Hostname: page-component-669899f699-tzmfd Total loading time: 0 Render date: 2025-04-25T15:46:22.277Z Has data issue: false hasContentIssue false
  • English
  • Français

Obligation, Informed Consent, and Health-Care Reforms in China

Published online by Cambridge University Press:  01 April 2024

Jia Liu Open the ORCID record for Jia Liu [Opens in a new window]
Jia Liu*
Affiliation:
Institute of Public Policy, South China University of Technology, Guangzhou, Guangdong Province, China
*
Email: liujia@scut.edu.cn
Get access Rights & Permissions [Opens in a new window]

Abstract

Drawing on recent jurisprudential literature that emphasizes the role and function performed by obligation, this article examines how the ethical doctrine of informed consent has been implemented in the context of health-care reforms in China. It argues that, while the Chinese incorporation of informed consent has sought to empower patients, the major medical laws and social policies fail to instantiate the obligations. Along with this failure, the Chinese medical laws have also failed to secure the bond of trust between them. This article also points out that a rounded analysis of the implementation of informed consent in China must take into account the obligation and function of the major components of the health-care delivery system other than physicians and hospitals, such as health-care insurance schemes.

Keywords

obligationinformed consentmedical lawhealth-care reformChina
Type
Research Article
Information
Asian Journal of Law and Society , Volume 11 , Special Issue 3: Comparative Legal History in an Asian Context , September 2024 , pp. 343 - 364
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of Asian Journal of Law and Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Baier, A. (1986). “Trust and Antitrust.” Ethics, 96(2): 231–60.CrossRefGoogle Scholar
Bok, S. (1982). Secrets: On the Ethics of Concealment and Revelation. New York: Pantheon Books.Google Scholar
Brazier, M. (2006). “Do No Harm—Do Patients Have Responsibilities Too?”, Cambridge Law Journal, 65(2): 397–422.CrossRefGoogle Scholar
Chen, Meei-Shia. (2001) “The Great Reversal: Transformation of Health Care in the People’s Republic of China.” In Cockerham, W. & Hendry, D., eds., The Blackwell Companion to Medical Sociology, 456–82. Hoboken: John Wiley & Sons.CrossRefGoogle Scholar
China Health Yearbook Editorial Committee. (1983). Zhongguo Weisheng Nianjian [Yearbook of Public Health in the People’s Republic of China]. Beijing: Renmin Weisheng Chubanshe [People’s Health Publishing House].Google Scholar
Cong, Yali. (2004). “Doctor-Family-Patient Relationship: The Chinese Paradigm of Informed Consent.” Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy, 29(2): 149–78.CrossRefGoogle ScholarPubMed
Davies, B. (2020). “The Right not to Know and the Obligation to Know.” Journal of Medical Ethics, 46(5): 300–3.CrossRefGoogle ScholarPubMed
Ding, Chunyan. (2007). “Yihuan Guanxi yu Xiaofeizhe-Jingyingzhe Guanxi: Jiekai Zhengyi de Miansha [Physician-Patient Relationship v. Consumer–Provider Relationship: Lifting the Veil of the Debate].” Journal of Law and Medicine, 14(3): 184–94.Google Scholar
Draper, H. & Sorell, T.. (2002). “Patients’ Responsibilities in Medical Ethics.” Bioethics, 16(4): 335–52.CrossRefGoogle ScholarPubMed
