Developing World Bioethics
March 2018 Volume 18, Issue 1 Pages 1–64
Special Issue: Rebuilding Patient-Physician Trust in China, Developing a Trust-Oriented Bioethics
Rebuilding patient–physician trust in China, developing a trust-oriented bioethics (pages 4–6)
Jing-Bao Nie, Joseph D. Tucker, Wei Zhu, Yu Cheng, Bonnie Wong and Arthur Kleinman
Version of Record online: 18 SEP 2017 | DOI: 10.1111/dewb.12172
In a short period of nearly four decades, China, with one fifth of the world’s population, has rapidly evolved from a predominantly agricultural, poor and developing country to an upper middle-income country. At the same time, China faces numerous daunting social challenges. One of them is the widespread, profound, and advancing crisis of patient–physician trust. Among the many manifestations of this crisis is an unprecedented process characterized by rapidly increasing levels of violence involved in disputes between patients and their relatives against medical professionals and institutions.
Like many other challenges that China faces, this crisis of trust in the health sector is by no means merely a Chinese problem. There is much convincing evidence that it is a global issue, emerging in developing and developed societies alike, although the scale and depth of such a crisis may vary considerably from one place to another. More generally, a serious crisis of trust can be observed across geographic areas and societal sectors. It affects all professions, businesses, the media, governments, and international affairs.
Though its significance often goes unrecognized, trust plays a vital role for interpersonal and social life as well as healthcare. In the field of bioethics, however, attention paid thus far to the question of trust in general, and to patient–physician trust in China in particular, is far from sufficient in spite of some pioneering studies.1 Such deficits in bioethical scholarship is in marked contrast to the fields of social and political sciences, where trust has been a key subject for the past few decades, with a large and growing literature. Due to its essential role for good social life and good healthcare, trust deserves a place in the central agenda of bioethics in China and globally.
..The first two papers are anthropological and sociological studies of the broader socio-political, cultural and healthcare context of patient–physician mistrust and its major sources in contemporary China. Yunxiang Yan demonstrates how patient–physician mistrust, and patient–physician relations in general, has been a part of a grand moral and political transformation unfolding in China over the past few decades; this include the growth of individualization and the rising awareness of the values of human dignity, respect, and individual rights. Based on two years of ethnographic research, Cheris Chan examines the major sources of medical mistrust at societal, institutional, and interactional levels. She highlights the role of funding mechanisms behind China’s healthcare system, whereby public hospitals and health professionals alike are largely forced to finance themselves, in generating mistrust.
…To conclude, it should be emphasized that the situation in China and the crisis of trust now unfolding on a global scale should not be framed in totally negative terms. As the two Chinese characters for crisis, weiji, aptly reflect, any crisis presents both dangers and opportunities simultaneously. In the Chinese context, distrust and mistrust of medical professionals and healthcare systems amongst individual patients and patient populations means that people are developing higher expectations of competence, caring, respect, dignity, recognition, rights, high-quality services, and active participation. In spite of its immediate and long-term negative consequences, the widespread and profound mistrust therefore presents opportunities to reform existing but ethically unsound medical practices and institutions, and ensure the moral accountability of institutions and individuals in power.