On Oct. 19, National Taiwan University Hospital denied a request from Chao Chien-ming (趙建銘), President Chen Shui-bian's (陳水扁) son-in-law, to return to his job. saying he had violated medical ethics. But isn't medical ethics a required course for Taiwanese medical students? Is something wrong with our medical training?
Before the hospital explained its position, a lot of people suspected that it had reached its decision on Chao as a defense against media pressure and public criticism. Chao's case made many of us in the medical profession feel that merely providing medical ethics training is not enough. Without the inculcation of the most basic social values and ethics, similar cases could occur again.
Some may ask why doctors should spend their whole career under the weight of medical ethics. The 12 doctors who leaked Taichung Mayor Jason Hu's (
If a doctor commits a mistake, the first thing we should ask is whether it was committed during the course of administering medical treatment. Did he or she take advantage of his authority as a doctor or political or business connections to gain unjust benefits from a patient, or even accept a gift of money? Was he or she guilty of deviant behavior in the place of treatment? Did the doctor violate a patient, or feign good intentions to promote medically unproven treatments or medicine? Was he or she guilty of academic plagiarism?
If any of these questions are answered in the affirmative, then he or she has of course violated medical ethics. If, however, a doctor is guilty of other moral misconduct, he or she has violated social ethics, not medical ethics.
The first principle of ethics is not to hurt others. Applying this to medical ethics, no doctor should hurt a patient. If a doctor hurts a patient and damages the image of the medical profession in the course of medical treatment, that doctor has violated medical ethics. A doctor's private mistakes, however, constitute violations of social ethics, not medical ethics.
Here is a simple example: A doctor has a fight with somebody in a ball game after work. In doing so, he has damaged the image of doctors, but has he really violated medical ethics? Or if a doctor invests in a business and then takes investors' money and runs, she may have hurt others, but has she violated medical ethics?
They are indeed guilty of betraying the principles of honesty and responsibility, but they have not necessarily violated medical ethics. Apart from having to face legal punishment, they must also face the torture of their conscience and public criticism.
But is it a violation of medical ethics if a doctor recommends some untested alternative treatment to patients? That answer is certainly "yes," just as an intellectual making a similar recommendation of such groundless treatment would have violated social ethics.
Society has extremely high expectations of doctors. Unfortunately, their image has declined in recent years. Consequently, education on medical ethics has been proposed. But will this solve the problem? Perhaps we should not criticize this naive expectation too much, but it does seem to contradict reality.
In Taiwan, where utilitarianism rules the roost, personal desire often outweighs conscience, not to mention the public's double standards. Public opinion is controlled by the media, and the public's distinction between right and wrong is surprisingly obscure. The root of the problem is blurred, and this cannot be remedied by medical ethics.
A doctor may damage the image of the medical profession by violating medical ethics, but he or she may also be disliked by the public for violating social or commercial ethics. Chao indeed shamed the medical community. The problem is not only one of medical ethics, but also of social values and civic ethics.
Taiwan needs to rebuild its fundamental values. We cannot ignore medical, social, environmental, business or civic ethics. This process must start in the home and be strengthened by our educational system. We must set a good example for our children or the problem will remain forever unresolved.
Michael Tai is a professor at Chung Shan Medical University.
Translated by Eddy Chang
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