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Bioethics ISSN 0269-9702 (print); 1467-8519 (online) Volume 28 Number 3 2014 pp ii–iv
doi:10.1111/bioe.12087
EDITORIAL 2014 INTERNATIONAL BIOETHICS FORUM BETWEEN UK AND CHINA AND THE PROFESSIONAL DEVELOPMENT OF BIOETHICS IN CHINA On 8–9 March 2014, a new initiative will bring together two journals, Chinese Medical Ethics and Bioethics, in a conference which aims to promote exchange in and development of Bioethics in different cultures, and to provide ethical defence and guidance for medical science and healthcare reform. The 2014 International Bioethics Forum between UK-China will be held in Nanjing, China and will be a collaboration between the two journals and the Jingling hospital (Nanjing, China). Issues to be addressed at the conference include: 1. 2. 3. 4.
new challenges for health justice; ethical issues in epigenomics and genetic technology; cross-cultural issues new trends and achievements in international bioethics; 5. ethical research in organ donation; 6. problems and countermeasures in ethical review; 7. fairness and efficiency in health reform. The current situation in Bioethics in China, which forms a background to this conference, is set out below.
THE PROFESSIONAL DEVELOPMENT OF BIOETHICS IN CHINA In China, the term hodegetics is interchangeable with the term bioethics, for both words have essentially the same meaning although there are subtle differences between the two. It is reported that China’s first book on hodegetics was published in 1932: the author was Professor Song Guo-bing. This book showed that there were Chinese scholars doing research in the field at the time. In the 1970s, hodegetics entered a new phase as research on bioethics emerged gradually in western countries and it was soon introduced to China too. Research papers were published in journals such as Medicine & Philosophy and Health News.1 In May 1987, Professor Qiu Ren-zong, in the Institute of Philosophy at the Chinese Academy of Social Sciences, published his work entitled Bioethics, the very first book that systematically introduced the subject to China’s academia. Since then, the field has expanded in China. With rapid development of the discipline, the number of research institutes and personnel engaged in the field has steadily increased. More and more universities have 1 Du Zhi-zheng. Humble Opinions on Bioethics (part one). Chinese Hospital Management 1987; 7(1): 16–19.
set up research centers such as Peking Union Medical College and Wu Han University. More and more wellknown researchers such as Qiu Ren-zong, Zhai Xiao-mei and Wang Yan-guang have made important contributions to development of the discipline. In terms of educational background, most of the researchers majored in Medical Science and Philosophy.
2.2 Teachers of bioethics Since the 1980s, Bioethics has been introduced to students majoring in nursing and clinical medicine in universities in China and no one can become a licensed doctor without a basic knowledge of bioethics. Relevant courses are now available in more than 500 medical schools. There are thousands of full-time and part-time teachers who, through teaching and research, have made great contributions to the progress and development of the discipline. Some well-known teachers include Cong Ya-li, Zhang Xin-qing and Wang Hong-qi.
2.3 Inspectors of the practice of medical ethics During the last 20 years, more and more problems and controversies have emerged over medical ethics in China. In order to solve these problems and settle the disputes, special agents and offices were set up in hospitals under the guidance of the Ministry of Public Health throughout China. These inspectors can be described as the third type of practitioners in the field. They are mainly in charge of education on medical ethics as well as the daily inspection, management and evaluation of practices of medical ethics, and thus of improvement of the quality of daily medical services. Generally speaking, their functions and responsibilities are as follows:
A: Strengthening the teaching of medical ethics This includes the teaching of bioethics and medical ethics for all medical staff, especially newly recruited doctors and nurses.
B: Implementing norms and codes on medical ethics The implementation of a series of norms and codes set by the Ministry of Public Health is another responsibility of the inspectors. There are rewards to encourage good practice. There are also methods such as suggestion boxes, hot lines and special websites for patients to give their suggestions and make complaints about the practice of medical ethics practices in any hospital.
