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The Four Principles of Medical Ethics in Le Huu Trac’s Ideology

Le Thi Tam Hieu

Faculty of Marxist Leninist Ideology, Vietnam Military Medical University, Ha Dong, Hanoi, Vietnam

Abstract: Le Huu Trac, whose nickname is Hai Thuong Lan Ong, is regarded as the ancestor of Vietnamese medicine. He passed on to the later generations many significant medical works with valuable remedies and wise words on medical ethics. His research on medical ethics has played a significant role in enhancing medical ethics for physicians today. The author follows a method of analysis, synthesis and comparison of data sources, in addition to using the logical method combining history, to study Le Huu Trac's medical ethics ideology through approaching the four principles of medical ethics. This is a general, popular and widely accepted approach in biomedical ethics research since the 1970s. The research result shows that the four medical ethics principles are expressed in Le Huu Trac's medical ethics ideology, in which the principles of beneficence and nonmaleficence tend to prevail over the principle of respect for autonomy.

Keywords: Hai Thuong Lan Ong, Le Huu Trac, medical ethics principles, medical ethics ideology

Received October 12, 2020; Revised February 14, 2021; Accepted February 17, 2021

Citation: Le Thi Tam Hieu, The Four Principles of Medical Ethics in Le Huu Trac’s Ideology. World Journal of Social Sciences and Humanities, 7 (1). 34-40. January 2021. doi:10.12691/wjssh-7-1-5

1. Introduction

In the West, after the Hippocratic Oath, little work has been done to research and expand upon medical ethics. From the end of the eighteenth century to the beginning of the nineteenth century, only when there were changes in all aspects of social life, including medicine, the issue of medical ethics was seriously studied. Thomas Percival, an English doctor, introduced the modern medical ethics terms and code of conduct for physicians in his work "Medical Ethics; or, a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons” first published in 1803 such as: sincerity, knowledge, honesty, compassion... However, his thought only analyzed and clarified the content of the Hippocratic Oath", not yet developing ethical research in medicine to the theoretical level.

In the early twentieth century, disturbing experiments on the human body appeared, typically the Monster Study in the United States in 1939, the Guatemala Syphilis Experiment in 1946, "Unit 731" (1937-1945) ... have raised concerns about medical ethics and morality in medical study. The emergence of the Declaration of Helsinki (1964) and the Nuremberg Code (1947) had a great contribution to address this problem.

In 1979, the emergence of the work "Principles of Biomedical Ethics" by Tom Beauchamp and James Childress raised the theoretical level of ethical study in medicine, the four ethical principles were presented in a systematic way, including respect for autonomy, beneficence, nonmaleficence, and justice. In particular, with a patient-centered view, the authors emphasized the principle of respecting autonomy and affirm that the physician must: “1. Tell the truth; 2. Respect the patient’s privacy; 3. Protect the patient's confidential information; 4. Obtain consent for the patient's medical interventions; 5. Help the patient in making important decisions when asked” [[1], p.107].

Medical ethics principles become the basis for physicians to properly deal with situations in clinical medicine, especially situations where confusion or conflicts about what to do and not to do may arise in healthcare practice. Later works all approach medical ethics following the medical ethics principles such as "Doctor-Patient Communication" by David Pendleton and John Hasler, "Clinical Method: A General Practice Approach" by Robin C. Frank, “Principles of Health Care Ethics" by Raanan Gillon, "Principlism and Moral Dilemmas: A New Principle" by JP DeMarco, “Military Medical Ethics" consisting of 2 volumes by Thomas E. Beam and Linette R. Sparacino... to find out how to resolve conflicts specifically about medical ethics that occur during medical practice. The authors are often more inclined to the principle of respecting autonomy than other principles. Meanwhile, the Chinese scholar Daniel Fu Chang Tsai in "Ancient Chinese Medical Ethics and the four principles of biomedical ethics" has claimed that the four principles of medical ethics are all clearly expressed in ancient Chinese medical ethics, in which the beneficence principle has the most prominent position. This is different from the medical ethics ideology in the West, where the principle of respecting autonomy holds a more prominent place.

