A Research On The Medical Ethics Development In Ming And Qing Dynasties (1368-1840)

With a systematic scrutiny and reorganization of the governmental and physicians' medical ethics, the thesis investigates the medical ethics development in Ming and Qing Dynasties (1368 - 1840). The purposes are as follows: First, fully master the traditional medical ethics materials through exploring and sorting out the cognitive and practical data of the medical ethics the governments and Physicians' had in Ming and Qing Dynasties. Second, disclose the major standardization and development of medical ethics in Ming and Qing Dynasties, finding out its progress and limitations. Third, summarize the general development law of medical ethics in Ming and Qing Dynasties and its significance to today' medical ethics development.With the above statement as its basis, we adopt appropriate research approaches and orientations. There are two general research models in history study: one is comprehensive history research model, the other is dynastic history research model. The thesis belongs to the latter. Based on the sketch of the development of the Chinese medical ethics before Ming and Qing Dynasties, the thesis continues with the research on medical ethics in Ming and Qing Dynasties (1386 - 1840). During the process of writing, two research approaches are adopted. One is document analysis approach. It includes consulting Ming and Qing Emperors Live Record, Ming and Qing physicians' works, and relevant Ming and Qing governmental and physicians' research materials both manually and with the help of computer. Thus materials of governmental medical ethics and physicians' medical ethics are respectively obtained. The other is document synthesis approach. It induces, analyzes the collected data, synthesizes and draws out the governmental and physicians' medical ethics standards and characteristics in different periods, and sums up the Ming and Qing medical ethics characteristics and developmental laws.The thesis comprises four parts. First, briefly introduce the development of medical ethics before Ming and Qing Dynasties. Second, explore the conditions of medical ethics development in Ming Dynasty. Third, conduct a study on the development of medical ethics from Qing Dynasty to First Opium War. Last part isthe conclusion.The main idea of the first part is that Yin and Zhou Dynasties to the Spring and Autumn Period is the induction of the Chinese traditional medical ethics. Yin and Zhou set up the official witch physician post which is closely related with witchcraft and theology, and the witch physicians' medical ethics was confused by theology. Owing to the fact that in Zhou Dynasty the division of physicians and witches appeared and that the governors then respected the value of individuals, medicine and medical ethics acquired great progress. The Period of Warring States is the formation of medical ethics. During the first period, the contending of many schools, the continuous warfare and all kinds of plague engendered the improvement of medical theory. During the last period, the nation got united and Confucianism established its position in Chinese Culture. The Qin and Han Dynasties attached great importance to medical ethics, with the setting up of medical health system and the continuous improvement of the Chinese traditional medicine theories that are formed with the successive appearances of many medicine classics such as the Internal Canon of Medicine of Yellow Emperor 《黄帝内经》, Sheng Nong' s Herbal Classic《神农本草经》, Treatise on Fevers《伤寒杂病论》. The Chinese medical ethics theory came into being with the systematization of the Chinese medical ethics in these three works. The Chinese medical ethics came into mature from Wei and Jin Dynasties to Tang and Song Dynasties. During the periods of Wei, jin, and Southern and Northern Dynasties, although the nation was trapped in warfare, Buddhism and Taoism blending into Confucianism became metaphysics, the Chinese traditional medicine and medical ethics were developing upwards. Tang and Song Dynasties grew into the highest point among our Feudal societies with the unity of the whole nation, the flourishing of economy and the prosperity of culture as the main characteristics. With the successive screening and adjustment since Qin and Han Dynasties, the national political and ideological systems became stable, and Confucianism became the dominant social ideology with the perfection of Confucianism by many Confucianism learners. In terms of governmental medical ethics, the government medical health systems were of variety and systematized. It was generally acknowledged to develop medicine, lift medicine level and establish law to protect folk medicine and health interests of civilians. The royal government stressed compilingmedical books, setting up various charitable institutions. In terms of the physicians' medical ethics, that life is sacred and physicians should heal the wounded and rescue the dying were the principles of medical ethics which physicians were willing to obey. Physicians with Confucianism became the principal parts. They wrote medical works based on Confucianism, standardizing medical ethics and acquiring a profound understanding about the relationship between medicine and medical ethics. In either the first volume or the preface or the postscript, there are expositions about the relationship between medicine and medical ethics. Medical ethics education and medical ethics remarks came into being and many physicians with excellent medical ethics appeared who had far-reaching influence on the later generations.In the second part, the social development of Ming Dynasty is briefly introduced. Politically Ming Dynasty carried out the power-centered system, abolishing the position of prime minister, regulating the power construction and ending in the emperor' s mastery of all state powers. Economically Ming Dynasty underwent two ups and downs. The economy gradually went up from Hongwu 1st of the forefather of Ming Dynasty to Zhengtong 14th of the emperor Yingzong and the economy went down step by step from Zhengtong 14th of the emperor Yingzong to the end of Zhengde. Ideologically there were two striking aspects in Ming Dynasty. One was the enlightenment and induction of the modern scientific ideology. The appearance of the capitalistic economic elements, the introduction of foreign science and the prevalence of pragmatism caused science to revive from silence. The other was Li School experienced three changes from the "Zhu' theory-centered" period at the beginning, Wang Shouren' s heart-centered theory in the middle and the revival of the pragmatism