This essay indicates that Confucian family-based ethics is by no means a stumbling block to organ donation in China. We contend that China should not change to an opt-out consent system in order to enhance donation because a “hard” opt-out system is unethical, and a “soft” opt-out system is unhelpful. We argue that the recently-introduced familist model of motivation for organ donation in mainland China can provide a proper incentive for donation. This model, and the family priority right that this (...) model supports, is ethically justifiable in terms of Confucian family-based ethics. (shrink)
This essay explores a proper Confucian vision on genetic enhancement. It argues that while Confucians can accept a formal starting point that Michael Sandel proposes in his ethics of giftedness, namely, that children should be taken as gifts, Confucians cannot adopt his generalist strategy. The essay provides a Confucian full ethics of giftedness by addressing a series of relevant questions, such as what kind of gifts children are, where the gifts are from, in which way they are given, and for (...) what purpose they are given. It indicates that Confucians should sort out different types of enhancement and bring them to the test of the Confucian values in terms of both Confucian virtue principles and specific ritual rules. It concludes that Confucians can accept some types of enhancement but must reject others. (shrink)
Truth-telling to competent patients is widely affirmed as a cardinal moral and biomedical obligation in contemporary Western medical practice. In contrast, Chinese medical ethics remains committed to hiding the truth as well as to lying when necessary to achieve the family's view of the best interests of the patient. This essay intends to provide an account of the framing commitments that would both justify physician deception and have it function in a way authentically grounded in the familist moral concerns of (...) Confucianism. It reflects on the moral conditions and possibilities for sustaining a Confucian understanding of truth-telling and consent in mainland China. (shrink)
The rise in the recent Western pattern of surrogate decision making is not a necessary result of an increase in the number of elderly with decreased competence; it may rather manifest the dominant Western vision of human life and relations. From a comparative philosophical standpoint, the Western pattern of medical decision making is individualistic, while the Chinese is familistic. These two distinct patterns may reflect two different comprehensive perspectives on human life and relations, disclosing a foundational difference that can be (...) seen in the Aristotelian account of friendship and the Confucian account of humanity. The contemporary development of surrogate decision making in the West may illustrate a general tendency toward the Aristotelian account, while the Chinese approaches are congruent with the Confucian view. Also explored are some merits of the Chinese approach to family decision making for health care. (shrink)
This essay illustrates what the Chinese family-based and harmony-oriented model of medical decision making is like as well as how it differs from the modern Western individual-based and autonomy-oriented model in health care practice. The essay discloses the roots of the Chinese model in the Confucian account of the family and the Confucian view of harmony. By responding to a series of questions posed to the Chinese model by modern Western scholars in terms of the basic individualist concerns and values (...) embedded in the modern Western model, we conclude that the Chinese people have justifiable reasons to continue to apply the Chinese model to their contemporary health care and medical practice. (shrink)
Under the clear and thoughtful editorship of Ruiping Fan, The Renaissance of Confucianism in Contemporary China provides new and highly substantive insights into the emergence of a renewed, relevant, and perceptively engaged Confucianism in 21st century China. Through the vibrantly diverse essays contained in this volume, and in cogent overview through Fan’s introduction, one learns that Confucianism is thoroughly misunderstood, if it is seen only through Western lenses. It cannot be absorbed into that rights-based “global” discourse that has been the (...) West’s troubled inheritance from the Enlightenment. Extraordinarily thoughtful Chinese voices are found in this volume that converse with each other in serious and revealing ways. Should genuine exchange continue to develop between Western thinkers and Chinese Confucians, The Renaissance of Confucianism in Contemporary China will surely be an indispensable pathway into those core issues, moral and social, that will unavoidably be encountered as China and the West advance further into the 21st century. -/- -/- Stephen A. Erickson, Professor of Philosophy and the E. Wilson Lyon Professor of the Humanities, Pomona College, USA -/- -/- The Renaissance of Confucianism in Contemporary China features an important school of Confucianism in Mainland China today, “Political Confucianism,” powerfully articulated by Jiang Qing, author of the leading article in this volume. “Political Confucianism” is unique: on the “Political” side, it rejects many core values of liberalism, the dominant political ideology in the West; and on the “Confucianism” side, it rejects the one-sided emphasis on the inner sageliness of “New Confucianism” developed in Hong Kong and Taiwan in the last century. In this volume, the programmatic essay by Jiang Qing is followed by penetrating essays, either