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The Right to Exit and Skilled Labour Emigration: Ethical Considerations for Compulsory Health Service Programmes
Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Culture and Communication, Centre for Applied Ethics. University of Bern, Switzerland.ORCID iD: 0000-0003-2867-1212
2018 (English)In: Developing World Bioethics, ISSN 1471-8731, E-ISSN 1471-8847Article in journal (Refereed) Published
Abstract [en]

Compulsory (health) service contracts have recently received considerable attention in the normative literature. The service contracts are considered and offered as a permissible and liberal alternative to emigration restrictions if individuals relinquish their right to exit via contract in exchange for the state-funded tertiary education. To that end, the recent normative literature on the service programmes has particularly focused on discussing the circumstances or conditions in which the contracts should be signed, so that they are morally binding on the part of the skilled workers. However, little attention is devoted to the relevance of the right to exit for the debate on compulsory service programmes. In this paper, I argue that even if the service contracts are voluntary, and thus the would-be medical students voluntarily relinquish their right to exit, the reasons behind the right should be taken into account for the contracts to be morally valid. A clear understanding of the right to exit is a must in order not to breach its basic components and for the service contracts to be morally binding. To that end, I provide two accounts of the reasons to value the right to exit by presenting Patti Lenard’s discussion of the right and by reconstructing James Griffin’s account of human rights. I conclude by offering brief ethical considerations for compulsory health service programmes grounded in the reasons to value the right to exit.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018.
Keywords [en]
compulsory service, ethics, right to exit, contract, health workers, migration
National Category
Ethics Philosophy Medical Ethics Political Science (excluding Public Administration Studies and Globalisation Studies) International Migration and Ethnic Relations
Identifiers
URN: urn:nbn:se:liu:diva-152001DOI: 10.1111/dewb.12217PubMedID: 30548442OAI: oai:DiVA.org:liu-152001DiVA, id: diva2:1270216
Available from: 2018-12-12 Created: 2018-12-12 Last updated: 2019-05-27Bibliographically approved
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: 2019-05-27Bibliographically approved

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Yuksekdag, Yusuf

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