Ebner, A. (2015). “Marketization: Theoretical Reflections Building on the Perspectives of Polanyi and Habermas.” Review of Political Economy, 27(3): 369–89.CrossRefGoogle Scholar
Evans, M. (2007). “Do Patients Have Duties?” Journal of Medical Ethics, 33(12): 689–94.Google ScholarPubMed
Faden, R. R. & Beauchamp, T. L.. (1986). A History and Theory of Informed Consent. New York: Oxford University Press.Google Scholar
Fan, Ruiping. (1997). “Self-Determination VS. Family Determination: Two Incommensurable Principles of Autonomy.” Bioethics, 11(3): 309–22.CrossRefGoogle ScholarPubMed
Fan, Ruiping & Wang, Mingxu. (2015). “Taking the Role of the Family Seriously in Treating Chinese Psychiatric Patients: A Confucian Familist Review of China’s First Mental Health Act.” Journal of Medicine and Philosophy, 40(4): 387–99.CrossRefGoogle ScholarPubMed
Fu, Hongqiao et al. (2017). “An Evaluation of Systemic Reforms of Public Hospitals: The Sanming Model in China.” Health Policy and Planning, 32(8): 1135–45.CrossRefGoogle ScholarPubMed
Gu, E. (2001). “Market Transition and the Transformation of the Health Care System in Urban China.” Policy Studies, 22(3): 197–215.CrossRefGoogle Scholar
Gu, E. (2009). “Towards Universal Coverage: China’s New Healthcare Insurance Reforms.” In Yang, Dali & Zhao, Litao, eds., China’s Reforms at 30: Challenges and Prospects, 117–35. Singapore: World Scientific Publishing.CrossRefGoogle Scholar
He, Alex Jingwei. (2011). “Combating Healthcare Cost Inflation with Concerted Administrative Actions in a Chinese Province.” Public Administration and Development, 31(3): 214–28.Google Scholar
He, Alex Jingwei. (2018). “Manoeuvring within a Fragmented Bureaucracy: Policy Entrepreneurship in China’s Local Healthcare Reform.” The China Quarterly, 236: 1088–110.CrossRefGoogle Scholar
He, Alex Jingwei & Qian, Jiwei. (2013). “Hospitals’ Responses to Administrative Cost-Containment Policy in Urban China: The Case of Fujian Province.” China Quarterly, 216(216): 946–69.Google Scholar
He, Alex Jingwei & Qian, Jiwei. (2016). “Explaining Medical Disputes in Chinese Public Hospitals: The Doctor-Patient Relationship and its Implications for Health Policy Reforms.” Health, Economics, Policy and Law, 11(4): 359–78.CrossRefGoogle ScholarPubMed
He, Zhaoxiong & Chen, Lixing, eds. (1985). Yixue Lunlixue Gailun [Introduction to Medical Ethics]. Nanjing: Jiangsu Science and Technology Publishing House.Google Scholar
Hesketh, T. & Xing Zhu, Wei. (1997). “Health in China: The Healthcare Market.” BMJ, 314(7094): 1616–18.CrossRefGoogle Scholar
Hisao, W. (1995). “The Chinese Health Care System: Lessons for Other Nations.” Social Science & Medicine, 41(8): 1047–55.CrossRefGoogle Scholar
Huang, Xian. (2015). “Four Worlds of Welfare: Understanding Subnational Variation in Chinese Social Health Insurance.” The China Quarterly, 222: 449–74.CrossRefGoogle Scholar
Huang, Yanzhong. (2003). Mortal Peril: Public Health in China and Its Security Implications. Washington, DC: Chemical and Biological Arms Control Institute.Google Scholar
Huang, Yanzhong. (2013). Governing Health in Contemporary China. New York: Routledge.Google Scholar
Kaba, R. & Sooriakumaran, P.. (2006). “The Evolution of the Doctor-Patient Relationship.” International Journal of Surgery, 5(1): 57–65.CrossRefGoogle ScholarPubMed
Katz, J. (2002). The Silent World of Doctor and Patient. Baltimore: Johns Hopkins University Press.CrossRefGoogle Scholar
