Medical Ethics Education in China

To perform a comparative quantitative and qualitative analysis of Chinese and non-Chinese medical ethics literature using systematic research and literature analysis in order to discern research trends in the area and provide baseline data as a reference for relevant decision making and further study. We retrieved articles using MeSH terms and keywords related to medical ethics in PubMed and CNKI, and then constructed a set of charts by applying word co-occurrence, The Pathfinder Networks algorithms, an included subject chart, a research field relationship chart, and strategy coordination charts. The total of number of papers retrieved from PubMed was six times that retrieved from CNKI. Outside China, medical ethics has been studied in eight fully shaped subject fields, including morals, ethical review, physician-patient relationships, clinical trials, euthanasia, ethics education, clinical ethics, and health policy. In contrast, medical ethics research in China is still confined to five subject fields: morals, physician-patient relations, medical ethics education, ethical review, and medical research. Medical ethics research outside China emphasizes the application of medical ethics to solve emerging problems in clinical and medical research. It is mainly centered on morals, ethical review, and physician-patient relations. By comparison, medical ethics research in China places greater emphasis on morals and medical education. In order to narrow this gap between China and other countries, we should broaden the research scope of medical ethics and add more applied research, such as ethical review and medical education.

Chinese social thought and moral ethics underwent significant transformations because of modern social structure changes. Medical ethics with Chinese characteristics came into being with the introduction of modern western medicine and medical ethics into China. This indicated that Chinese medical ethics might be the integration of Chinese traditional ethics and western medical ethics. It was found that the development of modern Chinese medical ethics involved the following characteristics -- attaching importance to the consistence of the power and responsibilities of physicians, highlighting the function of medical societies and legislation in professional ethics, pledging their medical secrets, and being patriotic to their motherland. It was also found that the development of modern Chinese medical ethics had some deficiency because of the times and social backgrounds. These complicated characteristics and values of modern Chinese medical ethics can be taken as references for the further development of contemporary Chinese medical ethics.

LANGUAGE NOTE | Document text in Chinese; abstract also in English.本文通過中國和美國的醫學生對同一個案例的不同看法，提出了醫學倫理學教育的本質問題，即如何實現醫學生的道德？作者根據芝加哥大學臨床倫理中心和北京大學醫學倫理學教研室工作的實際情況繪出了兩個單位的工作示意圖，基於此，作者嘗試對北京大學和芝加哥大學醫學倫理學教育和實踐械制進行比較研究。總的來說，無論是從學生入學時的年齡和學生對學醫目的的明確上，還是從醫學倫理學的教學方法上，以及學校在醫學倫理學的教育體制等方面，二者都存在很大的差別。我國的醫學倫學教學雖然已經比較普及地進行案例教學。但案例教學若想深入下去還是比較困難的，若不成功，非常容易使學生得出學習醫學倫理學之後沒有什麼長進的感覺，表面上看是因為學科本身的對案例分析沒有明確答案的原因，但本質上是教師在引導學生思考的方式、角度和啟發性存在問題，沒能真正提高學生分析和解決問題的能力。所以，本文提出了我國的醫學倫理學教育是個系統工程，需要在案例分析方法、教師的素質本身的提高、帶教老師的倫理學培訓、教師與醫生聯合進行課題申請和研究、醫院成立醫院倫理委員會和IRB兩個與倫理學有關的職能部門等方面必須加強，也開展定期的發生在醫院內的案例討論，這樣既可以使醫學倫理學教學和科研人員能通過正常渠道進入醫療實踐中，充分實現醫學倫理學的實踐性，並反映到醫學倫理學的教學中，也能在醫學生的培養、醫學生成為醫生之後的繼續教育等方面取得突破性進展。Based on the fact that medical students at Peking University and at the University of Chicago have different moral responses to a case of medical ethics, this essay raises a question regarding the education of medical ethics: how can medical students realize their medical morality? It firstly offers a general introduction to the distinct working systems of the Center of Clinical Ethics at the University of Chicago and the Teaching and Research Office of Medical Ethics at Peking University Health Science Center. Then it compares the essential differences of the two institutions in their working systems. Generally speaking, there exist differences between the two institutions in the age of students at medical school, their objectives of choosing to study medicine; methods of medical ethics teaching, and education systems. In particular, even though case study as an important educational method is used commonly in current China, it is difficult to deepen the content and strategy of the teaching. Sometimes students think they have not learned anything from the teaching of medical ethics. Simply speaking, it is because there are no fixed, black-or-white answers to many cases used in the course. More essential reason, however, lies in the quality of medical ethics teachers themselves. They often cannot do a good job on the way of teaching and fail to lead students to think carefully. As a result, they cannot assist students to improve their ability to analyze and resolve ethical issues. The essay concludes that education of medical ethics is a systematic moral engineering. It should be paid attention not only to the effective methods of teaching (such as case analysis) and the promotion of the quality of medical ethics teachers, but also to the combination between medical ethics teachers and physicians in clinical practice, and the establishment of hospital ethics committees and IRBs. The essay recommends that Chinese medical ethics teachers, hospital managers and university administrators should appreciate the importance of medical ethics education and help medical ethics teachers and researchers go into practice through certain routine channels, strengthen the training of the humanities on the side of medical ethics teachers, and at the same time make good progress in the continuous ethical education of physicians.DOWNLOAD HISTORY | This article has been downloaded 12 times in Digital Commons before migrating into this platform.

