Wish tree at the International AIDS Conference in Vienna
By Mike Frick
Last week, China’s Ministry of Health released a draft “Code of Conduct for Medical Practitioners” for public review and comment. The document lays out a code of conduct for hospital administrators, doctors, nurses and other medical personnel. According to the ILO, many Chinese hospitals refuse to treat patients with HIV/AIDS – so there is definitely a need for new policies. We reviewed the draft code within Asia Catalyst and found some areas of progress, as well as some areas where the standards need a lot more work.
Combatting corruption: One piece of good news: the Code of Conduct addresses the need to reduce corruption. Article 8, for example, prohibits physicians from accepting gifts from patients or their relatives – a widespread practice in Chinese hospitals that places a heavy burden on families in need. Article 8 also calls on physicians to refuse free medications, medical equipment and recreational activities offered by medical sales companies, gifts that distort physician incentives and lead them to recommend more expensive care.
Improving informed consent: Many of the grassroots groups we work with tell us that there’s an urgent need to
ensure that patients have informed consent in Chinese hospitals, and we were encouraged to see informed consent – a basic tenet of medical ethics – appear throughout the Code of Conduct. Article 6 calls on all medical practitioners to respect informed consent and patient privacy. Article 25 asks doctors to fully educate patients and their relatives about new medical technologies and to respect patient decision-making about their use.
These are positive steps; they’d be even more positive if there were clearer mechanisms in the code of conduct to ensure accountability when hospital workers violate the code. So much for the good news – here are some of the weak points.
Universal precautions: The Code of Conduct does not mention universal precautions (sometimes called standard precautions), an essential policy when combatting medical discrimination against patients living with HIV/AIDS and other blood-borne illnesses. What are universal precautions? Basically, these include wearing medical gloves, goggles and face shields when handling all patient’s bodily fluids – and not just with some patients that health care workers suspect might be living with HIV.
Because they are used with all patients equally, universal precautions help to reduce the stigma and discrimination associated with fear of occupational exposure to the AIDS virus. As a report published by Asia Catalyst and Phoenix, a Chinese HIV/AIDS group, documented, this fear of occupational infection is a significant barrier to healthcare access among people living with HIV/AIDS in China, who are routinely turned away from hospitals – or in some cases, required to pay for all of the medical equipment used during their care.
Non-discrimination: Since we work with sex workers, drug users, LGBTQ people, and others at risk of discrimination, I was really disappointed by the Code of Conduct’s poor attention to medical discrimination against patients in hospitals. Only one article addresses it: Article 6 calls for non-discrimination in medical settings on the basis of race, religion, origin, social status, disability and illness — but omits age, sex and sexual orientation. Age, gender and sexual orientation not only influence individual risk for morbidity and mortality; they are often themselves the basis for medical discrimination. Leaving out these essential categories means leaving young people, older people, women and LGBTQ people without protection they need.
The “Code of Conduct for Medical Practitioners” arrives at an important moment in China’s AIDS epidemic. Chinese health care professionals will encounter growing numbers of HIV-positive patients in the coming decade as the government expands free testing and treatment programs. Establishing clear standards for informed consent, reducing corruption and educating health professional on universal precautions and non-discrimination will help to ensure access to equitable, ethical and affordable care for people living with HIV/AIDS and other patients who need help from China’s medical system.
Mike Frick is China program officer at Asia Catalyst.
