Most contemporary bioethicists believe that Western bioethical principles, such as the principle of autonomy, are universally binding wherever bioethics is found. According to these bioethicists, these principles may be subject to culturally‐conditioned further interpretations for their application in different nations or regions, but an ‘abstract content’ of each principle remains unchanged, which provides ‘an objective basis for moral judgment and international law’. This essay intends to demonstrate that this is not the case. Taking the principle of autonomy as an example, (...) this essay argues that there is no such shared ‘abstract content’ between the Western bioethical principle of autonomy and the East Asian bioethical principle of autonomy. Other things being equal, the Western principle of autonomy demands self‐determination, assumes a subjective conception of the good and promotes the value of individual independence, whilst the East Asian principle of autonomy requires family‐determination, presupposes an objective conception of the good and upholds the value of harmonious dependence. They differ from each other in the most general sense and basic moral requirement. (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)

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)

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)

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)

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)

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)

In recent years, Confucian ethics has been considered as an alternative to the individual-oriented model of medical decision-making that is dominating in the modern West.

This essay draws on classical Confucian intellectual resources to argue that the person who emerges from a head transplant would be neither the person who provided the head, nor the person who provided the body, but a new, different person. We construct two types of argument to support this conclusion: one is based on the classical Confucian metaphysics of human life as qi activity; the other is grounded in the Confucian view of personal identity as being inseparable from one’s familial (...) relations. These Confucian ideas provide a reasonable alternative to the currently dominant view that one’s personal identity “follows” one’s head. Together, these arguments imply that head transplantation is ethically inappropriate. (shrink)

Hong Kong’s Covid-19 epidemic circumstances have given us a valuable opportunity to reflect on Hong Kong’s elderly care policies. This essay argues that Hong Kong should learn from the West and provide a subsidy to family caregivers for proper elderly care. We rebut the social and moralistic reasons for not introducing such a subsidy in Hong Kong. We indicate that providing cash subsidy to family caregivers does not monetize or tarnish Confucian filial obligation to take care of elderly people, but (...) enable adult children from low-income families to undertake this obligation effectively. In addition, we contend that providing such a subsidy would not significantly affect the job market in Hong Kong and that incurred financial and manpower costs for monitoring family care are controllable. (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.

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 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)

It is generally recognized that China, while attempting to develop modern scientific medicine in carrying out its national policy for modernization, has also made significant efforts to integrate traditional Chinese medicine into its health care system. For instance, the World Health Organization's first global strategy on traditional and alternative medicine lists China as one of only four of its member states to have attained an integrative health care system. However, medical integration can take many different forms and involve quite different (...) health care standards. A health care standard is a set of mechanisms by which distinct diagnostic and therapeutic practices and products are validated or accredited for use in health care delivery. Traditional Chinese medicine and modern scientific medicine adopt different sets of such mechanisms and thereby engage different health care standards. Accordingly, in appraising the Chinese integrative health care system, it is important to investigate which health care standard has been appealed to. (shrink)

Ruiping Fan; The Memoirs of a Pagan Sojourning in the Ruins of Christendom, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 5, Issue 3.

: 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)

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)

It is generally recognized that China, while attempting to develop modern scientific medicine in carrying out its national policy for modernization, has also made significant efforts to integrate traditional Chinese medicine into its health care system. For instance, the World Health Organization's first global strategy on traditional and alternative medicine lists China as one of only four of its member states to have attained an integrative health care system. However, medical integration can take many different forms and involve quite different (...) health care standards. A health care standard is a set of mechanisms by which distinct diagnostic and therapeutic practices and products are validated or accredited for use in health care delivery. Traditional Chinese medicine and modern scientific medicine adopt different sets of such mechanisms and thereby engage different health care standards. Accordingly, in appraising the Chinese integrative health care system, it is important to investigate which health care standard has been appealed to. (shrink)

This chapter attempts to build a Confucian conception of public reason for Confucian-influenced East Asian societies to adopt and tackle political and bioethical issues. The chapter first indicates that public reason is present at various levels of human collectives, namely, communitarian, national, and international. It concentrates on constructing a proper Confucian notion of public reason at the national level given that only the sovereign states are able to make effective public policy and laws to govern their people, although such a (...) Confucian notion can be shared by the peoples across East Asian countries and regions, such as mainland China, Hong Kong, and Taiwan. Then I lay out Rawls’ liberal conception of public reason and explicate why it is not suitable for an East Asian country like China to accept. This is followed by two sections addressing the two Confucian conceptions of public reason that have been proposed, respectively, by Joseph Chan and Sungmoon Kim. I indicate how each of them faces a dilemma that cannot be adequately resolved. In Sect. 4, I outline a new Confucian conception of public reason based on the view developed in my book Reconstructionist Confucianism, including a Confucian account of basic liberty, equality, and individual rights consistent with the central requirements of the Confucian virtues that are still vibrant in East Asian societies. The values of political justice under this Confucian conception integrate both Confucian virtues and basic rights. Finally, the chapter appeals to this conception to review the bioethical issue of medically assisted suicide and argues why it should not be legalized in East Asia according to this conception of public reason. (shrink)

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.

