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Empirical Bioethics and the Health ‘Brain-Drain’: a qualitative study of the experiential and ethical landscape of compulsory community service for a group of South African doctors
  1. Caitlin Victoria Gardiner1,2
  1. 1Global Health and Social Medicine, King's College London - Strand Campus, London, UK
  2. 2Developmental Pathways for Health Research Unit, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
  1. Correspondence to Dr Caitlin Victoria Gardiner, Global Health and Social Medicine, King's College London - Strand Campus, London, UK; caitlin.gardiner{at}kcl.ac.uk

Abstract

The health ‘brain drain’ (HBD) is an issue of significant global bioethical concern, resulting in severe maldistribution of healthcare workers (HCWs) and gross inequities in health service provision. The ethics of the HBD and its possible mitigation strategies are, however, complex and areas of active ongoing bioethical debate. South Africa faces a dire and worsening HBD crisis, and use a mitigation strategy of compulsory community service, or ‘comserve’, for most HCWs. While there is some literature on HCWs’ comserve experiences and the various ‘push and pull’ factors affecting their migratory decisions, there is a notable gap regarding their personal values, beliefs and ethics regarding the HBD and comserve, which, as this research supports, play a prominent role in migratory decisions. This empirical bioethics research aims to explore this among a group of South African doctors who recently completed comserve, as well as how their experiences affected their situation on the individualist-collectivist continuum. This was done qualitatively using semistructured interviews with 11 participants and analysed using reflexive thematic analysis under a methodology of critical realism. Themes identified were ‘Special Duties’; ‘Freedom and Autonomy’; ‘Justice and Accountability’; and ‘The Individualist-Collectivist Continuum’. Participants use a variety of ethical theories to discuss the HBD and oppose or support comserve, which play a significant role in their migratory decisions. Most find the policy to be theoretically ethically justifiable but note that procedures undermine this. There are also several factors that appear to affect participants’ position on the individualist-collectivist continuum, with some paradoxical effects on the HBD.

  • medical ethics/bioethics
  • Doctor
  • Health policy
  • human rights
  • Medical humanities

Data availability statement

The data that support the findings of this study are available from the corresponding author, CVG, upon reasonable request.

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Data availability statement

The data that support the findings of this study are available from the corresponding author, CVG, upon reasonable request.

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Footnotes

  • Twitter @CaitGardiner

  • Contributors CVG is the sole author of this work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.