Acupuncture Treatment for Primary Care Patients with Migraine

 Abstract

Does acupuncture to apply in treatment make worthwhile differences to primary care patients with migraine? To study of the relevant literature to evaluate the effectiveness and efficacy in order to point out certain evidence in future.

Traditional Chinese medicine (TCM) is a medical science that is based on clinical experience of the wisdom of ancestors. From the earliest records, human was the object of treatment, and accumulated abundant records were handed down as reference for later generations of doctors.

The electronic databases (PubMed ,Medline, Complementary Medicine) search using the terms “acupuncture” and  “migraine”  selected relevant publications. Based on this critical evaluation of the literature and the derivation of these indicators, we conclude SCI twenty-one articles available that acupuncture therapy is related with migraine which supported with certain evidence in research.

Keywords: Acupuncture, Migraine, Traditional Chinese Medicine

Introduction

Migraine (from the Greek words hemi, meaning half, and kranion, meaning skull) is a chronic neurological disorder characterized by moderate to severe headaches, and nausea. It is about 3 or 4 times more common in women than in men. A typical attack lasts between 4 and 72 hours. Which is one of the most common causes of patients’ seeking attention at neurology clinics, is a highly prevalent health problem and one with considerable socioeconomic impact? ^1-4  The International Headache Society (HIS) differentiates each type of headaches based on the number of attacks per month, length of time per attack, characteristics of the pain, and other accompanying symptoms.

According to HIS(1988) report, Migraine afflicts 28 million Americans, with females suffering more frequently (17%) than males (6%). in persons between the ages of 25 and 55 years, In Spain, the prevalence of migraine is 16.9% among women and 7.4% among men ⁵, with 60% of patients having a family background of such headaches.⁶  some women who suffer from migraine headaches experience more headaches around the time of their menstrual periods.

This epidemiologic profile is similar to that reported for other countries, but lower in China. ^7-9

Modern scientific research has established the following mechanisms for headaches. Headache pain begins with the trigeminal nerve, which is located in the brain stem and carries sensory impulses to and from the face. When the trigeminal nerve is stimulated by a headache trigger such as anxiety, glare, noise, anger, improper diet, medications, or hormones, a burst of neurotransmitters is released. One of these neurotransmitters, serotonin, has the function of screening out "unimportant" signals to the brain, and admitting signals that demand attention. Serotonin fluctuation is the biochemical and neurological foundation of understanding headaches. Low serotonin levels make people more vulnerable to headaches.¹⁰

Traditional Chinese medicine differentiate groups of symptoms into a specific pattern, A headache pattern may be caused by external effects, such as chemicals, weather, and other environmental factors; or by internal imbalances, The most commonly-encountered headache patterns, such as : Wind Cold,. Wind Heat, Wind Dampness, Liver Yang arising, Kidney Deficiency, Blood Deficiency, Blood Stagnation, Phlegm Retention.

Materials and Methods

Data Source
   
The main source for the information used in this study was the PubMed database. This resource is updated weekly and accessible from the National Centre for Biotechnology Information (NCBI) of the US National Library Medicine via the Internet, where users may retrieve data without charge. Medline database was also used with the same search strategy for correcting the database bias.

Data Selection
   
The results of studies relating to migraine , the findings of systematic reviews, and relevant clinical cases were collected from a PubMed search following a search strategy, for the words “acupuncture” and “migraine”, and the search limits as following conditions: publication date to 2008/01/01, only items with abstracts and English. 

