Heal Thyself?

The

baby wasn't as lucky as my own infant son. Both were born in 1995 more than two months prematurely. After gazing at Roy in his incubator in the neonatal intensive-care unit of Peking Union Medical College Hospital in Beijing, I strolled past a row of bassinets containing other newborns. At the end lay a child with seaweed-colored skin stretched tight over his skull. I motioned to the young attending doctor, figuring she hadn't yet noticed his death. She had. The child's lungs were underdeveloped, she explained, and lack of oxygen at birth meant he would suffer severe mental and physical handicaps. The parents, preferring not to raise a disabled boy, asked the doctor to handle the matter. The physician, whose care for my own child had been exemplary, did so by withholding treatment and nourishment from this baby until he died.

Clearly upset by the incident, the doctor told me she had little choice in the matter. China's one-child policy encourages families to raise the best little emperors they can; doctor-aided euthanasia is not uncommon when children are born with birth defects. Infanticide is just one of the many ethical compromises forced upon China's doctors by an authoritarian government. Obstetricians under orders from bureaucrats perform late-term abortions, and psychiatrists commit sane political dissidents to mental institutions. In March and April, hundreds of doctors knew that Party officials were risking lives by denying the scope of the SARS epidemic. Only one, 71-year-old military doctor Jiang Yanyong, went public with damning information. His colleagues, meanwhile, abetted a scheme to hide SARS patients in Beijing from World Health Organization inspectors. "Medicine is supposed to be the most ethical profession," says Qiu Renzhong, a medical ethicist at the Chinese Academy of Social Sciences, "but Chinese doctors work in the most unethical environment."

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Even if the country's physicians subscribed to the Hippocratic oath, the ancient moral dictum that guides Western medical workers, they would have to violate it. In China, doctors serve the all-powerful state, and when a professional code of conduct conflicts with the Party line, the latter often holds sway. "Of course it's an ethical problem," says a doctor who participated in Beijing's SARS cover-up. "We want to be honest, but if we don't go along, we can't exist."

Shanghai doctor Zhang Shuyun discovered the perils of following her conscience after exposing abuses at Shanghai's main orphanage in the early 1990s. For years, the orphanage cleared room for new children by neglecting existing charges until they died, often emaciated and lashed to their cots. Shanghai officials fired Zhang for demanding an investigation. She fled to England with a suitcase full of documents and photographs that became the basis for a chilling 1996 Human Rights Watch report called Death by Default. Her actions helped clean up the orphanage, but today Zhang fears she has sent the wrong message to colleagues back home. She must live in exile, but the man whom Human Rights Watch blamed for covering up the scandal, Wu Bangguo, is No. 2 in the Politburo. "Other doctors will learn from my experience and keep their mouths shut," Zhang says.

The roots of complicity go beyond the fear of being ostracized. In China, required reading for every medical student is On the Absolute Sincerity of Great Physicians, a 1,400-year-old treatise by Sun Simiao that Hippocrates would appreciate. But traditional ethical tracts never addressed the greater role that doctors play as guardians of public health. Confucian Emperors were suspicious of physicians; books published in the Song dynasty encouraged self-diagnosis among citizens. This contrasts with the evolution of Western medical ethics, which stemmed from the pragmatic realization among 18th century European powers that strong armies and workforces depended on good public health, necessitating standard qualifications for doctors, regular hospital inspections and vaccinated conscript pools. But "Chinese physicians developed no group identity of safeguarding the entire population or, if the government goes in the wrong direction, of voicing criticism," says Paul Unschuld, an expert on Chinese medical history at the University of Munich.

Today, only half of China's medical schools offer ethics courses. When such classes are provided, they suggest that thorny issues can always be resolved by adhering to government policy—and that individuals' health and welfare come second. One text, Analyzing Ethics in Clinical Cases, neatly files down the horns of a familiar dilemma. On page 24, the authors present the case of a seven-month-pregnant peasant woman who is forced by family-planning officials to abort. She submits, but the baby survives. When the woman refuses to let the doctors "dispose" of her infant son, the book says practitioners should "act according to the one-child policy... [and] point out that because medical abortions can affect a child's normal development, she should abandon" her protests and allow euthanasia. If that doesn't work, the authors say, "let the family-planning office decide." Of course, that office ordered the abortion in the first place.

The government ensures that doctors remain powerless by controlling medical societies, which in other countries help set ethical norms. The Chinese Medical Association is run by Zhang Wenkang, the former Health Minister who was sacked in April for covering up SARS. In 1999, legal reformers pushed through a law calling for the formation of a truly independent organization, the Chinese Medical Doctors Association. It was established last year—headed by retired officials from the Health Ministry.

Still, there are signs of protest, if not change. Huang Shurong, a peasant from the northern province of Heilongjiang, was committed by psychiatrists to a mental institution five times from 1998 to 2002 for complaining that local officials had taken her best farmland. A website run by the Procuratorial Daily, the newspaper of China's prosecutor's office, last year published a review of her case in which doctors were warned not to comply with police seeking expedient ways of incarcerating undesirables. "Medical staff are an essential link in the chain of evil that produces these abuses, and this should not be forgotten when allocating blame and punishment," the review stated. So far, no punishment has been allocated. Late last month, the World Psychiatric Association took China to task in an unusual statement calling on the country to allow international experts to investigate allegations that psychiatry is used as a political tool.

Meanwhile, Jiang Yanyong, the military doctor who exposed the government's SARS cover-up by publicly accusing the Minister of Health of lying about the capital's outbreak, has become a local hero. The China Women's News ran his photo ahead of those of government officials in a front-page piece headlined HONOR ROLL OF SARS FIGHTERS. Although Jiang has been told not to give interviews, he seems to have escaped retribution. Partly that may be because, as a top surgeon who has saved the lives of military leaders, he could count on protection. In an earlier interview with TIME, he acknowledged that his position allowed him to speak out. Others declined to take such risks, he said, because "China's system is not built for people to say no."

Inspired by Jiang's courageous stand, more Chinese physicians may begin saying no. I believe the doctor who helped deliver my son, and who couldn't look me in the eye as she explained what she'd done with the other baby, hopes that day will come soon.