Healthcare Systems and Medical Ethics in East Asia

Title: 1366 | Healthcare Systems and Medical Ethics in East Asia
Area: Northeast Asia
Stream: Anthropology
Presentation Type: Panel Presentation
Xisai Song, Cornell University, United States (organizer, chair, presenter)
Seonsam Na, Oxford University, United Kingdom (presenter)
Azumi Tsuge, Meiji Gakuin University, Japan (presenter)
Yi-Cheng Wu, Durham University, United Kingdom (presenter)
Xiaoling Chen, University of Colorado Boulder, United States (presenter)
Kwanwook Kim, Seoul National University, South Korea (discussant)


Social science scholars have long challenged the assumptions that regard biomedicine as an objective system of medical science with well-defined epistemology, ethical principles, and evaluative mechanisms. Instead, biomedicine—a seemingly universal medical system—is deeply shaped by local realities as it is practiced across the globe. How biomedicine, referred as “western medicine” in East Asia, becomes embedded in different East Asian contexts carries respective history trajectories, political agendas, and moral values. Bringing together five presenters of diverse intellectual and geographic backgrounds, this cross-disciplinary panel addresses how biomedicine is contextualized in different parts of East Asia, including China, Japan, Korea, and Taiwan. We historicize healthcare systems and unpack how healthcare systems influence the ethical formulation and clinical decision-making for doctors and patients in different East Asian contexts. Specifically, Na’s paper interrogates the dynamic relationships between the healthcare system, state-building, and social changes in Korea. Chen and Song’s articles adopt different opinions and approach to tackle the transformation of the healthcare landscape in China. Wu’s work addresses the ethical implications produced by the uneasy intertwinement of alcoholism and colonial politics in Taiwan. Tsuge’s study examines the ethical conundrums around a new but controversial prenatal test in Japan.

Panel Abstracts:
A County Public Hospital and the Social Transformation in China
China's healthcare system is widely considered as being problematic, a striking symptom of which is the frequent incidents of violent attacks against Chinese doctors. It is commonly assumed that the public healthcare system got marketized after China’s 1978 economic reform, and “marketization” is often mobilized to explain the widespread public criticism over today’s healthcare system in China. My research assembles the micro-history of one public county hospital in southwest China from the 1960s, based on oral history accounts I collected from five generations of health professionals, archival studies, and ethnographic studies in the clinical space of the county hospital. My research complicates the all-encompassing idea of “marketization.” Through tracing the history of one hospital, I untangle the social and historical processes through which the market logic emerges and in what forms. Further, I situate the shifting healthcare landscape in China within the transnational transformation of the biomedical paradigm. I unravel how transnational trends in biomedicine, including technological orientation, specialization, evidence-based medicine, and standardization, are articulated, embedded, and contested in everyday medical practices. I treat the healthcare system in China as a historically specific cultural system and demonstrate the moral and political order that underlies biomedicine in China. I argue that attributing the marketization of medicine to the1978 economic reform oversimplified the changes in China’s healthcare system. Rather, an inherent capitalist logic has been interwoven into today’s biomedicine, while “marketization” takes on a specific cultural form in China, shaped by the moral and political order of China’s healthcare landscape.

Doctors in Rebellion: The State, Medical Politics and Social Change in Contemporary South Korea
As 19th century Euro-American experiences testified, public health measures have been important in nation-building. The medical profession therefore has collaborated with the state. In East Asia, however, unlike in the west where long periods of haggling between the profession and the state had existed, the system of biomedicine-based governance was implanted without corresponding history. As an essential ingredient of state-making, it was imposed top-down as a legal institution, rendering the state-doctor relationship thus formed both absolute and fragile, being absolute in that the law is the prime guardian of doctors’ status and being fragile as their rights were not earned. As social class, therefore, medical profession occupies interesting space in which despite their clear dependence on the state, they are poised to struggle both to resist the overbearing state and to appeal to the public as their base to challenge state authorities. For the doctors in South Korea this paper investigates, this historical contingency becomes more salient as they practice traditional medicine; they are mainstream doctors who are not wholly biomedical. Staging additional, epistemic battle, they occupy even more unstable space than their biomedical counterparts. With these insights in mind, this paper looks at conflicts that occurred among these doctors in relation to a set of governmental initiatives, and aims to explore the nature of medical governance, and of stakeholder relationship in general, in society that faces increasing demands on democratic representation and welfare provision. In doing so, it also seeks to identity factors driving changes in contemporary Korean society.

