s a basic aspect of human study, ethics is regarded as discipline and practice. As far as clinical research, ethically justified criteria can be identified by obligations to both the researcher and human subject [1][2]. There are some main sides of ethics in research, such as informed consent, confidentiality, privacy, privileged communication, and respect and responsibility. Medical ethics is the core of health system and hospital management, so it should be widely concerned and paid attention [3]. The main functions of noble medical ethics are to improve the health care reform, build a harmonious society, and achieve universal access to health services. However, due to healthcare and society environment change, medical ethics is worrying [2]. There are some immoral behaviors, such as accepting a bride, giving expensive medicine, and getting rake-off. Under the circumstance of increasing number of hospitals, doctors, and patients, public hospitals in China undertake the most of medical treatments, which is an challenge not only for hardware of hospitals, but also for software of hospitals, that is, doctors' professional ethics [4][5].

We use literature review method, Delphi method and expert consultation to get overall information of medical ethics in domestic and foreign, to get strategies to optimize.

A systematic literature search of Englishlanguage and Chinese-language articles on Pubmed, ISI web of knowledge, Science direct, Google scholar, the Cochrane database of evidence-based reviews, and the Database of Abstracts of Reviews of Effects was performed by connecting the Mesh terms ("ethics evaluation", "medical research", "research ethics evaluation", "medical education", "research ethics principles").

System in Chinese Public Hospitals

Public hospitals are the window of city spirit. Doctors' ethics can influence the first impression about cities. In order to enhance practicing doctor management, improve doctors' ethics, ensure medical quality and safety, Chinese government formulates some rules to regularize doctors' behaviors, such as regular evaluation, self-evaluation and department evaluation [6]. However, although public hospitals have taken medical ethics into performance evaluation, basic researches are lacked and evaluation system is deficient.

With the development of market economy, some public hospitals despise medical ethics education, but pay much attention to physician quality. Nowadays, ways of ethics education are backward, and training methods are simple, which cannot keep pace with thoughts of doctors, making them short of sense of identity [7,10]. Unfortunately, a few doctors' ethics is weakened by the market economy. Also, utilitarianism is been increased. They are lack of service awareness, patient relationship nervous, which damages the image of doctors [8].

Although Chinese government attach extreme important to ethics evaluation, medical ethics education and building can be value by China. China is short of perfect mechanism and system to supervise and manage for medical ethics education [9]. These disadvantages cannot ensure evaluation on the rails. What is more, some public hospitals are careless, don't archive evaluation documents, and don't establish incentive mechanism. So, government should, in order to enhance effectiveness and pertinence of medical ethics evaluation, improve evaluation system, complete evaluation mechanism to reduce doctor-patient contradiction.

In recent years, bribery cases are occurred frequently in pharmaceutical sales. Due to profit-driven, leaders in public hospitals use their purchase power to accept briberies, which are offered by pharmaceutical companies so that they loosen supervision for new medicines and medical equipment. Pharmacists with drug purchase power use their position advantages to get briberies [10][11]. Moreover, doctors with prescribing lead patients to prescription of expensive and excessive drugs. Those behaviors not only violate patients' benefit, but also damage social morality. Furthermore, market and medical order are disturbed by those behaviors, forming unfair competition, making high price of medicines, and aggravating financial burden for patients [12].

Although Chinese government still promotes medical ethics evaluation, establish medical ethics documents, there is not obvious effective for medical ethics evaluation, as leaders are indifferent for evaluation results [13]. Results never are used to be evidences for promotion position and titles, and further study. Evaluation has a guiding role for people. If evaluation results cannot be used effectively, guiding roles will lose its significance. For this reason, doctors will pay little attention to medical ethics evaluation results as well as they don't realize to improve their professional ethics [14].

Medical ethics evaluation is a baton for doctors. During evaluation process, appraisers need focus on pertinence and maneuverability to make doctors on their ethics track. Though medical ethics evaluation, appraisers can judge doctors' behaviors to strengthen doctors' ethics consciousness, improve their selfdiscipline. Medical ethics evaluation system must include who evaluation, evaluation who, what evaluation, how to evaluate, and what to do [15]. Evaluation system need to be designed by works, duties, and behaviors to make sure systematicness and integrity.

