Preliminary study on constructing good medical ethics from two dimensions

: Medical ethics is a quality that should be possessed by healthcare workers. There is an urgent need for the development of medical and health services, which carries the people ’ s aspiration for a better life. We should vigorously promote the construction of medical ethics, in which the author believes that “ nourishing ” is the cornerstone and “ guidance ” is the core. In this paper, we discuss the construction of medical ethics from the two dimensions of how medical and health institutions can make good use of “ nourishing ” and “ guidance ,” and put forward corresponding countermeasures from the current status quo of medical ethics. Our aim is to develop and strengthen the medical and health service team in terms of quality, quantity, ability, and moral integrity, thereby promoting the construction of the Healthy China Initiatives.


Introduction
Strengthening the construction of medical ethics is the basis for the realization, development, and safeguarding of the health rights and interests of the broad masses of the people in medical and health services, and is an important symbol to measure if we have always put people and their lives first in our medical and healthcare work.Following the Party's 18th National Congress, China has made great progress in medical and health services.The people's sense of well-being has increased, and the major health indicators in China are among the highest in the middle-and high-income countries, and the people's health rights and interests are protected.These achievements have been made under the correct leadership of the Party and the Government, and are inextricably linked to the lofty professional spirit of all medical workers of respecting life, healing the wounded and rescuing the dying, being willing to dedicate themselves, and maintaining boundless love, and to the performance of the sacred duties of preventing and treating diseases and protecting the people's health.In 2021, the total number of health workers in China reached 13.983 million, and the proportion of primary healthcare professionals and technicians was 72%, according to public information [1] .It is undeniable that among such a large number of healthcare practitioners, inevitably, there are problems with the medical ethics of individual medical workers that need to be strengthened, thus highlighting the importance of continuous industry-wide efforts to strengthen medical ethics.

Main problems in the current medical ethics 2.1 Absence of morality
It is a characteristic of the profession that doctors are held to high ethical and technical standards past and present, at home and abroad.As a doctor, there may be highs and lows in skills, but ethical standards cannot be lowered.Medical staff shoulder the glorious mission of "healing the wounded, rescuing the dying, treating diseases, and saving lives.Noble medical ethics and rigorous medical style are the qualities and prerequisites for qualified doctors.The moral characters manifested by the cultivation, conduct, and habits of medical workers have an essential impact on their practice.A rigorous scientific approach, superb medical skills, and warm humanistic care have always been indispensable parts of medical services.The most important aspect of nourishing the moral conscience is to improve humanistic qualities.If medical workers are heartless and lack of moral conscience, it will be more difficult to consciously strengthen medical ethics and to resist with determination in the face of harmful social trends, which will inevitably lead to the absence of medical ethics.

Poor compassion
"Patients, for they do not know how to judge the correctness or incorrectness of a medical procedure, become weak once they go to the hospital." [2]Patients need to be psychologically comforted as the relatively vulnerable party in the process of medical treatment.The reality is that some medical workers downplay "patient-centered" concept in their practice, and have become overweening, blunt in their bearing, and lack compassion.This brings out the question of whether a doctor sees a "disease" or a "person."The focus should not be on the "disease" but on the "person."During the Covid-19 pandemic, an incident in Xi'an Gaoxin Hospital in which a pregnant woman could not be admitted to the hospital in time due to no nucleic acid test results and resulted in miscarriage caused widespread concern in society with a bad social impact, which reflects the serious lack of the "patient-centered" concept of some medical institutions and medical workers and indicates that medical staff should put themselves in patients' shoes and show more compassion.

Over-ambitious profit-seeking
While the market economy and medical technology develop at a rapid pace, "hospitals' profit-seeking behavior ballooned, pharmaceutical companies, hospital operators, and doctors have formed commercial alliances, and medicine has developed in the direction of 'treating diseases of fewer people with more expensive treatments'". [3]At the beginning of 2022, a photo of the team building of Dongguan Kanghua Hospital, on which the slogan "Forge ahead with the vigor and vitality of the tiger, and the operating room will be full of money" circulated online, causing an uproar and strong doubts about the hospital's medical ethics from the netizens.A small number of doctors regard treating diseases and saving people as a means of getting rich, accepting "red envelopes" and "kickbacks," issuing extraordinary prescriptions, indiscriminately examining patients and using antibiotics and high-priced drugs, which seriously damage the image of medical workers.These reflect that medical institutions and medical workers are guided by economic indicators, deviating from their original mission, equating the medical act of treating patients and saving lives with commercial acts, and having a profit-seeking mentality that is chilling.

