‘Family-centred care’ in American hospitals in late Qing China Michelle Renshaw Inspired by the consumer-led movements of the nineteen sixties, and encouraged by research from psychologists who wrote about 'maternal deprivation' of institutionalized children, American parents had started to campaign against restrictions on visiting their children in hospitals. 1 In Massachusetts they formed ‘Children in Hospitals’, an organisation which, in 1973, started to conduct and publish bi-annual surveys of visiting hours in the state’s hospitals. It is unlikely they could have foreseen their activism leading to the widespread adoption of an entirely new approach to patient care that pertains in American hospitals today. 2 This new policy approach goes by the name of 'family-centred' care. Developed originally with children in mind, one of the first concrete moves in its direction was legislation passed in Massachusetts in 1980 requiring hospitals to institute twenty-four- hour family access to paediatric wards. 3 Today it is a well-developed system with an agreed set of principles and protocols. 4 Over the years it has extended its reach and is increasingly being adopted by hospitals for the aged as well as for adults in acute care hospitals. 5 Like fathers wanting to be present at the birth of their child – including those carried out by caesarean section – family members are expecting to be present even during invasive and emergency procedures. 6 The cornerstone of the family-centred policy – emphasized in many hospital advertisements – is a belief that 'health care providers and the family are partners, working together to best meet the needs of the child.' 7 Of course, neither the idea nor the practice of families caring for their sick is new and, before the advent of hospitals for other than the very poorest of them, patients were routinely cared for at home with occasional visits from a physician. What is new in America is the idea that the family should take on a significant, if not central, role in patient care within the hospital setting. But, there have been manifestations of the American hospital from which the family was never excluded – those established by Protestant missionaries in nineteenth-century China, for example. There, the presence of family and friends was commonplace well into the twentieth century and continues in the Chinese successors of these hospitals today. 8 So, the questions I will address in this essay include: what economic, political and cultural factors operated in China to distinguish the American hospital in China from its counterpart at home, particularly in relation to the presence of patients’ family and friends? To what extent and in what capacities were these ‘visitors’ involved in the actual operation of mission hospitals? And, what were the possible consequences of the families’ involvement, so far as outcomes were concerned, for the Chinese patients, their families and for hospital staff? Lacking first-hand contemporary accounts by either Chinese patients or their families, I rely on annual reports published by a wide range of hospitals operated by various missionary societies and articles in missionary journals, particularly those written for and by medical missionaries. For the history of hospitals and present-day practices in America, I use secondary sources. 1