This volume brings together a set of conceptual, moral, and cultural concerns carefully to assess a significant public policy issue: the development and proliferation of sex robots. Critics argue, for example, that sex robots present a clear risk to real persons as well as a degradation of society. They claim that the prevalence of sex robots will increase sexual violence, immorally objectify women, encourage pedophilia, reinforce negative body image stereotypes, increase forms of sexual dysfunction, and pass on sexually transmitted disease. (...) Proponents judge robotic sexual companionship as just another step in the exploration of human erotic desire. Sex robots, and similar technology, such as virtual reality pornography and other forms of “digi-sexuality,” are appreciated as providing autonomy affirming companionship, sexual release for the lonely, and a relatively harmless outlet for sexual fantasies that avoids the use of human prostitutes and thus reduces sexual victimization. As these chapters explore, to secure normative claims about sexual activity with artificial humanoids, one will need first to understand what the meaning of the morality of sexual activity can be as well as the significance of various practices with robotic partners on such cardinal social institutions as the family and the relationship between the sexes. One will also need to consider in terms of which ranking of human goods, right-making conditions, social outcomes, or personal virtues we ought to evaluate the significance of sexual relations with robots that look like women, men and children. Without such analysis, it will be unclear whether sex robots ought to be appreciated as a social evil that will further degrade moral culture, a positive technological innovation that will help preserve human dignity, or a more or less harmless pastime. (shrink)

This chapter provides conceptual and ethical comments on Hong Kong’s interview findings and survey results regarding the three types of incentive for organ donation. It focuses on three particular conceptual and ethical issues. First, it shows that there is not always a clear-cut distinction between an honorary and a compensationalist incentive measure for organ donation. Instead, a measure such as offering a public columbarium niche to a deceased donor in Hong Kong carries both honorary and compensationalist elements and can, as (...) a mixed type of incentive measure, be ethically justified for adoption in that society, even if purely monetary incentives cannot be similarly ethically justified. Moreover, in relation to the proposal to offer a familist incentive in Hong Kong (namely, to give patients with a first-degree family member who was a cadaveric donor, or who have themselves previously been live donors, a priority right for a transplant over other medically similar patients), it is argued that no proposed opposing reason is ethically convincing. Finally, the chapter demonstrates that there are legitimate considerations to support maintaining Hong Kong’s familist decision-making model regarding organ donation. (shrink)

This issue of The Journal of Medicine and Philosophy brings together an international group of scholars from Hong Kong, Mainland China, and North America, critically to explore whole-body/head transplantation. The proposed procedure raises significant philosophical, ethical, and social/political questions. For example, assuming transplant is successful, who survives the surgery? Does personal identity necessarily follow the head? The contributors to this special thematic issue explore the nature and ground of personal identity, what it would mean to preserve personal identity, given such (...) a significant set of physical changes, as well as the morality of such a procedure. As the authors make clear, careful conceptual philosophical analysis is essential for understanding whether whole-body/head transplantation is a life-saving/life-enhancing technological innovation, or a bioethical morass that should not be attempted. How we come to terms with such conceptual and moral concerns will have a significant impact on the future of medicine and medical technological innovation. (shrink)

本书阐述了作者“重构”儒家生命伦理学的主张，从儒家的家庭主义、社会责任、环境伦理、道德之善与礼乐教化等角度全面审视了西方理论的问题，并提出了儒家思想的解决之道。.

2020年，新冠肺炎病毒在全球爆發，威脅公眾健康、打亂生活節奏、衝擊社會經濟。病毒沒有種族，也沒有國界，人們在共同面對這一瘟疫大挑戰時，健康價值固然重要，與此同時，倫理道德和人類價值如平等、自由、公正 等同樣不能忽略。 本書收錄二十多篇，由兩岸三地的學者撰寫的重大議題文章，從基礎倫理、防控倫理、法律倫理、醫療倫理、責任倫理、關懷倫理六個角度，探討如何在大疫當前的困境下，建構中國生命倫理學。書中提出多個引人反思道德傳統 、倫理精神和價值取向的問題，如防控措施與個人權利應如何平衡？健康碼的追蹤程序能否保障個人隱私權？醫療資源稀缺情況下限制老人的醫療供給是否合理？如何保障一線醫護人員的基本安全？ 作者期望通過本書補充生命倫理學的「缺如」，並為健全社會防疫意識、完善醫療衛生體系、增強道德研究，以及建構具有中國特色的生命倫理學盡一分力。在此疫情仍然嚴峻的今日，絕對值得一讀。.