Acupuncture for Headaches

Acupuncture is not only effective for migraine headaches, but also works very well with tension headaches, cluster headaches, post-traumatic headaches, and disease-related headaches that might be due to sinus problems, TMJ, stroke, high blood pressure, or sleeping disorders.¹¹

In an open, randomized trial, evaluated by Allias et al.(2003), sixty women suffering from transformed migraine were assigned, after a one month run-in period, to three different treatments: TENS (Group T; n=20), infrared lasertherapy (Group L; n=20) or acupuncture (Group A; n=20). In each group the patients underwent ten sessions of treatment and monthly control visits. A basic formula (LR3, SP6, LI4, GB20, GV20 and Ex-HN5) was always employed; additional points were selected according to each patient's symptomatology. The number of days with headache per month significantly decreased during treatment in all groups. The response in the groups differed over time, probably due to the different timing of applications of the three methods. TENS, lasertherapy and acupuncture proved to be effective in reducing the frequency of headache attacks. Acupuncture showed the best effectiveness over time. ¹²

Critique point: The prevalence of migraine is 16.9% among women and 7.4% among men, some women who suffer from migraine experience around the time of their menstrual periods. Further research is needed to determine the extent to which variability in male or other acupuncture point selection among acupuncturists and affects clinical outcomes. In calculating the sample size seems too small be undertaken 60 females only. We propose to recruit more patients (around 300 patients) in order to allow for a 20% withdrawal rate.

The Remy R. et al. (2006) also indicated that some variation in TCM pattern diagnosis and point selection for persons with frequent headache was observed for all subjects. This study point out Liver Yang and Qi dysfunction were diagnosed in more than two thirds of subjects. Acupuncture points LR3, LI4, and GV20 were the most commonly selected points for treatment.¹⁶

Critique point: There is variability among acupuncturists in the diagnosis of TCM patterns and the selection of acupuncture points or channel for needling. A treatment manual provides a precise way to train and supervise practitioners, enable evaluation of conformity and competence,facilitate the training process, and increase the ability to identify the active therapeutic ingredients in clinical trials of acupuncture.

In Germany, Linde K, et al., (2005) investigated the effectiveness of acupuncture compared with sham acupuncture and with no acupuncture in patients with migraine. Three-group, randomized, controlled trial (April 2002-January 2003) involving 302 patients (88% women), mean (SD) age of 43 (11) years, with migraine headaches, based on International Headache Society criteria. Acupuncture, sham acupuncture, or waiting list control. Acupuncture and sham acupuncture were administered by specialized physicians and consisted of 12 sessions per patient over 8 weeks. Patients completed headache diaries from 4 weeks before to 12 weeks after randomization and from week 21 to 24 after randomization.

Acupuncture was no more effective than sham acupuncture in reducing migraine headaches although both interventions were more effective than a waiting list control. The measure outcomes as follows.¹³

·No difference was detected between the acupuncture and the sham acupuncture groups (0.0 days, 95% confidence interval, -0.7 to 0.7 days; P = .96)

·While there was a difference between the acupuncture group compared with the waiting list group (1.4 days; 95% confidence interval; 0.8-2.1 days; P<.001)

Critique point: Too high rate in women (88%), we need to concern the participant (male or both) in future. According to which each activity consumes resources (inputs) – personal, materials and pharmaceutical – in order to produce results (outputs). Characteristic diagnostic variables according to traditional Chinese medicine the following factors: (1) the location of the headache; (2) the meridian or meridians most likely to be involved; (3) internal factors such as Blood, Qi, Yin, Yang, etc.; (4) external pathogens such as Wind, Phlegm, Cold, etc.; (5) the internal organs affected; (6) the state of internal body functions such as Stagnation, Excess, or Deficiency.

The GERAC Migraine Study Group in Germany, A multicentre randomised controlled clinical trial by Diener HC et al., (2006) assessed the efficacy of acupuncture for the prophylaxis of migraine. This study was a prospective, randomised, multicentre, double-blind, parallel-group, controlled, clinical trial, undertaken between April 2002 and July 2005. Patients who had two to six migraine attacks per month were randomly assigned verum acupuncture (n=313), sham acupuncture (n=339), or standard therapy (n=308). Patients received ten sessions of acupuncture treatment in 6 weeks or continuous prophylaxis with drugs. Primary outcome was the difference in migraine days between 4 weeks before randomisation and weeks 23-26 after randomisation. ¹⁴

The primary outcome showed a mean reduction of day as follows:

·         2 .3 days (95% CI 1.9-2.7) in the verum acupuncture group.

·         1.5 days (1.1-2.0) in the sham acupuncture group.