In performance evaluation, hospitals are inclined to use 360°performance appraisal. Similarly, this method also is used in medical ethics evaluation [8]. Appraisers need to know who will be evaluated. Also, they need be fair and equal. What is more, doctors should be assessed from every aspects, such as leaders, colleagues, and external staffs [12].

i. National Health and Family Planning Commission National health and family planning commission is direct supervisor of public hospital in China. Leaders of national health and family planning commission must realize that medical ethics evaluation is the most important component content for developing medical and health services, perceive medical ethics problems in public hospitals, and come up with constructive suggestions and remediation actions, according to circumstance and epoch [16]. Furthermore, leaders should put forward rules and policies for developing medical ethics evaluation in public hospitals. National health and family planning commission shoulders a responsibility to improve the doctors' ethics in China. It also needs to enhance spiritual civilization in public hospitals, doctors' responsibility. Last but not least, it have to attach much importance to carry on medical ethics evaluating.

ii

At the last stage of evaluation, the most important thing is to avoid blaming and passing the buck between doctors and appraisers. Therefore, public hospitals should establish a Responsibility Group to assign a first-in-charge person, who is in charge of evaluation results, feedback evaluation suggestions and rectification results. Moreover, two organizations should be established: one is that party secretary and president need to be the first-in-charge person in hospitals; the other is that directors, head nurse should be the first-incharge person in each department. Though this way, hospitals form a One Position, Two Responsibility dynamic mechanism to make sure medical ethics evaluation in order [17].

iii

Chinese public hospitals are lack of a complete organization system to evaluate medical ethics, which generates that medical ethics evaluation becomes formalistic. Perfect organization system is the most important prerequisites for keeping evaluation smooth.

Volume XV Issue VIII Version I Year ( ) A Firstly, leaders should pay much attention to evaluation work to make sure the process going well. Secondly, hospitals should establish two-stage organization [18][19]. Department of medical ethics management is charge of evaluation and ranking. What is more, evaluation committee is constituted by leaders to evaluate uniformly and carry out specific works.

Negative List is an international management method for foreign investment. And it is a business list for nation to prohibit foreign investment into China or restrict the ratio of foreign investment [20]. It is like a blacklist in investment area, which includes many management measures, such as national treatment, most-favored-nation treatment, performance and management request. Chinese medical ethics evaluation should imitate Negative List Management System to notify the cordon of medical ethics evaluation for doctors.

According to the situation of the first affiliated hospital of Chongqing medical university, leader established a complete and scientific medical ethics evaluation system, including Rules of Strengthen Style Construction of Medical Staffs -Twelve Prohibits in the first affiliated hospital of Chongqing medical university, Methods for Constructing Honest Party in the first affiliated hospital of Chongqing medical university, and Liability System to Build Honest Party and Anticorruption. The first affiliated hospital of Chongqing medical university use Twelve Prohibits as Negative List.

In principle, Chinese government laws should be the standards for medical ethics evaluation standards. For example, Medical Moral of Medical Staffs in the People's Republic of China is formulated by National Health and Family Planning Commission. In the process of evaluation, each city need supply and intensify evaluation criterions, according to their own characteristics.

iii. Improve Doctors' Awareness of Medical Ethics Doctors should realize that medical ethics evaluation is the most important component content for medical ethics construction. Evaluation not only improves doctors' qualities, but also punishes immoral behaviors. As we all know, to change one's behaviors is the lengthy process. Doctors should learn more knowledge about medical ethics. Moreover, hospitals should carry out Mobilization Corporation regularly for evaluation, organize medical ethics lessons and seminars, and request doctors to learn documents, which are formulated by government, in order to improve consciousness.

How to treat evaluation results is related to doctors' attitude towards medical ethics evaluation, functions of evaluation, and subsequent measures.

This document, which is kept forever, is an original record for recording doctors' medical ethics behaviors. Also, it can be the most important substratum for doctors' performance evaluation.

ii. Reward Advanced Doctors for Remarkable Medical Ethics Hospitals could set up individual reward for medical ethics in end-of-year evaluation. Counterparts and patients select a doctor with remarkable medical ethics together, and give him award. However, doctors with inferior medical ethics should be punished severely.

iii. Punish and Warning According to severity, hospital should dispose the doctors with inferior medical ethics.

For evaluation unqualified, hospital should suspend or cancel their qualification of specialist clinic and operation; teaching; applying scientific projects; assessing professional; and further study.

For low scores, hospital and department should give a warning to help them correct.

Medical ethics is a social ideology. Though medical ethics evaluation, people can distinguish good and evil, and transform it into specific behavior. Medical ethics education and evaluation are complementing each other, mutual complementation. Hospital should do medical ethics education integrating medical ethics evaluation. Furthermore, though the feedback from patients and society, hospital can use them for vivacious examples. Hospitals should improve consciousness of medical ethics evaluation to promote development of medical ethics construction. For gravity of the circumstances, hospital should investigate the legal responsibility, according to the Criminal Law of PRC, the criminal cases relating to commercial bribery.