Kleinman, A. et al. (2011) “Introduction.” In Kleinman, A. et al., eds., Deep China: The Moral Life of the Person, 1–35. Berkeley: University of California Press.Google Scholar
Li, Keqiang. (2011). “Buduan Shenhua Yigai Tuidong Jianli Fuhe Guoqing Huiji Quanmin de Yiyao Weisheng Tizhi [Continue to Deepen the Healthcare Reform, Promote the Establishment of the Medical and Health System that Suits the National Conditions and Benefits All the People].” Qiushi, 22: 3–10.Google Scholar
Li, Ling & Fu, Hongqiao. (2017). “China’s Health Care System Reform: Progress and Prospects.” The International Journal of Health Planning and Management, 32(3): 240–53.CrossRefGoogle ScholarPubMed
Liebman, B. L. (2013). “Malpractice Mobs: Medical Dispute Resolution in China.” Columbia Law Review, 113(1): 181–264.Google Scholar
Liu, Xingzhu & Hsiao, W.. (1995). “The Cost Escalation of Social Health Insurance Plans in China: Its Implication for Public Policy.” Social Science & Medicine, 41(8): 1095–101.CrossRefGoogle Scholar
Liu, Yuanli. (2002). “Reforming China’s Urban Health Insurance System.” Health Policy, 60(2): 133–50.CrossRefGoogle ScholarPubMed
Luhmann, N. (1982). Trust and Power: Two Works by Niklas Luhmann. Chichester, New York, Brisbane, Toronto: John Wiley & Sons.Google Scholar
Marsh, S. & Dibben, M.. (2005). “Trust, Untrust, Distrust and Mistrust: An Exploration of the Dark(er) Side.” In Hermann, P., Issarny, V. & Shui, S., eds., International Conference on Trust Management, 17–33. Berlin: Springer.Google Scholar
Nie, Jing-Bao. (2011). Medical Ethics in China: A Transcultural Interpretation. London: Routledge.Google Scholar
Nie, Jing-Bao et al. (2017a). “The Crisis of Patient-Physician Trust and Bioethics: Lessons and Inspirations from China.” Developing World Bioethics, 18(1): 56–64.CrossRefGoogle ScholarPubMed
Nie, Jing-Bao et al. (2017b). “The Vicious Circle of Patient-Physician Mistrust in China: Health Professionals’ Perspectives, Institutional Conflict of Interest, and Building Trust Through Medical Professionalism.” Developing World Bioethics, 18(1): 26–36.CrossRefGoogle Scholar
No author. (1981). “Yide Lunli Daode Xueshu Taolunhui Jiyao [Proceedings of the Colloquium on Medical Ethics].” in Medicine and Philosophy, ed., Yide Lunwen Ji [Collection of Essays on Medical Ethics], 6–9. Unpublished.Google Scholar
Qian, Xinzhong. (1981). “Yanjiu Yixue Lunlixue Tigao Yixue Daode Shuiping [Studying Medical Ethics Improving Medical Ethics].” Yixue yu Zhexue [Medicine and Philosophy], 1: 1–2.Google Scholar
Qiu, Renzong. (1987). Shengming Lunlixue [Bioethics]. Shanghai: Shanghai People’s Publishing House.Google Scholar
Qiu, Renzong, Xiaoqin, Zhuo & Jianmei, Feng. (1996). Bingren de Quanli [Patients’ Rights] (病人的权利). Beijing: Beijing Medical University and Peking Union Medical College.Google Scholar
Qiushi. (2021). “Heros of the Fight Against COVID-19,” http://en.qstheory.cn/2021–03/18/c_603662.htm (accessed 28 November 2023).Google Scholar
Ramesh, Mit, Wu, Xun & Jingwei He, Alex. (2014). “Health Governance and Healthcare Reforms in China.” Health Policy and Planning, 29(6): 663–72.CrossRefGoogle ScholarPubMed
Raposo, V. L. (2019). “Lost in ‘Culturation’: Medical Informed Consent in China (From a Western Perspective).” Medicine, Health Care and Philosophy, 22(1): 17–30.CrossRefGoogle Scholar