In Vietnam, medical ethics principles have not been systematically studied by physicians or theorists, but the ideas of medical ethics principles have been expressed very early, such as in the "Hai Thuong y tong tam linh", including 28 sets, 66 volumes by Hai Thuong Lan Ong Le Huu Trac (1720-1791), focusing on "Y Huan Cach Ngon", “Y Ly Thau Nhan Lai Ngon” and “Y Am An”.

However, the research works on Le Huu Trac in Vietnam are few and often only focus on his philosophical and medical ideas such as “The Spirit of Science and Public Service of Hai Thuong Lan Ong Le Huu Trac'' by Nguyen Dong Chi, "Try Learning about the Famous Vietnamese Medicine Man in the Eighteenth Century” by Van Tan, the set of "Hai Thuong Y Tong Tam Linh" with the application of Chinese philosophical ideas in ancient times by Tran Van Thuy, "Le Huu Trac's Materialistic View on Nature” in Tran Van Thuy's set of "Hai Thuong Y Tong Tam Linh", "Ideology on Human through the Medical Works of Hai Thuong Lan Ong Le Huu Trac” by Pham Cong Nhat, "The Theory of Yin-Yang and Five Elements with the Work "The Emperor of Internal Medicine" and "Hai Thuong Y Tong Tam Linh" by Tran Thi Huyen, “Applying Medical Theory into Medical Practice through the Medical Works of Hai Thuong Lan Ong” by Pham Cong Nhat, “Famous Masters of Medical Ethics” by Quy Long, Kim Thu, Le Huu Trac’s Philosophical Idea in the Work “Hai Thuong Y Tong Tam Linh" by Nguyen Thi Hong Mai, "Le Huu Trac’s Philosophy" by Le Thi Hoang Yen...

When studying Le Huu Trac’s medical ideology and philosophy, the authors have interpreted and integrated his thoughts on medical ethics, focusing on eight virtues to be improved and eight bad ones to be eliminated, perspective on creative learning as well as compassion for the patient. However, Le Huu Trac's ideology on medical ethics approaching the four medical ethics principles has not been studied by domestic and foreign scholars, so there is a gap in understanding.

2. Content

2.1. Brief Historical Background and Biography of Le Huu Trac

Le Huu Trac (1720 - 1791) was a writer and an ideologist in the Late Le dynasty. He was born in a time when Vietnamese society had many changes. The whole country was divided into the Southern and Northern regions. The South was led by Lord Trinh serving the Le dynasty, while the North which is the territory above Ngang Pass was led by Lord Nguyen, i.e. Nguyen Hoang. The feudal forces fought for power, the court fell into recession, the national treasury was poor, the army and people were starved and became sick. Peasants were suppressed, which led to successive revolts that broke out from 1737 to 1786. The contemporary social reality of this time led to three attitude trends among Confucians: follow the oppressing rulers to earn some fame, or follow the insurgents to fight back the cruel feudal rulers, or retreat to recluse.

Le Huu Trac came from an academic family. His grandfather, Le Huu Danh, placed second in the national doctoral exam; his father, Le Huu Muu placed third; and his brother, Le Huu Kien placed third. Le Huu Trac's father was a mandarin official in the Le Du Tong dynasty. He was promoted to court counsellor and was posthumously honored as minister. Being of noble blood and intelligence, Le Huu Trac could have followed the academic tradition of his family and became a great mandarin or a general to show his great will of the king.

However, he was born in a period of hunger and people hated the feudal rulers to the marrow, along with the family's changes when his father and brother passed away. Therefore, Le Huu Trac chose to resign to take care of his mother in Huong Son - a mountainous area of Nghe An and went to medical school, staying away from world affairs.

While living a life of a recluse, he named himself Hai Thuong Lan Ong, "Hai" (the name of Hai Duong province), "Thuong" (the name of Thuong Hong district), "Lan" (meaning lazy but not lazy with work, just lazy with fame). He refused the military order to be a martial arts general or mandarin, but devoted himself to medical research to benefit life. During his professional practice, living close to poor peasants suffering from hunger and illnesses, he found that working in medicine to save people’s lives was a proper orientation for his humanity. He considered the medical profession as humanity, for the purpose of healing and saving people only. Unlike many physicians who consider medicine a profession to earn money, seek fame, and profit, he wanted to work in the medicine profession as a humanitarian contribution and to build medicine in the country.

