Research objectives: Study the rationale on medical ethics and the development of medical ethichs of military physicians; survey analysis and evaluate the development of medical ethics of doctors and the causes of the restriction; propose measures to develop medical ethics of military physicians today; ponduct empirical measures of some measures to develop medical ethics of military physicians.
1 INTRODUCTION 1. An overview introduction of the thesis A true physician treats diseases to save patient not only for his/her responsibility, but also for his/her professional conscience, for his/her compassion for the patient. President Ho Chi Minh wrote in a letter to staffs of the health sector: "A physician must be as a gentle mother", which is to teach the physician to be moral (ethics) in his work. If the art of medicine makes fame, medical ethics creates the human dignity of the physician, all for the sake of human life In today's society, to the rapid development of science, and technique, people’s physical and spiritual life is getting more and more improved, people’s increasing health care needs requires the physicians to have the professional capacity and good moral character. Due to the reverse side of the market economy, ethics of physicians now have signs of degradation, creating discontent in public opinion. Therefore, the study of developing the medical ethics of physicians in general and developing the medical ethics of military physicians in particularly has become imperative in both theory and practice Developing ethical themes of the current military physicians systematizes ideas and ethical studies, clarifies the nature of medical ethics and the development of medial ethics of military physicians; indicates the current context and the factors affecting the development of medial ethics, operational characteristics of military physicians and the role of the development of medial ethics; gives the content of the development of medial ethics and the criteria to assess the development of medical ethics; builds measures to education, retraining and training the development of medial ethics to military physicians in order to meet the requirements of health care and health protection for the troops and the people in the process of building and protecting the country today 2. Reasons for choosing thesis Morality is a social phenomenon which plays a particularly vital role in the life of humanity. Ethics is relevant to all members of society, to all areas of human activity, including health sector Medical ethics is ethics of the medical profession a noble quality of a physician, medical ethics is formed thanks to the education in schools and developed thanks to selftraining, and cultivation in practical activities of each physician Ethics of physicians is always affected by the social and political factors in each period, and stage of social development , and the professional activities. Therefore, the study of the development of medical ethics of military physicians which owns particular characteristics in the current situation is an issue that needs to be studied further as a standalone topic that military medical practices are required Since the Vietnam People's Army was founded until now, in wartime as well as peacetime, teams of military physicians are always present everywhere, at all times, even in the most dangerous places, in the most fierce point, to rescue, care for and protect the health of the troops to defeat the enemy. Military physicians also participate in scientific research contributing to the improvement of the country's medical quality and quality improvement activities at the military base, striving par with other medical facilities in the country and in the region Currently, military physicians not only undertake health policy of Vietnam Communist Party, and VN Government but also participate in combined military operations civilian medical and health care for the people, the work of epidemic prevention, disaster recovery and begin to engage in humanitarian activities, peace protection of the UN During the journey of dedication and maturity, military physicians have the example of the will of fighting, the attitude of serving patients, demonstrating sublime qualities of military doctors Uncle Ho's soldiers loved by the army and people Central Resolution 9 course XI has identified, along with the socioeconomic development of the country "The recession in terms of ideology, politics, ethics and lifestyle within the Vietnam Communist Party and in society tends to increase" [17, p.155]. Due to the impact from the downside of the market mechanism, of individualism, there has been led to the decline of morality and lifestyle of a section of officers and Vietnam Communist Party members, including medical staffs Having a phenomenon of running after money, lack of sense of responsibility when serving the sick, and looking down on health and life of the patient have reduced the confidence in the army and the people. Some officials and medical staffs have misconceptions about ethical values, neglect of selftraining and self care. If the negative expressions are slowly recovered, the confidence of the people for the good traditions of the health sector in general and military medicine in particular will be eroded In terms of theory, there have been many research projects and ethical course of moral education for physicians in the country and the world. However, the problem of development of medical ethics of military physicians, particularly in terms of market economy, international integration has never been studied systematically by any authors Finding answers to the issue of medical ethics development of military physicians in the new era is an objective