Do Not Choose Prenatal Tests in Order to Avoid Situations That You Must Choose
Japan has been discussing the implementation of the guideline of NIPT (Non-Invasive Prenatal Genetic Testing) after practicing along with the present guideline established by the Japan Society of Obstetrician and Gynecology (JSOG), the Japanese Association of Medical Sciences (JAMS) and others. The present guideline allows only medical institutions that are certified by JAMS to conduct NIPT. However, not a few clinics have started to offer NIPT without certification and without genetic counseling system for economic gains. It causes debate about the present guideline of NIPT. Ministry of Health and Welfare and Labor has begun to exam what kind of new system is adequate for Japanese Society. According to NIPT consortium Japan, there were 65,265 cases of NIPT between April 2013 and September 2018 in Japan with a gradual increase per annum, even though it is still only one to two percent of annual births. It is in such an environment that women and/or couples eligible to decide whether to have the tests and what to do when the results come out. The issue is particularly pressing for women of advanced maternal age that is now the most common medical indicator. It is thought that the termination of pregnancy by the result of prenatal diagnosis inherently involves ethical questions of “what kind of life is worth living and who is entitled to decide,” which in turn reflects what choices are considered legitimate in Japanese society. Then, we discuss how Japanese women consider “women’s choice on prenatal testing.”

Ethical Reflection on the Health Narratives of Indigenous People’s Drinking Practices in Taiwan
Given the stigmatization of Taiwanese indigenous people to be alcoholic, this paper aims to open up the meaning of indigenous people’s drinking practices and bring ethical reflections on health narratives by rethinking the relation between drinking and the colonial situation of indigenous people in contemporary Taiwan. In recent years, transitional justice for indigenous people has become a prominent issue in Taiwan. The notion of transitional justice that provides reparations or compensation for the deprivation of indigenous rights has brought up the need to rethinking health narratives and medical interventions on indigenous people’s drinking practices, which represent the symbolic violence of colonial power. Based on the 12 months of multi-sited research, this study finds that indigenous drinking practices have been both generated and reshaped by their life situations, both historically and contemporarily. Drinking becomes a ‘passage to rights’ that represents the struggle of indigenous people in search of traditional values that have been abandoned under colonial power and the rights that they are deprived of today. Health narratives based on individualized pathologizing drinking as a mental health ‘problem and medical interventions that represent the colonial body governance may reinforce stigmatization and results in further marginalization.

Evaluating the Local Effects of China’s Health Care Reform: An Ethnographic Study in Huizhou City, Guangdong Province, China
The last fifteen years have witnessed the State initiated several rounds of health care reforms that oscillated between pro-government and pro-market approaches. The former elicits substantial funding to improve health care services and health coverage, while the latter promotes marketization of the health sector and rolls back funding, coupled with policies that emphasize individual responsibility. How have these uncertain and contradictory policies affected the health-seeking practices and navigation of the health care system among Chinese health-seekers? This research proposes a bottom-up ethnographic approach that highlights a more extensive and in-depth assessment of State health reforms in Huizhou city of Guangdong Province, China. It adopts multi-scalar research with a suite of methods to enrich and triangulate the data, including semi-structured interviews, participant observation, and focus group interviews, with health-seekers. My paper uses the lens of “analytics of government” (Dean 2010) to investigate the rational activity undertaken by various actors, emphasizing not only the deliberate calculations were undertaken to shape conduct toward particular norms but also the necessarily implied judgment and evaluation of such conduct according to those same norms. In doing so, this paper identifies the ways and processes in which multifaceted factors intersect to affect Chinese citizens’ health-seeking practices, and thus the gap between the demands for health and claimed effects of the reforms

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