05 Carens.indd Expanding the Brain Drain Debate JOSE PH H. C A R E NS University of Toronto AbStRACt The article argues that Blake and Brock do not disagree on any important issues of principle, thus bringing their positions closer together than is suggested in the “debate” language that frames their book. The article also recommends that the discussion of the brain drain be expanded beyond the question of whether or not governments may restrict emigration to include questions about the moral responsibilities of rich states to prevent harmful brain drain and the moral responsibilities of skilled individuals to serve the communities in which they have been raised. Keywords: brain drain, emigration, immigration, moral duties, skilled medical personnel INTRODUCTION The subtitle of Debating Brain Drain is the question “May Governments Restrict Emigration?” As this suggests, the central focus of the book is on the question of whether or not it is morally permissible for the governments of poor states to take legal measures to reduce the movement of their talented and skilled citizens to other countries, especially rich ones. Gillian Brock and Michael Blake are distinguished philosophers, and they provide a nuanced, thoughtful, and illuminating discussion of this question. While they differ in the emphasis they place on certain considerations, I do not think there is any real disagreement between the authors on the fundamental question posed in the subtitle, and I do not disagree with their shared conclusion. I should perhaps acknowledge, however, that in claiming that Brock and Blake are in basic agreement, I am disagreeing to some extent with Brock and Blake. 05 Carens.indd 132 21/4/17 13:27 Expanding the Brain Drain Debate 133 LEAP 4 (2016) 1. THE BROCK/BLAKE CONSENSUS Brock and Blake agree that there are empirical disputes about the effects of the emigration of talented and skilled people from poor states on the people left behind in those states and on the ability of those states to build better economic and political institutions. Brock’s reading of the literature leaves her more pessimistic about the consequences of such emigration and Blake’s reading leaves him more optimistic. Both acknowledge, however, that they are not specialists with an independent basis for judging the overall effects of emigration. Neither am I, and so I will try to construct a response that does not depend on a particular view of the empirical literature. Obviously, it makes no sense for poor states to seek ways to reduce emigration that is beneficial to them. So, it is appropriate to focus, as the authors do, on cases where emigration is actually harmful to those left behind in poor states. Both authors treat the emigration of skilled medical personnel as the prime example of such a case. Blake argues that, from a liberal perspective, individuals have a fundamental moral right to emigrate and a fundamental moral right to renounce their citizenship in their country of origin if they have another citizenship (Blake and Brock 2015: 114) He points out that these moral rights are ref lected in the Universal Declaration of Human Rights, and he insists that states normally may not use coercive measures to prevent individuals from exercising these rights, even when doing so would be good for other citizens. I agree with Blake about these claims.1 So far as I can tell, so does Brock. It may be fair to say that Brock does not emphasize the moral importance of the right to leave in the way that Blake does, but she does accept that right as a constraint upon morally legitimate policies. Nothing in Brock’s account suggests that she thinks it is morally acceptable for a state to adopt policies that violate the Universal Declaration of Human Rights, including its provisions regarding the right of exit and the right to change nationalities. The key point for Brock is that these rights are not absolute. That is something that Blake also acknowledges, however. While Blake insists that the right to exit and the right to renunciation are so fundamental that they may not be restricted for the sake of distributive justice or the promotion of the good of others, he explicitly says that “violation of a free and informed 1 I would enter a note of caution, however, about Blake’s claim that the right to change nationality (which is what the UDHR protects) entails a right to renounce “any particularistic claim of justice” towards the inhabitants of the state one has left (Brock and Blake 2015: 114). Blake seems to be assuming here that all particularistic claims of justice must be legally enforceable. As I will argue below, this presupposes far too narrow a conception of justice. 