MHPs in Cana da and Australia to gauge how
exis ting ri ghts imp lemen tation proces ses fun ction fo r this co hort. As we will s how, this method a llows th e diagno -
sis of specific are as of human rights vulner ability and the deline ation of potential areas for ref orm.
This pape r focuses on MHPs for sever al reasons. Fi rst, MHPs c an be crucial to the func tioning of count ries’
medical systems (as they are in the two case st udy countries), making up sizable proportions of their workforces,
and catering to critical areas of need, including rural and remote service delivery. Second, MHPs encounter chal-
lenges re sembling th ose facing ot her skilled m igrant worker s, such as fac ing local res triction s on educatio n, train-
ing and cer tification. Yet third, MHPs remain a somew hat unique cohort , becaus e of the mu ltiple bar riers to
professional practice—not merely in terms of e ducation, accr editation and entry ex aminations (which occur for
many profes sions), but also their need to access scarce training and entry-level emp loyment opport unities (e.g.,
residencies , specializations). As we will see, MHPs provide a telling example of the way that human rights concerns
can arise when offici als within a system can profoundly affec t particular groups but do not have the mandate, will,
resources or info rmation to accommodate the ir rights-based claims.
Australia and Canada were chose n as case s tudies be cause th ey are both m ajor dest ination cou ntries for
MHPs, and both signatories to the WHO Code (see below). They are also close enough economically and politica lly
to make comparisons possible—b ut at the same time have sufficien tly dissimilar MHP regimes to make comparison
valuable. Finally (in line with our thesis t hat otherwise effective rights-protection regimes can struggle to cope
with MHPs), they both have bro adly effective regimes for rea lizing human right s, with both n ations consistently
named in the higher groups of count ries worldwide in f reedom and human r ights rankings.1. Howeve r, and as we
will see, this do es not necessarily mean t hese countries are protec tive of migrants’ human rights.2.
It is wort h noting the lin ks between the human rights co ncerns raised he re and the broad er issue of (usuall y un-
skilled) migrant precarity. As we will see , MHPs’ hu man rig hts con cerns resemb le sever al issu es rais ed unde r the ban ner
of migrant precarity, includ ing work risk an d uncertainty, o ngoing temporarin ess and exploit ation by employer s. Yet
MHPs are not subject to the level of work informalization, wage squeeze, systemic discrimination, risk of poverty and
even existentia l vulnerability as th e unskilled workers of th e precariat (Schierup e t al., 2015: 50–52; Hennebry, 2014:
371; Schierup & Jørgensen, 2016; Hari & Liew, 2018). As such, the human right s concerns raised for MHPs have paral-
lels, but also key differ ences, with the (often more urgent) eth ical concerns faced by the precar iat.
We begin in the first section by explaini ng the moral approach to human rights, and the way that this approac h
sees human rig hts as being realized—name ly, through strategic governa nce of overall systems of inst itutions. The
second s ection outline s the inst itutional stru ctures MHPs typically negotiate on th eir pathways to professional
practice in dest ination countri es. With these ana lyses in tow, the t hird section explores the specia l challenges
these sys tems face in real izing MHPs’ human r ights. We argue t hat the nation-st ate is stymied in its normal role
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