Lack of responsibility
As a doctor, the most basic and important quality is being responsible.Doctors who are not responsible may not strictly abide by the core medical system and follow the diagnosis and treatment standard and operation specifications; and may result in failure to value the clinical manifestations of patients and to carefully check the medical records and prescriptions, or the writing of medical records is not standardized, wrong injections or giving the wrong drugs, wrong site surgery, and medical devices and other items are left in the patient's body during operation, causing losses, injuries and even disability and death to patients.These derelictions of duty caused by irresponsibility often cause conflicts between doctors and patients, giving rise to medical disputes and damaging the interests of the people.As the famous Dr. Zhang Xiaoqian of Union Medical College Hospital once said: "How can we not feel fear when our patients are putting their lives in our hands?" [4].Hence, there is no reason why doctors should not give their all with the strongest sense of responsibility to treat a patient.
3 Construction of fine medical conduct from two dimensions of "nourishing" and "guidance" 3.1 A solid foundation of medical ethics is built with the essence of "nourishing"

Learning good medical ethics from traditional Chinese culture
Medical and health institutions should guide medical workers to practice the fine Chinese traditional culture in their daily lives, to see the suffering of patients with the "compassion" of Buddhism, to respect every life with the "cause and effect" of Taoism, and to pity every patient with the "benevolence" of Confucianism.For instance, Dharma Master Cheng Yen of Taiwan, China, guided by the simple concept of "providing medical care to the poor," founded the Buddhist Tzu Chi Medical.One of Tzu Chi's medical missions is: "Doctors should be as merciful as Buddha, and treat the patients like their family members."The fine traditional Chinese culture contains many philosophies that persuade people to strive for excellence and be benevolent, such as "Ji Suo Bu Yu, Wu Shi Yu Ren," [5] "Shan, Ren Zhi Bao," [6] translated into English respectively, the meanings are as follows: "Do not do to others what you do not want others to do to you," "Goodness, the treasure of man."The culture of striving for excellence and developing stronger virtues inherits the essence of the fine traditional Chinese culture and embodies the consciousness and introspection of patients first, proceeding, and goodness, which can stimulate the sense of moral responsibility of the medical workers.

Searching for demonstrations that nourish medical ethics from the centuries-old practice of Chinese medicine
The essence of the traditional culture of Chinese medicine in China is the spirit of healing the wounded and rescuing the dying, just as Sun Simiao said in the Important Prescriptions Worth a Thousand Gold for Emergency: "Human life is of utmost importance and is worth a thousand pieces of gold."He talked about medical ethics in the book: "When great doctors treat patients, they are usually calm and concentrated without any desire and avarice.They have great sympathy for the patients and are determined to save the people from suffering" [7] .It can be described as a Bible of the cultivation of medical ethics, which has influenced generations of doctors to practice medicine and conduct themselves in society.Another example is the famous saying of Fan Zhongyan, a great man of the Song Dynasty, recorded in the Enlarged Ode of Things: "If I cannot be a good prime minister, I must be a good doctor, for doctors can save people too."It is a great honor for the practitioner to be compared a good prime minister.In addition, traditional medical allusions such as "Xing Lin Chun Nuan," "Xuan Hu Ji Shi," and "Ju Jing Quan Xiang" indicate profound self-cultivation ethics for being a doctor, and they are of exemplary guiding significance for our practitioners in the medical and health industry today.

A powerful moral call where medical ethics are benchmarked against the core socialist values
The core socialist values we advocate are the concentrated reflection of the spirit of contemporary China, the "greatest common divisor" of the values of all Chinese people, and the common value pursuit of all the people.Medical workers should take the lead in extensively practicing the core socialist values and nourishing medical ethics with their strong moral inspiration.For example, from the core socialist values of "dedication," "integrity," and "friendship," we can easily find the answer in the many moral quotes of the sages, such as "Jun Zi Yang Xin Mo Shan Yu Cheng," [8] "Min Wu Xin Bu Li," [5] translated into English respectively, the meanings are as follows: "For a gentleman to nourish his mind, nothing is more excellent than truthfulness," "The country will collapse if the people have no trust in it," which are exactly the values that our Chinese nation has inherited and persisted for thousands of years.Medical workers across the country should integrate these values into their sincere emotional identity and daily behaviors, thus, they will become the code of conduct for medical practitioners to use every day without realizing it.

