Medicine Is a Humane Art

By Zhang, Daqing; Cheng, Zhifan | The Hastings Center Report, July 2000 | Go to article overview

Medicine Is a Humane Art


Zhang, Daqing, Cheng, Zhifan, The Hastings Center Report


The Basic Principles of Professional Ethics in Chinese Medicine

The value system of medical ethics in China has a long tradition that can be traced back to ancient times. Those values are reflected in the (Confucian) precept that "medicine is a humane art." That is, medicine is not only a means to save people's lives, but also a moral commitment to love people and free them from suffering through personal caring and medical treatment. Although this precept has been well accepted as the basic principle of professional ethics as a general principle that emphasizes doctors' self-accomplishment and self-restraint, there has never been a universally accepted professional code and binding principles in Chinese medicine comparable to the Hippocratic Oath in western medicine.

Medical Ethics in Ancient China

As in ancient Greek medicine, the professional values f ancient Chinese medicine arose with the development of medical professionalism itself. In ancient China, "profession" meant one's duties. During the Zhou Dynasty (from 1065-771 B.C.E.), an independent medical profession and medical system took shape, built around four aspects: dietetic, internal, surgery, and veterinary. Standards for evaluating, and paying, doctors were established. Thus the Rites of the Zhou Dynasty records that "at the end of each year, doctors are paid according to their medical performance, the highest payment to those who got 100 percent cure rate, the payment for 90 percent cure rate ranks the second, 80 percent the third, and so on."[1]

During the Spring and Autumn Period (770-476 B.C.E.) and the Warring States (475-221 B.C.E.), medicine began to divorce itself from witchcraft and became an experience-based knowledge and a professional skill. At the same time, professional physicians emerged as a distinct social class, no longer seen as wizards with superman skills but as ordinary technicians, whose relationships with patients and among themselves were being redefined. Codes of ethics and standards concerning medicine arose, and the emergence of schools of medicine laid the foundation for the development of formalized medical ethics.

In ancient China, folk physicians didn't have fixed clinics or hospitals but went from one place to another practicing medicine freely. They hadn't formal training and weren't licensed, but performed their work by their own skills and consciences. As a result, there were deceitful quacks as well as experienced, good-hearted physicians. Physicians also ran tremendous risks while practicing medicine. For instance, in the Code of Hanmorabe (1700 B.C.E.), there were severe punishments for physicians' wrongdoings. Wenzhi, a 5th century B.C.E. physician, lost his life for failing to cure Emperor Qi's illness. To preserve their own reputations and distinguish themselves from quacks and to protect themselves, values emerged among physicians and between physicians and their disciples, such as emphasis on prognosis and observation of codes of conduct. These values gradually formed the foundation of early medical ethics.

Unschuld identifies three protective mechanisms for physicians in medical history: sorcery, prognosis, and medical ethics.[2] We agree with Unschuld but we also think that these mechanisms are basically stages in the development of medical ethics. However, the evolution of these three stages isn't simply a substitute of one for another; there are overlaps among them and even coexistence of them. The first mechanism, sorcery, hinges on belief in ghosts and gods and supernatural power to effect treatment; it is the domain of wizards and magicians.

The second mechanism, prognosis, rests on the advancement of medical knowledge and therapies and changes in people's conceptions about illness to believe that natural and reasonable factors cause disease. As physicians distinguished themselves from wizards and medicine lost the protective aura of magic, prognosis became the new protective mechanism. …

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