The article examines the issue of teaching medical ethics in leading Chinese universities in the training of medical professionals and found that medical ethics courses for physicians are an innovation for Chinese medical high schools. Due to different cultural traditions, researchers of Chinese medical ethics hold conflicting views on the scientific importance and practical necessity of medical ethics and bioethics. The study found that medical ethics education in China has gradually adapted the experience of leading countries such as the United States and the United Kingdom in teaching ethics. China is now in the process of discussing how to develop its own traditional ethics in the context of globalization. It is established that in the program of masters in medicine the formation of ethical knowledge is a mandatory subject. The teaching of medical ethics takes place not only while studying in Chinese universities, but is a long-term lifelong process in which the student summarizes the results of their efforts, combining moral reflection, learning and leadership. The article analyzes the methods and content of teaching medical ethics, which include relevant cultural, social and personal development, and the education of masters in medicine at Chinese universities.Teaching ethics in medical universities is a relatively new area of medical education in China, ethics curricula have different levels of development. In order to determine the peculiarities in the contents of curricula, teaching and learning methods, forms of evaluation and quality of teaching ethics in China, it was analyzed ethical education in several leading medical universities in China: Wuhan University School of Medicine, Guangzhou Medical University and Peking University School of Medicine. In the process of scientific research on the teaching of ethics in universities, it was found that medical ethics for some time was part of the mandatory course of disciplines, with a strong tendency to emphasize the correct ideological thinking of future physicians.Key words: specialist in medicine, medical ethics, master’s degree, higher medical education in China, professional competence of doctor.

Since the late 1970s, American appraisals of Chinese medical ethics and Chinese responses to American bioethics range from frank criticism to warm appreciation, from refutation to acceptance. Yet in the United States as well as in China, American bioethics and Chinese medical ethics have been seen, respectively, as individualistic and communitarian. In this widely-accepted general comparison, the great variation in the two medical moralities, especially the diversity of Chinese experiences, has been unfortunately minimized, if not totally ignored. Neither American bioethics nor Chinese medical ethics is a field with only one dominant way of thinking. Medical moralities in America and China -- traditional and modern -- have always been plural and diverse. For example, American and Chinese cultures and medical moralities both exhibit individualistic and communitarian traditions. For this reason, bioethics in general and cross-cultural bioethics in particular must be fundamentally interpretive. Interpretive cross-cultural bioethics appreciates the plurality of medical morality within any culture. It can serve as a vital means of social and cultural criticism through engaged interpretations.