05 Carens.indd 133 21/4/17 13:27 134 Joseph H. Carens LEAP 4 (2016) contract” can be grounds for limiting these fundamental liberties (Brock and Blake 2015: 115). A hundred pages later, he says that this makes it morally permissible for states to use contracts to limit emigration temporarily (Brock and Blake 2015: 215). While he insists that this is only a “very qualified yes” to the use of this technique, so far as I can see the qualifications he wants to impose are all ones that Brock herself accepts as limits on the policies that states may legitimately use to reduce unwanted emigration. This becomes particularly clear in her discussion on p. 275 of the ways in which their views converge around educational contracts, taxation of emigrant citizens, organization of medical training, etc. I can find no actual policy proposal that Brock endorses that Blake rejects.2 The fact that Brock and Blake do not disagree about permissible policies does not prove that there are no significant philosophical differences between them. People can sometimes agree on policy proposals while disagreeing about principles. For example, conservatives may favor reducing criminal sentences because they think keeping people in prison is too costly, even though they regard long sentences as morally acceptable in principle. Liberals may favor reducing criminal sentences because they think that long sentences are unfair in principle. In that sort of case, the parties agree on a policy but not on moral principles. But I don’t think that is what is going on in the Brock/Blake exchange. While Blake talks more about freedom and Brock more about reducing the harms of emigration, each accepts the other’s principles. Brock does accept the principle that states may not violate the freedoms that Blake is emphasizing. That is why she focuses on contractual arrangements and on the background conditions within which agreements take place. Indeed, I think it becomes clear in Brock’s response to Blake that the whole purpose of her long discussion of the limited character of the demands being made upon potential emigrants was not to say, as Blake seems to think, that intrusions on fundamental rights are acceptable so long as they are only modest intrusions, but rather to show that the contractual conditions required of those seeking medical training are not so unconscionable as to void the claim that it is legitimate to enforce the contract (see Brock and Blake 2015: 2 Blake says that “many of the ‘compulsory service’ proposals Brock defends … are unavailable for use by a liberal state” (Brock and Blake 2015: 112). The footnote specifies that he is actually rejecting only the first three of the seven proposals that Brock mentions (on 49-50), and he offers no reason for thinking that these three proposals would be unacceptable if constructed as contracts rather than as imposed policies. I would add that Brock herself notes that the label “compulsory service” given to these proposals was supplied by the authors of the article she is discussing and is not a label that she herself would necessarily accept. In any event, her actual policy proposals on p. 275, which use the same sorts of mechanisms as the ones discussed on pp. 49-50, all involve contractual agreements that meet Blake’s concerns. 05 Carens.indd 134 21/4/17 13:27 Expanding the Brain Drain Debate 135 LEAP 4 (2016) 256 and 271). And Blake does accept the ideas that the emigration of skilled medical personnel from poor states contributes to global injustice, that poor states have strong and legitimate reasons to try to reduce this emigration if they can do so in a way that respects human freedom, and that contractually agreed upon restrictions on emigration are morally permissible given appropriate background circumstances. He may be more skeptical than Brock about how effective such permissible policies will be but that is an empirical disagreement not a difference of principle. In sum, the contrasts between them on the key question that the book addresses are more rhetorical than real, ref lecting differences in emphasis rather than actual disagreements. 2. EXPANDING THE MORAL TERRAIN OF THE DEBATE One thing that puzzles me about the overarching framework of the book is that its focus is overwhelmingly on the question of what legal restrictions poor states may place on the emigration of their talented and skilled citizens. This is an important question but not the only one we should ask. Indeed, the authors themselves wander off at various points to explore other parts of the moral terrain in which the brain drain problem is situated, only to have such explorations short-circuited, as it were, by a renewed focus on this question of what legal restrictions poor states may legitimately enact. In the rest of my comments, I want to bring more clearly into view some of the other moral issues related to the brain drain. 3. THE DUTIES OF RICH STATES Brock and Blake seem to agree that the brain drain problem emerges primarily as a byproduct of global inequalities that are themselves deeply unjust. They also both agree that rich states benefit from these unjust global inequalities. So, it seems natural to ask what (if anything) rich states ought to do to address this problem. Even if we wanted to keep the focus entirely on what to do about the brain drain problem, rather than on the broader question of what to do about the global inequality that gives rise to the brain drain problem, why should we limit our normative evaluation to the behavior of poor states? Are there morally permissible, or perhaps morally obligatory, steps that rich states can and should take with respect to the brain drain? After all, the brain drain exists as a problem only because rich states are willing to admit the talented and skilled from poor states. So, one solution might be for rich states to stop such admissions. What should we think of that approach to the issue? 