requirement, which is urgent both theoretically and practically. For these reasons we selected the issue on the Development of medical ethics of military physicians to address my doctoral thesis 3. Purpose and tasks of the research 3.1. Research purposes Study the rationale and survey of the ethical status of military physicians; propose measures of development of medical ethics of military physicians in the current situation 3.2. Research Tasks Study the rationale on medical ethics and the development of medical ethichs of military physicians Survey analysis and evaluate the development of medical ethics of doctors and the causes of the restriction Propose measures to develop medical ethics of military physicians today Conduct empirical measures of some measures to develop medical ethics of military physicians 4. Object, subject and scope of research 4.1. Object of research The process of education, cultivation, and training the dignity of military physicians 4.2. Subject of research The development of medical ethics military physicians in current period 4.3. Scope of research Content: The thesis studies on the rationale, practices and measures of human medical ethics development of military physicians The survey's objectivity: physicians working in hospitals, institutions, schools and military units; students studying in the military field;patients and patients' relatives Time: the survey data collected from 2009 to the present 4.4. Hypothesis Development of medical ethics of military physicians now is dominated by objective factors and subjective conditions in the market mechanism, the development of modern medicine, as well as the characteristics of the medical profession in military. If we combine political and ideological education, medical ethics and medical law, military discipline and raise the level of expertise as well as participate in the fight of prevention of and against corruption in practice, medical ethics of military physicians will be developed 5. Methodology and Methods of Research 5.1. Methodology The research project is based on the view of dialectical materialism, thought of Ho Chi Minh, and the line of Vietnam Communist Party about revolutionary ethics and education of the development of medical ethics The research project was conducted on the access of system structure, historical perspective – logical, developing perspective activity, practical perspective to analyze, evaluate, and review related issues 5.2. Methods of Research The thesis uses the combinations of the following methodologies: The theoretical research methods The practical research methods The support methods 6. New contribution to the thesis Reasoning: The thesis overviews ideas and work on medical ethics, build concepts to clarify the issues of ethical reasoning and medical ethics development of the physicians, launches the content and criteria to evaluate the development of medical ethics, points out the role as well as the factors affecting the development of the medical ethics of military physicians in current period In practice: clarify the current situation, characterize human activities of military physicians; practically evaluate the development of medical ethics with objective data, point out the experience and trends of medical ethics development of military physicians, propose measures to develop medical ethics of military physicians today 7. Theoretical and practical meaning of thesis The reasoning: The thesis contributes additionally to the rationale on medical ethics and medical ethics development of physicians in general, and military physicians in particular On reality: The thesis provides document on the status of the medical ethics development of physicians, proposes measures to develop medical ethics of military physicians. The thesis can be used as a reference in research, teaching, training medical ethics and management for trainers, managers at the military medical units and hospitals in and outside the military 8. Structure of the thesis The thesis includes: an introduction, an overview of research issues, four chapters (11 periods), conclusions and recommendations. In addition, there is a list of published works by authors, portfolio of references and appendices OVERVIEW OF THE RESEARCH Studies of medical ethics and medical ethics development abroad 1.1. Thoughts of medical ethics and medical ethics development in the world The moral issue of physician (medical ethics) was formed and developed very early in the history of world medicine. In civilization, historical period in the East or the West has made the teaching, medical and ethical basis, regulations, ethical standards for practitioners. Under development line of the history of medicine, medical ethics conceptions is gradually completed and there have been published works about the rules of ethics in the practice of medicine and human health. These are the basic ethical standards that physician must have during their professional activities 1.2. The foreign research on medical ethics and the development of medical ethics Overseas, medical ethics issues, education, development of medical ethics of physicians have been studied under many different angles, as represented by the following works: The teaching of medical ethics , the premise of medicine by Pappworth M.H. (1978); The first issue of Healthcare by Butterworths Heinemann, Nigel C.H Stott (1983); Ethics in medical practice by Verlag Berlin Heidelberg, Robet K. Mckinly, Pauline A. Mc Avoy (1996);Awareness of medical students on medical ethics education program by Johnston C. and Haughton P (2007). In their studies, the authors have mentioned the need to educate medical ethics in teaching, in clinical practice and health care. Also, the authors also point