·         2.1 days (1.5-2.7) in the standard therapy group.

These differences were statistically significant compared with baseline (p<0.0001), but not across the treatment groups (p=0.09). The proportion of responders, defined as patients with a reduction of migraine days by at least 50%, 26 weeks after randomisation, was 47% in the verum group, 39% in the sham acupuncture group, and 40% in the standard group (p=0.133). Treatment outcomes for migraine do not differ between patients treated with sham acupuncture, verum acupuncture, or standard therapy.

Critique point: Monitoring data and side effects: Records will be kept of all side effects that are reported, and possible adverse events caused by the experimental treatment or the medication provided, and stating the date of occurrence. Sociodemographic variables related to the severity of the problem, occupational aspects and an estimation of direct tangible costs.

Discussion and Conclusion

The objective was to assess whether there is evidence that acupuncture is more or similarly effective than other interventions in the treatment of migraine headaches.

Our literature search did not identify eligible trials from China, Taiwan and Korea where acupuncture is widespread. As the literature from these countries in only partially covered by most data bases it might be that unidentified eligible trials from these countries exist. Evidence from these countries has to be interpreted with caution as almost positive results by researchers.^15-17

Assessing chronic headaches in a clinically meaningful manner is a complex issue that involved intensity, duration, medication needs, accompanying symptoms, mood, social functioning, daily activity, and workdays lost are all relevant indicators. The evidence derived from such trials might underestimate the benefits from acupuncture treatment. More pragmatic trials comparing acupuncture with no prophylactic treatment and other prophylactic interventions are needed to evaluate effectiveness and efficiency under real life conditions

Although randomized controlled trials (RCTs) are the gold standard for evidence, it is also important to synthesize the available evidence when there is no or few RCT in interesting area. Overall, the existing evidence suggests that acupuncture has a role in the treatment of Migraine headaches. However, the quality and amount of evidence is not fully convincing. There is urgent need for well-planned, large-scale studies to assess effectiveness and efficiency of standard operating procedures (SOP) for acupuncture.¹⁸

The British Professor Archie Cochrane, his book “Effectiveness and Efficiency” won acclaim among health practitioners after its publication in 1972, with later referral to it establishing the concept. In general, Evidence-based medicine (EBM) consists of five steps: (1) formulation of answerable clinical questions; (2) literature search for the best evidence; (3) critical appraisal of the relevant material; (4) clinical application of the evidence; and, (5) audit of the above.¹⁹  Which is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.²⁰

As acupuncture is an invasive treatment, safety in clinical application should be closely monitored. We believe that investigations will be quantitatively and qualitatively improved, and that clinical trials will be conducted in accordance with the principles of multi-centre and randomized controlled trials in future. This will allow consensus to be established with respect to the safety and efficacy of acupuncture, allowing this important traditional complementary therapy to keep pace with conventional medical practice and its emergence as a mainstream treatment.

Another key aspect of evidence-based medicine is the collection and dissemination of information to help guide decisions by clinicians, patients and other decision makers.

Overall, acupuncture seems to be relatively safe in the hands of qualified providers, also beneficial, lower side effect(0.14%) by Yamashita,et al.(1999) ²¹. Although it still present insufficient methodology quality, and the small size of the studies revered. We conclude that migraine headache patients who want to try acupuncture should not be discouraged. In future, may be minimized by improved medical education and technical training of acupuncturists.

 

 

