Medical Morality Is Not Bioethics—Medical Ethics in China and the United States

MEDICAL MORALITY IS NOT BIOETHICS—MEDICAL ETHICS IN CHINA AND THE UNITED STATES RENÉE C. FOX* andJUDITH P. SWAZEYt Confiants dans les "lumières de la raison naturelle" . . . Us n'ont pas vu qu'ils étaient en présence d'une conception du monde et de modes de pens ée fondamentalement différents des leurs et que ces modes de pensée étaient en rapport avec la morale, Us attitudes religieuses, l'ordre social et politique des Chinois. [I]1 Drawing in part on a medical sociologicaljourney that we made to the People's Republic of China in 1981, this paper examines what the Chinese call "medical morality": the form currently taken by medical ethical interest and activity in their society. But our reason for having explored and written about medical morality is not confined to things Chinese. Another primary goal has been to obtain some cultural perspective on what we in the United States term "bioethics." Bioethics is the neologism coined in this country in the 1960s to refer to the rise ofprofessional and public interest in moral, social, and religious issues connected with the "new biology" and medicine and to the emergence of an interdisciplinary field of inquiry and action concerned with these issues. Medical morality not only exemplifies the at-once ancient and contemporaneous "Chinese-ness" of Chinese medical ethics. Seen in a comparative An earlier version of this paper was presented by Renée C. Fox as the Fae Golden Kass Lecture at Harvard Medical School and Radcliffe College, February 22, 1983. The authors are indebted to Judith Berling and David Smith, Indiana University; James Gustafson, University ofChicago; and Willy De Craemer, Setha Low, and Nathan Sivin, University of Pennyslvania, for their critical reading of the manuscript. ?Annenberg Professor of the Social Sciences, University of Pennsylvania, Philadelphia, Pennsylvania 19104. tPresident, College of the AUantic, Bar Harbor, Maine 04609. 'Description ofthe problems that the firstJesuit and Franciscan missionaries to China, in the late fifteenth and early sixteenth centuries, had in understanding and analyzing the Chinese way of thought—and their own thought in relation to it. See [1, p. 274].© 1984 by The University of Chicago. AU rights reserved. 0031-5982/84/2703-0379$01.00 336 J Renée C. Fox andJudith P. Swazey · Medical Ethics in China framework, it also helps to illuminate what is characteristically Western about "our" bioethics and highlights some of the ways that it is specifically American. Our title—"Medical Morality Is Not Bioethics"—is a rather mischievous one. It was provoked by an article, "Bioethics in the People's Republic of China," that we read before we went to China in 1981 and reread upon our return [2]. It is a "traveller's report" written by a professor ofthe philosophy ofmedicine, on behalfofa group ofprominent bioethicists (mainly associated with the Kennedy Institute of Ethics, Georgetown University) who made a 2-week-long trip to China in 1979. In his report, H. Tristram Engelhardt attributes solely to MaoismLeninism -Marxism what he loosely terms the "moral viewpoint" of the Chinese scientists, professionals, and intellectuals with whom he and his companions discussed questions ofmedical ethics. No allusion is made to possible Confucian, Taoist, or Buddhist origins of what the Chinese define as ethical matters or of how they think about them. Instead, Engelhardt expresses puzzlement over what he experienced as the "resistance " of his Chinese interlocutors to "intellectually justifying" their moral outlook within the framework that he considers properly and logically philosophical. In this regard, Engelhardt's reaction resembles that of the first Christian missionaries who lived and worked in China in the late sixteenth and early seventeenth centuries, and who assumed that the Chinese "do not have logic." Even the most culturally learned and responsive of the Jesuit missionaries, Father Matteo Ricci, did not fully recognize that his Scholastic notion of Reason was not universal or that the Chinese also reasoned systematically within their own internally consistent modes of thought [1, p. 327 et passim]. Engelhardt's failure to discern the pattern and logic oftoday's Chinese thought is related to the inadvertent ethnocentricity of the implicit premises on which his article rests. Bioethics, particularly its philosophical aspects, is viewed as...