Medicine is a life science. Doctor' s professional quality and the level of moral standards directly affect patients life. The medical students therefore should be aware of the importance of medical ethics from the theoretical and practical understanding. In the long history of ancient and modern society, there are many well-known physicians who with their exquisite art and lofty medical ethics have left their good names for hundreds years and generations. And in medical ethics, the biggest influence is from ancient famous traditional Chinese medical doctor SUN Si-miao and ancient Greek physician Hippocrates. Medical ethics elaboration by SUN Si-miao is highly esteemed by the later generations. And Hippocrates is regarded as the father of medicine. Hippocrates' oath has become the sworn word of many western medi-cal institutions at their graduation ceremonies. The medical ethics of both the Chinese and Western medical ethics each represents their own concept where two different times, different social environment in which, by the thinking of different ideas, make them the medical ethics differently. While Hippocrates' s idea for evaluation of doctors pay greater attention to those who are or are not talent, SUN Si-miao' s, however, to hard working. But in medicine and in the cultivation on virtues, the two have a common concept of medical ethics. The concepts include the idea that good moral character and behavior are the criteria for qualified doctors and patients should be treated equally. These concepts of medical ethics are still of guiding signifi-cance to today's medical students in our culture and will be melted into all aspects of student' s learning through various forms of medical ethics education in teaching. Key words: Morals porinciple of traditional Chinese medicine and western medicine; Medical eth-ics education; SUN Si-miao; Hippocrates

The authors' primary goal was to provide a comprehensive and current review of the literature surrounding ethics education for medical students. Following this review, the authors summarize the deficits in the current literature and provide recommendations for future inquiries on medical ethics education. In 2004, the authors searched MEDLINE and PubMed using the following search terms: ethics, ethics education, medical ethics education, curriculum, undergraduate medical education, virtue, role model, philosophy of medicine, and outcomes research. No limit was placed on dates for this literature search. Articles whose primary focus was professionalism were excluded because the professionalism literature tends to focus on competencies and postgraduate education, whereas the primary focus of this study was on undergraduate education. Literature on physicians as role models to medical students as a form of teaching medical ethical ethics was excluded as well because the current discussion examines the formal undergraduate medical ethics curricula. Also excluded were reports from foreign countries (unless there were no equivalent studies in the United States). The authors found almost no literature exploring students' backgrounds (cultural, religious, socioeconomic, etc.) and the teaching of medical ethics in medical schools. Otherwise, the authors reviewed everything they could find, regardless of imperfections in individual reports such as small sample size or poor research methodology. The review, which encompassed articles from 1978 to 2004, revealed that deep shortcomings exist in the literature on medical ethics education. Deficits exist in all areas of the literature: (1) theoretical work done on the overall goals of medical ethics education; (2) empirical studies that attempt to examine outcomes for students; (3) studies examining teaching methods in medical ethics education, and (4) studies evaluating the effectiveness of various teaching methods. There are substantial opportunities for contribution to the literature on medical ethics education in all of the areas where deficits exist. The literature suggests that two points of view exist regarding the purpose of teaching medical ethics: (1) that it is a means of creating virtuous physicians; and (2) that it is a means of providing physicians with a skill set for analyzing and resolving ethical dilemmas. This dichotomy made it difficult to arrive at a consensus regarding the goals of medical ethics education. The field would benefit from further theoretical work aimed at better delineating the core content, core processes, and core skills relevant to the ethical practice of medicine. The time has come to organize an effort to improve and validate medical ethics education. In the end, effective medical ethics education will further the goals of medicine in dramatic and tangible ways.

