Bioethics in China (1990-2008): Attempts to Protect the Rights and Health of Patients, Human Subjects and the Public

A s i a n B i o e t h i c s R e v i e w D e c e m b e r 2 0 0 8 i n a u g u r a l e d i t i o n 44 Bioethics in China (1990–2008): Attempts to Protect the Rights and Health of Patients, Human Subjects and the Public Q I U R E N Z O N G The development of bioethics in China in the period of 1990–2008 was characterised by more concerns with policy, regulations and law in the field of biomedicine and biotechnology for equitable rights for the protection of patients and human subjects. It was also a period that symbolised the emergence of the subject of bioethics from its ivory tower and brought into focus and subsequent intervention on real issues emanating from societal life and actual practices. Reflection on Healthcare Sector Reform In 1985 China launched its market-oriented healthcare sector reform. It was said that the Chinese government accepted the recommendations by some liberal economists to withdraw from the healthcare field and to leave its development entirely to market forces. The core of the healthcare sector reform consisted of dramatic reduction of resources allocated to healthcare, and public healthcare institutions in particular, so as to lessen the burden of the government. By the “cessation of lactation” (断奶 duan nai) or “cutting off grains” (断粮 duan liang) — expressions alluding to the end of public funding and aid — the public healthcare institutions were forced into the open market. Currently, the funding from the government to public healthcare institutions amounts to only 3–8% of the total incomes of those institutions. In other words, 92–97% of incomes of public healthcare institutions are derived from payments for medical examination and treatment of patients, which could be borne fully or partially by employers or entirely from the patients’ own pockets with the policy which 44–57 Asian Bioethics Review December 2008 inaugural edition R E T R O S P E C T I V E 45 B i o e t h i c s i n C h i n a ( 1 9 9 0 – 2 0 0 8 ) Q i u R e n z o n g permits public hospitals and healthcare institutions “selling drugs (and charging for medical examinations) to support hospitals”.1 Unfortunately, this reform has brought much bitterness instead of sweetness. Twenty years of reform has certainly raised the standard in medical diagnostics and treatment. China now possesses advanced technological means to provide the highest levels of medical care for all sorts of patients. It has built many hospitals and institutions which compare favourably with the most advanced counterparts from the rest of the world. It has also trained a range of young and able professionals to provide excellent medical care. Many reputable clinical institutions all over the country no longer need to rely mainly on the government for financial support. Instead, they not only assume the sole responsibility for their own bottom lines, but also the authority to utilise surplus funds. As a result, the incomes and living standard of medical professionals have been greatly improved. This was the original intention of the healthcare reform. However, the costs for these achievements are heavy or even tragic, because many more people than before have little or no resources to seek medical attention, since free medical care is a thing of the past. Regrettably, some of them have to sell all their belongings and even property for medical costs, thereby plunging them back into poverty again. The Third National Survey on Healthcare Services published towards the end of 2004 shows that 48.9% of Chinese did not see a doctor when they fell ill, and 29.6% who could have been admitted to hospital did not do so.2 The survey also shows that from 2000 to 2004 the average income of inhabitants in urban areas increased by 8.9%, by 2.4% in rural area, but the healthcare payout increased to 13.5% and 11.8% respectively. According to the data in the Summary of 2005 China’s Healthcare Statistics published by...