05 Carens.indd 135 21/4/17 13:27 136 Joseph H. Carens LEAP 4 (2016) Brock has written extensively about global justice, of course, and she summarizes some of her key claims in chapter 2 of this book. Surprisingly, however, she does not say much about what she thinks rich states ought to do (if anything) with respect to the brain drain problem. In particular, she does not address the possibility of changing the immigration polices of rich states (apart from endorsing Blake’s support of “ethical recruitment” while expressing skepticism about the effectiveness of that approach). By contrast, Blake does spend five pages on the topic (Brock and Blake 2015: 219-224). So, let me start with that. Blake’s discussion is brief, but it provides a basis for beginning to identify some of the issues we need to consider in thinking about rich states and the brain drain. Blake begins by raising the possibility of a rich state excluding immigrants whose entry will contribute to the brain drain. He rejects that idea for three reasons. Blake’s first argument is “that the right to exclude is limited at best” (Brock and Blake 2015: 219). Having argued for open borders and for freedom of movement as a human right, I am myself quite sympathetic to this formulation, but it seems to me to be a curious claim for an author who is at pains elsewhere to defend the right of states to control immigration. In elaborating the point, Blake says that “those suffering under a non- representative regime” have “rights to be admitted into a functioning liberal democratic state” (Brock and Blake 2015: 219). This sounds like an expansive definition of who ought to qualify as a refugee. Again, I’m sympathetic but I would note that a great many people would probably qualify as refugees under this formulation, and Blake has provided no basis for restricting the number admitted. So, treating the right to exclude as limited in this way seems to open the door to mass migration from poor states to rich ones, not a brain drain but a population drain. That raises a number of interesting questions that go well beyond the issue of the brain drain, but I don’t have space to explore them here.3 The main point is that this limitation on the right to exclude is not one that has any special bearing on the highly skilled. If the requirements to qualify for entry on the grounds that one is “suffering under a non-representative regime” are interpreted more narrowly, the right to exclude will seem more robust. That is the conventional view, and normally it is Blake’s view as well. From that perspective, most people from poor states don’t have a moral claim to entry into rich states, whether they are talented and skilled or not, and rich states thus do no wrong in excluding them. 3 For an attempt to do so, see Carens (2013: chs. 10-12). 05 Carens.indd 136 21/4/17 13:27 Expanding the Brain Drain Debate 137 LEAP 4 (2016) Blake’s second argument is that “exclusion might produce underemployment and undocumented migration rather than foreign skills acquisition” (Brock and Blake 2015: 220). Blake gives no reason for supposing that this is a likely development, and it seems to me empirically implausible. The more important point, however, is that this suggestion is a distraction from the questions about principles that are the primary focus of the book. No one favors counter-productive policies. It is a premise of the whole brain drain discussion in the book that no state should adopt policies to reduce emigration from poor states if those policies are ultimately harmful to those left behind in the poor states. The philosophical debate is about whether it is morally justifiable, or perhaps even morally obligatory, to find ways to reduce emigration from poor states when that is beneficial to the poor states and their populations. It seems plausible to suppose that there are at least some circumstances under which reduced emigration would be beneficial. So, the key question is whether, under those circumstances, restrictions on immigration by rich states would be morally permissible, or perhaps even morally obligatory, if the restrictions helped to contribute to a reduction in emigration that would be beneficial to poor states. Blake’s third argument is that for a rich state to restrict entry of the talented and skilled from poor states would be “objectionably paternalistic” (Brock and Blake 2015: 220). Blake notes that he has argued that a poor state may not restrict the liberty of its own citizens for the sake of social justice and contends that it would be “equally disturbing” for a rich state to do this to the “foreign poor” (Brock and Blake 2015: 220). But this argument ignores the difference between a right of exit from one’s own state and a right of entry to another state. On Blake’s own view and in international human rights documents, this difference is fundamental. The former, the right of exit, is a basic human right. The latter, the right to enter a state where one is not a citizen, is not conventionally seen as a basic human right.4 So, denying entry is normally not as “disturbing” as denying exit. Of course, some reasons for denying entry (e.g., racial discrimination) may be morally objectionable, but on the conventional view states can justifiably refuse entry for many reasons that would not constitute a justification for refusing exit. The conventional freedom and human rights objections to restrictions on exit that constrain the way poor states may deal with their own citizens thus do not apply to restrictions on entry imposed by rich states. 