C: Carrying out evaluations on practices of medical ethics The Ministry of Public Health has issued the pilot edition of a document entitled ‘Guidelines for Evaluations on the © 2014 John Wiley & Sons Ltd
Editorial practices of Medical Ethics of Medical workers’ (hereafter referred to as ‘Guidelines’). Prescriptions in it range from methods and contents of evaluations to principles of implementation. Many hospitals have begun to collect information on their medical workers’ practices of medical ethics, in order to make routine quantitative assessments.
D: Intensifying supervision on practices of medical ethics In 2012, the Ministry of Public Health, the CFDA and the State Administration of Traditional Chinese Medicine jointly issued ‘Norms on Medical Ethics for Medical Workers’ in order to check the daily practices of medical ethics in hospitals throughout the country. The norms are based on the main principles of bioethics and the implementation of the norms is the main job for the inspectors in every hospital. Although there are many administrative factors in the inspectors’ daily work, their job is based on the principles of bioethics therefore plays a special part in the development of professionalization of Bioethics in China.2
2.4 Members of Bioethics Committee and Institutional Review Board (IRB) The issue and application of a series of medical-ethicsrelated documents in the late 1990s propelled the establishment of Bioethics Committees in China. These committees were founded on three different levels: national or local governmental level; institutional or university level; and hospital level. On the national level, the Bioethics Committee is attached to the Ministry of Public Health and its main job is to do research and provide consultation as well as ethical review for government funded programmes. The Institutional Review Boards (IRB) at institutional level, university level and hospital level, undertake ethical reviews of scientific research on humans and animals as well as examining protocols for clinical trials investigating new drugs. Members of the IRB are part-time experts from Bioethics Committees. There are also one to three full-time secretaries in the IRB of every major hospital; and there are 770 major hospitals in China, therefore more than 1000 full-time secretaries are the main force of the professionalization of bioethics. In some major hospitals, special Bioethics Committees have been set up, mainly to provide consultation for intractable cases and supervise the practices of medical ethics at the same time.3
iii
2.5 Editors of the Journal of Chinese Ethics Review Professional journals are very important for development of the discipline and the Journal of Chinese Ethics Review is the only professional journal about bioethics in China. It is edited and published bi-monthly. It has published 148 volumes with 6000 articles since its founding in 1988. Apart from that there are also columns about bioethics in some other journals such as Medicine and Philosophy and Medicine and Society. These journals have provided a platform for academic exchanges on bioethics and propelled the development of Bioethics in China.
3. THE SIGNIFICANCE OF PROFESSIONALIZATION OF BIOETHICS IN CHINA With the rapid development of bioethics, both the research and the teaching of bioethics are becoming more and more professionalized in the following ways.
3.1 Promoting medical ethics consciousness and a basic knowledge of bioethics among medical staff The establishment of medical-ethics-related agents and offices is beneficial for promoting medical ethics consciousness and a basic knowledge of bioethics among medical staff. Training in medical ethics organized by the Bioethics Committees of different institutions, universities and hospitals is key. Inspectors in major hospitals supervise and standardize the practices of medical ethics in order to develop sound values among medical staff. In summary, the situation of medical ethics related problems in China is improving. Patients’ informed consent rights are protected and their opinions are welcomed in cooperating with doctors to treat their diseases. Paternalism in daily medical practices is decreasing.
3.2 Promoting healthcare reform and medical equity The process of professionalization of bioethics, in addition to borrowing ideas from other countries, helps to instil the basic ideas of bioethics into the minds of all medical staff, particularly those in the position of policy making and daily management. This improves the policymaking system and the relationship between patients and hospitals. The above mentioned process should ultimately contribute to the achievement of medical equity and the construction of a harmonious society.4 So far,
2
Li en-chang & Chang yun-li. On the significance of bioethics in the Health Care Industry. Chinese Medical Ethics 2012; 25(1): 14–17. 3 Li en-chang, Du ping, JI Ke-zhou et al. Chinese Ethics Review: System and Chinese Medicine Ethical Review: Past, Present, and Future. Chn J Intear Med 2011; 17(11): 864–869.
