Ethics Education or Moral Preaching? The Sino-German International Workshop about Ethics in Medical Education in China. Xi'an, 18-19 Sept., 2000

- Ole Doering, Ph.D., Germany

Eubios Journal of Asian and International Bioethics 10 (2000), 185-186.
To modernize the Chinese education system is high among the priorities of Chinese domestic policies. The enhancement of knowledge and skills in general, and diversified training in special fields is seen as a key to strength and competitiveness, elevating China onto the global scale of developed nations. Given the multiple trauma China has suffered during this century, the task is ambitious. Especially the demand for meaningfulness and practical knowledge creates an urge for health, in a most comprehensive sense, which will unlikely be satisfied by overcome institutions and ideology. The rise of Falungong may be understood as indicative of the significance of this urge for health, physically, socially and spiritually. In this situation, generating a flourishing human capital must include efforts in improving the underlying cultural, civil and social wellbeing of the nation. Medicine and ethics, in this light, appear to be two pillars upon which to build the nation, as a civil society based on a state of righteousness, civil accountability and trust.

The Xi_fan ethics workshop was part of a research project on medicine and ethics in contemporary China, conducted by the author at the Institute of Asian Affairs (Hamburg) since 1996. This project includes three conferences to date. It is sponsored by the Dr. Helmut Storz Foundation.

This workshop was held in conjunction with the 15th annual conference of the Chinese-German and German-Chinese Medical Societies, in Xi_fan. It was the first time that the Societies would provide a special forum for ethics in medical education. 12 speakers represented multiple professional perspectives (philosophy, medicine, genetics, economy, medical ethics), cultural diversity (participants came from Beijing, Shanghai, Guangzhou, Xi'an, Goettingen and Hamburg) and three generations (retired seniors, active leaders and upcoming young scholars). Top class scientists such as Yang Huanming (Director of the Chinese Human Genom Research Center at Beijing), Chen Renbiao (ELSI-Department, National Human Genome Center at Shanghai), Du Zhizheng (President, Chinese Bioethics Association, Dalian), and Li Ruiquan (Director, Graduate Institute of Philosophy, Chungli) presented their views, and engaged open-mindedly in critical discussion. Information about the special issue of informed consent was provided by Nikola Biller (G_ttingen) who introduced the related experience in German medical ethics education. Some 40 German and a few Chinese physicians attended. A group of 30 advanced medical students from Jiaotong University engaged in the discussion. While stimulation originated from the round table, students and audience where encouraged to speak up. Both latter groups also shared their concerns and insights, making them part of the workshop. Altogether, this conference resulted in a successful first round in what is hoped to become a long term Sino-German cooperation in medical ethics.

Du Zhizheng called ethics education very urgent. Currently, medical students would not care about society, and would fail to understand ethics. They feel in particular appalled by the authorities attempts to preach them morals. To make it worse, only one third of medical ethics teachers have actually been educated in ethics. The most important task for ethics education in medicine in China is, according to Yang Huanming, to educate the educators. They should become highly qualified, and promote medical ethics in China towards an international level. The teachers situation is lamentable, also due to their poor social and economic situation. Teaching methods and communication between student and teacher are inadequate, discouraging and old-fashioned. The quality of textbooks is not acceptable. Chen Renbiao announced plans to edit a nationwide medical ethics reference. The lack of appropriate standards and standardization in ethical, legal and social norms in China was referred to as an obstacle in the process of modernization, especially in implementing the international medical ethics guidelines in China. On the other hand, it remains a fact that standardization in an authoritarian political system is always in danger of being instrumentalized for mere secondary interests, e.g. for eugenics policies.

Currently, medical ethics courses are mandatory. This practice was compared with the German optional system, which seems to attract relatively few but significantly more engaged students. Whether making it optional in China will increase or decrease the interest of the students depends on the structure of the medical curriculum as well as on the ethical teaching itself. One student voted for a third way approach, combining a mandatory system with modern teaching methods. Real life issues, such as case studies are widely missed, and also the cooperation of ethicists and clinicians needs to be improved. The curriculum should be mindful of the fact that the ethical situation is worst in the hospitals, though much change is needed in research and general practice as well.

Fundamental challenges result from a striking imbalance between rural and urban areas, and between the private and public sectors of medicine and education. Even more generally, the underdeveloped state of law, and the staggering implementation of standards pose severe threats to the building of a peaceful society. Medical ethicists should encourage active civil and social responsibility. They should work for a more reasonable distribution and allocation of health resources. Given the difficulties and the key function of ethics in medicine, education should be maintained as a field where money is spent. Medicine and ethics education should be exempted from the overall imperative of making money. The rich must share, and support the poor (Zuo Chuanchang, Guangzhou).

Recently, it seems that authorities pay some attention to medical ethics, with a tendency to use it as a vehicle for moral indoctrination. It is up to medical ethicists to make sure that ideology is kept away from the serious education of ethics in medicine, and that ethics is distinguished from moralism and emotionalism in the first place.

The two Medical Societies presidents, Prof. Seitz and Prof. Gong, and the Delegate of the Federal Republic of Germany in China, Mr. Yess, expressed during the formal opening of the conference that ethics education in medicine is a key to the future. To develope this key and to employ it prudently is not just a task for China, but a challenge for physicians and ethicists in every country aspiring for a humane 21st century.

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