out the principles in practicing professional ethics of physicians Studies of ethics and medical ethics development in Vietnam 2.1. Thought of medical ethics and medical ethics development in Vietnam Ethics of physician Vietnam was formed and developed under the history of the medicine of the country. At first, it has the color of compassion, charity, morality influenced by oriental traditions, on the basis of Confucianism and Buddhism, creating distinctions in medical ethics in Vietnam Typical thoughts about ethics in medicine of home countries are as: Pham Cong Ban (13th century) but came home to treat diseases for poor people. Chu Van An (1292 1370) was a physician, a teacher with virtue and talent. According to him, the crux of medicine profession is the humanirity. There must be humanarity then there will be intelligence, and intellectuals. Morality is the most important of the physician. Great physician Tue Tinh (Nguyen Ba Tinh, 13251399) has actual medical opinion and humanitarian. He advised the physician to do good, to help patients with a wide range, to bring the happiness for posterity. Hai Thuong Lan Ong Le Huu Trac (1720 1791) is the one who constructs the system of ethical standards for medical practice in Vietnam on the basis of inheriting the ethical ideology from Eastern culture to fit with Vietnam culture. Ethical issues was raised to new heights revolutionary medical ethics by President Ho Chi Minh According to him, ethics is not only a love for the patient, but also professional awareness, the cultivation to enhance the professional capabilities in order to better meet the demands of caring for and protecting the health of the army and the people 2.2. The domestic research on medical ethics and the development of medical ethics In Vietnam, the issue of medical ethics and medical ethics education has also attracted the attention of many researchers and scientists. There have been many published works, including a number of works such as: Development of health work in our country in the current phase of Do Nguyen Phuong; Viewpoints on medical ethics of President Ho Chi Minh in Vietnam Health sector currently by Phan Viet Dung Tran Van Thuy; State Administration by law in the health sector in our country today by Nguyen Huy Quang. In these works, the authors have clarified the views on the care and protection of people’s health , set ethical requirements for physicians in accordance with the thought of Ho Chi Minh, studied the works of formulation, promulgation and implementation of laws and the handling of violations of the laws of health In the field of military medicine, There has also been a number of research projects such as: Improving the quality and effectiveness of the military medical guarantee by Nguyen Van Thang; Communication problems of military medical doctors with the patient during medical treatment by Nguyen Thi Thanh Ha; The solutions of combined medical ethics education through teaching specialized medicine subjects by Nguyen Quang Phuc; Improving the quality of VN communist party work and the work of politic contributes to fostering medical ethics in the military hospitals in the new situation by Nguyen Hong Giang; Research on solutions to improve the quality and capacity of medical staffs in the level of military detachments in the condition of the current economic market by Vu Dang Khien The authors have stressed that military physicians have to dedicate in their work, communicate sensitively, and consider the health of patients as the health of their family members. In medical ethics education both professional competencies and personal qualities of physicians should be concurrently developed to enhance the political and ethical movement of military medical staffs, which meet the requirements of the current military operation General evaluation of research results of scientific works published and issues the thesis focuses on solving 3.1. General evaluation of the research results of scientific works published The above studies have mentioned aspects of medical ethics and medical ethics education, including the following outstanding results: Having clarified the importance of ethics in health care for patients. The physician must know how to selfimprove and professional ethics in medicine, to give treatment, to rescue people so as to fulfill his duties Having already mentioned the content of medical ethics of physicians. The authors suggest that genuine physicians have characteristic qualities, that is ideal, professional ethics, all for the patient's life Having proposed rules, ethical standards. Provide advice, guidance on ethics in the activity of medical and pharmaceuticals, in communicating with patients, in scientific research and clinical trials However, the research also shows: Not having clarified the ethos of medical ethics of ilitary physicians currently Not having clarified the influence of market mechanisms on medical ethics of military physicians , value orientation, the outlook on life of the physician, as well as measures to develop medical ethics in processes of medical practice Studies just stop at the general level for the target audience of doctors, medical students and medical practitioners and military medical officers, without referring to other subjects such as nurse, orderlies, nurses, pharmacists, assistant pharmacists 3.2. Issues the thesis focuses on solving Based on the above analysis, the thesis focuses on the following issues: First, clarifying the peculiarities of medical ethics of military physicians. Military pysicians are both medical personnels, and soldiers Their serving objects are war invalids, sick soldiers, the troops and the people. Their working place is often difficult, remote, mountainous