further expanding on or critically examining various themes of Jiang’s original essay, by eminent scholars, many of whom are committed Confucians themselves. The volume concludes with an informative biography of Jiang Qing. It is a must-read for anyone who is interested in learning about the situation of Confucianism in contemporary China in particular and about Confucianism or contemporary China in general. -/- -/- Yong HUANG, Chief Editor, Dao: A Journal of Comparative Philosophy -/- This is the most important recent study of Chinese culture and political theory. It offers a rich insight into the renaissance of authentic Confucian commitments in contemporary China and the foundationally different moral and political direction that it proposes for China’s future. The essays Fan brings together tie the power of China’s rich past to the prospect of a China quite different from what the West envisages. It is a “must-read” for anyone seeking to understand China in the 21st century. -/- -/- David Solomon, W.P. and H.B. White Director of the Center for Ethics and Culture, University of Notre Dame. (shrink)
: This paper argues that three salient corrupt practices that mark contemporary Chinese health care, namely the over-prescription of indicated drugs, the prescription of more expensive forms of medication and more expensive diagnostic work-ups than needed, and illegal cash payments to physicians—i.e., red packages—result not from the introduction of the market to China, but from two clusters of circumstances. First, there has been a loss of the Confucian appreciation of the proper role of financial reward for good health care. Second, (...) misguided governmental policies have distorted the behavior of physicians and hospitals. The distorting policies include (1) setting very low salaries for physicians, (2) providing bonuses to physicians and profits to hospitals from the excessive prescription of drugs and the use of more expensive drugs and unnecessary expensive diagnostic procedures, and (3) prohibiting payments by patients to physicians for higher quality care. The latter problem is complicated by policies that do not allow the use of governmental insurance and funds from medical savings accounts in private hospitals as well as other policies that fail to create a level playing field for both private and government hospitals. The corrupt practices currently characterizing Chinese health care will require not only abolishing the distorting governmental policies but also drawing on Confucian moral resources to establish a rightly directed appreciation of the proper place of financial reward in the practice of medicine. (shrink)
Across the world, socio-economic forces are shifting the locus of long-term care from the family to institutional settings, producing significant moral, not just financial costs. This essay explores these costs and the distortions in the role of the family they involve. These reflections offer grounds for critically questioning the extent to which moral concerns regarding long-term care in Hong Kong and in mainland China are the same as those voiced in the United States, although family resemblances surely exist. Chinese moral (...) values such as virtue and filial piety embedded in a Confucian moral and social context cannot be recast without distortion in terms of modern Western European notions. The essay concludes that the Confucian resources must be taken seriously in order to develop an authentic Chinese bioethics of long-term care and a defensible approach to long-term care policy for contemporary society in general and Chinese society in particular. (shrink)
This essay argues that the Chinese Mental Health Act of 2013 is overly individualistic and fails to give proper moral weight to the role of Chinese families in directing the process of decision-making for hospitalizing and treating the mentally ill patients. We present three types of reactions within the medical community to the Act, each illustrated with a case and discussion. In the first two types of cases, we argue that these reactions are problematic either because they comply with the (...) law but undermine the patient’s interests by refusing the family’s request to have the patient hospitalized, or violate the law by hospitalizing patients in response to the real concerns of their families. In the third type of situation, psychiatrists inappropriately encourage families to produce evidence of the patient’s behavior that is harmful to self or others in order legally to commit the patient. Each of these problems, we conclude, should be tackled by supplementing Article 30 of the Act with the stipulation that a psychiatrist may authorize the involuntary hospitalization of a patient, who is not at risk of causing physical harm to self or others, with the consent of all major family members. Drawing on the deeply culturally embedded moral traditions of Confucian medical familism, this proposal would facilitate the proper treatment of a significant number of Chinese mentally ill patients under the care of their families. (shrink)
This paper focuses on Confucian formulations of personhood and the implications they may have for bioethics and medical practice. We discuss how an appreciation of the Confucian concept of personhood can provide insights into the practice of informed consent and, in particular, the role of family members and physicians in medical decision-making in societies influenced by Confucian culture. We suggest that Western notions of informed consent appear ethically misguided when viewed from a Confucian perspective.