Raz, J. (1984). “On the Nature of Rights.” Mind, 93(370): 194–214.CrossRefGoogle Scholar
Rothman, D. J. (2003). Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making. New York: Walter de Gruyter.Google Scholar
Sun, Shuangyi et al. (2021). “COVID-19 and Healthcare System in China: Challenges and Progression for a Sustainable Future.” Globalization and Health, 17(1): 1–8.CrossRefGoogle Scholar
Supiot, A. (2017). Governance by Numbers: The Making of a Legal Model of Allegiance. Oxford, Portland, OR: Hart Publishing.Google Scholar
Tang, Lu & Guan, Mengfei. (2018). “Rise of Health Consumerism in China and Its Effects on Physicians’ Professional Identity and the Physician-Patient Relationship and Communication.” Health Communication, 33(5): 636–42.CrossRefGoogle Scholar
Veitch, K. (2019). “Obligation and the Changing Nature of Publicly Funded Healthcare.” Medical Law Review, 27(2): 267–94.CrossRefGoogle ScholarPubMed
Veitch, S. (2015). “Common Good No More? Some Jurisprudential Reflections on European (Dis)Integration.” In Ellsworth, J. & ven der Walt, J., eds., Constitutional Sovereignty and Social Solidarity in Europe, 139–64. Baden-Baden, Germany: Nomos/Bloomsbury.Google Scholar
Veitch, S. (2017). “The Sense of Obligation.” Jurisprudence, 8(3): 415–34.CrossRefGoogle Scholar
Veitch, S. (2021). Obligations: New Trajectories in Law. London, New York: Routledge.CrossRefGoogle Scholar
Wang, Mingxu, Le, Ma & Hui, Yuen. (2013). “Informed Consent in Chinese Medical Practice: The Whole Family as a Decision-maker.” International Journal of Chinese & Comparative Philosophy of Medicine, 11(2): 141–5.CrossRefGoogle Scholar
Wang, Shaoguang. (2008). “State Extractive Capacity, Policy Orientation, and Inequality in the Financing and Delivery of Healthcare in Urban China.” Social Sciences in China, 29(1): 66–87.CrossRefGoogle Scholar
Wang, Shaoguang. (2010). “China’s Double Movement in Health Care.” Socialist Register, 46: 240–61.Google Scholar
Wang, Shaoguang & Fan, Peng. (2013). Zhongguoshi Gongshixing Juece: “Kaimen” yu Mohe [The Chinese Model of Consensus Decision-making: A Case Study of Healthcare Reform]. Beijing: China Renmin University Press.Google Scholar
World Health Organization. (2021). “Universal Health Coverage and Health Reform in China,” https://www.who.int/china/health-topics/universal-health-coverage (accessed 28 November 2023).Google Scholar
Yan, Yunxiang. (2018). “The Ethics and Politics of Patient-Physician Mistrust in Contemporary China.” Developing World Bioethics, 18(1): 7–15.CrossRefGoogle ScholarPubMed
Zhan, Jifu (2014). Sanmingshi Gongli Yiyuan Zonghe Gaige [Comprehensive Reform of Public Hospitals in Sanming City]. Fuzhou: Fujian People’s Press.Google Scholar
Zhao, Xiju. (2008). Yishifa Yanjiu [Study on Medical Law]. Beijing: Law Press China.Google Scholar
Zhao, Xiju. (2013). The Duty of Medical Practitioners and CAM/TCM Practitioners to Inform Competent Adult Patients about Alternatives. Heidelberg: Springer.CrossRefGoogle Scholar
Zhu, Wei. (2009). Shengming Lunli zhong de Zhiqing Tongyi [Informed Consent in Bioethics]. Shanghai: Fudan University Press.Google Scholar
Zuo, Yilu. (2024). “Ideological and Cultural Policy as Speech Policy: An Overlooked Aspect of Speech Rights in China.” Asian Journal of Law and Society, forthcoming.CrossRefGoogle Scholar