4 For a defense of the view that freedom of movement should be seen as a basic human right, see Carens (2013: ch. 11). Blake himself explicitly rejects this view, however. 05 Carens.indd 137 21/4/17 13:27 138 Joseph H. Carens LEAP 4 (2016) It seems to me therefore that Blake has not offered any compelling moral reason why rich states should not restrict the entry of talented and skilled immigrants from poor states, when doing so would reduce the sort of brain drain that he himself sees as morally undesirable. Indeed, the logic of Blake’s own argument seems to lead to just such restrictions. A bit later on in this section, Blake says that the most important thing that rich states can do to address the brain drain problem is to invest the resources needed to train their own doctors and nurses domestically (Brock and Blake 2015: 223). (I agree with this recommendation, by the way.) Blake does not fully spell out why this approach would help to address the brain drain, but the implicit rationale seems to be this. If rich states had nothing to gain by admitting doctors and nurses (because they had an adequate internal supply), they would no longer give foreign doctors and nurses priority in admissions and indeed might not admit them at all, since the opportunities for foreign medical personnel to use their talents and skills productively in the receiving state would be limited. If skilled medical personnel cannot get into rich states, they will stay home and the harmful brain drain will be reduced. Notice that there are two implicit presuppositions that underlie Blake’s view, the first empirical and the second normative. First, rich states will construct their admissions policy with a view to their own interests. They admit skilled medical personnel now only because they see it as advantageous to do so. If they no longer have anything to gain by admitting skilled medical personnel, they will cease to admit them or at least cease to give them priority in admissions. Second, this sort of restrictive immigration policy is morally permissible because (on the conventional view) immigrants with particular talents and skills have no special moral claim to priority in admission or indeed to admission at all. States are free to select immigrants on whatever basis they want, so long as they do not engage in impermissible forms of discrimination such as selection on the basis of race or religion and so long as they respect certain kinds of moral claims to admission such as those made by asylum seekers who qualify under the Geneva Convention and close family members who have a moral claim for family reunification.5 So, while Blake ostensibly resists the idea that rich states should address the brain drain problem by restricting certain kinds of immigration, he actually recommends a course of action that is designed to lead to precisely that result. Indeed, we could go further. While Blake does not explicitly describe the domestic production of an adequate supply of medical personnel as a moral duty for rich states, it seems to me that his own analysis implies that it is, precisely because the failure to do this is directly 5 For a fuller discussion of acceptable and unacceptable criteria of selection and exclusion under the conventional view, see Carens (2013: chs. 9-10). 05 Carens.indd 138 21/4/17 13:27 Expanding the Brain Drain Debate 139 LEAP 4 (2016) connected to the reasons why rich states recruit skilled medical personnel from poor states. Notice that what I am talking about is quite different from the “ethical recruitment” policies that Blake and Brock endorse. Recruitment efforts already presuppose the existence of demand for the people with the skills and talents being recruited and the possibility of people with those skills and demands gaining admission. If doctors and nurses from a poor state stood no better chance of gaining admission to rich states than any other normal citizen of the same poor state, there would be no recruiters knocking at their doors. 4. MORALITY AND INTEREST Brock and Blake have focused their discussion on what poor states may legitimately do to reduce harmful brain drain, and I have explored what rich states might do. There is, however, an important difference between the position of rich states and poor states with respect to the relationship between morality and interest when it comes to the brain drain. Assume (as an unrealistic but analytically useful simplification) that governments want to act in the interests of those they govern. The governments of poor states have an interest in reducing emigration that harms those left behind. They have to be able to distinguish between harmful and beneficial emigration, of course, and to find policies that reduce the former but not the latter (at least on balance). As we see in this book, that is not always easy. But in this process, morality acts primarily as a constraint upon policy choices, not as the main motivation for a policy choice. To be morally acceptable, the policy must respect the moral claims of the state’s own citizens, especially their basic human rights which include the right of exit. But the main motivation and justification for a (morally permissible) policy that reduces emigration can be simply that it serves the interests of the population that is being governed. Contrast