There are many reasons for the phenomenon of "medical trouble", which have both human basis and social and cultural roots. In essence, the social root of "medical trouble" is the break in the process of economic and social development, the cultural root is the break in the fields of science and humanities, and the normative root is the break in the resources and supervision in the medical field. Therefore, the radical cure of "medical trouble" does not lie in "medical trouble" itself, but should start with system and culture. The angle I choose is to reshape medical ethics through the return of humanistic spirit.
(A) the lack of medical ethics and the lack of humanistic spirit: the fracture between science and humanities
Medicine is people-oriented, people are benevolent, and benevolence is also people-oriented. People-oriented medicine is because medicine itself is human science, and the ultimate mission is the humanistic care of doctors for patients. "The essence of humanistic care is people-oriented, patient-centered, showing concern and concern for the meaning of human existence, the value of patients, the rights and needs of patients, and the personality and dignity of patients." [1] It is said that benevolence is the essence of human beings, and the core of traditional Confucianism in China is benevolence, which is also the first of the five virtues. The word "benevolence" occupies a dominant position in Confucianism, and the Confucian classics are permeated with benevolence everywhere, such as "people are ruthless, like courtesy?" People are heartless, so what are you happy about? "(The Analects of Confucius Bashu)" Benevolence and wisdom do not come from the outside, but are inherent in me. " ("Mencius told the son") "pan-loving people and loving benevolence" ("The Analects of Confucius learning") and so on. Because the essence of benevolence is to love and care for others, the so-called "benevolent loves" (Mencius, benevolent loves) and the so-called "benevolent loves" (Mencius, wholeheartedly). Therefore, "the core of medicine is humanism and humanitarianism, followed by professional ethics, industry system and specific skills." " [2]
Based on this, when people don't love others and are heartless, it is the day when science and humanities in the medical field break, the day when doctors lose their professional ethics and the day when doctors lose their ultimate mission. In the doctor-patient relationship, patients are in an almost absolute weak position, and they are extremely unequal to doctors in information, technology and system, and this sense of inequality will be further deepened in the process of solving medical disputes. In the process of medical appraisal and medical litigation, patients will lose trust in the appraisal results because of the institutional connection between medical appraisal institutions and hospitals. As a result, patients think that it is impossible to realize rights relief in institutions and judicial institutions, so they will choose relief channels outside the system and outside the judiciary. The tension between doctors and patients, represented by the phenomenon of "medical trouble", is certainly affected by the overall social environment, but the root cause is the lack of doctors' professional ethics and humanistic care.
(B) the essence of medical ethics: the combination of science and humanities
Edmund D. Perry Greenough, an American professor of medical ethics and philosophy, said: "Medicine is the most humanistic science, the most experienced art and the most scientific humanities." Medicine is essentially the perfect unity of science and humanities, and the ultimate mission of doctors and other medical workers is humanistic care.
From the perspective of space, the humanistic essence of medicine embodies the commonness of Chinese and western medical ethics. Humanistic care is not only the spirit advocated by traditional Chinese medicine, but also the essence of western medicine. "A good doctor is either a good doctor or a good doctor", "Doctor's Parents' Heart" and "Great Doctor's Sincerity" all embody China's relatively simple traditional medical ideal and medical ethics, while the Hippocratic Declaration and Nightingale spirit are the essence of western medical ethics. The similarities between Chinese and western medical ethics lie in not hurting, benefiting patients, patient autonomy, fairness and justice.
From the perspective of time, the humanistic nature of medicine can also link China's traditional medical ethics with modern medical ethics. In China's traditional medical ethics, both medical ethics and medical skills are equally important. Humanistic care for others should conform to both Confucian ethics and Mohist school's view of love. Mohist thought also embodies humanistic care for others everywhere, such as "those who follow God's will, love each other and benefit each other will be rewarded." Those who violate God's will, do not be evil, and thieves will be punished "("Mozi Tianshang "). God bless those who love others and benefit others; Thieves are thieves, and the sky is a disaster "("Mozi Yi Fa "), and so on. Confucius and Mencius advocated benevolence, while Mozi advocated universal love, which was their common ethical principle and behavioral pursuit. The current medical ethics in China has lost the humanistic thought of traditional medical ethics to a certain extent, and has not been in line with the humanistic thought of western medical ethics, resulting in the fracture between science and humanity. Therefore, only by cultivating and carrying forward the humanistic spirit can we bridge the gap between science and humanities, fundamentally alleviate the contradiction between doctors and patients, and reduce the phenomenon of "medical trouble".
