Ethical Reflection On Family Physician Contract Service

Family Physician Contract(FPC)policy is a significant reform to establish a tiered system of medical care and promote the construction of Healthy China.However,in the process of implementing the FPC policy,there are many limitations in terms of concepts,management and ethics,especially in solving the following two key questions that have not been fully considered:why to carry out the FPC policy and how to carry out FPC policy ethically?This paper aims to analyze the concepts related to contract service,identify the basic ethical principles that should be followed in the contract service,based on the framework of ethical analysis constructed to answer the problems in the contract service,such as the division of health responsibility,respect for residents' autonomy,and family privacy protection,and put forward corresponding ethical suggestions.In order to achieve the above research objectives,this paper adopts literature analysis,empirical research method and logical analysis method.Our study summarizes the basic ethical principles to be followed in the contract service:benefit,fairness,respect and responsibility,and then forms the framework of ethical analysis.The basic points of this paper are as follows:1)in terms of health responsibility,individuals,families,family physician teams and the government should share the health responsibility;2)in the definition of health responsibility,conditions such as autonomy,voluntariness,availability of alternative options and level of information should be met;3)considering current residents' willingness to sign contracts and other restrictive factors,the ethical defense can be obtained by respecting residents'autonomous choice of primary care;4)in the contract service,privacy protection should be studied with the family as the unit,and the family doctor team should balance the impact of patient confidentiality and door-to-door service on the family.Finally,this paper proposes that the family doctor team should follow six ethical principles:1)establish the service concept of taking contracted residents' health as the center;2)guarantee the informed choice of the contracted residents;3)achieve procedural justice and information disclosure in the process of contract signing;4)support the participation of individuals and families in medical decisions.5)balance information disclosure and privacy protection to promote the health of residents and their families;6)pay attention to the special health needs of different groups,particularly vulnerable groups.This paper suggests that the government should lead the establishment of the decision-making mechanism for residents to participate in the policy improvement of contract service,and explore the strategies for individual-family-community health promotion.