By Mike Frick
Last week, China's Ministry of Health released a draft "Code of
Conduct for Medical Practitioners" for public review and comment. The
document lays out a code of conduct for hospital administrators,
doctors, nurses and other medical personnel. According to the ILO,
many Chinese hospitals refuse to treat patients with HIV/AIDS - so
there is definitely a need for new policies. We reviewed the draft
code within Asia Catalyst and found some areas of progress, as well as
some areas where the standards need a lot more work.
Combatting corruption: One piece of good news: the Code of Conduct
addresses the need to reduce corruption. Article 8, for example,
prohibits physicians from accepting gifts from patients or their
relatives - a widespread practice in Chinese hospitals that places a
heavy burden on families in need. Article 8 also calls on physicians
to refuse free medications, medical equipment and recreational
activities offered by medical sales companies, gifts that distort
physician incentives and lead them to recommend more expensive care.
Improving informed consent: Many of the grassroots groups we work with
tell us that there's an urgent need to ensure that patients have
informed consent in Chinese hospitals, and we were encouraged to see
informed consent - a basic tenet of medical ethics - appear throughout
the Code of Conduct. Article 6 calls on all medical practitioners to
respect informed consent and patient privacy. Article 25 asks doctors
to fully educate patients and their relatives about new medical
technologies and to respect patient decision-making about their use.
These are positive steps; they'd be even more positive if there were
clearer mechanisms in the code of conduct to ensure accountability
when hospital workers violate the code. So much for the good news -
here are some of the weak points.
Universal precautions: The Code of Conduct does not mention universal
precautions (sometimes called standard precautions), an essential
policy when combatting medical discrimination against patients living
with HIV/AIDS and other blood-borne illnesses. What are universal
precautions? Basically, these include wearing medical gloves, goggles
and face shields when handling all patient's bodily fluids - and not
just with some patients that health care workers suspect might be
living with HIV.
Because they are used with all patients equally, universal precautions
help to reduce the stigma and discrimination associated with fear of
occupational exposure to the AIDS virus. As a report published by
Asia Catalyst and Phoenix, a Chinese HIV/AIDS group, documented, this
fear of occupational infection is a significant barrier to healthcare
access among people living with HIV/AIDS in China, who are routinely
turned away from hospitals - or in some cases, required to pay for all
of the medical equipment used during their care.
Non-discrimination: Since we work with sex workers, drug users, LGBTQ
people, and others at risk of discrimination, I was really
disappointed by the Code of Conduct's poor attention to medical
discrimination against patients in hospitals. Only one article
addresses it: Article 6 calls for non-discrimination in medical
settings on the basis of race, religion, origin, social status,
disability and illness -- but omits age, sex and sexual orientation.
Age, gender and sexual orientation not only influence individual risk
for morbidity and mortality; they are often themselves the basis for
medical discrimination. Leaving out these essential categories means
leaving young people, older people, women and LGBTQ people without
protection they need.
The "Code of Conduct for Medical Practitioners" arrives at an
important moment in China's AIDS epidemic. Chinese health care
professionals will encounter growing numbers of HIV-positive patients
in the coming decade as the government expands free testing and
treatment programs. Establishing clear standards for informed consent,
reducing corruption and educating health professional on universal
precautions and non-discrimination will help to ensure access to
equitable, ethical and affordable care for people living with HIV/AIDS
and other patients who need help from China's medical system.
Mike Frick is China program officer at Asia Catalyst.
Sara L.M. Davis, Ph.D. ("Meg")
Executive Director
Asia Catalyst
www.asiacatalyst.org
Tel: (212) 967-2123
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