Thousands of health professionals who share common interests enroll in associations by their own choices. In China medical associations are academic organizations classified by specialty, and membership is voluntary. Medical associations are not trade guilds, nor are they family or religious groups or professional societies. Each has its own constitution. They include the China Medical Association (CME), Chinese Academy of Preventive Medicine, Traditional Chinese Medicine Association, Chinese Nursing Association, Chinese Pharmaceutical Association, and Chinese Association of Combined Chinese Traditional and Western Medicine. Some were founded nearly 100 years ago, such as the China Medical Association, founded in 1915; the Chinese Pharmaceutical Association; and the Chinese Nurses' Association (now the Chinese Nursing Association), founded in 1909. Other early modern organizations were Doctoring, founded in 1897 in Shanghai; the Shanghai Chief Association of Medicine (1906); and the China Medical Research Institution (1904).[1] Medical associations in China are expected to establish professional standards (both technical and ethical) to guarantee individual or public health, to disseminate knowledge of new medical advances and techniques, and to spread medical ethics. Each association is expected to protect its members' interests as well. Members are expected to contribute their membership responsibilities and enjoy corresponding privileges. They are given opportunities to carry forward medical science by publishing their new findings and exchanging their ideas in the association's academic forum or journals, and receive the latest medical information to promote individual academic ability and moral values as well. Medical associations in China are thus both academic organizations designed to spread medical knowledge and organizations that cultivate medical ethics. Contemporary medical associations are the product of modern science and technology, but they have ancestors in China's long history. The earliest medical association, Yititang Association of Benevolent Doctors, was founded in 1568 during the Ming Dynasty by Xu Chunpu, the emperor's physician.[2] The tenet of the association was to practice medicine as a humane art and to promote medical professional values, its main tasks were to discuss medical skills and promote professional competence. Its members--forty-six physicians from various provinces who were living in Beijing at that time--were expected to adhere to twenty-two precepts: sincerity, good sense, self-restraint, prudence, reason, high morale, self-improvement, teaching, being good at pulse feeling, careful prescription, cautiousness, sympathy, self-respect, abiding the law of nature, devotion, avoidance of avarice, pity for the poor, self-fulfillment, understanding, wisdom, and not participating in abuse. Although it set out an ideal academic attitude, methods, and key points in pursuing and promoting professional values, the Yititang Association of Benevolent Doctors ultimately had little impact on later medical associations. The main ideas of medical ethics in China are to cherish life and fulfill one's medical duties accordingly. Medical associations are expected to disseminate bioethical values. The 1980s began what might be described as an ethical Renaissance in China. Academic exchange in ethics among medical associations at all levels took place frequently. International and national experts were invited to give lectures, and seminars were held to disseminate theories of medical ethics and achievements in bioethics. Thousands of medical professionals in teaching and research have communicated ideas with each other, published their papers and accomplishments in a variety of journals, such as Medicine and Philosophy and launched a new national publication, Chinese Medical Ethics. In 1988 the China Medical Association established the Chinese Association of Medical Ethics, which unites medical science and medical humanism structurally and serves to support and disseminate research in medical ethics and bioethics. …

The objective of this paper was to investigate what kind of postgraduate education in medical ethics medical residents in Japan receive and what they want for ethical education and guidelines. Sixteen teaching hospitals that provide a general internal medicine residency programme in Japan were used (145 medical residents working at the departments of general internal medicine). A total of 114 residents participated in our survey, yielding a response rate of 79%. Of these, 28% received education in medical ethics more than once a month; 24% were offered it only when ethical problems were involved in actual patient care; and 18% answered that opportunities were very rare and sporadic. A full 30% had received no education in medical ethics at all. Many residents (71%) learned medical ethics from individual supervising doctors. A majority of the residents had been taught about informed consent (79%) and doctor-patient relationships (54%); 46% had learned about the appropriateness of truth telling and of ethical decisions regarding withholding and withdrawing a life-sustaining treatment, respectively. A total of 85 residents (75%) wanted to have more comprehensive education in medical ethics, 13% could not decide, and 12% did not want it. Many (66%) thought that both doctors and ethical philosophers should jointly teach medical ethics in postgraduate residency programmes. The results suggest that many residents desire more comprehensive and interdisciplinary education in medical ethics and educators in Japan should aim to develop education programmes to meet these desires.

