Although Chinese law imposes informed consent for medical treatments, the Chinese understanding of this requirement is very different from the European one, mostly due to the influence of Confucianism. Chinese doctors and relatives are primarily interested in protecting the patient, even from the truth; thus, patients are commonly uninformed of their medical conditions, often at the family’s request. The family plays an important role in health care decisions, even substituting their decisions for the patient’s. Accordingly, instead of personal informed consent, (...) what actually exists is ‘family informed consent’. From a Western perspective, these features of Chinese law and Chinese culture might seem strange, contradicting our understanding of doctor-patient relationship and even the very essence of self-determination and fundamental rights. However, we cannot forget the huge influence of cultural factors in these domains, and that ‘Western’ informed consent is grounded on the individualistic nature of Western culture. This article will underline the differences between the Western and the Chinese perspectives, clarifying how each of them must be understood in its own cultural environment. But, while still respecting Chinese particularities, this paper advocates that China adopt patient individual informed consent because this is the only solution compatible with human dignity and human rights. (shrink)

How health care providers are paid affects how medicine is practiced. It is thus important to assess provider payment models not only from the economic perspective but also from the ethical perspective. China recently started to reform the provider payment model in the health care system from fee-for-service to case-based payment. This paper aims to examine this transition from an ethical perspective. We collected empirical studies on the impact of case-based payment in the Chinese health care system and applied a (...) systematic ethical matrix that integrates clinical ethics and public health ethics to analyze the empirical findings. We identified eleven prominent ethical issues related to case-based payment. Some ethical problems of case-based payment in China are comparable to ethical problems of managed care and diagnosis related groups in high-income countries. However, in this paper we discuss in greater detail four specific ethical issues in the Chinese context: professionalism, the patient-physician relationship, access to care and patient autonomy. Based on the analysis, we cautiously infer that case-based payment is currently more ethically acceptable than fee-for-service in the context of China, mainly because it seems to lower financial barriers to access care. Nonetheless, it will be difficult to justify the implementation of case-based payment if no additional measures are taken to monitor and minimize its existing negative ethical implications. (shrink)

ABSTRACTIn Western and non‐Western societies, it is a widely held belief that the concept of human rights is, by and large, a Western cultural norm, often at odds with non‐Western cultures and, therefore, not applicable in non‐Western societies. The Universal Draft Declaration on Bioethics and Human Rights reflects this deep‐rooted and popular assumption. By using Chinese culture as an illustration, this article points out the problems of this widespread misconception and stereotypical view of cultures and human rights. It highlights the (...) often ignored positive elements in Chinese cultures that promote and embody universal human values such as human dignity and human rights. It concludes, accordingly, with concrete suggestions on how to modify the Declaration. (shrink)

In Western and non-Western societies, it is a widely held belief that the concept of human rights is, by and large, a Western cultural norm, often at odds with non-Western cultures and, therefore, not applicable in non-Western societies. The Universal Draft Declaration on Bioethics and Human Rights reflects this deep-rooted and popular assumption. By using Chinese culture(s) as an illustration, this article points out the problems of this widespread misconception and stereotypical view of cultures and human rights. It highlights the (...) often ignored positive elements in Chinese cultures that promote and embody universal human values such as human dignity and human rights. It concludes, accordingly, with concrete suggestions on how to modify the Declaration. (shrink)

This dissertation is a collection of four studies which collectively explore a hypothesized construct of ‘moral evaluation of patient behaviors’ (MEPB) as a driver of health professionals’ readiness to interact humanistically with their patients. In these studies, ‘humanistic interactions’ refer to the non-technical, intangible skills and factors of clinical competence; the factors specifically explored in these studies were compassion toward patients, self-efficacy for treating patients, and optimism toward patient treatment. For the purpose of specificity, all factors were examined as they (...) pertained to patients with substance use disorders. Survey data from a convenience sample of 524 health professionals (i.e. physicians, nurses, and other health professionals) from three culturally distinct areas of the world (i.e. California (n = 173), urban France (n = 102), and urban China (n = 249)) were analyzed using analyses of variance, Welch’s t-tests, confirmatory factor analyses, and structural equation models. Results indicate: 1.) Psychometric support for the survey tool that was created for the assessment of the hypothesized construct of MEPB among health professionals, and information on differences on this hypothesized construct by age group, occupation, and country of residence; 2.) Indication that this survey tool operates differently among health professionals in different countries, which supports the notion that people from differing cultures have differing notions about morality. 3.) In the California sample, results indicate that while moral judgements of patients’ behavior carries mixed associations with factors of health professionals’ readiness to interact humanistically with these patients, moral judgements of the self (or, moral self-image) have only positive associations with factors of this readiness for humanistic interaction. This finding supports the notion that having a healthy self-concept strengthens one’s ability to support others. 4.) In all three countries, moral evaluations were positively associated with optimism toward treating patients, and in urban China, they were additionally positively associated with compassion and with self-efficacy. Given weak measurement invariance (i.e. differences in the operation of the measurement of moral evaluations by country), more research is needed in this area. The current research provides a tool for examining research of just this nature, and most importantly suggests that morality does not need to be eliminated from perspectives of mental illness or addiction, but rather that more nuanced moral perspectives are needed. Future research may explore distinctions between moral appraisals and stigma, and associations between moral evaluations (both among health professionals and among patients) and clinical/health outcomes such as rates of relapse and recovery. (shrink)

This study is a contribution to Chinese-Western dialogue of bioethics but perhaps the first one of its kind. From a Chinese-Western comparative ethical perspective, this work brings Chinese ethical theories, especially Confucian ethics, into a contemporary context of the epidemic of HIV/AIDS, and to see how the deeply-rooted thoughts of Confucius interact, compete, or integrate with concepts from Western ethical traditions. An underlying belief is that some ideas in Confucian ethics are important and insightful beyond their cultural and historical origins (...) in China and other Confucianism influenced societies.Methodologically, this thesis employs two approaches, conceptual normative analysis combined with critical interpretation. The ‘interpretive’ approach I employ, as an important methodology supplementing my normative analysis, not only deals with Chinese ancient texts, but also explains specific beliefs and practices in China.With a critical eye, this thesis carefully examines a number of key topics in the ethics of AIDS in China from a cross-cultural perspective. Topics including: views on personhood and the vulnerability of People Living with HIV/AIDS; prioritising and balancing the role of ‘harm reduction’ and the role of ‘eradication of deviant behaviour’ in AIDS policy in China; rights-based opt-out approach and duty-based family-centred approach in HIV testing and Biobanking; blood donation; moral responsibility and personal responsibility for health; and the popular rhetoric of ‘innocent infection’ versus ‘guilty infection’ in AIDS. My overall aim in this work is to present a cross-cultural bioethics study through the investigation of some ethical issues in AIDS in China from a Chinese-Western comparative perspective and also attempt to suggest a humane and effective policy for HIV/AIDS which I believe is appropriate to both traditions. I believe this work has contributed to our knowledge in three related but independent areas: the control of the epidemic of HIV/AIDS in China; medical ethics in China; and to both the methods and the utility of cross-cultural study of bioethics between China and the West. (shrink)