this with the situation of the governments of rich states. If rich states stop giving preference in admission to skilled medical personnel from poor states (and assume here, for the sake of this argument, that this would in fact reduce harmful emigration from poor states), they will have to spend more money on training and educating medical personnel domestically or leave their populations underserved. Either way, they will be adopting a policy that is contrary to the interests of the population that 05 Carens.indd 139 21/4/17 13:27 140 Joseph H. Carens LEAP 4 (2016) they govern, at least as interests are conventionally understood.6 Here morality becomes not simply a constraint on acceptable public policy, but its main motivation and justification. Duty, not interest, would be the driving force behind the proposed policy change. The government would have to say we are adopting this course because it is morally wrong to continue to take advantage of the medical training provided by poor states to serve our needs in the rich states. That might work politically in some contexts, but it might not in others. As a general matter, it is easier to get governments (and ordinary people) to act in accordance with moral duty when their duty coincides with their interests, at least their long-run interests, than when it conf licts with their interests (as is sometimes the case). 5. MORAL TRAGEDY AND THE BRAIN DRAIN One issue on which Brock and Blake do disagree is on whether it is appropriate to see the brain drain as a moral tragedy. Towards the end of his initial statement, Blake suggests that we think of the brain drain as a moral tragedy, i.e., a situation in which “we face significant injustice, and yet we cannot move away from that injustice without deploying means that are themselves unjust” (Brock and Blake 2015: 226). Brock expresses skepticism that this is an appropriate way to characterize the brain drain problem, given the range of policies that she and Blake agree it would be morally permissible to employ to reduce the effects of the brain drain (Brock and Blake 2015: 267-273). I agree with Brock, but I would like to sharpen the critique even further. Blake sets his worries about whether we know how to address the morally undesirable forms of brain drain in ways that are morally acceptable in the context of a wider concern about whether we know how to reduce global inequalities (which he regards as unjust) in ways that are morally acceptable. In effect, this attributes the enduring character of global injustice to a failure of knowledge, rather than a failure of will, on the part of rich states and their populations. I think that is a mistake. I do not mean to deny that there are lots of puzzles about the best way to eliminate poverty or promote economic development or reduce global inequalities and that some policies adopted with the best of intentions have proven to be counterproductive. But I also think that there are many, many examples of rich states simply pursuing their own interests at the 6 As Plato shows in the Republic, it is possible to argue that we always have an overriding interest in being just regardless of how that affects our interests conventionally understood. I set aside here the possibility of reinterpreting our interests in this way. 05 Carens.indd 140 21/4/17 13:27 Expanding the Brain Drain Debate 141 LEAP 4 (2016) expense of poor states (e.g., in trade negotiations). In such cases, it is not knowledge of what would benefit poor states that is lacking but the willingness to put their interests ahead of the interests of rich states. Or take the current refugee crisis. In my view, what justice requires is plain enough: the admission and settlement of large numbers of refugees in Europe and North America. The problem is not that we don’t know how to do this, but rather that most rich states and their populations are unwilling to do what is morally required. So, they off load the responsibility for refugees onto the states nearest the ones from which the refugees are f leeing. There is no moral justification for this course of action. It is a failure of will, not knowledge. In sum, it is essential not to characterize these sorts of moral failures as moral tragedies brought on by our ignorance about what to do to reduce global injustice. With respect to the brain drain, the situation is perhaps a little more complicated. Nevertheless, Blake’s own analysis shows that one important way to reduce the demand for skilled medical personnel from poor states is for rich states to produce an adequate supply from within their own populations. And, as I have just argued, if they did that, the rich states would no longer have any incentive to give priority in admission to skilled medical personnel from poor states and they would violate no moral rights (as conventionally understood) in not giving admission priority to skilled medical personnel. I don’t say this would solve all of the issues raised in the brain drain debate, but it seems like one relatively clear and positive step that the rich states could take. Again, the main problem, it seems to me, is not a lack of knowledge but an unwillingness on the part of rich states and their populations to do what is morally required when that conf licts with their interests. 