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Health Without Care? Vulnerability, Medical Brain Drain, and Health Worker Responsibilities in Underserved Contexts
Linköping University, Department of Culture and Communication, Centre for Applied Ethics. Linköping University, Faculty of Arts and Sciences. (The Ethics of Migration)ORCID iD: 0000-0003-2867-1212
2018 (English)In: Health Care Analysis, ISSN 1065-3058, E-ISSN 1573-3394, Vol. 26, no 1, p. 17-32Article in journal (Refereed) Published
Abstract [en]

There is a consensus that the effects of medical brain drain, especially in the Sub-Saharan African (SSA) countries, ought to be perceived as more than a simple misfortune. Temporary restrictions on the emigration of health workers from the region is one of the already existing policy measures to tackle the issue - while such a restrictive measure brings about the need for quite a justificatory work. A recent normative contribution to the debate by Gillian Brock provides a fruitful starting point. In the first step of her defence of emigration restrictions, Brock provides three reasons why skilled workers themselves would hold responsibilities to assist with respect to vital needs of their compatriots. These are fair reciprocity, duty to support vital institutions, and attending to the unintended harmful consequences of one's actions. While the first two are explained and also largely discussed in the literature, the third requires an explication on how and on which basis skilled workers would have a responsibility as such. In this article, I offer a vulnerability approach with its dependency aspect that may account for why the health workers in underserved contexts would have a responsibility to attend to the unintended side effects of their actions that may lead to a vital risk of harm for the population. I discuss HIV/AIDS care in Zimbabwe as a case in point in order to show that local health workers may have responsibilities to assist the population who are vulnerable to their mobility.

Place, publisher, year, edition, pages
Springer, 2018. Vol. 26, no 1, p. 17-32
Keywords [en]
medical brain drain, ethics, vulnerability, Zimbabwe, HIV/AIDS, health workers
National Category
Ethics Philosophy Medical Ethics International Migration and Ethnic Relations
Identifiers
URN: urn:nbn:se:liu:diva-134570DOI: 10.1007/s10728-017-0342-xISI: 000425320600002PubMedID: 28224293OAI: oai:DiVA.org:liu-134570DiVA, id: diva2:1074937
Funder
Lars Hierta Memorial Foundation, FO2013-0484
Note

Funding agencies: Stiftelsen Lars Hiertas Minne [FO2013-0484]

Available from: 2017-02-16 Created: 2017-02-16 Last updated: 2019-05-27
In thesis
1. Doctors Behind Borders: The Ethics of Skilled Worker Emigration
Open this publication in new window or tab >>Doctors Behind Borders: The Ethics of Skilled Worker Emigration
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This doctoral thesis within applied ethics consists of four articles together with a cover essay. All articles concern the ethics of skilled health worker emigration from under-served and resourcepoor regions, often referred to as ‘medical brain drain’. Methodologically, the thesis utilizes normative ethical theory to analyse the justifiability of temporary or long-term emigration restrictions, such as compulsory health service programmes, that are employed by developing countries with the aim of safeguarding their needs for health care provision. Such programmes restrict the mobility of individual health workers and give rise to conflicts between different types of rights and interests.

The ethics of skilled worker emigration warrants an exploration of the ethical implications of such restrictive programmes for different stakeholders, such as the under-served countries and health workers; and a clarification of the rights and duties of the concerned parties. This thesis provides a thorough analysis and clarification of such rights restrictions and offers theoretically and empirically grounded recommendations as to how they ought to be managed. Rights theory and accounts of individual responsibilities are employed to assess the acceptability of restrictive health service programmes.

In brief, the thesis (a) discusses the conditions under which individual health workers may have responsibilities to attend to the basic health needs of a population, (b) explicates the rights at stake such as the freedom of movement and the right to exit, (c) offers insight into what it means to restrict one’s right and its implications and (d) suggests ways for conflicting rights and interests to be balanced and resolved. Taken together, the thesis presents a nuanced approach towards individual responsibilities in under-served contexts and an improved understanding of the right to exit as well as the implications of restricting the right. The thesis also contributes to the ethics of skilled worker emigration with a discussion on the responsibilities of skilled workers when the other parties do not fulfil their fair share of responsibilities.

Abstract [sv]

Denna avhandling i tillämpad etik består av fyra artiklar jämte en längre introduktion. Samtliga artiklar behandlar etiska aspekter på emigrationen av högutbildad vårdpersonal från utvecklingsländer och resursfattiga regioner, ett fenomen som ofta beskrivs som medicinsk kunskapsflykt (Medical Brain Drain). Utifrån normativ etisk teori analyseras i vilken utsträckning, om alls, utvecklingsländers ansatser att säkerställa nationella vård- och omsorgsbehov med hjälp av begränsningar av vårdpersonals mobilitet kan anses vara etiskt försvarbara. I avhandlingen analyseras också olika intressenters skyldigheter och rättigheter utifrån teorier om ansvar och rättigheter. Det gäller bland annat frågan om sjukvårdspersonalens individuella ansvar att stanna i hemlandet för att tillgodose grundläggande vårdbehov hos befolkningen.

Avhandlingen bidrar med ett klargörande av (i) argument för och emot begränsningar av vårdpersonals rätt att lämna landet, (ii) relaterade rättighets- och intressekonflikters natur och (iii) teoretiskt förankrade rekommendationer för hur denna typ av konflikter bör hanteras. Avhandlingen synliggör etiskt relevanta följder av obligatoriska vårdprogram för olika intressegrupper (stakeholders) som stater, vårdgivare, vårdpersonal och vårdtagare, liksom vilka rättigheter och skyldigheter som står på spel, som exempelvis rätten att fritt lämna sitt land och rätten till grundläggande hälso- och sjukvård. Sammantaget bidrar avhandlingen med en grundlig analys av skäl för och emot begränsningar av den fundamentala men sparsamt analyserade mänskliga rättigheten att lämna det egna landet.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019. p. 69
Series
Linköping Studies in Arts and Sciences, ISSN 0282-9800 ; 767CTE, ISSN 1402-4152 ; 18
Keywords
Brain drain, compulsory service, contracts, emigration, ethics, health workers, medical brain drain, skilled workers, responsibility, the right to exit, vulnerability, non-ideal theory, Etik, kontrakt, kunskapsflykt, mänskliga rättigheter, migration, moraliskt ansvar, obligatoriska vårdprogram, rättighet, utsatta grupper, vårdpersonal
National Category
Ethics International Migration and Ethnic Relations Globalisation Studies
Identifiers
urn:nbn:se:liu:diva-157076 (URN)10.3384/diss.diva-157076 (DOI)9789176850893 (ISBN)
Public defence
2019-06-14, KEY 1, Hus Key, Campus Valla, Linköping, 10:00 (English)
Opponent
Supervisors
Available from: 2019-05-27 Created: 2019-05-27 Last updated: 2019-11-01Bibliographically approved

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