As political instruments, human rights can be challenged in two important ways: first, by undermining the claim to universality by appealing to a kind of cultural relativism, and second, by accusing human rights of unjustifiably imposing values that are not genuinely universal (which I dub the problem of parochialism). The human right to health is no exception. If a human right to health is to be a useful instrument in mobilizing action for global health justice, then we need to take (...) seriously the ways that health intersects with culture. Universal applicability is essential to both the legitimacy and efficacy of human rights. But without cultural sensitivity, additional injustices and imperialistic harms may be perpetuated. There are two goals within this paper—(1) to show that cultural imperialism is a moral and practical hazard, both in general and for the human right to health in particular and (2) to articulate a way of thinking about the human right to health that can minimize these hazards and arm it with moral credibility and political weight. (shrink)

Based on an analysis of a landmark case Lim Mey Lee Susan v Singapore Medical Council in Singapore where a doctor was professionally disciplined for over-charging a wealthy patient, a judgement upheld by the Singapore High Court, this paper will discuss the notion of an ‘ethical price’ (EP) and its determination with respect to the provision of healthcare services. It will first examine the limitations of a legal approach for setting an ethical limit to pricing. From there, it will argue (...) that Confucian philosophy provides a useful ethical framework to explore EP, with focus on the context of Singapore. The following question is addressed: What is an ethical pricing standard for medical practice from a Confucian perspective? The strengths and limitations of a Confucian value base as regards the determination of an objective EP will be analysed through an examination of the shortcomings of the doctor’s behaviour in the Susan Lim case as well as other case scenarios. The paper will conclude with some practical suggestions on how Confucian-based ideas can be applied to decision-making on pricing and the importance of this for medical professionalism and ethics teaching. (shrink)

The unique mix of modern Western and traditional Confucian values in Singapore presents young people with contradictory views on duties to aging parents. It remains to be seen whether the changing demands of modern life will result in new generations giving up Confucian family ethics or whether the Confucian dynamic will find a way to adapt to the new pressures. It is the opinion of this author that the Confucian family structure has mixed potential for the growing crisis of elder (...) care. Alone, both Confucian traditions and typical Western institutional approaches toward elder care fall short of what is necessary for intergenerational social justice, yet a hybrid of the two has great potential for the growing aging crisis. To demonstrate this, I first give a brief account of the history of filial piety in Confucianism as well as the social environment from which it originated. Then I turn my attention to the present issues of an aging population and elder care that face much of the developed world in the twenty-first century. Finally, I show how adherence to Confucian filial traditions can both help to address many of these issues and how it can potentially leave unjust gaps in elder care. Ultimately, I conclude that the crisis of elder care may be best dealt with through a hybrid of Confucian values and Western approaches. (shrink)

This article is about the dream of a global bioethics. It touches upon some big issues concerning how progress in biomedicine and biotechnology might best be linked to justice and human flourishing in all parts of the world and not just in the global North. More specifically, however, it is about disappointment and regret when this dream is placed alongside the realities of living and working in a resource-poor setting in the global South. The essay focuses on a narrative account (...) of the work of an Indian medical educator and his efforts to embrace and promulgate the insights and benefits of bioethics in his own professional environment. It explores an individual biography in which intellectual frictions and... (shrink)

In Western countries, the ideal professional and ethical attributes of healthcare providers and the ideal patient-doctor relationship have been analysed in detail. Other cultures, however, may have different norms, arising in response to diverse healthcare needs, cultural values and offering alternative perspectives. In this paper, drawing a case study, we introduce the concept of Shinmi, used in Japan to describe a desirable approach to medical care. Shinmi means kind or cordial in Japanese. In the medical context, it refers to doctors (...) treating patients with a degree of emotional closeness as if they were the doctors’ own family. We analyse the concept of Shinmi, drawing on virtue ethics. We distinguish two different elements to a Shinmi-na attitude. As illustrated in our example, excessive Shinmi can be problematic for patients and doctors. Furthermore, elements of Shinmi may conflict with existing Western values (for example, norms that encourage emotional detachment and discourage doctors’ treatment of family members). However, if pursued appropriately, we argue that a balanced Shinmi-na approach can be conducive to the goals of medicine. The concept of Shinmi may be valuable for medical students, in Japanese and potentially other health care systems, and help them to cultivate a virtuous approach to meeting the emotional needs of patients. (shrink)

Objective: The objectives of this study are to understand the current functions, structure and operation of hospital ethics committees (HECs) in Shanghai and to facilitate their improvement. Methods: (1) A questionnaire survey, (2) interviews with secretaries and (3) on-site document reviews of HECs in Shanghai were used in the study, which surveyed 33 hospitals. Results: In Shanghai, 57.56% of the surveyed hospitals established HECs from 1998 to 2005. Most HECs used bioethical review of research involving human subjects as well as (...) bioethical review or consultation regarding medical care services and administrative decision- making. Of the surveyed HECs, 14.3% did not provide any formal bioethical training to the HECs’ members and many HECs had no standard operating procedures. Some HECs had no clear definition of what was “conflict of interest” that should be considered by the HECs, while 44.4% of the HECs did not perform continuing review. Discussion: After the issues of related national regulations, more and more hospitals established HECs in Shanghai, but the functions of HECs need to be further developed and formal training on bioethics should be provided to HEC members. To assure the independence and good performance of HECs, the conflict of interest procedure, the standard operating procedures and bioethical review should be improved. Conclusion: HECs in Shanghai had developed in the preceding 10 years and they played great roles in protecting the rights and welfare of human subjects and patients; some areas need improvement. (shrink)

