February 25, 2024

Fighting the scourge of ‘red envelopes’ for China’s doctors

Is it corruption or a recognition of their dignity?

In the Ming Dynasty (17th century), an eminent doctor, Chen Shigong, promulgated his Five Precepts and Ten Musts for Medical Practitioners. Chen’s five precepts are: “No despising the poor and currying favour with the rich; No committing unprincipled conduct; No acting upon mercenary motives; No neglecting of duty; No being flippant and hypocritical”.

While these noble aspirations still resonate with doctors, the medical profession in China is demoralised. They feel overworked and victimised. More than 90% feel that they are underpaid; 79% say that they would not choose medicine again if given a second chance. Violence against doctors is a serious problem. In 2016 alone, 7 people were condemned to death for murdering medical practitioners.

Therefore, contend three Chinese medical ethicists in Developing World Bioethics, it is unsurprising that doctors in China are willing to accept “red packets” in connection with their services. The ancient practice of offering a gift in gratitude has been transformed into a system for bribing doctors to provide services. The official government line is that this constitutes corruption, but both doctors and patients look upon it as recognition of their professional status and dignity. There are few complaints or arrests.

The authors say that the solution is not higher wages – which is a convenient line for supporters of China’s socialist medicine. They argue instead that ethical training is needed to root out the corrupting scourge of red packets. Apparently this is almost completely lacking in Chinese medical schools.

For a long time, there has been a general lack of medical ethics and humanities education in the training of medical practitioners. In the medical universities and nursing schools across the country there is a dearth of such courses available for students to choose from …

Executive pronouncements mandating prohibition, punishment, or salary increases alone will not help find the final solution to the problem. What will really enable the issue to be handled successfully in the end will be a massive and consistent effort to boost the medical humanities and ethics education among medical practitioners and those about to enter the profession. It will be a new generation of medical professionals, with their restored sense of dignity, their professional pride and their renewed ability to make sound moral judgments, who will say a resounding NO to the red envelopes.

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