6. DUTIES AND COMMUNITIES Finally, the brain drain raises a number of interesting and important questions about the nature and extent of our moral obligations to particular communities or persons. Leave aside for a moment questions about legal restrictions. Do skilled medical personnel in poor states have a moral duty to stay at home and put their abilities to use in serving their fellow citizens? Do they act unjustly if they move to a rich state, even if they are legally free to do so? Brock and Blake touch upon these questions, but again I think their exploration of them is short-circuited by their focus on legal constraints and the possibility of contractual agreements that can make legal constraints justifiable. Brock spends a bit of time at the beginning of 05 Carens.indd 141 21/4/17 13:27 142 Joseph H. Carens LEAP 4 (2016) chapter four identifying normative arguments about the duties of citizens to contribute, but she frames this as a part of a report to a government seeking to implement a legally binding policy, and, as I indicated before, her focus is on showing that the conditions to which people are asked to consent are not unreasonable. So, we don’t really get the fuller sort of inquiry that would be required to explore questions about the nature and extent of our moral duties to contribute to the political communities in which we live and whether we have any obligations beyond what can be extracted from a formal contractual arrangement. This is an important question for the brain drain because if skilled medical personnel in poor states only stay at home as long as it takes to fulfill the requirements of a reasonable contractual agreement, the existence of such policies will not do much to remedy the problem. It may matter a lot whether people with medical training feel they have a duty to stay and help out or whether they feel morally entitled simply to pursue their own interests and inclinations wherever those lead. And our ideas about our duties and our entitlements do not simply fall from the sky. They are taught to us, formally and informally, by our families, our schools, and our society. There is no social order without social norms. But, of course, some social norms infringe unduly on personal freedoms, and some ways of inculcating social norms are morally problematic. Leave aside for the moment questions about the ways in which the normative ideas are passed on. What sorts of norms and values is it morally permissible for a political community to seek to transmit with respect to the concerns raised by the brain drain? For example, would it be morally acceptable for a poor state to teach children that those with special gifts and opportunities for advanced training have a particular obligation to use their gifts and training in ways that will benefit the community? Would it be morally acceptable to tell students that they should not seek medical training unless they are willing to commit themselves to working within their home state over the long run, at least under normal circumstances, (even if there were no effort to enforce this commitment legally)? Would it be morally acceptable to make that norm part of their professional training? Medical ethics routinely comprises part of the training of doctors. Would it be reasonable to see this sort of norm as one component of medical ethics for doctors in poor states? Would it be morally acceptable if this sort of expectation became part of a wider social culture, so that most people in a poor state felt it would normally be wrong for skilled medical personnel to move to a rich country? I think that Brock might be inclined to respond positively to some of these questions, but her focus on what legal requirements states can 05 Carens.indd 142 21/4/17 13:27 Expanding the Brain Drain Debate 143 LEAP 4 (2016) impose prevents her from exploring them adequately. This is not a criticism. To explore one topic thoroughly, one often has to bracket others. My goal here is simply to draw attention to some of the interesting questions that have been left unaddressed. It might seem as though Blake provides more resources than Brock for answering at least some of these questions, and in Blake’s case the answer would appear to be in the negative, because he does spend a fair amount of time in chapters 7 and 8 criticizing arguments that seem to advance these sorts of claims about our moral duties. At almost every critical juncture in his discussion, however, Blake falls back upon an insistence that whatever sorts of moral duties we might have towards our communities or towards other people, they don’t justify using the coercive power of the state to compel people to take on certain jobs or perform certain tasks or to forfeit their legal right to exit. So, in the end, he doesn’t really tell us whether or not it is morally acceptable to have social expectations about what people do with their talents and skills or whether it is appropriate to see such expectations as legitimate moral duties. Nor does he show that it can never be morally wrong, even unjust, to leave a society, even when one has the legal right to do so. Consider, for example, Blake’s discussion of the novel Stoner in which the main character chooses to become an English professor rather than to acquire agricultural knowledge and return home to help with the family farm as his parents expected him to do when they paid for his college edu- cation. Blake says that we can