areas, border and island. Medical condition is often in war field with insufficient medical equipment Second, analyzing the expression of medical ethics so as to see the peculiarities of medial ethics of military physicians Third, clarifying the process of education, medical ethics development. It is the process of education, training, ethics training for the physicians – soldiers. There should be processes, principles and specific methods, starting from the military medical school to activities in the health service Fourth, clarifying the relationship between ethics, politics and law. Medical ethics of military physicians relates to the objects of service, to military tradition, social system and laws of the state. This is an issue that needs to be studied both in terms of theory and practice 10 Fifth, clarifying the development of medical ethics in scientific research and clinical trials. Medical ethics must now be conducted in scientific research, in clinical trials, corresponding to the development of modern medicine These issues will be studied in a systematic way in the thesis: "Medical ethics development of military physicians currently." 14 Education, medical ethics training and ethical selfeducation, self discipline cultivate ethical dialectical relationship with each other. Education, and training ethics create conditions, the premise which are the basis for selfeducation, selfcultivation ethics training; meanwhile, selfeducation, and selfdiscipline promote the development of medical ethics of every military physician Practices against negative manifestations in the health sector and in military medical units The effectiveness of the fight against all manifestations of negative ethical of military physicians depend on the combination of building the revolutionary ethics, with resolutely fight against all negative manifestations taking place in the sector and in military medical units 1.3. Content of the development of medical ethics and evaluation criteria on the development of medical ethics of military physicians 1.3.1. Content of the development of medical ethics of military physicians First, developing medical ethics ideal of revolutionary physicians Second, deeply imbuing with ideology "A physician must be as a gentle mother" of President Ho Chi Minh Third, forming the discipline and willpower in medical preofesion activities Fourth, strictly implementing ethical standards in every clinical situation Fifth, developing medical ethics associated with awareness of politics and law Sixth, developing the capacity of leading, and managing military medical activities 1.3.2. Criteria for evaluating the development of medical ethics of military physicians Criteria for evaluating the development of medical ethics of military physicians include: ethical awareness; ethical feelings; ethical beliefs;ethical wills Criteria for evaluating the development of ethical attitudes of military physicians include: attitudes towards patients; attitude with colleagues, with the masters; attitude with society, community; attitude to work and with oneself 15 Criteria for evaluating the development of ethical behavior of military physicians include: Acts of responsibility in activities of treatment for patients; Acts of communication, dealing with all objects; Activities of fostering ethical selftraing and selfdiscipline; The observance of the regulations, statutes and laws of the state Conclusion Chapter 1 Medical ethics is one of the basic elements of human nature in general and military physicians in particular. In every period of history of the development of medicine, medical ethics of physicians always be honored and is the concern of the whole society. As our society develops, the medical ethics of physicians is also improved. The development of medical ethics of physicians aims to build Vietnam medicine and modern military medicine, humanities to respond to the demands of military development, the country in the trend of international and region integration 16 Chapter 2 RATIONALE OF MEDICAL ETHICS DEVELOPMENT OF MILITARY PHYSICIAN CURRENTLY 2.1. Methods of doing survey and assessing the situation * Survey purpose: To evaluate comprehensively and closely to the characteristics of the medical activities of military physicians. As a basis for proposing practical measures to develop medical ethics of military physicians today * Survey content: Evaluating the development of consciousness, attitudes, and ethical behavior of military physicians; Program, contents, methods and forms of education, ethics training for military physicians and the medical ethics environment in military * Survey objects, location, and time: Survey objects: The total number of respondents is 668 people, including 453 doctors ; 120 military cadets; 95 patients Survey areas: the tertiary health centres of military, hospitals, military medical unit in the military regions, corps, army troops, and at Vietnam Military Medical University Time survey: from February to June 2014 * Survey methodology Research, survey, observe, exchange and dialogue. Using mathematical statistical methods with the aid of SPSS software version 16.0 for data processing 2.2 The development of medical ethics of military physicians currently 2.2.1. Subjects of ethical development Assessment results of the development of medical ethics of military physsicians shows: Most of the military physicians develop 17 their awareness, attitude and good ethical behavior. However, some doctors’ development of medical ethics is at the level of "Medium". These limitations manifest in cognitive distortions about the role, the importance of medical ethics and attitude in resolving ethical relations and ethical behavior of each physician, but also spread