Rebuilding patient-physician trust in China, developing a trust-oriented bioethics.

In a short period of nearly four decades, China, with one fifth of the world’s population, has rapidly evolved from a predominantly agricultural, poor and developing country to an upper middleincome country. At the same time, China faces numerous daunting social challenges. One of them is the widespread, profound, and advancing crisis of patient–physician trust. Among the many manifestations of this crisis is an unprecedented process characterized by rapidly increasing levels of violence involved in disputes between patients and their relatives against medical professionals and institutions. Like many other challenges that China faces, this crisis of trust in the health sector is by no means merely a Chinese problem. There is much convincing evidence that it is a global issue, emerging in developing and developed societies alike, although the scale and depth of such a crisis may vary considerably from one place to another. More generally, a serious crisis of trust can be observed across geographic areas and societal sectors. It affects all professions, businesses, the media, governments, and international affairs. Though its significance often goes unrecognized, trust plays a vital role for interpersonal and social life as well as healthcare. In the field of bioethics, however, attention paid thus far to the question of trust in general, and to patient–physician trust in China in particular, is far from sufficient in spite of some pioneering studies.1 Such deficits in bioethical scholarship is in marked contrast to the fields of social and political sciences, where trust has been a key subject for the past few decades, with a large and growing literature. Due to its essential role for good social life and good healthcare, trust deserves a place in the central agenda of bioethics in China and globally. According to Confucianism—one major cultural framework of morality in the Chinese tradition—an essential device for thinking about and discussing ethical and political matters is “rectifying names”. Names are not merely words, but are always morally laden and practically pertinent. For this thematic issue in particular, we must first clarify the usage of a key term. The phrase “yihuan guanxi”, “physician–patient relationship” or “doctor–patient relationship”, has been conventionally employed in academic literature, the mass media, and everyday discourse in both Chinese and English. In this issue, however, we choose to use the term “huanyi guanxi”, “patient–physician relationship” or “patient–doctor relationship”, to underscore that health care should be patientcentred and that the ultimate moral end of medicine is to serve patients and improve their health and welfare. In this relationship, patients’ relatives and other medical professionals like nurses and health officials are included on the patient and physician sides, respectively. The topic—patient–physician trust and mistrust—is rife with conflicting personal experiences, competing institutional norms, various sociopolitical forces, and different local life worlds in scope. This complex set of elements calls for research that employs methods and conceptual frameworks drawn from a range of academic disciplines including the social sciences and bioethics. This thematic issue presents papers by an international team of anthropologists, sociologists, sinologists, physicians, philosophers and bioethicists from China (including Hong Kong), the United States and New Zealand. Methodologically, the various contributions integrate systematic and indepth empirical investigation with normative bioethical inquiries. Based on highly original and collaborative interdisciplinary research, they altogether aim to achieve the following twin overall aims, one focusing upon China and the other upon bioethics: