{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:48:14Z","timestamp":1791906494972,"version":"4.3.4"},"reference-count":40,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Developing World Bioethics"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Based on 24 semi\u2010structured interviews with secondary hospital doctors, we empirically investigate how a new two\u2010way referral system in China influences the alignment between referring doctors, patients, and doctors who receive referrals. In particular, we focus on how this system addresses the challenges of trust, autonomy, and bioethics during the shared decision\u2010making process. Our research shows that the two\u2010way referral system has spawned new acquaintance networks, therefore improving communication and collaboration between doctors. Especially during upward referrals, benefits associated with care continuity have been made possible. However, doctors still tend to adopt defensive patient\u2010centered strategies in referral communication. They consult patients' desires and play an information provider role. This is influenced by both procedural requirements imposed by managerial rules and uncertainty caused by medical consumerism. Thus, we argue that the Chinese bioethical issue of doctor\u2013patient relationships has gradually turned to a mismatch of concerns between doctors and patients.<\/jats:p>","DOI":"10.1111\/dewb.12491","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T19:39:53Z","timestamp":1750880393000},"page":"32-42","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Chinese Bioethics of Trust and Autonomy: How Doctors Make Patient Referrals After the Introduction of a Two\u2010Way Referral System"],"prefix":"10.1111","volume":"26","author":[{"given":"Zihan","family":"Wu","sequence":"first","affiliation":[{"name":"Graduate School of Interdisciplinary Information Studies, The University of Tokyo Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Cardiology Changxing Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,25]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"993","volume-title":"Handbook of Global Bioethics","author":"Zhang H.","year":"2013"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32136-1"},{"key":"e_1_2_11_4_1","first-page":"76","article-title":"Paradox of Sense of Gain Between Doctor and Patient Groups and Its Remedy: The Study of Doctor\u2010Patient Relationship as a Social Psychological Issue","volume":"1","author":"L\u00fc X.","year":"2019","journal-title":"Journal of Nanjing Normal University (Social Science Edition)"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61120-X"},{"key":"e_1_2_11_6_1","unstructured":"United Kingdom National Health Service Referrals for Specialist Care (2023) https:\/\/www.nhs.uk\/nhs-services\/hospitals\/referrals-for-specialist-care\/."},{"key":"e_1_2_11_7_1","unstructured":"Seifu Kouhou Online. (Japan) Shoukaijo Nashi De Daibyouinn De Jyushin Suru To Tokubetsu No Ryoukin Ga Kagari Masu [If You Go to a Major Hospital Without a Letter of Referral a Special Fee Will Be Charged] (2023) https:\/\/www.gov-online.go.jp\/useful\/article\/201603\/5.html."},{"key":"e_1_2_11_8_1","doi-asserted-by":"crossref","unstructured":"K.Eggleston \u201cHealth Care for 1.3 Billion: An Overview of China's Health System \u201d Stanford Asia Health Policy Program Working Paper No. 28 (2012) https:\/\/doi.org\/10.2139\/ssrn.2029952.","DOI":"10.2139\/ssrn.2029952"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.904384"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.4161\/23288604.2014.995005"},{"key":"e_1_2_11_11_1","unstructured":"W.Zheng \u201cWhy China Is Targeting the Corruption Tumour at the Heart of Its Ailing Health System \u201dSouth China Morning Post (2023) https:\/\/www.scmp.com\/news\/china\/politics\/article\/3231815\/why-china-targeting-corruption-tumour-heart-its-ailing-health-system."},{"key":"e_1_2_11_12_1","unstructured":"General Office of the State Council. (China) Guanyu Tuijin Fenji Zhenliao Zhidu Jianshe de Zhidao Yijian [Guiding Opinions on the Construction of a Hierarchical Medical System] (2015) https:\/\/www.gov.cn\/gongbao\/content\/2015\/content_2937321.htm?eqid=ce89e4de00093f1e00000002648134d1."},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzab027"},{"key":"e_1_2_11_14_1","unstructured":"General Office of the State Council. (China) Guanyu Tuijin Yiliao Lianheti Jianshe he Fazhan de Zhidao Yijian [Guiding Opinions on the Construction and Development of Medical Alliances] (2017) https:\/\/www.gov.cn\/gongbao\/content\/2017\/content_5191699.htm."},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2024.101161"},{"key":"e_1_2_11_16_1","unstructured":"X.Liao \u201cShuangxiang Zhuanzhen Tichang Rongyi Tuidong Nan [Easy to Propagate Two\u2010Way Referrals But Difficult to Implement] \u201d (2015) http:\/\/www.xinhuanet.com\/health\/2015-11\/17\/c_128436405.htm."},{"key":"e_1_2_11_17_1","unstructured":"Xinhua News Quanguo Gong Jiancheng Gezhong Xingshi Yilianti 1.8 Wanyuge [More Than 18 Thousands Medical Alliances Have Been Established] (2024) https:\/\/www.gov.cn\/lianbo\/bumen\/202402\/content_6934829.htm."},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/dewb.12162"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/dewb.12170"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/nhs.12311"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0963180111000144"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/10410236.2012.718252"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.3402\/gha.v9.29964"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.841196"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgpj.2024.10.002"},{"key":"e_1_2_11_26_1","volume-title":"Professionalism: The Third Logic","author":"Freidson E.","year":"2001"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2004.03332.x"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.2307\/3349493"},{"key":"e_1_2_11_29_1","first-page":"122","volume-title":"Policy, People, and the New Professional","author":"Kremer M.","year":"2006"},{"key":"e_1_2_11_30_1","volume-title":"Trust and Power","author":"Luhmann N.","year":"1979"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1086\/228791"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511606250"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2004.11.067"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1744133116000128"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2012.05.026"},{"key":"e_1_2_11_37_1","unstructured":"National Health Commission. (China) Guanyu Jiaqiang Shouzhen he Zhuanzhen Fuwu Tisheng Yiliao Fuwu Lianxuxing de Tongzhi [Guidance on Improving Care Service Continuity by Strengthening First\u2010Visit and Referral Services] (2024) https:\/\/www.gov.cn\/zhengce\/zhengceku\/202411\/content_6989637.htm."},{"key":"e_1_2_11_38_1","unstructured":"General Office of the State Council. (China) Guanyu Yinfa Yiliao Jigou Gongzuo Renyuan Lianjie Congye Jiuxiang Zhunze de Tongzhi [Guidance on the Notification of Nine Principles on the Integrity of the Medical Profession] (2022) https:\/\/www.gov.cn\/gongbao\/content\/2022\/content_5678098.htm."},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1076\/jmep.29.2.149.31506"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13561-024-00520-8"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12962-023-00461-9"}],"container-title":["Developing World Bioethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dewb.12491","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/dewb.12491","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dewb.12491","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:15:33Z","timestamp":1791904533000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dewb.12491"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,25]]},"references-count":40,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1111\/dewb.12491"],"URL":"https:\/\/doi.org\/10.1111\/dewb.12491","archive":["Portico"],"relation":{},"ISSN":["1471-8731","1471-8847"],"issn-type":[{"value":"1471-8731","type":"print"},{"value":"1471-8847","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,25]]},"assertion":[{"value":"2024-09-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}