(C) the humanistic reconstruction of medical ethics: the blending of science and humanities
At present, the remodeling of medical ethics in China is essentially to abandon technicalism and integrate humanistic care into medical practice, so that science and humanities can blend and complement each other. Specifically:
First of all, implement humanistic spirit and humanistic medical education, and establish the main spirit of medical humanistic spirit. The so-called humanistic education is simply the education of cultivating humanistic spirit, which is essentially a kind of human nature education. It takes the perfection of individual mind as the highest goal, and mainly embodies the educational values based on individual development needs. Medical humanistic education is to cultivate doctors' real humanistic care for patients and form benign interaction and trust between doctors and patients. Medical education has both "technique" and "Tao", and "Tao" is the basis of "technique". Medical humanities education is the "Tao" of medical education and an indispensable part of medical education. "At present, the dilemma of medical humanistic education lies in: medical humanistic education is confused with political education, and the goal of humanistic education is unknown; Medical humanities teaching is divorced from social reality, and the effect of humanities teaching is not good. " [3] To break through the existing medical humanistic education, the most important thing is to grasp the essence of humanistic education and establish doctors' sense of honor, responsibility and mission.
Second, re-endow the hospital with public welfare orientation and consolidate the medical humanistic foundation. An important institutional reason why hospitals and doctors can't really care about and treat patients well is the market positioning of hospitals. Because hospitals are involved in the wave of marketization, they need to operate independently and be responsible for their own profits and losses, which objectively makes doctors and hospitals lose or partially lose their public welfare orientation. Let doctors have humanistic spirit not only for patients, but also for medical staff, which is the living environment of both doctors and patients. Only when its doctors really have full humanistic spirit can patients have real trust and respect for their doctors. In this way, even if there are medical problems and medical accidents, medical disputes can be minimized or malignant mass incidents that will not lead to medical disputes can be avoided.
Third, establish a hospital ethics committee to carry out self-monitoring of medical humanistic care. Some foreign countries have established hospital ethics committees. The ultimate goal of hospital ethics committee is to safeguard patients' health interests, promote medical development and improve patient-centered service consciousness, give consideration to the interests of doctors and patients, and finally promote the establishment and development of medical ethics. The hospital ethics committee consists of doctors, pharmacists, nurses, medical technicians, hospital administrators, psychologists, legal workers and social workers. The establishment of the hospital ethics committee is essentially to shape the medical ethics of benign interaction between doctors and patients through the establishment of humanistic spirit. The establishment of hospital ethics committee is not only a rediscovery of humanistic spirit in traditional medical ethics, but also related to humanistic spirit in modern western medical ethics to some extent.
Osler, the father of modern clinical medicine, told the graduates of medical college more than 100 years ago: "Ladies and gentlemen, opportunities are open for you, and your future is limitless. If you only pursue your own interests, turn a lofty and sacred mission into a despicable business, treat your compatriots as tools for many transactions, and concentrate on getting rich, you will definitely get what you want. But in this way, you have betrayed a noble legacy, ruined the well-maintained title of doctor as a friend of mankind, and distorted the fine tradition of a long-established and respected industry. " Therefore, the humanistic spirit of caring for patients must be placed at the core of doctors' professional ethics in order to reap the dual achievements of science and humanities in the development of modern medicine. Only in this way can we truly establish a harmonious doctor-patient relationship and a benign medical dispute resolution mechanism.
References:
Zack Zhang. From numbness to recovery--concern and expectation for medical humanistic care. Medicine and Philosophy (Humanities and Social Medicine Edition), 2006(8).
[2], Hui people. On professional indifference and humanistic care in medical behavior. Medicine and Philosophy (Humanities and Social Medicine Edition) 20 10(3).
[3] Zhang Jun. The current plight and outlet of higher medical humanities education. Medicine and Philosophy (Humanities and Social Medicine Edition), 20 1 1(8).