The crisis of patient‐physician trust and bioethics: lessons and inspirations from China

Abstract

Trust is indispensable not only for interpersonal relationships and social life, but for good quality healthcare. As manifested in the increasing violence and tension in patient-physician relationships, China has been experiencing a widespread and profound crisis of patient-physician trust. And globally, the crisis of trust is an issue that every society, either developing or developed, has to face in one way or another. Yet, in spite of some pioneering works, the subject of patient-physician trust and mistrust --a crucial matter in healthcare especially because there are numerous ethical implications --has largely been marginalized in bioethics as a global discourse. Drawing lessons as well as inspirations from China, this paper demonstrates the necessity of a trust-oriented bioethics and presents some key theoretical, methodological and philosophical elements of such a bioethics. A trust-oriented bioethics moves beyond the current dominant bioethical paradigms through putting the subject of trust and mistrust in the central agenda of the field, learning from the social sciences, and reviving indigenous moral resources.In order for global bioethics to claim its relevance to the things that truly matter in social life and healthcare, trust should be as vital as such central norms like autonomy and justice and can serve as a potent theoretical framework. KEW WORDSChina, trust, patient-physician relationship, healthcare, trust-oriented bioethics, global bioethics 2 The theme of this special issue is "Rebuilding patient-physician trust in China, Developing a trust-oriented bioethics." Utilising a methodology that integrates anthropological and sociological inquiry with ethical analysis, the previous articles have investigated the phenomenon and sources of patient-physician mistrust and the mechanisms required to rebuild a trust in the healthcare system in mainland China. Drawing lessons as well as inspirations from China, in this paper we argue for the necessity of a trust-oriented bioethics and outline the theoretical and methodological foundations of such a bioethics. By so doing, this paper addresses specifically the second main aim of this thematic issue."People cannot stand without trust," as Confucius asserted 2600 years ago in one of his best-known statements, recorded by his disciples in Lunyu (The Analects) (Book XII: 7). Among other things, this means that if trust is absent, neither individual life nor local communities and the wider society can thrive or even survive. The central thesis of this paper (and the entire thematic issue) is that, to paraphrase Confucius, medicine cannot stand without mutual trust between patients and their relatives, on the one side, and health professionals and institutions on the other. And neither can bioethics in China and around the globe stand upright without placing trust in its central agenda. PATIENT-PHYSICIAN MISTRUST IN CHINA: CONSEQUENCES AND CONTEXTChina, the world's most populous country where more than 1.3 billion people live, has been experiencing an e...

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