552Challenges for Bioethics from Asia
The methods and contents in teaching medical ethics obviously need to accommodate the respective cultural, social and personal situation of the particular individual. In class, individuals or groups of students can practice to change perspective. From the view of being a patient, e.g., they may ponder, what type of doctor one would prefer to see, or sympathise with the patient, or cultivate themselves accordingly. Ultimately, this approach assists students in departing from our socially or ‘self-inflicted (moral) infancy’ (Kant), using each one’s own pace and stile in advancing. A Chinese medical student, for instance, brings in her or his unique set of moral preoccupations, experiences, narratives of social life and moral concepts, which can be expected to be different from those of a colleague from Germany or Canada. And the medical student from Beijing will most likely be different from a classmate in Chengdu and other places in China, as he might meet shared views and interests with a peer in Hamburg. The individual’s practical experience is an important lens through which we are motivated to rethink, not only actions, but also categories of “good”. Students should be encouraged to use and develop their nascent moral sense, especially in situations that confront what they thought to be good and experience to be different, or when conflicting norms constitute a dilemma. Only from active engagement of one’s own moral reasoning will the student learn to improve the wisdom in her decisions.
Interpreting ‘education in medical ethics’ in terms of an integrated process of moral and professional cultivation makes it easy to connect contemporary challenges in teaching medical ethics with the enlightened or Daoism-related traditions of early Confucian pedagogy and moral philosophy.
3 Conditions of teaching medical ethics in China
Notwithstanding their heterogeneous individual motivations and beliefs, Chinese medical students and their teachers in ethics classes encounter a shared cluster of challenges, which result from their country’s social, scientific and educational systems’ transformation. China’s system of medical education is currently changing, with a notable lag on the side of poorer provinces and regions to be accounted for. Medical ethics has been taught as a required course until recently, with a strong tendency to emphasize correct ideological thinking, instructing students in being moral models of humane behaviour, and to avoid conflicts. It is estimated that, currently, less than 200 scholars from different academic backgrounds are engaged in medical ethics education all over China. Classes are huge in size (up to 300 students). These professors hardly receive adequate training in ethics, nor does the curriculum include much of the related literature or updated theories and concepts in medical ethics, neither as compared with the respective international standards, nor as incorporating relevant interdisciplinary insight, e.g. from the critical social sciences, humanities and pedagogy. The professors’ salary seems to be insufficient to compensate the high level of responsibility medical ethics teachers bear, with their impact on moulding the new generation of medical professionals. There is serious demand for training specialists in advanced professions in medical ethics (such as IRB members) and to counterbalance the omnipresent rationality of consumerism, pragmatism and market economy. In general, the situation can be regarded as inadequate on all levels. Teachers report that they are frustrated, students annoyed, while ethics is regarded as a pointless waste of time.
The real development in medicine and on the health sector in China has made this state unbearable, even for those experts with no special interest in ethics. Real life is moving on. Modernisation advances rapidly but unequally. Technology plays a greater role. New legal and technical standards are implemented, and, more recently, an increasing awareness and readiness among patients and human subjects to claim their rights, while the ‘red envelope’ is increasingly rejected as a practice of corruption, has changed the cultural and socio-economic environment dramatically. High standard medical services are advancing, offering the best to a privileged few, whereas the vast majority among the population often has difficulties to access the basics. In the absence of medical insurance coverage for more than two third of the population, illness is one of the main causes for poverty in China. (Lawrence 2002)
At the same time, the state encourages creativity, individual decision making, responsibility, accountability and competitiveness among the academic elite in particular, as