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Sun Simiao Medical Ethicist Tang Dynasty

What is ethics? Ethics is a system of moral principles that govern behaviour or how people conduct an activity. Applied ethics can encompass what is right and wrong, the balancing of people’s responsibilities and rights. Ethics supports analysis and problem-solving abilities and can offer guidance on how to live a better, good and more enriching life.

We have Aristotle, Plato, Kant, Solomon, Peterson and Seligman and I’d like to highlight that we also have Laozi a Daoist philosopher, and Sūn Sīmiǎo a “medical ethicist.”

Sūn Sīmiǎo from the Tang Dynasty (618-907 A.D.) was motivated and dedicated to make a change to the care of patients and practise of medicine. Responsive to ethical dilemma, Sūn created one of the world’s most scholarly revolutionary integrational frameworks that can today support contemporary medical healthcare in principle, practise and leadership.

Read Lianne Aquilina’s book review on Healing Virtue-Power: Medical Ethics for Journal of Chinese Medicine below.

Healing Virtue-Power: Medical Ethics and the Doctor’s Dao

n Sīmiǎo and Sabine Wilms PhD

What insight can Sabine Wilms provide to Chinese medicine practitioners through her superlative translation of, and reflections on, the work of Sūn Sīmiǎo in Healing Virtue-Power: Medical Ethics and the Doctor’s Dao? Can this insight affect how we situate ourselves in the tradition of practice, and help us to carve out a positive forward path? I see this material as contributing to the spheres of health and social sciences, and as a historical seminal work on ‘transformational leadership’. It is wisdom and vision shared for positive change through the communication of values and profound principles, along with a balance of applied Taoist, Buddhist and Confucian philosophy.

In this text Sūn Sīmiǎo conveys the importance of integrity, a sense of purpose and authentic action. He sets the foundation to navigate change and survive an environment he believed to be fraught with risk. He states he provides ‘great detail’ on the matter of resolve. n Sīmiǎo understood the capacity of Chinese medicine to treat illness and alleviate suffering – yet the competency of doctors needed to be more sophisticated and virtue ethics applied (p.129). Sabine explains that Sūn Sīmiǎo is thought to have initiated the concept of the ‘scholar physician’, rather than establish it; it took centuries for his vision and advice to filter into practice (p.35). Sūn Sīmiǎo addresses professional practice and the sincerity of great doctors, aiming to motivate colleagues with inspirational and caring advice on best conduct (‘If you can be like this, you can serve as a great doctor to the masses’) and advises doctors to open their hearts deeply to patients’ suffering and misery. He sets out to prompt effective behavioural change, aware of likely resistance, by evoking a sense of guilt and duty (‘… otherwise you are a horrid thief to all sentient beings.’) (95).

 Sūn Sīmiǎo’s work demonstrates that there was a need to improve how Chinese medicine was practised in his day. He displays virtues such as wisdom, justice, courage, compassion and transcendence in pursuit of excellence and to help communities to grow and flourish. It is clear to me as a practitioner that his scripts are a display of interpersonal insight and wisdom gained through observation and self-reflection, drawn from interaction with patients and colleagues. This book offers social intelligence. We know that if we are not due-diligent with our work it will negatively impact treatment; Sūn advises ‘…acquaint yourself intimately with each case so there can be no doubt’ (p.113); success is ‘…characterised by the utmost in both skill and beauty’ (p.65). Sūn monitored and moderated his feelings when treating his patients; for example, he writes that he would ‘not allow myself even a single thought of resentment, this is my resolve’ (p.111). We are advised by Sūn to study a range of literature to become knowledgeable, and to apply and refine our theoretical, clinical and critical thinking skills (pp.41, 51, 57, 73, 79, 85). Other key advice includes staying composed (p.113), maintaining a calm clear shen when treating patients (p.93), exercising humility (p.121), being kind and empathetic (p.95), treating patients fairly (p.93) and protecting patients’ and colleagues’ dignity (p.111, 129).

Sūn expresses that wisdom occurs through processes that transcend our physical body and that Chinese medicine is a spiritual practice. We should be intentionally, actively virtuous and remember that we are rewarded in spiritual ways (p.123). Professional practice of the great doctor and sublime sincerity of the great doctor are what is most enriching. These messages are still relevant to how we operate today as practitioners, particularly in the upholding of professional standards.

Why did it take centuries for Sūn Sīmiǎo’s vision to become established? Sabine notes that change occurred when social circumstances were right (p.35). Learning more about this could inform future strategy as we continue to advance as a profession, overturn resistance to our paradigm and finalise matters of professional recognition. We have some information regarding factors that may have hindered Sūn’s vision. Sabine outlines that he was likely not recognised as a professional medical physician at the time, and a strong role model is required to implement change. It appears that Sūn’s beliefs and values were not widely shared. Sabine states that his colleagues were likely to have considered his advice as ‘revolutionary and impractical’ (p.97). To embed change, a number of conditions need to be met: people need shared values and beliefs, a shared vision and access to resources, training and feedback.

We can develop and apply virtuous ethics in contemporary medical practice to support vulnerable patients. An example where this is greatly needed is in the IVF sector, where the patient’s desire for a baby and the huge financial rewards for service providers can drive questionable behaviour and unethical treatment. Sincerity in professional practice can limit unnecessary chaos, hurt and stress that might otherwise be experienced by practitioners and patients leading to complaints or issues around compliance. Healing-virtue power and medical ethics comes from developing good habits just like Sūn Sīmiǎo – self and social awareness, compassion, self-control, honesty and fortitude to speak out. The overall objective of Sūn was to alleviate suffering and ill-health within the bigger picture of preservation, cultivation and nurturing life to bring about harmonisation and enlightenment.

 Sabine’s translation and discussion can help each one of us navigate our professional and interpersonal journey. It has helped me to remember to intentionally take care of the heart, both of myself and my colleagues, to try to pacify escalating emotion – particularly anger/hatred (p.161), and to resolve demoralisation as this creates sabotage. Several of the scenarios I have witnessed could have been prevented. How? First and foremost, by knowing that there are complex factors that lead to difficult situations in governance and people displace their feelings and become resentful. Resilience, persistence, kind-heartedness and compassion is required. We can also make a considerate judgement of what to and what not to engage with. We do not always need to act – this is also wisdom (pp.57, 161).

From reading this book I realised that yì 意 refers not only to concentration, focus or intention and the ability to diagnose and treat a condition, but also to power of awareness’, a mental capacity prior to thought, words, or form. According to Rickett (in Guanzi. Political, economic and philosophical essays from early China. Volume Two, 1998) yi also refers to a sense of duty, doing the right thing in the right situation, which in my opinion is central to the work of Sūn Sīmiǎo.

It is extraordinary to imagine that Sūn Sīmiǎo’s advice is so ancient yet still so advanced for today. I highly recommend wherever you are in your journey of mastery of ethical practise that you join Sabine for this detailed exploration of medical virtue (醫德 yīdé), the great doctor (大醫 dàyī), scholar/Confucian physician (儒醫 rúyī), virtue power ( dé) and virtuous actions in alignment with the dao (德行 déxíng), and so much more.  Through her careful translation and engaging discussion Sabine connects us in spirit for the good of our profession, our health and the care of our patients.

Lianne Aquilina