disagree about the morality of Stoner’s choice but he should not be forced to study agriculture and to return to the farm. I certainly agree, but I would be interested to know whether Blake thinks that Stoner’s choice is morally justifiable or not and why. The fact that Stoner should not be forced to act in a particular way does not help us in answering that question. Would it be reasonable to say that Stoner has failed in a moral duty in acting as he did, and even perhaps that he acted unjustly? (Of course, we would need more information than Blake provides to assess that question since it would presumably depend in part on whether he simply abandoned his parents or took positive steps to repay the money they had invested in his education or to provide for them in some other way.) Blake sometimes writes as though any moral demand on a person to act in a certain way or to choose a certain path is an unreasonable infringement on free choice, but he doesn’t really develop that line of argument systemati- cally, and I think it would be hard to sustain. At one point he distinguishes between “a duty of virtue” and “an enforceable duty of politics”, but I see no reason to assume that every political duty must be legally enforceable (Brock and Blake 2015: 121). Similarly, on the same page, he seems to want to limit 05 Carens.indd 143 21/4/17 13:27 144 Joseph H. Carens LEAP 4 (2016) the terms “justice” and “rights” to matters that are legally enforceable, but he provides no reason for this restriction and I don’t think it corresponds to the way we use these terms in ordinary moral life. Later in the book, in criticizing the idea that it might be appropriate to say that people with greater abilities have stronger obligations because of those abilities, he criticizes the conventional gendered division of labor within the family, saying “we should recognize that we ought to allocate the burden of parenting fairly” (Brock and Blake 2015: 172). In this context he has no difficulty in recognizing that the language of fairness (justice?) can be invoked even when there is no question of legal enforcement of the requirements of fairness. The “we ought to allocate” is precisely a recognition of the existence of social norms (in this case, norms relating to gender) which are constructed collectively and which are an appropriate topic for political and moral disputation. So, in the same way, I don’t think that Blake could rule out of bounds, as he sometimes seems to try to do, the sorts of moral demands that some people would like to address to skilled medical personnel in poor states. But as with Brock, I think the main reason that Blake does not provide answers to the questions I have asked is simply because he has chosen to focus primarily on the issue of legitimate legal restrictions on exit, and that is a reasonable strategic choice. So, how should we answer the sorts of questions I have posed? I must confess that I do not have a clear answer. On the one hand, like Brock and, I think, more than Blake, I am sympathetic to the idea that a just society can include legitimate expectations and social norms with respect to the ways in which people make use of their talents and skills. Choice is morally important, but it is not the only morally important consideration. In that respect, I’m sympathetic to the idea that it is reasonable to expect skilled medical personnel in a poor state to use their abilities to meet the health needs of their fellow citizens rather than using them simply for material gain or professional advancement in another society. On the other hand, we don’t live in a just world. So, I would also be sympathetic to a doctor or nurse from a poor state who said, “Why should I be the one to bear the burdens of serving the health needs of this community especially since they are in important respects the byproducts of an unjust social order? Why shouldn’t skilled medical personnel from rich states be the ones with a duty to come and address these problems?” From this perspective, those who go to work for Medecins sans Frontieres are simply fulfilling a moral duty, not acting altruistically as we are often inclined to think. And the doctors who stay in their home rich states are the ones failing in their moral duties, not the doctors who leave the poor states. 05 Carens.indd 144 21/4/17 13:27 Expanding the Brain Drain Debate 145 LEAP 4 (2016) To be frank, that is just the starting point for some of the intellectual puzzles that emerge when we seek to talk about moral duties in an unjust world. Often we invoke the language of rights and duties in a context that simply screens this background injustice from view. That is understandable and perhaps even necessary to guide action in the world, but from an intellectual and moral perspective it is also unsatisfactory. I think that these deeper puzzles about moral rights and duties in an unjust world that emerge from thinking about the brain drain in a wider perspective deserve the same sort of extensive and thoughtful treatment that Brock and Blake have given to the question of whether states may legally restrict emigration. BIBLIOGRAPHY Brock, G. and Blake, M, 2015: Debating the Brain Drain: May Governments Restrict Emigration, Oxford: Oxford University Press. Carens, J. H, 2013: The Ethics of Immigration, Oxford: Oxford University Press. 05 Carens.indd 145 21/4/17 13:27