References

1. International Headache Society Classification Subcommittee Cephalalgia. 2. Vol. 24. 2004. The International Classification of Headache Disorders; pp. 9–160.
2. Monzon MJ, Lainez MJ. Quality of life in migraine and chronic daily headache patients. Cephalalgia. 1998; 18:638–643. doi: 10.1046/j.1468-2982.1998.1809638.x
3. Fernandez-Concepcion O, Canuet-Delis L. [Disability and quality of life in patients with migraine: determining factors] Rev Neurol. 2003; 36:1105–1112.
4. Martinez Eizaguirre JM, Calero MS, Garcia Fernandez ML, Tranche IS, Castillo OJ, Perez II. [Attitudes of Spanish primary care doctors to migraine] Aten Primaria. 2006; 38:33–38. doi: 10.1157/13090029.
5. Badia X, Magaz S, Gutierrez L, Galvan J. The burden of migraine in Spain: beyond direct costs. Pharmacoeconomics. 2004; 22:591–603. doi: 10.2165/00019053-200422090-00004.
6. Stewart WF, Lipton RB, Celentano DD, Reed ML. Prevalence of migraine headache in the United States. Relation to age, income, race, and other sociodemographic factors. JAMA. 1992; 267:64–69. doi: 10.1001/jama.267.1.64.
7. Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007; 68:343–349. doi: 10.1212/01.wnl.0000252808.97649.21.
8. Lipton RB, Bigal ME. The epidemiology of migraine: American Journal of Medicine Supplement.Vol 118, (Suppl 1): 3-10, 2005
9. Lipton RB, Stewart WF. Migraine in the United States: epidemiology and health care use. Neurology 43 (Suppl 3): 6-10, 1993
10. Migraine Pathophysiology. Headache. 44(7):735-739, 2004.
11. Vickers AJ, Rees RW, Zollman CE, McCarney R, Smith CM, Ellis N, Fisher P, Van Haselen R. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. BMJ. 328(7442):744, 2004.
12. Allais G, De Lorenzo C, Quirico PE, Lupi G, Airola G, Mana O, Benedetto CNon-pharmacological approaches to chronic headaches: transcutaneous electrical nerve stimulation, lasertherapy and acupuncture in transformed migraine treatment. Neurol Sci. 2003 May; 24 Suppl 2:S138-42.
13. Lined K, Streng A, Jürgens S, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, Pfaffenrath V, Hammes MG, Weidenhammer W, Willich SN, Melchart D. Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universität München, Munich, Germany. 2005 May 4; 293(17):2118-25.
14. Diener, HC et al. Efficacy of acupuncture for the prophylaxis of migraine: a multicentre randomised controlled clinical trial. Lancet Neurol. 5(4):310-6, 2006.
15. Von Der Laage D. [Acupuncture for headache]. Schmerz 1997; 11(1):4-8.
16. Remy R. Coeytaux, Wunian Chen, Catherine E. Lindemuth, Yanmin Tan and, Aimee C. Reilly. The Journal of Alternative and Complementary Medicine. 12(9): 863-872, 2006.
17. Melchart, D et al. Acupuncture for recurrent headaches: a systematic review of randomized controlled trials. Cephalalgia 1999; (19):779-86.
18. Sutherland SE. Evidence-based dentistry: Part IV. Research design and levels of evidence. J Can Dent Assoc，2001，67: 375-378.
19. Yamashiro S. Practice and application of evidence-based medicine. Rinsho Byori，2000，48: 1149-1155.
20. Sackett DL. Clinical epidemiology. what, who, and whither. J Clin Epidemiol， 2002， 55: 1161-1166.
21. Yamashita H, Tsukayama H, Tanno Y, et al. Adverse events in acupuncture and moxibustion treatment: a six-year survey at a national clinic in Japan. J Altern Complement Med，1999，5: 229-236

Traditional Chinese Medicine the Core of Confucian Ethics

 

Abstract

First, I will indicate the doctor-patient relationship, in which, the complexity of the issues involved in the different areas of expertise, and ethical characteristics of research different from other disciplines. For those of modern medical ethics of the doctor-patient relationship put forward by the six types of analysis to discuss the ethical assessment of the physicians when confronted with a patient may play different roles.¹

In the medical commercial consumer society, physicians, therefore, become providers inevitable from the consumer services. However, because of the unique nature of health care spending, not only to meet the interests of consumers and well-being, healthcare professionals should have higher self-expectations and ethical standards, so a doctor the most important ethical thinking has not then just the right medicine and the sick are healed, but must be extended with a loving heart to provide a good medical care of the patient, to  promote health condition by strengthening the confidence and reducing fear of the patient. Under Patient-centered ethical thinking, put forward four basic beliefs, and thus show the four patients cares in needs.

