Abstract
After reviewing the historical development of ethics and individual-based bioethics in Western countries, and comparing that in China, this paper starts from the extreme Beijing Tongren Case and the dilemma in the reform of health system in the Chinese mainland, and puts forward the topics of bioethics and medical professionalism under the circumstances of globalization, global health, and global health system reform. It compares the individual-based bioethics in Western countries and the structure-based bioethics in the Chinese mainland, and discusses the lessons of structure-based bioethics for other countries. The historical experience of health system reform in the Chinese mainland indicates that the health care system is welfare in nature, which is crucial; that the welfare health care system is the systematic foundation of medical professionalism; that there should not be direct economic interest generated in doctor-patient relationship since the marketization of health financing may lead to not only the structure intension of doctor-patient relationship, but also a total collapse of the medical professionalism. Therefore the Health Finance rather than Health Economics should be the material foundation of medical professionalism. The paper also points out that the main determinants of medical professionalism are not individual medical professionals, but the outcome of interaction between socio-cultural institutions and individual professionals, in which the sociality and structure are the most important components.
Highlights
Beijing Tongren Hospital 同仁医院, the best known eye hospital in the Chinese mainland, witnessed an intensified doctor-patient relationship in September, 2011, when a chief physician was hacked more than a dozen times by one of her patients (China Youth Daily, 2011)
Why does the health system reform in the Chinese mainland lead to the structural tension in doctor-patient relationship? What is the reason behind the hurting, abusing and killing doctors in the Chinese mainland? Is it due to the decreasing professionalism of Chinese doctors or the common challenge faced by doctors around the world? How to build harmonious doctorpatient relationship, and re-establish the medical professionalism? If individual-based professional ethics does not adequately explain such dilemma in the health system reform, what is to be blamed and how to solve the problem? And what lessons can other countries and global medical community draw from this? The above questions are to be discussed in this paper
The reform in health system in the Chinese mainland is facing an unprecedented structural dilemma, of which the structural dilemma of bioethics is erroneously considered as the main reason for the tension in the doctor-patient relationship and the decreasing of doctors’ professionalism
Summary
Beijing Tongren Hospital 同仁医院, the best known eye hospital in the Chinese mainland, witnessed an intensified doctor-patient relationship in September, 2011, when a chief physician was hacked more than a dozen times by one of her patients (China Youth Daily, 2011). Two lessons we can learn from the typical and extreme case in Tongren Hospital and the health system reform dilemma in the Chinese mainland are: First, health care system is, after all, welfare in nature, and second, the quality of medical professionalism depends on the quality of health care system (Liu Jitong, Guo Yan, Chen Ningshan et al, 2007).
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