I just returned from a week-long trip to Southeastern China, where I visited a large and well-respected Chinese medical school in the city of Guangzhou in Guangdong Province. My University has a relationship with this sister school in China, Sun Yat-sen University, and I was lucky to receive an invitation from the faculty involved in the medical school bioethics curriculum, because the group is in the process of revising their undergraduate ethics curriculum. I got to meet with faculty, the dean of education for the medical school, many undergraduate medical students, post-graduate residents, and students from the integrated schools of public health and nursing. I visited one of the affiliated specialty hospitals (specializing in liver disease and liver transplantation) and got experience as a patient in the main university hospital, where I was treated by a traditional Chinese physician for back pain after registering as a patient in the Chinese health care system.
As is nearly always the case with international travel, and especially in a place so different from what we are accustomed to in the United States, the whole experience was delightfully eye-opening, both for those dimensions of medical care and education that struck me as remarkably similar, as well as those that seemed wholly foreign. One of the more striking things I learned about the undergraduate ethics curriculum at this medical school, which in its original form has been in place for nearly ten years, was that most of it was based on cases and principles derived from Western references. This was striking to me, given how radically different Chinese culture is from US and Western culture (as if either of these were homogeneous enough to make such a statement!). Take abortion or transplant ethics, for example. Abortion is widespread and commonplace in China, in part because of the one child per family policy that is in place for families who reside in urban areas. Many Chinese people consider themselves atheists. How could the debate about abortion, which polarizes along lines such as those represented by the pro-life and pro-choice viewpoints in the Western world, possibly have the same outlines in such a different culture? Procuring organs for transplant, as another example, is not done on a completely voluntary basis in China. So the ethical framework for organ procurement and transplantation is just different, and analysis of a case based on Western experiences will have a completely different valence. One suggestion I talked a lot about during my meetings with faculty was to develop a curriculum based on Chinese cases, using a Chinese framework. This suggestion was not popular.
I stood in several long lines to register to become a patient, to obtain a medical record document, to be evaluated by one physician, then to be treated by another. It was clear to me that no one has his or her own physician. I stood in line again to pick up a prescription that had been entered into a computer by the treating physician and was then sent electronically to one of about 30 pharmacy windows, where it was ready for me when I arrived there to pick it up.
Even though throngs of people stood in line everywhere (including to get into the parking garage—police had created a special lane of traffic along the boulevard just to handle those awaiting entry), it did not feel inordinately chaotic, and I didn’t identify anyone who appeared upset or witness anyone complaining (although I might have missed this, given how limited my Chinese language skills are). I was told by students and residents and faculty that the sense of communitarianism that permeates Chinese culture would make it unusual for any one person or family to demand special treatment.
I did not leave China with the sense that there was very much about the Chinese healthcare or medical education system that we should adopt, but as we enter an era of healthcare reform after decades of prioritizing doctors’ individual rights and authority, as well as patients’ expanded ability to demand treatments no matter how expensive, I wonder where we will get a bit more communitarian spirit, and I begin to see many of the choices we will have to make in the light of our collective and interconnected lives. I remain anxious that our prospects for being successful at this are limited.