The Teaching of Medical Ethics in Beijing Medical University

- Dr Cong Yali
Dept. of Social & Human Science
Beijing Medical University
38 XueYuan Rd
Beijing 100083, CHINA

Eubios Journal of Asian and International Bioethics 7 (1997), 71.

The teaching and research office of medical ethics was established in the 1980s, and the course was available to the undergraduate students (except the school of pharmacy). Before 1992, the teacher only taught some theories, principles and standards of general ethics and medical ethics. The students did not show much interest in the course, which showed that the teaching way was out of date. With the support of The China Medical Board of New York in 1992, we tried to reform the medical ethics teaching. The following are some methods in detail which I want to share with all medical ethics teachers.

In the third school year when the students began their clinical studies, the teachers spend half their time in teaching the students medical ethics systematically, including their historical development of medical ethics, some basic theories (Deontology, utilitarianism, virtue ethics and so on), principles (nonmaleficence, beneficence, justice and autonomy). Some further explanation is needed: in the west, the principle of autonomy is put before the other three principles, but in China, people pay much attention to the relationship. For example, if a patient needs an operation, a doctor will discuss with the relatives instead of the patient themselves, that is to say, the patient has less autonomy, so the principle of patient autonomy is behind the other three principles in China. The relationship between patients and medical workers, between medical workers and society, moral problems in some special departments (such as emergency room, department of pediatrics, department of infectious diseases, department of stomatology, department of psychiatry), and moral dilemmas in bioethics are other contents.

The other half of the time is spent discussing some typical cases, which is different from the old teaching way. For example, we have discussed this case: a worker who is only 36 years old needs a kidney transplantation, but he and his factory do not have enough money, the medical workers don't know what to do. Some students think that the society should help him with money or source of kidney, some students think that the hospital should decline the transplantation price, some students argued that the hospital is not a mercy institution and shouldn't decline any price, other students would like to donate money or kidney which moved me very much. All of this makes me understand that the teaching of medical ethics is not only teaching itself but also a study for the teacher which in Chinese is called "teaching and studying to help each other and share mutual action."

We can see the attitude change of students towards the course according to a survey on 107 sample students: before taking the course, 31% students were not interested in, or reluctant to choose the medical ethics course, 40% of students showed some curiosity on the course, but only 27% really thought the course was important for medical students. After taking the course, the uninterested and reluctant figure dropped to 11%, 73% of students thought the study was important and useful. 16% of students demanded more time on medical ethics study. These figures show that the reformed teaching way is better than the old one.

In addition, we train some clinical doctors and teach them how to lead the clinical students to resolve moral problems around them.

This is main reformed method in our university, and here I want to exchange experience with other readers. Considering the future, I am worried about how to reform further, here I seek any advice on raising the level of medical ethics teaching in order that we can do our work better.

Commentary on Cong: Teaching Medical Ethics, a Call for an Asian and International Discussion

- Frank J. Leavitt, Ph.D.
The Jakobovits Centre of Jewish Medical Ethics
Faculty of Health Sciences, Ben Gurion University of the Negev,
Beer Sheva, ISRAEL (Home Tel/FAX: +972-2-9963048)
(Email: yeruham@bgumail.bgu.ac.il)

Dr. Cong Yali's report is a welcome addition to discussions we've had on these pages (also recently by Yaman Ors) on teaching medical ethics. The subject is very important because it is through our students, the future physicians, nurses and biologists, that bioethics will be put into practice. Dr. Yali asks for advice in improving the level of medical ethics teaching, and I would like to appeal to all Eubios readers to contribute their ideas and experiences. My own comments are, first: I think that the third year is a little late to start. First-year students are fresh and open. By third year they may have already begun to develop a rigid "physician's" way of thinking. But in First Year we can discuss abstract things with them and accustom them to the fact that ethical and philosophical concepts are an inseparable part of medical education.

Secondly: I am surprised that the theoretical content which Yali mentions is so highly Western ("Deontology", "autonomy" etc.) Of course medicine is an international profession and Western ideas have their place. But then so do ideas from our own cultures. Just as Jewish tradition cannot be ignored in medical ethics teaching in Israel, so I should have expected more attention to Confucianism, the Tao, Marxism. In Chinese medical ethics education I should have expected also more mention of traditional Chinese medicine (a subject of great interest here in Israel incidentally). Thirdly I think that involving the patient's family should really give more autonomy rather than less. This point came out very clearly in a paper a few years ago by Naoko T Miyaji (Soc. Sci. Med. (1993) 36: 249-264)

The Eastern physician-family relationship can give the patient much more support and strength than the Western physician-patient relationship where the patient may find oneself an isolated, alienated individual, with no supportive family backing, totally dependent upon the physician's decisions.

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