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.
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
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)
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.
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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2. Beauchamp, T., Childress, J. (2001). Principles of biomedical ethics, 5th Ed. New York; Oxford University Press.
3. H. Tristram Engelhardt, Jr. (2006). Global bioethics: the collapse of consensus. 207-237.
4. Reeder, Leo G. The Patient-Client as a Consumer. “Some Observations on the Professional Client Relationship” Journal of Health and Social Behavior 13(1972):134.
5. Higgs, J and Jones, M. (2000). Clinical reasoning in the health professions-2nd ed. 66-73.
6. Veatch, Robert M. (2000). Sun Szu-miao and the origins of the debate on medical ethics in China. Cross cultural perspectives in medical ethics-2nd ed. 308-316.
7. Veatch, Robert M. (2000). Confucianism, Traditional and Contemporary China; Cross cultural perspectives in medical ethics-2nd ed. 292-300.
8. Munro, D J. (2005). A Chinese Ethics for the New Century: The Ch’len Mu Lectures in history and culture, and other essays on sciences and Confucian ethics. The Chinese University of Hong Kong.
9. Yang KS. Social orientation and individual modernity among Chinese students in Taiwan. The journal of social Psychology 1981; 113:159-70.
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