After Tue Tinh, Vietnamese medicine has not developed yet. There were rarely medical writings. Medicine learners just study by experience and refer Chinese medicine books. Rarely was a physician who dared to go against ancient books or create new medicines. Facing that reality, Le Huu Trac devoted his mind to research. In “Y duong an”, he confided that: “I was a Confucius, when I was a little, things were in chaos, thanks to Huong Son I could take care of my mother. While my reputation got obstacles, I became eager to learn about medicine in my spare time. It turned out that the more I learn, the more passionate I become. I first cure my family members, then other people. I have gained many experiences, then gain more confidence to cure more and more people” [[2], p. 414].

In addition to studying Chinese medicine texts, he also gathered experience in folklore, collected medicinal herbs, and found new medicines. He took medical records to gain experience. In the process of both researching and treating human diseases, he was very passionate about writing and printing books, and opening classes to teach medicine. After 30 years of hard work, he finished a monumental project named “Hai Thuong Y tong tam linh” including 28 sets, 66 volumes; in which outstanding works are “Noi kinh yeu chi”; “Ve sinh yeu quyet”; “Van khi bi dien”; “Y hai cau nguyen”; “Chau ngoc cach ngon” talking about medical issues and his philosophical view. The book set is his entire work on traditional Vietnamese medicine in the eighteenth century.

In his works, Le Huu Trac has expressed very clearly the idea of medical ethics and medical theory. His medical theory, despite inheriting Chinese philosophical ideas such as the yin-yang theory, the five elements, the Chu Dich ideology, the categories of Confucianism- Buddhism- Doctrine, was based on materialistic and atheistic worldview. His medical theory demonstrates a close connection between philosophy and medicine for the purpose of saving people. He affirmed: “You can not talk about Confucianism or medicine without understanding Heaven and Earth. Study the I Ching first then you can talk about medicine!" [[3], p.539]. His medical ethics ideology reflects a deep human value that is to love and serve the people.

2.2. The Four Principles of Medical Ethics in Le Huu Trac’s Ideology

2.2.1. The Principle of Autonomy in Le Huu Trac’s Medical Ethics Ideology

Respect for autonomy means that the patient (who has the ability to make decisions) has the right to participate in decisions related to diagnosis, treatment, and care for his or her medical condition. The physician must respect those rights. People who are considered capable, according to Beauchamp and Childress, are under three conditions: having intentional behaviors, independent knowledge, and freedom [[1], p.104]. If individuals have no capability (including children under 15 years old, patients with mental problems and are not conscious enough to make decisions, or patients who are comatose, incarcerated, or with HIV/AIDS), it is necessary to have a legal representative who can make decisions for them... in descending order like husband and wife, adult children, siblings, cousins…” [[4], p. 47-48]. Only in the case that the patient has no legal representative, it is the physician who makes the decision.

To ensure that this principle is not violated, the physician needs to comply with the following rules: tell the truth; respect the patient's privacy; protect confidential information; obtain consent from patient for intervention; help patients make important decisions when asked [[1], p. 107].

Le Huu Trac was initially aware of this problem. He said to the physicians “before giving any prescription, we should inform the patient's family clearly before giving any medicine; because it is them who will buy medicine. By doing so, if the medicine works, they will thank us. Even if it does not work, they will not bring doubts, resentment towards us, and we will not have to be ashamed of what we did” [[3], tr. 25]. The physician must clearly, accurately, completely and honestly notify the patient of information. It does not only build trust of the patient but it also helps the physician avoid being sued or criticized later. Contemporarily, he met and vehemently criticized physicians who were not honest when giving information to patients. They are guilty of being “greedy”, "not telling the truth but talking vaguely to make money"; “deceiving that one simple thing is complicated to scare people to get more money" [[2], p.460]. They have deprived patients of the right to know their health information and to make their own decisions on treatment. These physicians have sold their conscience and reputation cheaply, considering the medical profession merely as a means of making money, and taking advantage of the poor understanding of the patient to benefit themselves.