influence on building ethical environment, comprehensive strong unit and the education, training, ethics training of military physicians 2.2.2. The external impact promoting the development of medical ethics According to the physicians participating in the survey, the leaders, commanders at all levels in the military sector have been concerned with the education, ethics training for medical workers, have selected content, and have used flexible forms and methods to conduct education and fostering ethical matching with characteristics of activities of medical physicians. However, the work of building programs, contents, methods and forms of education and training towards strengthening ethics education, values education, ethical standards is limited; the effects of education are general, not very effective Physicians themselves have no their own plans for the education and training of the medical ethics 2.2.3. The cause of the limitations First, the impact of the social situation and the downside of the market mechanism Second, the shortcomings in the education and fostering ethics process Third, selfeducation, selfcultivation and selfdiscipline of the medical ethics of military phyicians are limited 18 Fourth, the cultural environment, politics, ethics in the military medical unit has not been promoted in developing ethics 2.3. The lessons learned about the development of medical ethics of military physicians First, there should be regular education, fostering ethics for military physicians to fit the characteristics of military medical sector Second, negative manifestations in health care activities should be timely prevented Third, enhancing professional competence, communication style for military physicians Fourth, building a strong military medicine force, a clean and healthy medical ethics environment Conclusion Chapter 2 Activities of military physicians are particular activities, associated with high responsibility, courage and bravery in the medical work, to ensure the health and lives of patients. Over the years, military physicians always cultivate their ethics training to overcome all difficulties and shortages to maintain physical health, medical ethics and themselves. But compared to the requirements of military medicine, the demands of the army and the society for medical work in the new situation, the development of medical ethics of military physicians also reveals some limitations Evaluating, surveying the current situation, identifying the causes, drawing the lessons from developing medical are the basis for us to propose measures for the purpose of developing medical ethics of military physicians currently in order to meet the demand of health care for the troops and the people in the new situation which will be presented in the next chapter 19 Chapter 3 MEASURES OF DEVELOPING MEDICAL ETHICS OF MILITARY PHYSICIANS CURRENTLY 3.1. Development Trend of medical ethics and the problems faced with military physicians today First, maintain and develop the traditional ethical values which is a key role in the developing medical ethics of military physicians Second, consider the use of modern technical equipment, look down on ethical standards in clinical activities Third, "chasing" social needs, look down on education, and ethics training Fourth, enhance physical benefits which are obstructing the cultivation of the development of medical ethics of military physicians 3.2. Measures to develop medical ethics of military physicians 3.2.1. Combining education with political and ideological education and moral law for military physicians Improving the quality of political and ideological education and revolutionary ethics for military physicians Education and dissemination of health law, professional regulations, ethical rules suit each content, and each object in the military medical schools and military medical units Military schools, military units often associate traditional education with oriented social values and military for their physicians Educating, and building the sacrifice virtues for the sake of patients in military physicians (a physician is as a gentle mother) Educating, and practicing the profession, building responsible conscience of military physicians 3.2.2. Revolutionary ethics education in accordance with the thought of Ho Chi Minh 20 Educating, and building in military physicians the absolute loyalty to the Fatherland, VN communist Party and the People; Self reliance in overcoming difficulties, ready to receive and complete tasks; strictly abide by state law, military discipline, regulation of the sector Military physicians bring all of their expertise to examine, treat and care for patients; devote to the cause of caring for and protecting the health of soldiers and people Developing in the physicians tender hearts, caring attitude and courteous when exposing to the patient. Do not have the attitude of favors, authoritarianism, abuse professional to harass and cause inconvenience to the patient Developing humility, cooperation and solidarity to help each other; having healthy lifestyles, truthfulness, thrift, integrity, primary and public, and impartial Building in military physicians motivation to learn, research and train to improve themselves comprehensively 3.2.3. Developing programs for professional medical ethics taught in schools and training in military medical units Asking to develop programs, course content for medical ethics: Content of medical ethics courses in details: Topic 1, Introduction of ethical history and medical ethics Topic 2, Idealizing medical ethics through the medical oaths Topic 3, The basic principle of medical ethics Topic 4, Building relationships between patients and physicians, colleagues, and social community Topic 