Ole Doring's Confucian approach to East Asian bioethics and culture

Bioethics has been dominated by a European model, with European worldviews and philosophies dominating the discourse. This is true in academia as well as in public policy.

The need for global bioethics discourse is pressing, because the life sciences are no longer regional or provincial in scope.

For example, there has been a lot of speculation as to the progress made in East Asian cloning laboratories, particularly in China and South Korea.

Claims that scientists have successfully cloned human beings are unsubstantiated.

However, the speculation does give rise to an important need to discuss bioethics from an East Asian perspective, using East Asian ethical frameworks like Confucianism.

In 2006, the International Association for Bioethics' (IAB) held its world congress in Beijing, a sure sign that the global bioethics community is becoming less Euro-centric in its approach.

Bioethics is starting to integrate non-European ethical and philosophical traditions.

It is of the utmost importance to refrain from the blanket term of Asian bioethics, and to focus on culturally specific ethical traditions, the most obvious in East Asia being Confucian ethics.

Bioethics has yet to be integrated with clinical practice in China in a formal. This does not mean that medical ethics in China do not exist. In fact, medical ethics have a long tradition in China but mainly with regards to outlining the physician-patient relationship.

However, the traditional study of ethics and the practices of medical science do not frequently collide and bioethics has yet to develop as a fully fledged academic or pragmatic endeavor.

Within the last ten years, the life sciences in China have been responding to the need to infuse ethics into practice.

There is some push in China toward creating official bioethics departments at the level of university and administration.

China has begun to protect its intellectual property rights on its biological science resources (such as tissue samples or embryos), which has also raised important ethical questions.

Standardization and codification is just beginning, with some journals and resource books on bioethics being published in China.

There are few private sponsors of scientific research, let alone bioethics research, in China.

The government agencies primarily responsible for funding research in biological sciences and life sciences include the Ministry of Science and Technology (MOST), which is connected with the National Natural Science Foundation (NNSFC).

Foreign private sources and international research foundations like the Ford Foundation have been and will continue to be critical in promoting bioethics and biomedical research in general in China.

It is important to distinguish between bioethics and medical ethics. The latter refers mainly to physician codes of behavior and the physician-patient relationship, which according to Confucian traditions, is paternalistic in nature as is the Western model.

Medical ethics in China also refers to questions related to social security and universal health care.

Bioethics, referring to such questions as the implications for cloning, is something totally different from medical ethics because it tends to be more theoretical in nature.

The current leader of the bioethics movement in China is Qiu Renzong, who is instrumental in shaping an "Asian ethos" version of bioethics that can exist independently from and possibly counterbalance the dominant Western bioethical model (p. 134).

Qiu Renzong warns against "ethical imperialism," and also claims that there can be no universal ethical standard except for some of the most obvious moral precepts such as refraining from killing the innocent (p. 135).

Diversity, pluralism, and even relativism remain the current themes in crafting a Chinese approach to bioethics.

It is again important to point out that Confucianism is but one of many different ethical and cultural threads even in China, where Taoism, Buddhism, Christianity, and other traditions offer their own input into ethics.

Some Chinese ethicists like Tang Refeng have proposed that it is more feasible to consider what is "good," when formulating ethical precepts and guides for behavior, not what is "right," which adds unnecessary absolutes. For example, the population control policies in China are "good" from a utilitarian perspective, and it does not matter whether Westerners believe the policy is "right" from a more deontological point of view.

Promoting quality of life can be considered an ethical standard.

It is important to refrain from generalizations and stereotypes, such as assuming that all Chinese ethics are based on social responsibility or collectivism versus individualism, liberty, and equality.

At the same time, Confucianism and neo-Confucianism generally uphold ethical standards of behavior that emphasize choices that benefit society rather than benefitting the individual.

Confucianism may be outdated, overly conservative, and even anti-modern, offering poor opportunities for contributing to modern/postmodern ethical discourse, especially with regards to bioethics.

Concepts of humanity and human potential are being gradually integrated into contemporary Chinese philosophy, which may be gradually shifting away from its traditional Confucian values and embracing more a celebration of individuality and "human process-identity," (p. 141).

How the individual is conceptualized, and viewed in relationship to the society is significant because the concept of autonomy is in fact central to bioethics and medical ethics.

One interesting point of view is the "non-rights-based notion of personhood" proposed and developed by Taiwanese/Hong Kong-based philosopher Ip Po-keung. Rooted in traditional Confucianism, a non-rights-based notion of personhood recognizes the essence and value of individualism while denying the concept of individual rights trumping the greater cause of the greater good.

Much of the current ethical and bioethical debate in East Asia is unfortunately clouded by biases and remains premature, unable to adequately inform public policy or practice.

It is also worth noting that, at least with mainland China, developing meaningful and workable bioethical standards for practice may take time due to historical and sociological constraints.

Unfortunately, some of the historical and sociological constraints are not acknowledged or disavowed in Chinese literature and academia in general.

Until China or East Asia develops cohesive bioethical theories, the dualistic East/West divide remains.

It is also important to qualify what bioethics is: "Ethics is all about preventing harm and suffering when they result from action, and understanding the meaning and functionally of harm," (p. 145).

Pragmatic questions include how to reconcile situational ethics versus absolute ethics.

Central to bioethics is also the concept of "the humane," which can be a universal moral imperative (p. 145).

A universal moral imperative is possible, contrary to strict relativism: "Such a universal moral claim has nothing to do with hegemonic conformity," (p. 145). For example, it can be considered always appropriate to give voice to the oppressed and most vulnerable populations who are systematically exploited -- a major concern in bioethics when it comes to testing on subjects in developing countries that lack ethical standards of research.

Human rights remain a major point of contention in global bioethics. The key to resolving the East/West divide may be to come from a point of mutual respect, rather than projecting prejudices and presuming normative universality. To avoid perceptions and/or practices of hegemony, a cross-cultural bioethics dialogue should ensue.

Clearly there needs to be some set of global standards in bioethics, because like all other fields, the life sciences are globalized.