After telling the truth to the patient's family, especially for a difficult disease, according to Le Huu Trac, the physician still has to constantly make every effort to "find life in a dead place for people, it is good if it works out, even if it does not, we do not have to be ashamed that we did not try our best” [[2], p.447]. “We have to go for every possible chance when we still can” [[2], p.442]. He fiercely criticized the physicians for saving their reputation and benefits by mercilessly neglecting the patient’s life with an excuse "you can only cure diseases, not fate" when facing difficult diseases. He denied the notion of fate and said: "What is the point of being a physician if you refuse to cure difficult diseases?” [[2], p.414].

Respecting the patient’s autonomy is also respecting the patient's dignity, and having the right attitude when examining women. In "Y huan cach ngon", Le Huu Trac instructed: "When examining women or nuns, widows, there must be someone else accompanying them, in order to prevent suspicion; even when examining prostitutes, the physicians must maintain their righteousness, consider patients as family. Do not behave half-serious and half-joking to bring into disrepute and suffer from retribution" [[3], p.25].

In fact, the principle of respecting the patient’s autonomy has only recently been seriously studied since 1979, in the work "Principles of Biomedical Ethics" by Tom Beauchamp and James Childress in 1979, in which the fundamental base was respecting human rights. Therefore, this principle content may not be found much in medical ethics ideology of physicians in Eastern countries in general, and Le Huu Trac in particular. It is more difficult to practise in Eastern countries, especially those influenced by Confucianism and Buddhism promoting collective spirit and having little emphasis on individual factors. In China, Chu Hui-ming (AD 1590) and Chen Shih-kung (AD 1605)... were the first physicians to address this issue, but Chu Hui-ming only mentioned it is the physician’s duty not to lie. Chen Shih-kung also just mentioned the aspect of respecting the patient’s dignity, especially women. In his thought, Le Huu Trac discussed quite a lot of the two above contents with a patient-centered viewpoint. Not only that, he also put it in each specific case and especially emphasized the aspect that despite telling the truth to the patient's family, especially about severe cases, the physicians still have to try to do the best to cure them. Therefore, the main basis of this principle is still about the physician’s beneficence.

2.2.2. The Principle of Beneficence in Le Huu Trac’s Medical Ethics Ideology

In the medical field, beneficence can be understood as a physician who not only works with honor and pride but also for a good society, for everyone's happiness, including the physicians themselves This principle reminds the doctor to always empathize with the patient's suffering, consider the patient as his or her relative; consider all benefits before providing any treatment, ensure that benefits outweigh risks, minimize harm; always be ready to help patients in all situations; consider the patient's financial situation before giving any treatment or prescribing home treatment.

In Le Huu Trac's medical ethics ideology, this principle is applied in every professional practice of his. The medical profession, according to him, is "beneficence", which means "embracing compassion and always thinking about saving people" [[2], p.424]; is to keep people's lives, neglect profit, always put the patient's life first; it is "worrying about human fate, worrying about people's worries, enjoying the joy of others, just saving people’s lives as their duties" [[3], p.26]. In "Y am an", he affirmed: "Making medicine is beneficence, just think of saving lives, do not trade conscience off for wealth, help others is common sense, which should be called “dogma" [[2], p.455]. His beneficence also never considers the patient as an experimental object, therefore when giving prescriptions, the physician must always be careful and cautious.

The physician with beneficence sometimes has to sacrifice their free time because “when they are not home, someone may come to ask for emergency help, then they will not meet people’s expectations and cause harm. Thus, they need to know their duty in this” [[3], p.25]. This is not an easy job. Sometimes he did want to have fun but his heart still worried about the sick” [[3], p.45]. Moreover, with the mindset of always putting the patient first, the physician does not mind and is always willing to go through hardship, still fighting the sickness with the patient even when the physician is sick. He thinks:

“The old sick people want to relax,

I was more strenuous when getting sick

Ask for medicine, I know they are knocking on the door,

Closing the door when there are no visitors

The eastern village has just recovered from the emergency.