In this article, I offer an abridged reconstruction of the foundational elements of Confucian moral commitments, which, I will argue, still provide the background moral substance for moral reflection in mainland China, Hong Kong, Taiwan, Singapore, and Korea. The essay presents implications of Confucianism for establishing an appropriate health care system and critically assesses the features of current health polices in mainland China, Hong Kong, and Singapore. The goal is to offer a family-oriented, non-individualist account of resource allocation that takes (...) family authority and responsibility seriously. (shrink)
Healthcare systems in Singapore, Hong Kong, and mainland China are strikingly distinct from those in the West. Economically speaking, each of the aforementioned Eastern systems relies in great measure on private expenditures supplemented by savings accounts. Western nations, on the other hand, typically exhibit government funding and wariness about healthcare savings accounts. This essay argues that these and other differences between Pacific Rim healthcare systems and Western systems should be assessed in light of background Confucian commitments operating in the former. (...) In the Confucian context, bioethics and healthcare policy have a unique content, texture, and set of implications that often affront Western assumptions about the appropriate individual autonomy of patients and the appropriate character of social safety nets for healthcare. (shrink)
An enormous challenge facing China is how to provide sustainable care for its rapidly-increasing elderly population. Its recent policy directives include three medical forms—the institution-cooperation-form, the institution-medical-form, and the family-physician-form—to integrate medical care into ordinary care for the elderly. This essay indicates that China will not be able to maintain sustainable elderly care unless it places emphasis on the family-physician-form that focuses on family physicians and the use of primary care services. The essay constructs arguments for this policy suggestion based (...) on China’s long-standing Confucian ethical resources of filial piety and family-based concerns for elderly care. (shrink)
Recently implemented Chinese health insurance schemes have failed to achieve a Chinese health care system that is family-oriented, family-based, family-friendly, or even financially sustainable. With this diagnosis in hand, the authors argue that a financially and morally sustainable Chinese health care system should have as its core family health savings accounts supplemented by appropriate health insurance plans. This essay’s arguments are set in the context of Confucian moral commitments that still shape the background culture of contemporary China.
Article 14 of the UNESCO Declaration on Bioethics and Human Rights sets forth a few basic principles regarding social responsibility for health. It states in part that 14.1 The promotion of health and social development for their people is a central purpose of governments that all sectors of society share. 14.2 Taking into account that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, (...) economic or social condition, progress in science and technology should advance: access to quality health care and essential medicines, especially for the health of women and... (shrink)
This special thematic issue of The Journal of Medicine and Philosophy brings together a cross-cultural set of scholars from Asia, Europe, and North America critically to explore foundational questions of familial authority and the implications of such findings for organ procurement policies designed to increase access to transplantation. The substantial disparity between the available supply of human organs and demand for organ transplantation creates significant pressure to manipulate public policy to increase organ procurement. As the articles in this issue explore, (...) however, even if well intentioned, the desire to maximize organ procurement does not justify undermining foundational elements of human flourishing, such as the family. While defending at times quite different understandings of autonomy, informed consent, and familial authority, each author makes clear that a principled appreciation of the family is necessary. Otherwise, health care practice will treat the family in a cynical and instrumental fashion unlikely to support social or individual good. (shrink)
The family is the exemplar community of Chinese society. This essay explores how Chinese communitarian norms, expressed in thick commitments to the authority and autonomy of the family, are central to contemporary Chinese bioethics. In particular, it focuses on the issue of surrogate decision making to illustrate the Confucian family-grounded communitarian bioethics. The essay first describes the way in which the family, in Chinese bioethics, functions as a whole to provide consent for significant medical and surgical interventions when a patient (...) has lost decision-making capacity. It is argued that the practice of not having an established order for surrogate decision makers (e.g., spouse, children, and then parents), as it is done in the United States, reflects the acknowledgment that the family as a social reality cannot be reduced to a stereotype of the appropriate order of default decision makers. This description of the family as being in authority to make surrogate decisions for an incompetent family member is enriched by an elaboration of the differences among the concepts of patient autonomy, family autonomy, and moral autonomy. The Chinese model, as well as the Confucian communitarian life of families, engages a family autonomy that is supported by a Confucian understanding of moral autonomy, rather than individual autonomy. Finally, the issue of possible conflicts between patient and family interests in relation to a patient’s past wishes in the Chinese model is addressed in light of the role of the physician. (shrink)
Contrary to the views proposed by modern animal rights scholars, this essay reconstructs the Confucian argument for the moral defensibility of the Confucian ritual use of animals by providing an expository analysis of classical Confucian literature. The argument is developed by focusing on the issue of the sacrificial use of animals in the Confucian tradition. While animals are treated according to certain regulations and restrictions, they are not spared from being offered as sacrifices. An essential component of Confucian virtues, reverence, (...) requires showing deep respect to Heaven, gods, spirits, and humans but not to animals. If Confucians change the rituals in ways that spare animals, they would fail to show the depth of reverence to gods, spirits, and humans that they should. (shrink)
