Abstract
There exists a serious shortage of organs for transplantation in China, more so than in most Western countries. Confucianism has been commonly used as the cultural and ethical reason to explain the reluctance of Chinese and other East-Asian people to donate organs for medical purposes. It is asserted that the Confucian emphasis on xiao (filial piety) requires individuals to ensure body intactness at death. However, based on the original texts of classical Confucianism and other primary materials, we refute this popular view. We base our position on the related Confucian norms of filial piety and ren (humaneness, humanity or benevolence), the tension between differentiated love and universal love, and belief in the goodness of human nature. In light of this, we argue that the Confucian ethical outlook actually calls for organ donation at an individual level, and supports an opt-out (presumed consent) system at the level of social policy. Furthermore, because the popular view is based on a number of dominant but misleading modes of thinking about cultural differences, our revisionist account of Confucian moral duties regarding organ donation has implications for developing a more adequate transcultural and global bioethics. These will be discussed and expanded upon.
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Notes
Literature on Jewish ethics is vast and there are always disagreements, just as it is the case with Confucian ethics or any other major moral tradition. According to Tana D’Bei Eliyahu 27, “If a person has enough food in their house and wishes to use it for charitable purposes to support others, they should first support their father and mother; if there is anything left, they should support their brothers and sisters; if there is anything left, they should support other relatives; if there is anything left, they should support their neighbor; if there is anything left, they should support those who live on the same street. Thereafter, they should distribute charity liberally to the rest of Israel.” And according to Babylonian Talmud Bava Metzia 71a, “Rabbi Yosef taught [about the verse in the Torah that says]: ‘If you lend money to any of my people that are poor with you.’ [This verse teaches that if you have to choose between:] a Jew and a non-Jew, give to the Jew first; a poor person and a rich person, give to the poor person first; a poor relative and poor people in your town, give to your poor relative first; poor people in your town and poor people in another town, give to the poor people of your own town first.” There are of course critical voices within Judaism: Arukh HaShulkhan Yoreh Deah 251:4 questions the above moral position by pointing out that the consequence is that “those poor who have no wealthy relatives will starve” and advocates instead that “Every wealthy man or householder must allocate a portion to poor who are not his relatives, but he should give a larger allocation to those who are his relatives; other categories of priority should be treated the same way.” (Bar-Ilan 2000).
References
(1) Primary Sources
Li, S. (1982. edition) 1596. Bencao Ganmu (Compendium of Materia Medica). vol. 2. Beijing: People’s Health Press.
Yuan, Y. 2009. [1812] (ed.) Shisan Jing Zhushu (The Thirteen [Confucian] Classics with Commentaries and Subcommentaries). Vols 5. Beijing, China Bookstore.
(2) Other Chinese and English References
Bar-Ilan, University. 2000. The responsa project. Ramat Gan: Bar-Ilan University.
Cai, Y. 2013. On the impacts of traditional Chinese culture on organ donation. Journal of Medicine and Philosophy 38: 149–159.
Ch’en, Ch’un. 1986. Neo-confucian terms explained [trans. and ed. W. T. Chan]. New York: Columbia University Press.
Chan, W. T. 1963. A source book in Chinese philosophy. Princeton: Princeton University Press.
Chen, Y. P., and L. He. 2011. Million patients for organ transplantation. New Fast Press, C2 (in Chinese). November 14 (quoted in Cai 2013).
Chen, J. X., T. M. Zhang, F. L. Lim, H. C. Wu, T. F. Lei, and P. K. Yeong, et al. 2006. Current knowledge and attitudes about organ donation and transplantation among Chinese university students. Tranplantation Proceedings 38 (9): 2761–2765.
Cooper, W. C., and N. Sivin. 1973. Man as a medicine: Pharmacological and ritual aspect of traditional therapy using drugs derived from the human body. In Chinese science: Explorations of an ancient tradition, eds. Shigeru Nakayama, and Nathan Sivin, 203–272. Cambridge, Massachusetts: The MIT Press.
Cuo, Q., and T. Cui. 2012. The value of Confucian benevolence and the universality of the Confucian way of extending Love. Frontiers of Philosophy in China 7 (1): 20–54.
Ding, S. Q., H. Lei, and J. S. Xu. 2010. The study on legal system of organ transplantation and donation. China Healthy Affair Management 5: 325–326. (in Chinese, quoted in Cai 2013).
Döring, O. 2009. Körper und Schuldigkeit in der chinesischen Bioethik: Zur philosophischen und practischen Bedeutung von Xiao (“kindliche Pietät”) in der aktuellen Debatte. In Kultur and Bioethik, eds. C. Steineck and O. Döring, 103–122. Baden-Baden: Nomos.
DTE (Down To Earth) Staff. 2015. Confucian beliefs hindering organ donation in China. Down To Earth, 13 July 2015. https://www.downtoearth.org.in/news/confucian-beliefs-hindering-organ-donation-in-china-48183. Accessed 11 Oct 2018.