The northern village is already worried about severe diseases

Strenuous not for any favor return,

Saving people is a duty to concern" [[3], p.51].

"Beneficence" should not just stop at saving people's lives, according to Le Huu Trac, the physician must also help the patient to have a fulfilling life both in terms of health and material. He constantly reminded physicians to pay special attention to the poor, the lonely, and filial piety and dedicated wives, because they not only did not have the money to treat the physician, but they also had no one taking care of them. Thus, besides curing them, why don’t we offer some help to support their life. Because if there is medicine but no food to eat, then they will soon die anyway. Beneficence is only gained if the physician cares about the patient’s fulfilling life as well [[3], p.26]. The physician with beneficence does not take advantage of people or boast about their deeds, or ask for the patient’s repayment. Instead, the physician must take saving people’s lives as an apparent duty. He emphasized: "The goodwill lies in saving people’s lives; the conscience needs no profit or repayment, poor but peaceful" [[3], p.47].

Being a patriotic Confucian, he looked down on fame, so he said: "It is easy to be humiliated praying for fame, pleasing people for ploy will cause unwanted consequences" [[3], p.26]. Therefore, saving people is common sense, it both makes the physician's conscience peaceful, not ashamed, leaving virtue legacy for the descendants and bringing happiness for people.

He strongly criticized physicians saving people for their own benefit, or neglecting the lives of the sick. They are physicians “taking advantage of the fact that the patient is experiencing fear, or people in a difficult situation to lie that it is difficult to cure, or threaten that the disease can cause death for bad intentions… Trading their beneficence off to get benefit for their own not only causes the living to blame and the dead to resent but it also is unacceptable and unforgivable" [[3], p.26]. He called these physicians "bandits", indifferent to human lives, only thinking about their own interests, tainting the reputation of the medical profession. From that reality, he repeatedly instructed his students to take their “conscience seriously to help people", not to mind profit or to boast, to avoid eight sins: inhumane, lazy, stingy, greedy, deceptive, unethical, narrow-minded and ignorant. At the same time, he also pointed out necessary attributes of a physician, which are: "compassionate, moral, clever, generous, sincere, honorable, diligent" [[2], p. 460]. In which, humanity and compassion for humans are always a prerequisite for learning to be a physician. Gaining humanity will help physicians form the other virtues and eliminate the above eight sins.

In fact, the principle of beneficence is widespread in both the East and the West. However, in the West, especially in recent writings on principles of medical ethics, the principle of beneficence rationale has explored many issues of medical practice, such as: doing no harm, balancing between benefits and risks, maximizing possible benefits and minimizing possible harm during treatment... Meanwhile, Eastern physicians often stop at aphorism, emphasizing the humane actions of the physician. Sun Szu-miao (581-682 AD), an ancient Chinese physician, said “The physician's purpose is to help the patient, not to gain material from that, a great physician should use their humanity and compassion to save people, including other living creatures" [[5], p.319]. Or the viewpoint of Kung Hsin (AD 1556) which emphasizes that a physician should be humane and just. The most important duty of a true physician is not glory or fame but to revive the dead, recover the health of the sick.

Le Huu Trac was also influenced by the category of benevolence and righteousness in Confucianism and with his humane nature, he not only stopped at humane aphorism about the medical profession but he also built the concept of “beneficence". He emphasized that this was an indispensable quality of the physician, and the instinct that motivates each physician to voluntarily try their best to fight against diseases and bring joy and happiness to humans. With compassion, the physician will always be fair, respect the patient in examination and treatment, together with the patient bravely face difficult cases, never give up. It helps the physician to form good virtues and eliminate selfishness, self-interest...

2.2.3. The Principle of Nonmaleficence in Le Huu Trac’s Medical Ethics Ideology

The principle of nonmaleficence is separated from the principle of beneficence by Beauchamp LT and Childress FJ because many problems in biomedicine need considering both aspects: compassion and no harm for the sick. The principle of nonmaleficence ensures that the physician does not harm the patient during treatment nor excuse actions violating his morality. To maximize benefits and minimize harm to the patient, the physician must consider this principle and adhere to the following rules: “Do not harm the patient in any way; do not cause physical or emotional pain to the patient; do not lose the patient’s conscience capacity; do not act criminally; Do not deprive patients of good living conditions” [[1], p.154].