Drawing upon Confucian ethical insights extracted from the Analects, this essay argues that principlism suffers from fundamental theoretical flaws. Its four principles do not genuinely capture universal principles, because they distort the practice-embedded nature of authentic moral norms found within actual moral cultures, as elucidated by Confucian insights. Specifically, Confucianism highlights the importance of a reflective equilibrium between constitutive rules and regulative principles. Principlism, in reality, represents an abridged version of modern Western liberal ethical norms, as it retains their significant (...) regulative principles while excluding their specific constitutive rules. The essay also employs prominent examples to illustrate the practical ineffectiveness of principlism. Given that diverse cultures either adhere to different regulative principles that diverge from the four principles or are obligated to specify them with their distinct constitutive rules, relying on the four principles as a uniform starting point falls short in providing and justifying universal solutions to the bioethical dilemmas confronting contemporary societies. In addition, the essay delves into the underlying factors that have led to the seemingly widespread adoption of the four principles across different regions worldwide. Lastly, the essay introduces the concept of regioglobal bioethics as an alternative to principlism for global bioethics, outlining a general Confucian endorsement of this proposal and providing a brief response to potential objections, aiming to pave the way for further research. (shrink)

Censorship in the area of public health has become increasingly important in many parts of the world for a number of reasons. Groups with vested interest in public health policy are motivated to censor material. As governments, corporations, and organizations champion competing visions of public health issues, the more incentive there may be to censor. This is true in a number of circumstances: curtailing access to information regarding the health and welfare of soldiers in the Kuwait and Iraq wars, poor (...) health conditions in Aboriginal communities, downplaying epidemics to bolster economies, and so forth. This paper will look at the use of a computer worm (the benevolent health worm) to disseminate vital information in␣situations where public health is threatened by government censorship and where there is great risk for those who ‹speak out’. The discussion of the benevolent health worm is focused on the Peoples’ Republic of China (China) drawing on three public health crises: HIV/AIDS, SARS and Avian Influenza. Ethical issues are examined first in a general fashion and then in a specific manner which uses the duty-based moral philosophy of Confucianism and a Western human rights-based analysis. Technical, political and legal issues will also be examined to the extent that they better inform the ethical debate. (shrink)

The target article by Laacke et al. focuses on the specific context of identifying people in social media with a high risk of depression by using artificial intelligence technologies. I...

Nursing research in China is at an early stage of development and little is known about the practices of Chinese nurse researchers. This interview study carried out at a university in central China explores the informed consent practices of Chinese nurse researchers and the cultural considerations of using a western technique. Nine semistructured interviews were conducted in English with assistance and simultaneous translation from a Chinese nurse with research experience. The interviews were analyzed by one western and two Chinese researchers (...) and major themes were identified. All participants endorsed informed consent as ethically required. Differences were noted between some of the informed consent practices typically recommended in the USA and those identified in this study, such as: recruitment using local and government officials, recruiting directly from medical records without special permission, family consultation in consent and consent control, and not revealing randomization to intervention groups receiving different treatments. (shrink)

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. (shrink)

Human embryonic stem cell research can bring about major biomedical breakthroughs and thus contribute enormously to human welfare, yet it raises serious moral problems because it involves using human embryos for experiment. The “moral status of the human embryo” remains the core of such debates. Three different positions regarding the moral status of the human embryo can be categorised: the “all” position, the “none” position, and the “gradualist” position.The author proposes that the “gradualist” position is more plausible than the other (...) two positions. Confucius’s moral principle of jen, which proposes a unique theory of “love of gradation”, and the principle of yi, which advocates “due treatment for persons”, are then explored. The author then argues that our moral obligations to do good to other living organisms, persons, and our families are different.Putting together the “gradualist” position on the human embryo, and Confucius’s theories of “love of gradation” and “due treatment for persons”, the author concludes that the early embryo has less ethical significance than the later fetus and adult human. The moral obligation we have toward persons is clearer and stronger than that which we have toward human embryos. Embryo research is justifiable if it brings enormous welfare to human persons that cannot be otherwise achieved. The “love of gradation” requires us, however, to extend love and respect towards other entities according to their different status. We should therefore be very cautious in using human embryos for research, acknowledging the gradualist nature of their moral status. (shrink)

The research reflects the philosophy of vitality, mortality, and immortality, based on the mystical life and theories of Hryhoriy Skovoroda and Confucius. What connects these two philosophers from different epochs and parts of the world? What makes them always stay interesting for each new generation? And what are their ideas still provoking plenty of interpretations? Dealing with real philosophy, there are always more questions than answers. We can never be sure whether the true ideas of the teachings of the philosophers (...) of such high level were revealed or stayed mysterious secrets for the next generations. But we hope to analyze the tips, given by the great minds, to find out someday the clues to the actual problems for humankind of any century: What is the sense of life? Where can we find happiness? Is it possible to predict death? Are there any possibilities for becoming immortal? This study is focused on investigating the possible answers to all these questions, using modern discoveries of American scientists and the clues left for us in the legacy of the philosophers beyond time and space: Hryhoriy Skovoroda and Confucius. (shrink)