in the later period. It continued with a study of the governmental medicine, health ethics and policies in the Ming Dynasty. Ming Dynasty founded South and North Imperial Hospitals, Imperial Clinic for the emperors, Security Hall (安乐堂) in the imperial harem, Drug Institutions (典药 局)for crown princes, Excellent Clinics for the military governors with the control and management of the Imperial Hospitals and fully guaranteed the medical interests of the royal families. Ming Dynasty valued military, social medical and health pension, established comparatively perfect medical pension institutions and systems. The Ming emperors thoughthighly of the protection and prevention of plagues and called for burying huge rotten bones, distributing drugs, decreasing taxes and giving out relief foods. The Ming emperor Shizong made a kind of drug called "Little Drink" to prevent plague. Many emperors in Ming Dynasty took a negative attitude towards supernatural beings and witchcrafts and forbade its application. They cracked down on superstitious activities and held a memorial ceremony for the dead doctors and standardized the medical activities on the basis of law. While it paid attention to the development of the imperial medicine, Ming Dynasty cared about the application of medicine to the society and implemented the system in which an official post of a physician could be handed down from one generation to another and local medicine. The inheriting system of physicians is good for the stability of doctor force and the passing down of the traditional medical ethics. Local medicine is favorable for the enlargement of doctor force and the standardization of the local medical activities. The thesis also pointed out the other aspect of the governmental medical ethics of Ming Dynasty. For example, the royal government of Ming Dynasty opposed witchcraft and making pills of immortality, but it didn' t form into a system or ancestral teachings and both Xuanzong and Yingzong had the hobby of advocating Taoism and taking immortality pills, with Yingzong' s poisonous death from taking too much. The Ming government was strict with the selection of medical students by examination, however, there existed a system in which the positions of medical officials could be bought by offering extra taxes, consequently there were incompetent physicians in the physicians' force. The last part studies the physicians' medical ethics in Ming Dynasty. Most physicians refused superstition, witchcraft and the so-called fortune-telling theory. They had faith that "Medicine valued specialization" , "Disease treatment aimed at getting at the root" , and they conducted treatment according to certain procedures. They formed materialist dialectics: it was the medicine theory that was unchangeable and it was its application that was changeable. " The physicians' understanding about physicians' responsibilities was reflected in two aspects: One was to heal the wounded and rescue the dying, thus lengthened the life. They regarded curing diseases without any conditions as their major task, putting forward the following views such as extending the same treatment to all, going all out to rescue the sick; helping the poor andsave the sick without any reward; taking serious, responsible and careful attitude. The other was making a research on the medicine theory. Physicians in Ming Dynasty proposed the spirit of being proficient and diligent without tiredness, enlarging their scope of professional knowledge to the origin of medicine and the spirit of persisting in science and seeking for truth. Physicians in Ming Dynasty attached importance to the study of the relationship between medicine and medical ethics. They at length expounded their responsibilities for the sick, the normal and abnormal relationships between physician and patient and other special relationships between physician and patient. They were also quite objective in relating the relationships between their colleagues. ? Physicians in Ming Dynasty doubted about the dutiful medical ethics and criticized the medical ethics of only paying attention to physicians' responsibility and duty and ignoring the patients' responsibility and duty. Experts in medicine in Ming Dynasty had a high requirement about physician' s self-cultivation. They thought that they should meet three requirements. One was they should be high in medical skills, the other was they should be high in medical morality, and another was they should be highly qualified. Most of these requirements deviated from the practical needs, appearing dull and stiff which did no good to medical activities. For instance, Physicians should try to go once they were invited by the officials and they shouldn' t talk about the conditions of the civilians. As for how to advance the improvement of medical ethics, physicians then raised that they should put theory into practice. In terms of the content, they thought that the first was the Confucian classics, the second was medicine classics, and the last was the knowledge concerning medicine. So far as the requirements about medical practice is concerned, they advocated physicians should take part in clinical practice as much as possible and begin their life career from the basic point, meanwhile, they emphasized the persistence in self-comprehension, self-discipline and prudent independence during the process of practice, and took the saying "As a man sows, so let him reap. " as their last persuasion to the training of physicians. Physicians in Ming dynasty had two prominent characteristics in their medical ethics practices. One is they should persist in innovation, adjusting to the development and tendency of society and medicine. For example, Han Feixia and Wang Kunestablished a new-style case, Chen Shigong created the new surgical operation theory. The other is insisting on dialectics, paying attention to systematization. For instance, Xu Chunfu' s " Tirenyihui " regulations of normalization, advocating regarding both medical skills and medical ethics as equally important, combining learning with application, upholding inheriting and innovating at the same time. Physicians of Ming Dynasty had many kinds of medical ethics evaluations. However, owing to the influence of Confucianism, most physicians thought highly of the governmental evaluation, thought highly of the honor given by government, consequently such a phenomenon appeared that the medical post could be bought by money. In terms of the evaluating content, Ming Dynasty adopted the combination of typical evaluation with comprehensive evaluation. The former conducted an evaluation on a specific person' s medical