Medical ethics and medical education.

The Confucian culture, rich in its contents and great in its significance, exerted on the thinking, culture and political life of ancient China immense influences, unparalleled by any other school of thought or culture. Confucian theories on morality and ethics, with 'goodness' as the core and 'rites' as the norm, served as the 'key notes' of the traditional medical ethics of China. The viewpoints of Confucianism on benevolence and material interests, on good and evil, on kindheartedness, and on character cultivation were all inherited by the medical workers and thus became prominent in Chinese traditional medical ethics. Hence, it is clear that the medical profession and Confucianism have long shared common goals in terms of ethics. Influenced by the excellent Confucian thinking and culture, a rather highly-developed system of Chinese traditional medical ethics emerged with a well-defined basic content, and the system has been followed and amended by medical professionals of all generations throughout Chinese history. This system, just to mention briefly, contains concepts such as the need: to attach great importance to the value of life; to do one's best to rescue the dying and to heal the wounded; to show concern to those who suffer from diseases; to practise medicine with honesty; to study medical skills painstakingly; to oppose a careless style of work; to comfort oneself in a dignified manner; to respect local customs and to be polite; to treat patients, noble or humble, equally, and to respect the academic achievements of others, etc. Of course, at the same time, Confucian culture has its own historical and class limitations, which exerted negative influences on traditional medical ethics. Now, if we are to keep up with the development of modern medicine, a serious topic must be addressed. That is how to retain the essence of our traditional medical ethics so as to maintain historic continuity and yet, at the same time, add on the new contents of medical ethics so as to incorporate modern features into our system. Therefore, when trying to reform medical practice in China, we are faced with the urgent need to inherit and promulgate the essence of Confucian ethics--discarding its obsolete concepts--while at the same time building up the new medical ethics that can meet the requirements of the outside world and the future.

Ethics has an established place within the medical curriculum. However notable differences exist in the programme characteristics of different schools of medicine. This paper addresses the main differences in the curricula of medical schools in South East Europe regarding education in medical ethics and bioethics, with a special emphasis on research ethics, and proposes a model curriculum which incorporates significant topics in all three fields. Teaching curricula of Medical Schools in Bulgaria, Bosnia and Herzegovina, Croatia, Serbia, Macedonia and Montenegro were acquired and a total of 14 were analyzed. Teaching hours for medical ethics and/or bioethics and year of study in which the course is taught were also analyzed. The average number of teaching hours in medical ethics and bioethics is 27.1 h per year. The highest national average number of teaching hours was in Croatia (47.5 h per year), and the lowest was in Serbia (14.8). In the countries of the European Union the mean number of hours given to ethics teaching throughout the complete curriculum was 44. In South East Europe, the maximum number of teaching hours is 60, while the minimum number is 10 teaching hours. Research ethics topics also show a considerable variance within the regional medical schools. Approaches to teaching research ethics vary, even within the same country. The proposed model for education in this area is based on the United Nations Educational, Scientific and Cultural Organization Bioethics Core Curriculum. The model curriculum consists of topics in medical ethics, bioethics and research ethics, as a single course, over 30 teaching hours.

