**6.1 Utilitarianism**

*Contemporary Developments and Perspectives in International Health Security - Volume 1*

(ratified by 48 of the 53 Member States).

linked to migration and ethnicity.

**5. Current situation and global trend**

prime reasons for this decision [9–11].

**6. Theories of morality**

resident nonimmigrants without basic healthcare.

action on the social determinants of health and

• The 2000 Protocol to Prevent, Suppress and Punish Trafficking in Persons, especially Women And Children (ratified by 52 of the 53 Member States).

• The 2000 Protocol against the Smuggling of Migrants by Land, Sea, and Air

• World Health Assembly resolution 62.14 on reducing health inequities through

• WHO Regional Committee for Europe resolution EUR/RC52/R7 on poverty and health, and related follow-ups, such as efforts to address health inequity

Changes in governments over time and change in the attitudes of people have made it hard to ensure enforcement of the international laws and guidelines on the provision of healthcare to refugees. Some of the countries such as Germany and Canada welcomed several refugees and provided asylum to them, while others such as the United States and Austria have taken a more rigid stance against them and have implemented legal and physical barriers against asylum seekers. These governments were elected based on their border policies, and therefore, the decisions are not those of individual people alone but a collective majority. This general trend based on a narrative of fear, racism, and scarcity is, unfortunately, proving to be an excellent political strategy. Chancellor of Germany, Angela Merkel, who strongly supported an open border for refugees making Germany one of the most refugee-friendly countries in Europe, had a decrease in popularity shortly after the most significant intake of refugees. News

Similarly, Donald J. Trump, president of the United States of America who won in 2016, has a strong anti-immigrant and closed border policy, which continues to be popular with many people in the United States. These recent global trends have made it harder to enforce policies to ensure health security for refugees. The British voted, by a significant majority, to leave the European Union for similar reasons. They cited "unacceptable strains on housing, welfare, and education" as one of the

Governments supporting closed borders and fueling racism have led to increase

Moral theories attempt to determine right and wrong conduct. They allow individuals and, in extension, countries to critically evaluate the decisions they make in terms of impact beyond the social and economic implications. Morality has allowed the human species to survive in mutual harmony and to promote maximum welfare.

in the backlash against immigrants or ethnically different groups. Right wing support correlated with hate crimes in Germany according to a survey analysis. Similary, hate crimes in India had surged by 300% which correlated significantly with the election of the right wing Hindu Nationalistic Party, "BJP" [12]. These changes are concerning as it not only endangers the new vulnerable influx population but also affects the integrated existing immigrants and their future generations. Far right policy changes could leave all refugees, immigrants, and even

articles reported that her decisions were not well received in the country.

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Utilitarianism holds that morality must aim to maximize human welfare and happiness as a species. John Stuart Mill, a utilitarian philosopher, claimed that actions are right in the proportion they tend to promote happiness and vice versa, where happiness is intended pleasure and absence of pain.

This moral theory supports many actions in medicine, such as triage and social medicine. However, it fails to take into account the age of the person or our obligations toward specific people such as our children or parents. Another reason why this theory is hard to uphold is the degree of self-sacrifice it demands. It obliges us to sacrifice our interests and the interests of the people close to us for the sake of people that we do not know if that is what will maximize good or utility. For example, it is hard to convince a physician in a developed world to move to a developing country while leaving or endangering their family for "utility." It is also hard to convince a physician in a developing country to avoid pursuing opportunities in developed countries. If going by utilitarian analysis for providing healthcare for refugees, the sheer number of refugees justifies spending resources to provide healthcare to this vulnerable population. In other words, the burden of cost is not high when compared to the suffering of the large number of refugees [4, 13, 14].