© 2014 John Wiley & Sons Ltd
4
Lu shu-cheng & Liu Ping. Hamonious Society and contradictions between patients and hospital – A view point from building service type government[J]. Studies on Mao Zedong and Deng Xiaoping Theories 2010; (4): 57.
iv
Editorial
great accomplishments have been achieved: more than 1.3 billion people already have basic medical insurance, which accounted for 95% of the population by 2011 while the percentage was 87% in 2008. The national public subsidy for outpatients has increased from ¥ 20 RMB to ¥ 200 RMB per person and 75% of the total fee for inpatients under the new system of rural cooperative medical and healthcare services.5 Nevertheless some challenges remain.
4. PROBLEMS WITH THE PROFESSIONALIZATION OF BIOETHICS IN CHINA 4.1 The lack of academic attainment among some practitioners Bioethics is an interdisciplinary comprehensive branch of learning which requires both a sound basis of medical knowledge and a well-founded academic attainment of bioethics. As things stand, some practitioners lack both academic attainment and a basic knowledge of medicine; some researchers maintain impractical ethical demands while turning a blind eye to the real working environment of medical staff; some IRB members with a background in medical education are short of either sound knowledge of bioethics or ethics review capacity. Some teachers in the field lack both a background in medical education and a sound knowledge of bioethics; and this affects their teaching of the subject.
4.2 The shortage of full-time staff Currently there are more part-time staff and fewer fulltime staff in the field. Therefore, working efficiency is inevitably lowered, since these part-time staff do not have time to acquire a basic and up-to-date knowledge of bioethics, or to engage in the relevant research and practices.
5. STRATEGIES FOR IMPROVING THE PROFESSIONAL DEVELOPMENT OF RESEARCH, TEACHING AND APPLICATIONS OF BIOETHICS IN CHINA 5.1 Laying down codes for further development of Bioethics in China The reform and opening-up of China has provided a sound social environment for the professional develop5
Medical and Health Services in China. [EB/OL]. Information Office of the State Council of PRC. December 2012. Beijing. Available from: http://wenku.baidu.com/view/7d98b816c5da50e2524d7fd3.html %202013-05-02.
ment of bioethics. Existing policies are very supportive for the normal development of Bioethics in China, although it is still far from satisfactory because of the lack of certain norms and codes. For example, there are norms and codes for the establishment of Bioethics Committees, procedures of research, and ethics review. However, in the existing norms and codes issued by the Ministry of Public Health and China Food and Drug Administration (CFDA), there are no explicit provisions for professional entrance, recognition of qualifications, or promotion. Therefore some staff members have entered the field without qualification certificates, which inevitably affects further development of the discipline. In the long run, specific codes should be laid down to improve the above-mentioned insufficiency, especially on professional entrance and recognition of qualifications for part-time IRB members and full-time secretaries.
5.2 Improving the professional qualities of practitioners by training Training is the key for the professionalization of research, teaching and applications of Bioethics in China; the existing training system, however, is imperfect and needs improvement. Firstly, instructions and guidelines should be established to provide a basic foundation on the national level. Secondly, institutes throughout the country should undertake the responsibility of drawing up training programmes and ensuring quality and continuity of the training.6 Last but not least, training courses should include both basic and front-line knowledge as well as introduction to the hot topics in the field, in China and the rest of the world. In this way, all the practitioners would enrich themselves with deeper knowledge and would have a broad view for solving problems in daily practice; thus they would advance the professional development of Bioethics in China.
EN-CHANG LI, MENG LI, JIA ZHOU AND PING LIU En-chang Li is the director of the Editorial Department and the vice editor-in-chief of the Journal of Chinese Medical Ethics, Medical School of Xi’an Jiaotong University, Xi’an, China. Meng Li is an Editor of the Journal of Chinese Medical Ethics, Medical School of Xi’an Jiaotong University, Xi’an, China. Zhou Jia is a senior lecturer in the Department of Social Science, Fourth Military Medical University, Xi’an, China. Ping Liu is an Editor of the Journal of Chinese Medical Ethics, Medical School of Xi’an Jiaotong University, Xi’an, China. 6 Zhai Xiaomei & Qiu Renzong. How to evaluate and improve the IRB’s work. Chinese Medical Ethics 2011; 24(1): 3–5, 26.
