Establish an Organ Donation Trust System Centered on the Public and the Families of the Donors / 中国医学伦理学

Public trust is the foundation for supporting the sustainable development of various social donation systems. However, the construction of trust system is continuous, long-term, and easily lost and difficult to defend. This study explored the multi-object and multi-dimensional trust demands of the public, donors and their families in interpersonal, system, social and supervision aspects. It was proposed that participating institutions and practitioners should take the multidimensional claims as an action-oriented, break the crisis of trust by building two major support systems centered on the public and donors’ families, and jointly safeguard the sustainable and high-quality development of organ donation.

"Brain death", autonomy, and the future of organ transplantation / Muerte cerebral, autonomía y el futuro del trasplante de órganos

Abstract: Autonomy and its companion, informed consent is regarded as fundamental in contemporary medical ethics. Still, the individuals are deprived of the possibility to make a genuinely informed choice with respect to organ donation in the event of "brain death". It can be easily argued, scientifically speaking, that the status of the "brain dead" patients is that of living beings, able to process nutrients and drugs and even to harbour and nourish their progeny into the womb. A philosophical, not scientific distinction between the "un-meaningful" lives of the "brain dead" and "meaningful" human life underlines the "brain death" concept. Yet, the public is told that the "brain dead" are dead, i. e. lacking life. Not only that this situation collides with the principle of autonomy, but it also poses a risk for public trust in organ transplantation. It is obvious that people have certain expectancies from health care professionals and the decision makers, and finding out about such inconsistences might drive the public reject organ transplantation, with the recourse to the "brain death" concept ultimately leading to the aggravation of the organ shortage, instead of the alleviation that it was expected to bring.

Resumen: La autonomía y su manifestación en el consentimiento informado es considerada fundamental en la ética médica contemporánea. Sin embargo, a los individuos se les priva de la posibilidad de realizar una elección informada genuina cuando se trata de donación de órganos en el caso de "muerte cerebral". Puede fácilmente argumentarse, científicamente hablando, que el estatuto de paciente con "muerte cerebral" es el de un ser vivo, capaz de procesar nutrientes y fármacos, incluso mantener y nutrir la progenie en el útero. El concepto de "muerte cerebral" está basado en una distinción filosófica, no científica, entre la vida "sin significado" del que tiene el "cerebro muerto" y la vida "con sentido". Sin embargo, a las personas se les dice que las personas con el "cerebro muerto" están muertas, carecen de vida. Esta situación no solamente colisiona con el principio de autonomía, sino que también supone un riesgo para la confianza pública en el trasplante de órganos. Es obvio que las personas tienen ciertas expectativas acerca de la toma de decisiones de los profesionales de la salud, y el conocer tales inconsistencias podría llevar a que las personas rechacen el trasplante de órganos con el recurso de "muerte cerebral", conduciendo a la agravación en el bajo suministro de órganos, en vez del alivio que se espera conseguir.

Changes in public trust in physicians: empirical evidence from China / 医学前沿

Studies examining the trends in public trust in physicians have provided a considerable amount of valuable policy implications for policymakers compared with cross-sectional studies on this topic in many countries. This study investigated changes in public trust in physicians in China based on two cross-sectional national surveys conducted in 2011 and 2016 and identified the determinants of these changes. The results indicated 83.4% of respondents in 2011 reported trust or strong trust in physicians in China, which decreased to 64.2% by 2016. The results of ordinal logistic regression demonstrated that public trust in physicians in China had decreased significantly from 2011 to 2016 (P< 0.001) after adjusting for other independent variables. Self-reported health status, self-rated happiness, and self-identified social class were all associated positively with public trust in physicians in China. The results also confirmed that decreasing public satisfaction with the most recent treatment experience was the major determinant of decreasing public trust in physicians in China. The findings of this study suggest that decreasing public trust in physicians deserves considerable attention from national policymakers and that improving satisfaction with treatment experiences would be the most effective strategy for enhancing public trust in physicians in China.

The effect of public trust in hospital on complaint behavior level / 中国卫生政策研究

The present study aims to explore the effect of public trust in hospital on complaint behavior in healthcare service, which could provide the foundation for the practice of public trust in hospital.A total of 331 participants who had complained about having a poor consultation experience in hospital were asked to answer the online questionnaire.The results show that: (1) public trust in hospital had a positive effect on both general complaint and third-party complaint, but its effect on third-party complaint was much higher;(2) public trust in hospital affected general complaint via consultation dissatisfaction, but it influenced third-party complaint via anticipated benefits of complaint;(3) public trust in hospital also influenced both the two types of complaint behavior via expectation gap of healthcare service and patients'' trust in doctors, but their mediation effects, especially the one of patients trust in doctors which was much smaller than that of patient dissatisfaction and anticipated benefits of complaint.The results indicated that complaint management is important for the practice of public trust in hospitals.On one hand, complaint management personnel and communication skills could enhance public trust in health care.On the other hand, legal action about complaint management could guarantee public trust in health care providers.

Medical ethics and self-regulation in Korean medical society

Consumption of medical services has been expanding since the health insurance system was established in the Republic of Korea. However, physicians do not seem to be satisfied with the current state of medical practice. One of the main reasons for this dissatisfaction seems to be related to underpayment of costs. The monopolistic insurance agency has kept reimbursements for appropriate medical services below cost. The public also seems to have less trust in doctors than in the past because of repeated scandales in the news media such as doctors' accepting inappropriate rebates from the pharmaceutical industry. Patients are vulnerable to illness and depend on their doctors' decision making and advising. Plus family members and taxpayers must share in caring and the financial burden that patients face. Therefore, society has high ethical standards for physicians. The medical society also has been responding to these practices. To meet society's expectations, doctors should not abandon self-regulation through the medical society. Furthermore, because the identity of a professional healthcare provider is based on the trust and endorsement of society, physicians should attempt to maintain appropriate care for patients' best interests. The public should support physicians' appropriate medical practice via reasonable reimbursement of medical costs. Through self-support and self-regulation to maintain appropriate medical practice for patients, physicians can enhance public trust. In turn, public trust in doctors will address this country's distorted medical services and restore the eroded reputation of physicians as healthcare professionals.

Maintain academic independence and justice to remodel the public trust in academia / 中华医学科研管理杂志

Acadamy is the basis of discipline construction,and the public trust is the life of academy.However,the decline of public trust has become prominent in our science field.This paper is aimed at revealing the potential factors for the decline,and to propose measures to counteract them,so as to to remodel the public trust in academia.