5, Educating medical profession for military physicians Topic 6, Enhancing 3.2.4. Encouraging and facilitating military physicians to selfeducating, and selftraining medical ethics Promoting the role of military physicians in selfeducation, retraining and selftraining to develop medical ethics 21 Regularly educating, building and fostering doctors’ professionscapacity, selfeducation, selftraining and selfdiscipline to develop medical ethics in military physicians Making military physicians regularly selfeducate, selftrain and selfdiscipline their medical ethics 3.2.5. Building a healthy ethical environment in military medical units and strictly implementing the provisions of law on health and military discipline Gradually building and perfecting the laws and ordinances of health for the organization and management of the sector to meet the development requirements of modern medical science Organizing and managing the implementation of health legislation to ensure effectiveness, efficiency Strictly punishing the violation of the law on health Leaders of units take care oftheir officers’ lives and ensure better policies for military physicians Regularly taking care of a really clean and healthy building ethical environment in military medical schools, and military medical units Conclusion Chapter 3 Development of medical ethics of military physicians currently is a long process with many difficulties and complication in trends containing both objective and subjective factors In one side, it creates an impetus for the development of medical ethics On the other hand, it causes the obstruction indeveloping medical ethics of military physicians In order to have the appropriate and effective education measures, education stakeholders must see performance characteristics of the profession, the efforts of the forces of education, training, ethics training and the activeness of military physicians 22 Chapter 4 EXPERIMENTAL TEACHING 4.1. Common issues on experimental teaching 4.1.1. Experimental purposes To test the validity of scientific theories, the feasibility of the proposed measures 4.1.2. Experimental Tasks To organize pedagogical impact: Through fostering and organizing educational activities, training for experimental objects 4.1.3. Experimental Hypothesis If the implemention has effective impact on a teaching intentionally, if there are programs and plans closely with content chosen by each specific topic, if using reasonable methodologies through activities of education and selfeducation for medical ethics training of the physician, the medical ethics will be developed 4.1.4. Experimental time The experimental time was conducted from August 2013 to September 2014 4.1.5. Experimental location Experiments were conducted at Vietnam Military Medical University 4.1.6. Experimental Content The military physicians cultivate ideological revolution of HCM and build and organize teaching medical ethics in schools and in military units 4.2. Organizing experimental teaching 4.2.1. Forces taking part in experiments Organizing experimental groups and control group: experimental groups: 28 resident doctors, the control group: 29 resident doctors 23 Forces taking part in experiments: the thesis author and collaborators 4.2.2. Time and measures used in experimental teaching From August 2, 2013 to September 26, 2014 4.2.3. Develop criteria for evaluating experimental results The thesis builds three basic criteria, each criterion is weighted according to the following levels: excellent level: from to 10 points; passable level: from 7 to less than 9 points; Average level: from 5 to less than 7 points; weak level: 1 to less than 5 points 4.2.4. The methods used to process experimental results Calculating the percentage % of possible answers; calculate average point; standard deviation 4.2.5. Comparing the difference between the outcome between experimental group and control group TStudent test helps us figure out the difference in outcome between experimental group and control group so as to prove the effectiveness of measures 4.3. Assessment Experimental teaching results The results of the excellent and passable in experimental group in all phases are higher than control group. Namely: excellent level: experimental Group: 7.1%; 17.9% and 46.4%, while the control group: 0.0%; 3.5% and 17.2%; Passable: experimental Group: 39.3%; 60.7% and 46.4%, while the control group: 24.1%; 31.0% and 51.7% Meanwhile in experimental group, the average number of resident doctors ranked lower and weaker than the control group. Namely, the average level: experimental Group: 46.5%; 21.4% and 7.1% lower than the control group: 65.5%; 58.6% and 31.1%; Weak: experimental group: 7.1%; 0% and 0% lower than the control group: 10.3%; 6.9% and 0% 24 The results demonstrate measures of developing medical ethics of military physicins curently are effective in experimental group. We perform the above result on the following chart: 25 1. Experimental groups Phase 1 Phase 2 1. Control group: Phase 1 Phase 2 Phase 3 Phase 3 Chart: 4:13: The development of medical ethics in experimental group and control group In summary, the proposed measures and experiments are upheld survive a high rate, reaching 91.6% of the need and feasibility. In particular, measure 2 reached 94.14% and 91.28% of the required feasibility; measure 3 reached 96.28% of the need and 92.42% of the required feasibility. The priority order of measures from high to low are: 3, 2, 1, 5 and 4. Among all of the 5 measures, the need reaches from (86.70% 92.28%); the feasibility reaches from (80% 90.26%). This indicates that, the proposed measure is a scientific basis, and suitable with the practices of medical ethics development of physicians at present 26 Conclusion