Background According to the status of ethics in medical education and owing to the students’ talent and rational spirit, it seems that the education system, despite the emphasis on courses such as medical ethics, should focus on the improvement of teaching quality of Islamic education and explanation of religious concepts, since emphasis on increasing the quality of Islamic education leads to the promotion of medical ethics. Objectives The current study aimed at evaluating the impact of courses on Islamic education and religious concepts on the promotion of medical ethics among the students of Kerman University of Medical Sciences, Kerman, Iran. Methods The current descriptive cross sectional study was conducted on 5831 students of Kerman University of Medical Sciences as the statistical population in the academic year of 2016 - 2017. Using the Morgan table, 360 subjects were selected as the study sample using stratified random sampling method. In order to collect data, a standard questionnaire, which its reliability was confirmed by Cronbach’s alpha coefficient, was used. Data were analyzed using structural equation modeling with AMOS software. Results Structural equation modeling was used to analyze the data and test the hypotheses. The models could explain the measurement indices, and based on the adopted method, the fitting indices of the measurement models showed the acceptability of the measurement models for Islamic education, religious concepts, and medical ethics. Conclusions In addition to the content-related relationship with medical ethics, the Islamic education promotes ethics in the target community and has a direct impact on the education of medical ethics. Also, the explanation of religious concepts has a major impact on the promotion of the quality of medical ethics, since religious concepts, as students' subjective presuppositions, help them to better understand the content of medical ethics. By the evaluation of the research hypotheses, a direct relationship was observed between the education of Islamic education and promotion of medical ethics. Accordingly, a relationship between the religious concepts and the promotion of medical ethics was also confirmed. The course of Islamic education has a lower impact on medical ethics compared with that of religious concepts. The attention paid by the medical education system to the results of data analysis leads to an increase in the quality of Islamic education course offered to the students.

The paper gives an analytical synopsis of the problem of developing medical ethics in the early half of the 1990s in China, as perceived by Chinese scholars and medical professionals interested in medical ethics. The views captured and analyzed here were expressed in one of the two major journals on medical ethics in China: Chinese Medical Ethics. The economic reform unleashed profound changes in Chinese society, including in the medical field, creating irregularities and improprieties in the profession. Furthermore, the market reform also created new values that were in tension with existing values. In this transitional period, Chinese medical ethicists saw the need to rebuild medical morality for the new era. Using the code of conduct promulgated by the Chinese Ministry of Health in 1989 as a basis, assessment and education aspects of the institutionalization of medical ethics are discussed. In addition to institutional problems of institutionalising ethics, there are philosophical and methodological issues that are not easy to solve. After all, to institutionalize medical ethics is no easy task for a country as old and as big as China. Chinese medical ethicists seem ready to confront these difficulties in their effort to develop medical ethics in Reform China.

The use of artificial intelligence (AI) in medicine, potentially leading to substantial advancements such as improved diagnostics, has been of increasing scientific and societal interest in recent years. However, the use of AI raises new ethical challenges, such as an increased risk of bias and potential discrimination against patients, as well as misdiagnoses potentially leading to over- or underdiagnosis with substantial consequences for patients. Recognizing these challenges, current research underscores the importance of integrating AI ethics into medical education. This viewpoint paper aims to introduce a comprehensive set of ethical principles for teaching AI ethics in medical education. This dynamic and principle-based approach is designed to be adaptive and comprehensive, addressing not only the current but also emerging ethical challenges associated with the use of AI in medicine. This study conducts a theoretical analysis of the current academic discourse on AI ethics in medical education, identifying potential gaps and limitations. The inherent interconnectivity and interdisciplinary nature of these anticipated challenges are illustrated through a focused discussion on “informed consent” in the context of AI in medicine and medical education. This paper proposes a principle-based approach to AI ethics education, building on the 4 principles of medical ethics—autonomy, beneficence, nonmaleficence, and justice—and extending them by integrating 3 public health ethics principles—efficiency, common good orientation, and proportionality. The principle-based approach to teaching AI ethics in medical education proposed in this study offers a foundational framework for addressing the anticipated ethical challenges of using AI in medicine, recommended in the current academic discourse. By incorporating the 3 principles of public health ethics, this principle-based approach ensures that medical ethics education remains relevant and responsive to the dynamic landscape of AI integration in medicine. As the advancement of AI technologies in medicine is expected to increase, medical ethics education must adapt and evolve accordingly. The proposed principle-based approach for teaching AI ethics in medical education provides an important foundation to ensure that future medical professionals are not only aware of the ethical dimensions of AI in medicine but also equipped to make informed ethical decisions in their practice. Future research is required to develop problem-based and competency-oriented learning objectives and educational content for the proposed principle-based approach to teaching AI ethics in medical education.