Chinese Medical ethics calls to mind a precious element within healing heart  it emphasize the traditional Confucian ethics advocated by the "benevolence” to expose people's true feelings between a human sense through as hand, foot and body pain with a sense of the disease between the sense of communication in modern society still has a universal value components, the traditional Confucian Medical spirit (ACME) and the reproduction of modern Western medical ethics medical profession (4PBE) of altruism and a moral appeal to each other.²

Finally, to achieve effective and ethical intercultural communication, I conclude by analysing my clinical practice what’s medical ethics orientation should I done, what’s principle need to be improved during Doctor-patient relationship.

 Key words: Confucian ethics. Patient-centred. Doctor-patient relationship.  Altruism.

Doctor-Patient Relationship Model

Emanuel, E. & Emanuel, L. et al (1992) in the "American Medical Association" (JAMA, Journal of American Medical Association) published an article, the doctor-patient  interaction according to roles, responsibilities, the value of the patient and autonomy to determine the differences in four indicators, the doctor-patient relationship is divided into four types. About each of the following:

1.       Paternalistic model- In this mode, the physician's responsibility to ensure that patients can receive the best medical ways to make patient access to health, the patient agreed to the arrangements for the physician to maximize their well-being. Between patient and therefore have the same objective with a recognition of the value. Patient autonomy does not demonstrate completely agree with the leading doctors

2.       Informative model - This model assumes that the value of the information and make a clear division; that the patient has both a fixed and definite value judgments, the lack of information, like a physician's duty professional technicians, to provide accurate information to maintain their professional competence; and patient health care decision-making and medical care is a complete way of autonomy and the right to choose

3.       Interpretive model- Physician's role is like psychological counseling, counselor's role in helping patients to clarify what they wants, not to tell patients what they choice, in particular by giving the patient more support in reaching a decision.

4.       Deliberative model- Physician should not only helps the patient to clarify her values, but may also discuss, and challenge, those values. The concept of patient autonomy (moral self-development) it related with medical care. The doctor thinks patients, such as teachers or friends as willing to discuss their own values.

In addition to those four modes, there are two modes should be discussed between doctors and patients interaction has a variety roles;

5.       Provider-consumer- Patients to become health care consumers, doctors play the role of health care providers, in a monopoly market mechanism, the provider can control the transaction, and in the free market mechanism, the provider must understand the needs of consumers, lower prices better service to attract more consumers. Doctor-patient relationship by the "physicians have the right, obligation to keep the patient" approach to change to "Patients (consumers) have the right to physician (traffickers) keep obligation" of the type.³

6.      Communities Alliance between doctor and patient - Recently Balint Balint (1996) proposed the concept of community alliance, that the highest priority responsibility of doctors must be able to continue to play a perpetual defender of appropriate care of patients, but also the same as teachers who educate the patient what is the proper care, also teach patients how to autonomy choice the medical decision-making. In this basis the doctor-patient alliance, to ensure the rationalization of the therapeutic relationship and quality, but also a positive impact on our health care system progress. The only way to the rational use of social resources while providing the most appropriate care for people.

Patient-Centred Society

Twenty-first century health care has been towards "patient-centred” medical model; ⁴  it will be a "patient-centred" ethical thinking.  "doctor-centred" medical practice is disease-centred. "patient-centred" approach is not only the discovery of the cause, but also to respect the feelings of the patient-centred.  Therefore, a doctor of the most important ethical thinking is no longer just the right medicine and the sick are healed, but must be extended to the loving care of the patient, to strengthen patient’s confidence and reduce fear to promote patient health by modern western medical ethics as follows:

1.   Autonomy-orientation: The principle of autonomy in the context of medical care, you can export the following moral rules, such as:
Honesty (truthfulness) ->
Do not hide the patient's condition and diagnosis, so they can be informed of the message according to a decision.
Confidentiality ->
Medical professionals generally have to protect patient privacy, patients are informed of matters of confidentiality obligations.
Informed consent ->
should inform the patient of adequate information, and obtain patient consent for medical treatment of patients.