chapter 4 Further analysis on the experimental results, we found test results on the development of ethical consciousness, ethical behavior and ethical manner of military doctors are correlated proportionally. The rise of ethical awareness has been accompanied by an increase in ethical behavior and ethical manner. That is, the physicians who have a high sense of ethics also have the development of ethical behavior and ethical manner respectively. With mesures of ethical content and ethical development of the military physicians, the purpose of the experiment was achieved experimentally. The thesis has affirmed the values, science and the effectiveness of measures to develop medical ethics of military doctors. At the same time, the scientific hypothesis of the thesis has been tested and proven 27 CONCLUSIONS AND RECOMMENDATIONS 1. Conclusion 1. Medical ethics is one of the basic elements of personality of military physicians. Development of medical ethics is to perfect the personality of military physicians to improve the quality of trreatment, care and health protection for the troops and the people, contributing to improving the combat power of the army. Development of medical ethics of military physicians also engages in the construction of a new ethics, new man, struggling to overcome the degradation of moral, society and lifestyle in today's military 2. From the perspective of Marxism Leninism and Ho Chi Minh, the view on Vietnam Communist Party about the moral of revolutionary ethics of military physicians. The dissertation clarifies the present development of medical ethics through moral concepts, professional ethics, medical ethics and the concept of development of medical ethics of military pphysicians; the thesis points out the role of development of medical ethics, clarifies the contents of development of medical ethics, develops criteria for evaluating the development of medical ethics of military physicians 3. The thesis has shown the impact factor, the status, causes, experience, ethics and trends of medical ethics development and proposed measures of development of medical ethics of military physicians presently ; simultaneously, conducting experimental teaching to clarify and affirm the necessity, feasibility, science, the effectiveness of the proposed measures 4. Development of medical ethics of military physicians is an issue which is not only directly significant, urgent, but also basic and significant in long term. This is a research project which is broad, deep and comprehensive, and requires a further research on many different aspects. From the perspective of school education, the thesis at first identified significant problems with methodologies. Based on the achieved results, the author will continue researching to complement, complete, develop the research questions and contribute to clarify the theoretical issues and practical imperative setting in developing the medical ethics of military physicians currently 2. Recommendations 28 1. Vietnam Communist Party, the State, and the Army should continue to further strengthen the fight against corruption and the campaign "Study and follow the moral example of Ho Chi Minh", effectively overcome the negative social problems today. Constructing cadres and Party members in general, and military physicians who has bright and clean lifestyle in particular; Considering this as a routine task to improve human quality in military medicine, building the environment of culture on ethics, and building comprehensive and strong military units in all aspects 2. The Ministry of Health, medical medicine need continue to research and develop the theory of medical ethics education; Compile document on ethical standards of the physicians and build programs, educational content on medical ethics as an independent task with duties of researching, further teaching on medical ethics; Innovate the content, formal methods of education, foster ethical by combining medical management, medicine and ethics in order to be consistent with the characteristics of the military health sector of military physicians 3. The Ministry of Health, and the Department of Defense need to study the proposed regime, rational policy, take care of officers’ material and spiritual life, ensure a stable life for the medical staffs, inadequate with specific job in the military field. There should be a policy for staff training in the rationale and science. There should be an incentive regime, and priorities for those military physicians, military students, military officers and military practitioners working in remote, disadvantaged, mountainous areas and borders of the country 4. The authorities, especially the political authorities of the educational institutions, schools, military academies, military units may use the research results of the thesis in compiling the content and conducting educational work and can apply professional ethics program to organize medical education for medical students, military trainees, training for officers and soldiers in the military unit, contribute to the improvement of professional ethics for military physicians ... proportionally. The rise of ethical awareness has been accompanied by an increase in ethical behavior and ethical manner. That is, the physicians who have a high sense of ethics ... the characteristics of the medical activities of military physicians. As a basis for proposing practical measures to develop medical ethics of military physicians today * Survey content: Evaluating... values and military for their physicians Educating, and building the sacrifice virtues for the sake of patients in military physicians (a physician is as a gentle mother) Educating, and practicing the profession, building responsible