Healthcare workers in Shanghai are walking the line after recent news that regulations issued by local health authorities will soon enforce the opening of an “ethics file” for each of the city’s 140,000 medical workers. According to the regulations, once it is found that medical workers have taken commercial bribery or hongbao (cash gift in envelopes), or even disrespected the rights and interests of patients, they will be deprived of the right to be awarded the title of “excellent worker” and the right to promotion. The regulations also advocate dismissal.
Many critics feel these measures are too little, too late. They point to the fact that an ethics file will have scant chance of saving the deteriorating professional code of conduct among doctors. This is in light of the fact that stricter written regulations and rules have already failed to realign the profession’s wavering moral compass.
Bribery-taking and other acts of blackmail are forbidden, yet some medical workers openly flout the laws by asking already cash-strapped patients for underhand payments before they are attended to.
So just how will the public’s trust in hospital services be restored? Some believe that Shanghai’s new measures may prove to be beneficial, as morality is at the root of the breakdown being experienced. When doctors begin to remember that their obligation is to save the dying and cure the sick, and they recall their professional ethics, and perhaps through this regulation, bribery and shoddy patient treatment may become a thing of the past.
Lame duck regulation
Chen Cai (guancha.gmw.cn): Doctors’ professional ethics is not a simple moral issue. Nowadays, hospitals have to rely on medicine sales for more profits, and the administrative links between medical institutions and health authorities make it impossible for the latter to act impartially when dealing with disputes between hospitals and patients. If these problems remain, ethics is bound to be an issue for medical workers.
Actually, Shanghai is not the first city to adopt the ethics file system. In 2002 and 2003, Suzhou in Jiangsu Province and Guangzhou in Guangdong Province began to pilot medical ethics files to local doctors. It’s true that the files have helped to curb things like bribery, but we all know that hospitals will never severely punish doctors who bring in profits, even if they are involved in scandals. This is why, in some areas, ethics files are useless.
Under China’s current hospital operation system, believe it or not, professional ethics runs against the interests of hospitals. For example, in line with ethical standards, medical workers should treat poor patients as they do the rich ones. However, in the case of a patient who cannot afford the medical fees, the hospital will face a dilemma. If it offers services, it will suffer losses, and if it does not, it violates the moral code.
Without a sound performance assessment system for medical workers, the shocking situation is very likely to continue that doctors who adhere to a code of ethics are seldom praised by their hospitals and hospitals will never dismiss doctors who cross the ethical boundary, as long as he or she can bring in money.
Lin Weiping (www. dzdaily.com.cn): It seems hard to tell whether a doctor is or isn’t adhering to a code of ethics as there are no strict criteria by which to measure this. The proposed ethics files are expected to provide just such a set of standards. If the files say someone is good, then he or she is a good doctor. However, we must not forget, professional ethics is not something that can be fully reflected by files.
In my opinion, the so-called ethics files are just another example of formalism.
First, when a scientific assessment system for doctors’ professional ethics has yet to take shape, what is recorded on current files is quite doubtful. It’s not easy to judge a doctor’s professional ethics, and taking bribes is only one of the many malpractices to prove a doctor’s lack of morality.
Second, ethics files are always kept in hospitals and can only be seen within the health system, while patients, who know best about medical workers, have no say in what should be written in the files. Besides, when patients want to query a doctor’s caliber they actually have no access to the files, as these usually remain confidential.
Third, who will maintain these ethics files? Who is qualified to leave comments on the files? If it is doctors themselves or senior hospital staff, then the files must be a record of praises or at least good remarks. This is not the kind of file beneficial to patients.
I don’t mean to say that the ethics files are totally useless, but the lack of an effective performance assessment system for medical workers and the lack of transparency of ethics files mean this new system is full of loopholes.