This essay addresses a moral and cultural challenge facing health care in the People’s Republic of China: the need to create an understanding of medical professionalism that recognizes the new economic realities of China and that can maintain the integrity of the medical profession. It examines the rich Confucian resources for bioethics and health care policy by focusing on the Confucian tradition’s account of how virtue and human flourishing are compatible with the pursuit of profit. It offers the Confucian account (...) of the division of labor and the financial inequalities this produces with special attention to China’s socialist project of creating the profession of barefoot doctors as egalitarian peasant physicians and why this project failed. It then further develops the Confucian acknowledgement of the unequal value of different services and products and how this conflicts with the current system of payment to physicians which has led to the corruption of medical professionalism through illegal supplementary payments. It further gives an account the oblique intentionality of Confucian moral psychology that shows how virtuous persons can pursue benevolent actions while both foreseeing profit and avoiding defining their character by greed. This account of Confucian virtue offers the basis for a medical professionalism that can function morally within a robustly profit-oriented market economy. The paper concludes with a summary of the characteristics of Confucian medical professionalism and of how it places the profit motive within its account of virtue ethics. (shrink)
The performance of military supply chain networks against disruptions is an important consideration for defense logistics decision making, and it is crucial to evaluate it scientifically and accurately. This paper highlights the problem from the perspective of targeted defense strategies before being attacked and analyzes the acceptable recovery time against attacks. A topological structure model, with three exclusive features, in contrast with traditional networks, is used to describe the structure of military supply chain networks. In order to provide a platform (...) for evaluating performance, a simulation method based on exploratory analysis is presented. Considering supply capability against disruptions and the acceptable recovery time for an MSCN after disruptions, evaluation metrics including supply capability and disruption recovery are proposed. By applying the model and algorithms to a POL supply network in a theater, we obtain the values of supply capability and disruption recovery against different disruptions. We also identify the key entities which can easily cause catastrophic failure to this network and which need to be protected against carefully. The results show that new evaluation metrics can capture important performance requirements for military supply chain networks. We also find that the proposed method in this paper can solve the problem of evaluating performance and analyzing disruption recovery in a feasible and effective manner. (shrink)
This study examined the metacognitive developmental patterns of Hong Kong school students. Students rated their own metacognitive competencies by responding to an inventory of six motivational‐ and cognitive‐metacognitive subscales. Results showed that students' metacognitive competencies decreased with age—from primary 4 to secondary 5 —with a sharp decline noticeable at the primary/secondary school transition. Age had a more powerful effect than gender on students' perception of their metacognitive competencies. This decreasing pattern of Hong Kong students' metacognitive competencies is contrary to the (...) developmental trends found in Western countries. However, the comparatively high academic performance of Hong Kong students also suggests some different recommendations about student learning. (shrink)
There is a prevailing conviction that if traditional medicine (TRM) or complementary and alternative medicine (CAM) are integrated into healthcare systems, modern scientific medicine (MSM) should retain its principal status. This paper contends that this position is misguided in medical contexts where TRM is established and remains vibrant. By reflecting on the Chinese policy on three entrenched forms of TRM (Tibetan, Mongolian and Uighur medicines) in western regions of China, the paper challenges the ideology of science that lies behind the (...) demand that all traditional forms of medicine be evaluated and reformed according to MSM standards. Tibetan medicine is used as a case study to indicate the falsity of a major premise of the scientific ideology. The conclusion is that the proper integrative system for TRM and MSM is a dual standard based system in which both TRM and MSM are free to operate according to their own medical standards. (shrink)
This rejoinder focuses on a few points of disagreement that I have with Li Chenyang, Ronnie Littlejohn, and Lauren Pfister regarding their critical comments on my book Reconstructionist Confucianism. In response to Pfister’s concerns, I point out that my book attempts to base on classical, rather than other, Confucian sources in order to reconstruct the Confucian virtue-based, ritual-guided, and family-oriented view of life for contemporary society. In appreciating Littlejohn’s suggestion on Confucian environmentalism, I contend that a kind of Grand View (...) Garden as we find in the Dream of Red Mansion would be a typical Confucian garden, manifesting the Confucian ideal of a family-oriented way of life that holds in harmonious relations with the rest of nature under the direction of the cosmic principles. Finally, I offer detailed replies to Li’s series of challenges to my view on li 禮, arguing for the essential constitutive nature of the Confucian rituals. (shrink)
Preface Content Type Journal Article DOI 10.1007/s11712-009-9155-4 Authors Philip J. Ivanhoe, City University of Hong Kong Department of Public and Social Administration, Governance in Asia Research Centre Tat Chee Avenue Kowloon Tong Hong Kong SAR Ruiping Fan, City University of Hong Kong Department of Public and Social Administration, Governance in Asia Research Centre Tat Chee Avenue Kowloon Tong Hong Kong SAR Journal Dao Online ISSN 1569-7274 Print ISSN 1540-3009 Journal Volume Volume 9 Journal Issue Volume 9, Number 1.