© 2014 John Wiley & Sons Ltd
Bioethics ISSN 0269-9702 (print); 1467-8519 (online) Volume 28 Number 3 2014 pp ii–iv
doi:10.1111/bioe.12087
EDITORIAL 2014 INTERNATIONAL BIOETHICS FORUM BETWEEN UK AND CHINA AND THE PROFESSIONAL DEVELOPMENT OF BIOETHICS IN CHINA On 8–9 March 2014, a new initiative will bring together two journals, Chinese Medical Ethics and Bioethics, in a conference which aims to promote exchange in and development of Bioethics in different cultures, and to provide ethical defence and guidance for medical science and healthcare reform. The 2014 International Bioethics Forum between UK-China will be held in Nanjing, China and will be a collaboration between the two journals and the Jingling hospital (Nanjing, China). Issues to be addressed at the conference include: 1. 2. 3. 4.
new challenges for health justice; ethical issues in epigenomics and genetic technology; cross-cultural issues new trends and achievements in international bioethics; 5. ethical research in organ donation; 6. problems and countermeasures in ethical review; 7. fairness and efficiency in health reform. The current situation in Bioethics in China, which forms a background to this conference, is set out below.
THE PROFESSIONAL DEVELOPMENT OF BIOETHICS IN CHINA In China, the term hodegetics is interchangeable with the term bioethics, for both words have essentially the same meaning although there are subtle differences between the two. It is reported that China’s first book on hodegetics was published in 1932: the author was Professor Song Guo-bing. This book showed that there were Chinese scholars doing research in the field at the time. In the 1970s, hodegetics entered a new phase as research on bioethics emerged gradually in western countries and it was soon introduced to China too. Research papers were published in journals such as Medicine & Philosophy and Health News.1 In May 1987, Professor Qiu Ren-zong, in the Institute of Philosophy at the Chinese Academy of Social Sciences, published his work entitled Bioethics, the very first book that systematically introduced the subject to China’s academia. Since then, the field has expanded in China. With rapid development of the discipline, the number of research institutes and personnel engaged in the field has steadily increased. More and more universities have 1 Du Zhi-zheng. Humble Opinions on Bioethics (part one). Chinese Hospital Management 1987; 7(1): 16–19.
set up research centers such as Peking Union Medical College and Wu Han University. More and more wellknown researchers such as Qiu Ren-zong, Zhai Xiao-mei and Wang Yan-guang have made important contributions to development of the discipline. In terms of educational background, most of the researchers majored in Medical Science and Philosophy.
2.2 Teachers of bioethics Since the 1980s, Bioethics has been introduced to students majoring in nursing and clinical medicine in universities in China and no one can become a licensed doctor without a basic knowledge of bioethics. Relevant courses are now available in more than 500 medical schools. There are thousands of full-time and part-time teachers who, through teaching and research, have made great contributions to the progress and development of the discipline. Some well-known teachers include Cong Ya-li, Zhang Xin-qing and Wang Hong-qi.
2.3 Inspectors of the practice of medical ethics During the last 20 years, more and more problems and controversies have emerged over medical ethics in China. In order to solve these problems and settle the disputes, special agents and offices were set up in hospitals under the guidance of the Ministry of Public Health throughout China. These inspectors can be described as the third type of practitioners in the field. They are mainly in charge of education on medical ethics as well as the daily inspection, management and evaluation of practices of medical ethics, and thus of improvement of the quality of daily medical services. Generally speaking, their functions and responsibilities are as follows:
A: Strengthening the teaching of medical ethics This includes the teaching of bioethics and medical ethics for all medical staff, especially newly recruited doctors and nurses.
B: Implementing norms and codes on medical ethics The implementation of a series of norms and codes set by the Ministry of Public Health is another responsibility of the inspectors. There are rewards to encourage good practice. There are also methods such as suggestion boxes, hot lines and special websites for patients to give their suggestions and make complaints about the practice of medical ethics practices in any hospital.