Le Huu Trac also mentioned this issue during the medical treatment process. He divided physicians into two types: of "Ba Dao" physician and "Vuong Dao" physician. The "Ba Dao" physicians, according to him, "when dealing with a severe disease, they only focused on curing the disease, forgot about patients themselves" [[2], p.399]. This is a metaphysical cure, only seeing the disease but not seeing the patient. They then use as much medicine as possible, regardless of the patient’s status, not knowing that the medicine sometimes also can do harm. He believed that these physicians only stopped at medical treatment technically and those taking such risks to harm people are "those who swing a sword to kill… How dare them!" [[2], p.399].

He urged physicians to follow the "Vuong dao” path, that is "medical ethics”. The physician with medical ethics will have visions and a dialectic method in the medical treatment process. No matter what kind of disease, they "will be determined not to just focus on small details on the skin then unconsciously harm the blood flow in the body. When that way succeeds, it can also help mental health become stronger than before" [[2], p.399]. Then, curing one disease can help curing others". This is a method based on the actual status of the patient, not a stereotype following an ancient remedy. Lee Huu Trac followed Tue Tinh that “Gain knowledge and experience from the ancients; implement methods by considering practical symptoms at that time” [[6], p.448].

He compared "making medicine is like using soldiers, and a physician is like a general. If a general does not understand soldiers, how can they lead the soldiers and fight against the enemy?" If a physician does not know the medicinal properties, he can not use it to help people” [[2], p.466]. However, in order to know the medicinal properties of plants and flowers to make medicine and do no harm, the physician has to constantly research and study.

His thought about learning is very unique. He highlighted the spirit of hard work, selective learning, creativity, independence, and innovation. He emphasized that the physician must understand the logic, know the transformational law of yin and yang, the five elements, from which the physician can cure diseases effectively.

In order to grasp the ancient remedies as well as build new therapies on their own, the physician must study hard. Spending leisure time not on enjoyment but on thinking about ancient remedies with the main purpose of making the medicinal sense clear.

He said that learning must be creative in order to “create initiatives that go beyond tradition during clinic practice” [[3], p.296]. Because he understands that, when practical conditions change, the factors (even health factors) or human illnesses will also change; the "human innate body at present differs from in the past, so does personality. Therefore, it is impossible not to create a new cure for humans today” [[3], p.237]. Therefore, if the physician only relies on old books, he will become confused and find it difficult to deal with new diseases, as Tue Tinh concluded: "Incompetent physicians are a result of being slow and clumsy" [[6], p.448]. The ancient remedies are not versatile and immutable. Physicians nowadays are flexible depending on the patient instead of using a one-size-fits-all cure. Le Huu Trac advocated that each physician must base their understanding on the old remedy and then, depending on the situation, create his own remedy, “should expand the thinking and flexibly make it clear when you deal with a certain type of disease. As a result, the medical profession will be comprehensive and thorough” [[3], p.296].

The principle of nonmaleficence lies in the principle of beneficence, but is intentionally separated to discuss in-depth issues related to the patient’s benefits and risks. With the Western medicine’s development, especially the application of science and technology to medical treatment, many issues in this principle are worth discussing such as: the definition of ‘doing harm’, technology application in medical treatment, the issue of assisted suicide etc. However, in the East, this principle is closely associated with the principle of beneficence, emphasizing that the physician should never harm the patient. Chinese physicians emphasize material preferences are factors leading physicians to easily violate this principle. Meanwhile, Le Huu Trac supposed that the lack of skills and understanding makes the physician harm the patient. To overcome this, he affirmed that the physician must be diligent in studying seriously, creatively, and know how to use the dialectic method in examination and treatment.