2.  Beneficience-orienation: The principle of beneficence do not harm others in doing good in principle, the principle of charity requires us to further concern and is committed to Enhance the well-being of others. The principle of charity is required to comply with health care professionals the basic obligations.

3.   Social-orientation: The so-called ‘’common morality" refers to the recognition by the social basis of human behaviour and existence of the social system and customs code of ethics can be learned. However, it is not just a systematic common sense, not the moral equivalent of the customs, but is defined as pretheoretic, beyond the view of local customs and moral point of view. Beauchamp and Childress stressed that there are moral the principle should be universally applicable.

4.  Principle-orientation: Even different ethical theories of moral justification process is so different, because the mutually acceptable ethical and moral life should be the guidance or management of such a concept,⁵ some form of rule utilitarianism and deontology can be developed similar or the same fundamental moral principles , rules  and recommended actions.

From the "patient-centred" view of the ethical thinking, Demand for the patient's feelings, the doctor must play the role of a friend; awareness for the needs of patients, doctors have to act as a health care information providers and counsellors; functional requirements for the patient's body, the doctor is again a trusted medical experts.

Doctors have become trusted medical experts; face all the expectations of patients, doctors had to assume the responsibilities of teachers and even parents.

1.  The patient's feelings (Feeling): fear, anxiety can affect the patient's mood, feelings and capabilities.

2.  The patient's cognitive (Ideas): the patient’s condition because of their cognitive error, also affects seeking behaviour. For example, to intake an animal kidney which can nourish their kidney’s function in traditional Chinese concept, and some more in the medicine will take effect with the double.

3. The patient's body functions (Functioning): each disease on the patients themselves will cause different effects, although the headache it would not make a person cannot function properly, but the effectiveness will decline, the spirit is also affected. Irritable, depressed ... ... and so different reactions, affect the life and physical function.

4.   Patient expectations (Expectation): Heart of do not do this or want to do, patients will want some way to restore lost function, "how can I do?" this always is the most important expected doubts which bother their thought.

 

Medical Ethics in Ancient China

ACME based on the spirit of Confucian ethics of medical knowledge and moral training of medical scientists, has always had strict requirements, the development of China's tradition of medicine. To Bain Que, Chunky Yi to Chongjin, Hua Tao, and from Wang Shu, Ge Hong, etc. to the ancient physician Sun Szu-miao, ⁶  who have been in the medical technology contributors, almost all in medical ethics to achieve a high accomplishment? and its dedication to the profession, do not ask the patient's poor, rich and poor , looks, race, affinities, wise and truly equal treatment, and always a sense of compassion and love mercy:

A)     Stand the human moral subject - the core of Confucian ethics is  ‘ Ren ‘ (humaneness, benevolence, kindheartedness) that is inherent in human nature presupposes the existence of free will and value, and thus stand self-awareness of humanity's moral subject, and demonstrated the dignity and value of personality.^7,8

B)      Carry forward the humanitarian altruism - the so-called "benevolence" is "love." declared a kind of benevolence and sympathy with all the direct sense of pain and illness through the channel. Undoubtedly illustrates the depth of Confucian ethics is an "altruism."(Tsai, DF-C. 2005)

C)      Legislation based on equality of intersubjectivity - the specific norms of Confucian ethics (Munro, DJ. 2005), Confucian scholars believe that the inner feelings and a sense of benevolence can not only lead to the individual subject through the sense of morality and values, but also by a sense of inter-subjectivity of benevolence through, breaking the status, wealth, race, sex, occupation, and so the caused by the gap between people.

D)     Valuing Loyalty to achieve the moral idealism – Scholars have pointed out that the Confucian benevolence of love has three basic principles: (1) Emphasis on respect for human life, (2) Emphasis on respect for the patient, (3) Emphasis on "Pan-loving public," said a doctor treating the patient should be treated equally, regardless of rich and poor, old Young beauty and ugliness, must be treated equally. 