Ebrey, P. D., ed. 1993 Chinese civilization: A sourcebook, 2nd Ed. The Free Press, New York.
Fei, X. 1992. From the soil: The foundations of Chinese society (trans. G. G. Hamilton, and Z. Wang). Berkeley: University of California Press.
Gordign, B., and H. ten Have. 2018. The trilemma of designing international bioethics curricula. Medicine, Health Care and Philosophy 21: 1–2.
Ikels, C. 1997. Ethical issues in organ procurement in Chinese societies. China Journal 38: 95–119.
Jones, D. G., and J. B. Nie. 2018. Does Confucianism allow body donation? Anatomical Sciences Education. https://doi.org/10.1002/ase.1771.
Jones, D. G., and M. I. Whitaker. 2009. Speaking for the Dead: The human body in biology and medicine. 2nd ed. Surrey: Ashgate.
Lam, W. A., and L. B. McCulough. 2000. Influence of religious and spiritual values on the willingness of Chinese–Americans to donate organs for transplantation. Clinical Transplantation 14: 449–456.
Nie, J. B. 1999. “Human Drugs” in Chinese medicine and the Confucian view: An interpretative study. In Confucian bioethics, eds. Ruiping Fan, 167–210. Dordrecht: Kluwer.
Nie, J. B. 2011. Medical ethics in China: A transcultural interpretation. London: Routledge.
Nie, J. B., and R. Fitzgerald. 2016. Connecting the east and the west, the local and the universal: The methodological elements of a transcultural approach to bioethics. Kennedy Institute of Ethics Journal 26 (3): 219–247.
Nie, J. B., and D. G. Jones. 2019. Confucian ethics on the commercial use of human bodies and body parts: yi (righteousness) or/and li (profit)? Anatomic Sciences Education. https://doi.org/10.1002/ase.1876.
Oliver, M., A. Woyodt, A. Ahmed, and I. Saif. 2010. Organ donation, transplantation and religion [Editorial Review]. Nephrology Dialysis Transplant 11 (1): 437–444.
Ramzy, A. 2013. No quick fixes for china’s overwhelmed organ transplant system.
Roetz, H. 1993. Confucian ethics of the axial age. Albany: State University of New York Press.
Rogers, W., M. P. Robertson, A. Ballantyne, B. Blakely, R. Catsanos, R. Clay-Williams, and M. F. Singh. 2019. Compliance with ethical standards in the reporting of donor sources and ethics review in peer-reviewed publications involving organ transplantation in China: a scoping review. BMJ Open 9: e024473. https://doi.org/10.1136/bmjopen-2018-024473.
Tai, M. C. 2009. An Asian perspective on organ donation. Wien Med Wochenschr 159: 452–456.
Ten Have, H. 2016. The encyclopedia of global bioethics. Cham: Springer.
Tsai, D. F. C. 1999. Ancient Chinese medical ethics and the four principles of biomedical ethics. Journal of Medical Ethics 25: 315–321.
Tsai, D. F. C. 2005. The bioethical principles and Confucius’ moral philosophy. Journal of Medical Ethics 31: 159–163.
Wang, M., ed. 2015. Medical ethics. Beijing: People’s Medical Publishing House.
Wang, X. 2016. Record high for organ donations. China Daily 3 August 2016. http://www.chinadaily.com.cn/china/2016-03/08/content_23788169.htm. Accessed 14 Sep 2016.
Wang, M., and X. Wang. 2010. Organ donation by capital prisoners in China: Reflections in Confucian ethics. Journal of Medicine and Philosophy 35: 197–212.
Wang, Y., L. Bo, and M. Yi. 2015. An analysis of impasse of cadaveric organ donation in our country [China]. Medicine and Philosophy 36 (4A): 13–15.
Wu, T., ed. 2013. Medical ethics. Beijing: Higher Education Press.
Yu, K. 2013. The Dao and reasons of the classic of filial piety. Hong Kong: Huizhi Press.
Zhang, L., J. Wang, S. Kwauk, Q. Wu, K. Nielson, F. Zeng, M. Bai, and C. Wang. 2011. Preliminary analysis of factors influencing organ donation rates in China. Transplantation Proceeding 43: 1421–1424.
Acknowledgements
Thanks to Arthur Kleinman and David Jones, the paper was presented (by Nie) at the Department of the History of Science, Harvard University, in September 2018. The comments and questions from the audience proved stimulating for the revision of this paper. We thank Ted Kaptchuk and Rabbi Dani Passow for the material on Jewish ethics. The advice by the anonymous reviewer of this journal has also been helpful for revising this paper.
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Nie, JB., Jones, D.G. Confucianism and organ donation: moral duties from xiao (filial piety) to ren (humaneness). Med Health Care and Philos 22, 583–591 (2019). https://doi.org/10.1007/s11019-019-09893-8
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DOI: https://doi.org/10.1007/s11019-019-09893-8