Gantsho Luvuyo, Wareham Christopher S
Dev World Bioeth. 2021 Sep;21(3):131-138. doi: 10.1111/dewb.12278. Epub 2020 Aug 12.
While there is a shortage of healthcare workers in virtually all countries, there currently exists a pronounced inequality in the distribution of healthcare workers, with a high concentration of healthcare workers in high income countries (HIC) and low concentrations in low- and middle- income countries (LMIC). This inequality in the distribution of healthcare workers persists, in spite of the fact that HICs enjoy a much lower disease burden than LMICs This inequality raises medical ethical issues related to what obligations health workers from HICs have to correct these imbalances by working in LMICs. While the biomedical principle of Justice, first formulated by Beauchamp and Childress, advocates for healthcare workers to conduct themselves in a manner that is fair and equitable in light of what is due or owed, it does not elaborate on what sort of obligation this places on healthcare workers from HICs to work in LMICs in a bid fairly distribute the availability of healthcare workers. As such, this paper gives a normative argument for why healthcare workers from HICs have a moral obligation to work in LMICs, a concept we call Medical Cosmopolitanism. Following our positive argument, we debunk prominent objections to the concept of Medical Cosmopolitanism and consider ethical, educational and governmental implications of our findings.
几乎所有国家都存在医护人员短缺的问题，而目前医护人员的分布存在明显不平等，高收入国家（HIC）医护人员高度集中，低收入和中等收入国家（LMIC）则分布较少。尽管高收入国家的疾病负担远低于低收入和中等收入国家，但医护人员分布的这种不平等现象依然存在。这种不平等引发了医学伦理问题，即高收入国家的医护人员有哪些义务通过在低收入和中等收入国家工作来纠正这些不平衡。虽然由博尚和奇尔德雷斯首次提出的生物医学正义原则主张医护人员应根据应得或应尽的义务，以公平公正的方式行事，但该原则并未详细说明这对高收入国家的医护人员在低收入和中等收入国家工作以公平分配医护人员可及性方面施加了何种义务。因此，本文提出了一个规范性论点，即为何高收入国家的医护人员有道德义务在低收入和中等收入国家工作，我们将这一概念称为“医学世界主义”。在给出肯定性论点之后，我们驳斥了对“医学世界主义”概念的突出反对意见，并探讨了我们研究结果的伦理、教育和政府层面的影响。
