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 paper is aimed at a critical assessment of the moral framework of the current Chinese health system from a Confucian perspective, by focusing on the debate between the individual directed approach and the family-oriented approach to a health care system. Concerned with the nature and status of the family in communal life, the paper deals with the following questions: to cope with the frailties of material life (including susceptibility to disease), what good is presupposed by human existence and flourishing; (...) why it is the family that serves as the primary locus of bearing and realizing this unique good; and what kind of society might possess the structures necessary to achieve the good thus conceived. All these questions lead to a revision of the theory of justice required in health care, in favor of family health saving accounts as an important institutional guarantee. (shrink)

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)

Bioethics is a subject far removed from the Chinese, even from many Chinese medical students and medical professionals. In-depth interviews with eighteen physicians, patients, and family members provided a deeper understanding of bioethical practices in contemporary China, especially with regard to the doctor-patient relationship (DPR) and informed consent. The Chinese model of doctor-family-patient relationship (DFPR), instead of DPR, is taken to reflect Chinese Confucian cultural commitments. An examination of the history of Chinese culture and the profession of medicine in China (...) is used to disclose the deep roots of these commitments. The author predicts that the DFPR model will further develop in China but that it will maintain its Chinese character. (shrink)

Decisions regarding clinical procedures or research participation typically require the informed consent of individuals. When individuals are unable to give consent, the informed permission of a legally authorized representative or surrogate is required. Although many proposed procedures are aimed primarily at benefiting the individual, some are not. I argue that, particularly when individuals are asked to assume risks primarily or exclusively for the benefit of others, family members ought to be engaged in the informed consent process. Examples of procedures in (...) which individuals are asked to assume risks primarily or exclusively for the benefit of others include living organ donation and research participation. (shrink)

This paper challenges the foundational claim that the human family is no more than a social construction. It advances the position that the family is a central category of experience, being, and knowledge. Throughout, the analysis argues for the centrality of the family for human flourishing and, consequently, for the importance of sustaining family-oriented practices within social policy, such as more family-oriented approaches to consent to medical treatment. Where individually oriented approaches to medical decision-making accent an ethos of isolated personal (...) autonomy family-oriented approaches acknowledge the central social and moral reality of the family. I argue that the family ought to be appreciated as more than a mere network of personal relations and individual undertakings; the family possesses a being that is social and moral such that it realizes a particular structure of human good and sustains the necessary conditions for core areas of human flourishing. Moreover, since the family exists as a nexus of face-to-face relationships, the consent of persons, including adults, to be members of a particular family, subject to its own respective account of family sovereignty, is significantly more amply demonstrated than the consent of citizens to be under the authority of a particular state. As a result, in the face of a general Western bioethical affirmation of the autonomy of individuals, as if adults and children were morally and socially isolated agents, this paper argues that social space must nevertheless be made for families to choose on behalf of their own members. (shrink)

This article discusses the practice and development of organ donation by capital prisoners in China. It analyzes the issue of informed consent regarding organ donation from capital prisoners in light of Confucian ethics and expounds the point that under the influence of Confucianism, China is a country that attaches great importance to the role of the family in practicing informed consent in various areas, the area of organ donation from capital prisoners included. It argues that a proper form of organ (...) donation from capital prisoners can be justified within the Confucian moral context in which the proper interests of capital prisoners and their families, the benefit of organ receptors, and a rightful order of society should all be appropriately considered. From the Confucian perspective, the act of donating organs from a capital prisoner must be decided by both the prisoner and his/her family (i.e., each side should hold a veto power), whereas such donation, in the proper circumstance protected by a rightful procedure, should be appreciated as a morally praiseworthy act of the prisoner who is willing to make the final effort to repent and correct his/her evil conduct and to leave something good to the world. (shrink)