2.2.4. The Principle of Justice in Le Huu Trac’s Medical Ethics Ideology

Health justice is a category of social justice that is a concern of every nation in all times. The "Geneva Conventions" (1948) clearly expressed this principle when saying that the physician did not allow concerns about age, disease or disability, belief, race, sex, nationality, political background, competition, sexual opinion, social status or any other factors to interfere their duties towards the patient.

The principle of justice has familiar contents with the conception of "responsibility" in Confucianism in the way that all physicians have to ensure benefits for patients of all sexes, ages, positions, and are not greedy for gain. Therefore, in Le Huu Trac's medical ethics ideology, he also mentioned this principle. He affirmed, whether rich or poor, people have the right to be medically taken care of, examined and treated. Justice, according to him, does not mean making everything the same. The level of care and treatment must be based on the patient’s health status and the physician must pay attention to the more disadvantaged, “if asked by many families to go cure at the same time, the physician should consider whether to go for the most serious and needy patients and also decide which ones can be delayed. The physician should not prioritize the rich and take the poor lightly” [[3], p.25]. Particularly, the physician should give priority to young children, the elderly, the people in need, the disabled and pregnant women. During the examination process, the physician should be completely honest and only depend on the patient's condition to decide who to examine first and after. They should not let any factors that benefit their interest and relationships intervene. Since then, he criticized physicians who are “only worried about the rich to gain material profit, neglecting the poor to death” [[3], p.26]. These physicians are not only unfair in the treatment process but they are also mercilessly indifferent to the poor. They are also determined not to examine the orphans, filial children because they think it is in vain. Le Huu Trac said: "They are physicians for the rich, not for the poor" [[2], p.462].

From justice in the examination process, Le Huu Trac also stated that it was necessary to be fair in the process of providing medicine, and not to discriminate against people" [[3], p.25]. He fiercely criticized physicians who were willing to lie about the patient's condition for their own benefit, saying an easy-to-treat illness into a difficult one to get more money; or who just let personal feud interfere with their willingness to cure the sick” [[2], p.460].

Justice, according to him, is also always respecting human dignity. Typically, when a physician examines and cures widows, nuns or prostitutes, they need to show respect and to not discriminate. The physician’s words and gestures must be appropriate. Because, as a physician, Le Huu Trac understands that individuals in such situations are vulnerable people in society. In order for them to cooperate in the examination and treatment process, the physician must understand them psychologically, to communicate appropriately.

Thus, from the inequitable practice in medical examination and treatment of contemporary physicians, Le Huu Trac has had basic ideas about the factor of injustice in examination and treatment. He not only advocates equality and non-discrimination in medical examination and treatment but he also encourage physicians to provide additional support for patients with special circumstances such as the poor and sick. This is also the popular ideology of physicians in the East. However, they only emphasized the physician's fair behavior towards all patients, including priority for patients with difficult circumstances. Equal distribution of rare medicine and new treatment methods have not been addressed.

In the current social reality, this principle is often neglected due to two factors: (1) Physicians prioritize their personal interests, considering the medical profession as only a money-making tool. Thus, there is a discrimination between the rich and the poor in the course of examination and treatment; (2) Objective factors such as overloaded hospitals and patients, lack of facilities, exhausted and mentally stressed medical staff, leading to the shortcomings in communication standards between medical staff and patients.

3. Conclusion

Le Huu Trac has mentioned the content of the four principles of medical ethics, in which, the principle of beneficence and nonmaleficence are the main principles. This is quite different from the West, where the principle of autonomy tends to prevail. The difference lies in different production methods, cultural and social factors. Medical ethics is professional ethics, so it belongs to the field of social consciousness, reflecting on the existence of society. In the West, there is a tendency emphasizing individualism, privacy, and autonomy, so the principle of autonomy tends to be more important.

In Vietnam, collective interests and family values are always placed above individual interests and rights. Besides, beneficence is the inheritance from the category of “humanity” in Confucianism. According to Daniel Fu Chang Tsai in "Ancient Chinese Medical Ethics and the four principles of biomedical ethics", “humanity" is the center category of Confucianism. Thus, among the medical ethics of ancient China, the principles of beneficence and nonmaleficence play a key role” [[5], p.320]. Meanwhile, Le Huu Trac is a Confusian who loves the people and the country, who does not care about fame and profit. From the above factors, it can be easily seen in his medical ethics ideology that the principles of beneficence and nonmaleficence are much more prominent. He affirmed that "Medicine doctrine is beneficence, specializing in human fate" [[3], p.26]. Therefore, the physician, at all times, must love human lives and the patient so that he can devote himself to save them.

