"Doctors are frequently attacked and the professional morale is very low."After reading her essay's first draft, I asked her to include the notion of professional ethics in the rewrite. The rewrite was better organized but she had failed to include ethics in her analysis. She instead explained the increasing violence against doctors on the shortage of hospitals, on doctors' low pay, on the superstitions of Chinese families, and the practice of using bribes to ensure the highest quality care. All of these elements play a role, but solving any one of them will likely do little to decrease the outright hostility that can erupt between patients and doctors. The factor that is the main cause of the violence directed against them is that Chinese doctors do not abide by their own ethical code of conduct.
Economic development and subsequent disparity have been the main drivers of change in China since the zeitgeist changed from 'serve the people', to the phrase, misattributed or not to Deng Xiaoping, 致富光荣, 'It is glorious to get rich'. He steered the country on a pathway that no longer guaranteed medical care as a right of the people and instead it became another commodity. As a result doctors have gotten very rich along with pharmaceutical salesmen, hospital administrators, and anybody who functions as a gatekeeper between patients and medical treatments.
As the young woman sat in my office, trying to make sense of violence against a woman close to her own age, I drew a diagram of what I perceived to be the three main players in this tragedy: a public official, a doctor, and a patient. In her narrative and in most of the news accounts, there has in fact been little mention of any medical staff's involvement. I asked her the question as to which of the three has the most power. She responded that the public official has all the power. And then my Socratic method kicked in.
"But it was a doctor who performed the abortion, correct?"A doctor who abuses his skills to perform a procedure on a resisting patient under orders from a third party betrays the most essential ethics of his profession and yet this contradiction doesn't enter into the discussion in China. Her first thought was to see the doctor as just somebody like her, obliged to obey any government official. She felt that his interest in protecting his job prospects trumped his role of protecting his patients. And not surprisingly accounts of the event and its aftermath also fail to mention any doctors by name. We can read about the suspension of family planning officials as though a chemically induced abortion occurred all on its own after the order was given.
"Yes, but if he had not done that, the hospital would have fired him?"
"Ok, and then what would have happened?"
"Another doctor would be told to abort the baby."
"And if he had said no, do you think the hospital would have fired all the doctors?"
A few bureaucrats who are willing to comply with and enforce party guidelines are easily replaced. This could be an opportunity for the members of the medical profession to ask themselves whether they want to hold themselves accountable for not carrying out forced medical procedures. It seems to me that they are the lynchpin in the chain of command and hold the ultimate power if they choose to recognize it.
The fallout of this event is still determining its own course. My first reaction to hearing about this story was: Why does this one case matter so much more than the other routine, and numerous instances of violence against the poor? The Marxist in me is the main source of my cynicism. It would not surprise me to hear an apologist for this practice point out how the family is the cause of their own suffering and that law must be obeyed by saying:
"Of course, if the family had just paid the 40,000 yuan fine, they could have had a second baby."Is this recent and broad discussion in some way connected to the greater awareness of the Chen Guangcheng legal efforts in rural Shandong? Is it evidence of the power of Weibo and a few visuals to drive home what is easier to ponder as an abstraction? Or is it a signal that the Party or a faction wants to modify the one child policy? (I doubt the last.)
Tom at Seeing Red in China has his own interpretation and also wonders as to why now this event has catalyzed the public discussion. He cites medical professionals who also feel that they are better off keeping their jobs than doing what they think is right. For those who want to see some of the images that started this all and learn how glorious it is to get rich by working in the Chinese medical field, here is a link.