C: Carrying out evaluations on practices of medical ethics The Ministry of Public Health has issued the pilot edition of a document entitled ‘Guidelines for Evaluations on the © 2014 John Wiley & Sons Ltd
Editorial practices of Medical Ethics of Medical workers’ (hereafter referred to as ‘Guidelines’). Prescriptions in it range from methods and contents of evaluations to principles of implementation. Many hospitals have begun to collect information on their medical workers’ practices of medical ethics, in order to make routine quantitative assessments.
D: Intensifying supervision on practices of medical ethics In 2012, the Ministry of Public Health, the CFDA and the State Administration of Traditional Chinese Medicine jointly issued ‘Norms on Medical Ethics for Medical Workers’ in order to check the daily practices of medical ethics in hospitals throughout the country. The norms are based on the main principles of bioethics and the implementation of the norms is the main job for the inspectors in every hospital. Although there are many administrative factors in the inspectors’ daily work, their job is based on the principles of bioethics therefore plays a special part in the development of professionalization of Bioethics in China.2
2.4 Members of Bioethics Committee and Institutional Review Board (IRB) The issue and application of a series of medical-ethicsrelated documents in the late 1990s propelled the establishment of Bioethics Committees in China. These committees were founded on three different levels: national or local governmental level; institutional or university level; and hospital level. On the national level, the Bioethics Committee is attached to the Ministry of Public Health and its main job is to do research and provide consultation as well as ethical review for government funded programmes. The Institutional Review Boards (IRB) at institutional level, university level and hospital level, undertake ethical reviews of scientific research on humans and animals as well as examining protocols for clinical trials investigating new drugs. Members of the IRB are part-time experts from Bioethics Committees. There are also one to three full-time secretaries in the IRB of every major hospital; and there are 770 major hospitals in China, therefore more than 1000 full-time secretaries are the main force of the professionalization of bioethics. In some major hospitals, special Bioethics Committees have been set up, mainly to provide consultation for intractable cases and supervise the practices of medical ethics at the same time.3
iii
2.5 Editors of the Journal of Chinese Ethics Review Professional journals are very important for development of the discipline and the Journal of Chinese Ethics Review is the only professional journal about bioethics in China. It is edited and published bi-monthly. It has published 148 volumes with 6000 articles since its founding in 1988. Apart from that there are also columns about bioethics in some other journals such as Medicine and Philosophy and Medicine and Society. These journals have provided a platform for academic exchanges on bioethics and propelled the development of Bioethics in China.
3. THE SIGNIFICANCE OF PROFESSIONALIZATION OF BIOETHICS IN CHINA With the rapid development of bioethics, both the research and the teaching of bioethics are becoming more and more professionalized in the following ways.
3.1 Promoting medical ethics consciousness and a basic knowledge of bioethics among medical staff The establishment of medical-ethics-related agents and offices is beneficial for promoting medical ethics consciousness and a basic knowledge of bioethics among medical staff. Training in medical ethics organized by the Bioethics Committees of different institutions, universities and hospitals is key. Inspectors in major hospitals supervise and standardize the practices of medical ethics in order to develop sound values among medical staff. In summary, the situation of medical ethics related problems in China is improving. Patients’ informed consent rights are protected and their opinions are welcomed in cooperating with doctors to treat their diseases. Paternalism in daily medical practices is decreasing.
3.2 Promoting healthcare reform and medical equity The process of professionalization of bioethics, in addition to borrowing ideas from other countries, helps to instil the basic ideas of bioethics into the minds of all medical staff, particularly those in the position of policy making and daily management. This improves the policymaking system and the relationship between patients and hospitals. The above mentioned process should ultimately contribute to the achievement of medical equity and the construction of a harmonious society.4 So far,
2
Li en-chang & Chang yun-li. On the significance of bioethics in the Health Care Industry. Chinese Medical Ethics 2012; 25(1): 14–17. 3 Li en-chang, Du ping, JI Ke-zhou et al. Chinese Ethics Review: System and Chinese Medicine Ethical Review: Past, Present, and Future. Chn J Intear Med 2011; 17(11): 864–869.