ethics and made a real and operational impression on people. The latter provided people with specific medical ethics images. The evaluation on the physicians in Ming Dynasty was characterized by the combination of various evaluations with different content-oriented evaluations.The third part explores the medical ethics development in Qing Dynasty from two aspects. Before the study, the thesis briefly sums up the social conditions from the beginning of Qing Dynasty to the Opium War. Generally speaking, politically centralization of state powers reached its highest point and subsequently choked the atmosphere in which they are subjectively yearning for development. Its economy experienced a process of recovery, development, prosperity and decline with a comparatively prosperous economy and stable economic order as its noticeable characteristics. Under the highly centralization of state powers, its conservative and stiff ideology and culture made many potential innovations under new circumstances strangled. To begin with, it studies the governmental medical ethics and policies of the earlier stage of Qing Dynasty. During this period, the Qing government incessantly reformed the royal medical administrative structure, abolishing the cumbersome royal medical institutions in Ming Dynasty, strengthening the governmental medical health functions. The Qing government actively developed Smallpox Department, set up Smallpox Department in the Imperial Hospitals, granted award to physicians who acquired the skill of smallpox vaccination andvaccinated children against smallpox. It supported the introduction of this technique to foreign countries. The Qing government attached great importance to the protection of racial medicinal materials and made laws to protect Manchu Changbai Mountain medicine base which is rich in wild ginseng. It also paid attention to the old people' s health and held many activities to care about the old people' s health. It put compiling medical books into an significant place. The first emperors of Qing stressed medicine, strongly opposed heresy, medical divination. The thesis studies the other side of its medical ethics. For instance, the Qing government was active in organizing people to compile medical books, however, they refused to take those medical works into account whose authors had racial thought, thus objectively lost its authority. And the royal medical education was very limited and the local medical education is inconsistent with its name. Then it studies the physicians' medical ethics in the earlier stage of Qing Dynasty. Physicians in Qing Dynasty explored medicine from different angles such as Ming (意), Art (艺), Change (易), Theory (理), Approach (法), Recipe (方), Drug (药), presenting people with rich content. There were four professional responsibilities to Qing physicians. The first was going all out to heal the wounded and rescue the dying in the same way as treating oneself without thinking about reward; The second was studying medicine theory, seeking for the law of life science, enlarging their scope of professional knowledge to the origin of medicine and trying to find the truth; The third was writing medicine books, familiarizing civilians with general medicine knowledge and raising their qualities. The fourth was praising the good and punishing the evil, optimizing the developing environment of education. Physicians in Qing Dynasty didn' t explore the relationship between medicine and medical ethics as extensive and dogmatic as those in Ming Dynasty. They tended to master it from a deeper and higher point of view. The so-called depth referred to that they were inclined to grasp the nature of it . For example, Yuchang perceived "Being loyal to feelings" as the central principle of medical ethics. The so-called height referred to physicians in Qing Dynasty considered their attitude towards the poor as one aspect to judge their medical ethics. They turned attention to the relationship between doctor-society, caring about medical development and the rise and fall of nationality. They not only emphasized respecting colleagues butalso highlighted learning from each other to acquire mutual development in view of the relationship between colleagues. In terms of the relationship between doctors and patients, they thought both sides should take their respective responsibilities and investigated the patient' s responsibilities, stressing mutual understanding and cooperation. In addition, facing the ever-prospering capitalistic economy, they realized the significance of the interest of doctor-patient relationship, asking for reasonable interests. The most striking point was some physicians doubted about the traditional "life-centered" theory, "duty-centered" theory, stressing that when treating a patient, if the patient was poor, more attention should be paid to; if the patient was rich, self-esteem shouldn' t be lost; if the patient was a Huren, treatment should be refused. They stressed both skills and morality in terms of the level of medical ethics self-cultivation; in terms of the realm of medical ethics, spirit state was highlighted, this description was somewhat idealistic though. In terms of the channel of medical ethics, they took reading, clinical practice, prudent independence and writing books as organically related. But they still didn' t get rid of the restraint of conscience and ghosts. There were many aspects worth learning in medical ethics practice: 1.Emphasizing practical results. 2. Emphasizing creativity. 3. Emphasizing society. 4. Emphasizing standardization. 5. Emphasizing self-cultivation 6. Emphasizing science. There also existed backward aspects. For instance, in academic practice many physicians preferred to write books only to be memorized by later generations, especially some liked to be different from others and liked to repeat popular things when they explained classics. They had more kinds of evaluation forms than those in Ming Dynasty. Most physicians then ignored being officially employed and what' s more, they refused to be hired officially by concealing their names. Even if they were invited to treat the emperor, they were unwilling to be an official. In various forms of medical ethics evaluations, Medical note and local chronicles played a key role in them. As for the evaluation content of medical ethics, they stressed the category analysis of medical ethics, and their combination with practice. Besides, they also stressed the inculpation principle, thus leading medical ethics evaluation to develop toward operation and profession.The last part is the conclusion which comprises four aspects. The first part sums up...