We should further establish clear guidance of "one-vote veto" for medical ethics construction with sound party discipline, state laws, rules, and regulations
The Opinions on Strengthening the Party Building of Public Hospitals explicitly stated that we should establish and improve the medical ethics evaluation system for medical workers, implement the "one-vote veto" system for medical ethics, and directly link the performance of medical ethics with medical workers' promotion, post-employment, appraisal, and regular assessment [9] .Article 3 of the Law on Doctors of the People's Republic of China, which came into effect on March 1, 2022, stipulates that doctors shall uphold paramountcy of the people and life, carry forward the spirit of humanitarianism, promote the lofty professional spirit of respecting life, healing the wounded and rescuing the dying, being willing to dedicate themselves, and maintaining boundless love [10] .To further strengthen the construction of the industry environment, in 2021, the National Health Commission, the National Healthcare Security Administration, and the National Administration of Traditional Chinese Medicine jointly issued the Notice on Printing and Distributing Nine Guidelines for the Honest Practice of Medical Institution Staff, which clarified the bottom line of basic behavior for medical workers across the country.The authors suggest that medical and health institutions at all levels can formulate corresponding rules and regulations for medical ethics in light of actual conditions to guide their medical workers to strengthen the construction of medical ethics further.As medical workers, we should bear in mind and be in awe of these party disciplines, state laws, rules, and regulations.

We should further establish clear guidelines for medical ethics by using moral examples from the medical and health industry
The image of a role model is the most intuitive, which can be seen, touched, and reached by people.Over time and worldwide, the medical and health industry has produced countless touching moral role models, from which medical workers should learn.A role model is like a beacon that shows the way.Li Juhong, a village doctor in Hechuan, Chongqing, who cannot walk on his feet, and relies on small benches and human backs, has served villagers for 15 years and traveled more than 80,000 kilometers to see villagers.In 1965, Yang Xiuyu, an obstetrician and gynecologist at Union Hospital, had a patient surnamed Cao in the choriocarcinoma group, who lost his breath and had only heartbeats.There is no ventilator in the hospital.The doctor used the anesthesia machine instead of the ventilator and kept pinching the ball of the anesthesia machine.All doctors took turns pinching the ball 16 times in 1 minute, which continued for 72 hours, and the patient finally breathed on his own [4] .Nightingale once said: "And common sense will point out that while the purity of air is essential, a temperature must be secured which shall not chill the patient." [11]his is patient-centeredness!This is an example of medical ethics!

We should further establish clear guidance for using negative typical cases in the medical and health industry to alert medical personnel
Having someone accountable for wrongdoing is better than a thousand times of mobilizations.Tough punishments may serve as a deterrent.Medical and health institutions should systematically analyze serious cases of violation of disciplines and laws in the medical and health industry regularly, such as illegal medical practice and corruption, and use them as negative teaching materials to provide warnings to the medical workers so that their spirits can be baptized and their souls deeply touched.For example, in early 2022, it was announced that Sun, in Zhongshan District, Dalian City, performed medical cosmetic surgery on patients without obtaining a Certificate of Doctors' Qualification and a Doctor's Practicing Certificate.Sun was given an administrative penalty of confiscating the illegal proceeds of 35,420 yuan and a fine of 100,000 yuan for the illegal practice of medicine in accordance with the Law on Licensed Doctors of the People's Republic of China.The deep-seated reason why medical personnel embark on the road of violating disciplines and laws the decline of ideals and beliefs and the distortion of life values among some of the medical workers, which lead to unruly and wanton behavior.
In short, the construction of medical ethics has never been achieved overnight or once and for all.We should persistently improve the humanistic comprehensive quality of industry practitioners by giving a silent transforming influence, face up to the current status quo of medical ethics in the meantime, provide positive guidance, necessary warnings, and punishments, and keep pace with the times to find an effective way for the medical ethics construction.