© 2014 John Wiley & Sons Ltd
4
Lu shu-cheng & Liu Ping. Hamonious Society and contradictions between patients and hospital – A view point from building service type government[J]. Studies on Mao Zedong and Deng Xiaoping Theories 2010; (4): 57.
iv
Editorial
great accomplishments have been achieved: more than 1.3 billion people already have basic medical insurance, which accounted for 95% of the population by 2011 while the percentage was 87% in 2008. The national public subsidy for outpatients has increased from ¥ 20 RMB to ¥ 200 RMB per person and 75% of the total fee for inpatients under the new system of rural cooperative medical and healthcare services.5 Nevertheless some challenges remain.
4. PROBLEMS WITH THE PROFESSIONALIZATION OF BIOETHICS IN CHINA 4.1 The lack of academic attainment among some practitioners Bioethics is an interdisciplinary comprehensive branch of learning which requires both a sound basis of medical knowledge and a well-founded academic attainment of bioethics. As things stand, some practitioners lack both academic attainment and a basic knowledge of medicine; some researchers maintain impractical ethical demands while turning a blind eye to the real working environment of medical staff; some IRB members with a background in medical education are short of either sound knowledge of bioethics or ethics review capacity. Some teachers in the field lack both a background in medical education and a sound knowledge of bioethics; and this affects their teaching of the subject.
4.2 The shortage of full-time staff Currently there are more part-time staff and fewer fulltime staff in the field. Therefore, working efficiency is inevitably lowered, since these part-time staff do not have time to acquire a basic and up-to-date knowledge of bioethics, or to engage in the relevant research and practices.
5. STRATEGIES FOR IMPROVING THE PROFESSIONAL DEVELOPMENT OF RESEARCH, TEACHING AND APPLICATIONS OF BIOETHICS IN CHINA 5.1 Laying down codes for further development of Bioethics in China The reform and opening-up of China has provided a sound social environment for the professional develop5
Medical and Health Services in China. [EB/OL]. Information Office of the State Council of PRC. December 2012. Beijing. Available from: http://wenku.baidu.com/view/7d98b816c5da50e2524d7fd3.html %202013-05-02.
ment of bioethics. Existing policies are very supportive for the normal development of Bioethics in China, although it is still far from satisfactory because of the lack of certain norms and codes. For example, there are norms and codes for the establishment of Bioethics Committees, procedures of research, and ethics review. However, in the existing norms and codes issued by the Ministry of Public Health and China Food and Drug Administration (CFDA), there are no explicit provisions for professional entrance, recognition of qualifications, or promotion. Therefore some staff members have entered the field without qualification certificates, which inevitably affects further development of the discipline. In the long run, specific codes should be laid down to improve the above-mentioned insufficiency, especially on professional entrance and recognition of qualifications for part-time IRB members and full-time secretaries.
5.2 Improving the professional qualities of practitioners by training Training is the key for the professionalization of research, teaching and applications of Bioethics in China; the existing training system, however, is imperfect and needs improvement. Firstly, instructions and guidelines should be established to provide a basic foundation on the national level. Secondly, institutes throughout the country should undertake the responsibility of drawing up training programmes and ensuring quality and continuity of the training.6 Last but not least, training courses should include both basic and front-line knowledge as well as introduction to the hot topics in the field, in China and the rest of the world. In this way, all the practitioners would enrich themselves with deeper knowledge and would have a broad view for solving problems in daily practice; thus they would advance the professional development of Bioethics in China.
EN-CHANG LI, MENG LI, JIA ZHOU AND PING LIU En-chang Li is the director of the Editorial Department and the vice editor-in-chief of the Journal of Chinese Medical Ethics, Medical School of Xi’an Jiaotong University, Xi’an, China. Meng Li is an Editor of the Journal of Chinese Medical Ethics, Medical School of Xi’an Jiaotong University, Xi’an, China. Zhou Jia is a senior lecturer in the Department of Social Science, Fourth Military Medical University, Xi’an, China. Ping Liu is an Editor of the Journal of Chinese Medical Ethics, Medical School of Xi’an Jiaotong University, Xi’an, China. 6 Zhai Xiaomei & Qiu Renzong. How to evaluate and improve the IRB’s work. Chinese Medical Ethics 2011; 24(1): 3–5, 26.
© 2014 John Wiley & Sons Ltd