Le Huu Trac's love for the sick in his medical ethics ideology was inherited by later physicians and became the tradition of Vietnamese medicine. This has helped Vietnam, a small country with poor medical equipment, to fight many epidemics such as SARS, H5N1... and most recently, the Covid-19 pandemic.

Most Western countries are influenced by a culture of individualism. In medicine, the principle of autonomy prevails over the others. Therefore, during the COVID-19 pandemic, a part of their population do not comply with the government's orders for social distancing and wearing masks. They even protest against the orders and demand the Government and doctors to respect their rights. This is one of the factors that makes it difficult to control the pandemic in some Western countries.

In Vietnam, up to now we still have good control of the pandemic. This result is due to the timely policies of the Party and State as well as the consensus to fight the pandemic of people nationwide. In which, the promotion of the principle of beneficence and compassion for the sick people among military medical doctors across the country is shining brighter than ever.

Vietnamese doctors are ready to be the first to fight the epidemic with the determination "no one will be left behind". Despite respecting the patients' right to be medically treated, for those who do not want treatment or isolation, Vietnamese doctors have patiently explained the dangers of the disease to patients and their families, eliciting solidarity, collective spirit, and patriotism (precious traditions of the nation and always flowing in the blood of every Vietnamese). It makes not only the sick but the entire Vietnamese people ready to set aside personal interests for the collective, for society, with the spirit of "fighting epidemic like fighting an enemy", voluntarily go to a gathered isolation place if suspected in order to protect the health of the community.

Vietnamese doctors also did not wait for help with medical supplies and medicines from other countries, they have tried their best to study Covid-19 Quick Test Kit, medical splash-proof caps, antibacterial liquid, face masks... In particular, doctors have researched and manufactured Nano Covax vaccine, and they are now cooperating with the Military Medical Academy to test on the human body, which the initial results are very positive.

Nowadays, many doctors have constantly been doing research, applying science and technology to medicine, using modern methods of examination and treatment to help patients live healthier, prolong their life span, and overcome their body disadvantages... However, on the other hand, it raises a number of medical ethics issues that need to be resolved such as: artificial insemination, fetal sex selection, the right to die... Sometimes by respecting the patient's autonomy, doctors may violate the principle of beneficence and nonmaleficence.

References

[1]   | Tom L. Beauchamp, James F. Childrenress, 2012, Principle of Biomedical Ethics, 7th edition, Oxford University Press, New York.
[2]   | Hai Thuong Lan Ong Le Huu Trac, 2005, Hai Thuong y tong tam linh, Vol. 2, Medical Publishing House, Hanoi.
[3]   | Hai Thuong Lan Ong Le Huu Trac, 2005, Hai Thuong y tuong tam linh, Vol. 1, Medical Publishing House, Hanoi.
[4]   | John R. Williams, 2015, Medical Ethics Manual, World Medical Association, 3rd edition.
[5]   | Daniel Fu Chang Tsai, 1999, Ancient Chinese Medical Ethics and the four principles of biomedical ethics, Journal of Medical Ethics.
[6]   | Nguyen Ba Tinh, 2007, Tue Tinh whole set, Medical Publishing House, Hanoi.
[7]   | Nguyen Thi Hong Mai, 2010, Le Huu Trac - the thinker of the Late Le dynasty, Vietnam Journal of Philosophy, 11, pp.76-82.
[8]   | Pham Cong Nhat, 2011, Applying medical theory to medical practice through medical works of Hai Thuong Lan Ong, Vietnam Journal of Social Science, No. 2/2011, p. 49-58.
[9]   | Tran Van Thuy, 1996, Le Huu Trac’s materialistic view of nature in the series” Hai Thuong Y Tong Tam Linh, Vietnam Journal of Philosophy, 2, pp.48-49. 37.