Ancient Chinese medical ethics provides an alternative model of the doctor-patient relationship that is beneficence oriented. ⁹ These formulated the standards for ancient traditional medical ethics, including:

• Be erudite in medical knowledge and diligent in learning: all doctors should progress constantly and keep improving their skill of the medical art and technical know-how.
• Be sympathetic to patients and serve them wholeheartedly. Serve all patients equally, regardless of their age, sex, wealth, rank, nationality and intelligence. Treat all patients as if they were your own relatives and their illness as if it were your own suffering. Meet the patient at any time or any place when a doctor's help is needed, notwithstanding any danger.
• Be painstakingly careful in diagnosing a disease. Think carefully when prescribing treatment. Be objective and avoid any personal considerations of responsibility or being swayed by personal feelings.
• Be solemn in one's conduct without making any personal demands: no humour, demands for money, or sexual issues should be raised.
• Be respectful to one's tutor and profession. Avoid any arrogance and rashness. Do not criticize other doctors' skill or conduct in the presence of a patient. Do not be arrogant about one's own achievement. Learn from other doctors to ensure one's own progress, only charlatans are jealous of other doctor's superb skills.

 

Conclusion

According to the tradition and the nature of medicine, it is a special kind of human activity. If the lack of humility, honesty, rationality, integrity, compassion, and self-restraint on excessive self-interest and other virtues, it is impossible to effectively; these features characterize physicians pursue their own interests for the same things other than the moral community members.

What’s the principle to apply in my clinical experiences and how to improve the variable of relationship between physician and patients? In generally, I will devote Confucian medical ethics basis follow the spirit of the compassion, benevolences and pursuit the rules and principles from the western medical ethics model as a whole.

1. The Principle of Autonomy

 This principle is the basis for the practice of "informed consent" in the physician / patient transaction regarding health care. Preparing a living will and it does not want to refuse any treatment.

2. The main principles of health (Medical Paternalism)

Medicine is often considered the main principle of patient autonomy and conflict, although the medical work is essentially based on the medical expertise of the play, but because of excessive authoritarian attitude it will destroy the doctor-patient relationship, thereby affecting the quality of care.

3. No harm principle (The Principle of Nonmaleficence)

The most basic medical services that are to avoid harm, but sometimes it will inevitably conflict with the principle of doing good. For example: For bleeding patients, endoscopy is beneficial, but can cause discomfort, how to strike a balance between benefits and harm, to be discussed with appropriate patients.

4. The principle of charity (Beneficence)

Beneficence includes humanity, altruism, compassion, love, good deeds and so meaningful, human nature is the driving forces us to benefit others, but also the moral goal in itself. It must be noted that physicians in the implementation of the principle of doing good, to the patient rather than physicians own decision in mind. Even if some treatments are not beneficial to the patient, but if patients

do not accept, nor can the temerity to perform. If the patient regardless of the intention that indiscriminate opinionated, will fall into the medical patriarchy (paternalism) the trap, resulting in opposing doctor-patient relationship.

5. The principle of justice

To be equitable distribution of health care resources (allocation of the justice), respect for human rights (right to justice) and respect for moral law allowed (legal justice).

6. The benefit principle (the principle of Utility)

Benefit principle, which is required to maximize efficiency (the maximization of utility), so the benefits of moral doctrine can be understood as: ethical behavior is on the behavior of all possible options were in line with the principles of effective behavior, that is, the so-called of behavior is the result of its practice act to produce the maximum benefit.

7. The principle of good faith (the Principle of Veracity)

Parties or others to provide real information or results, without any deception or concealment.

To sum up, Confucian ethics, in particular, apply under conditions of modern medical ethics time, inevitably has its limitations. For example: a strong family-ism, with a modern civil society, social integration and professional division of labour, it seems that cannot be adjusted. But to be fair, in the traditional and modern alternative century, and the depth of dialogue among Chinese and Western culture, Confucian ethics, there are still remain the elements of universal value; it is worth us to re-excavation.

References

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3.   H. Tristram Engelhardt, Jr. (2006). Global bioethics: the collapse of consensus.  207-237.
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