Medical Ethics in China: A Transcultural Interpretation (review)

It is with some ambivalence that I write the review of this book. It has received a glowing endorsement in a foreword by one of the leaders of the field, Robert Veatch: “We have a breakthrough to a new level of communication that will enrich not only the study of the relation between Chinese and Western medical ethics, but the entire field of cross-cultural and transcultural study of ethics … Nie is the first person in medical ethics who can seriously claim to be at home as an insider in both Chinese and Western thought … He is the first, really the only, scholar of medical ethics of China who I find comfortable thinking, feeling and analyzing as a Westerner while simultaneously retaining his deep and abiding commitment to his original culture”. As will be clear in my review, I am fundamentally uncomfortable about Nie’s approach and Veatch’s assessment of it. Having worked most of my career on the ethics of health policy and research ethics, I can claim no special expertise on Chinese medical ethics and on most of the topics covered in this book. However, my suspicion was confirmed that perhaps also Veatch does not know Chinese medical ethics very well, when he highlights the importance of the works of Ole Döring for an understanding of Chinese medical ethics, and minimises the contribution of Professor Qui Ren Zong to one who “exposed many Westerners to the basics of Chinese medical ethics”. I think most observers with even a superficial understanding of what goes on in China would disagree with that comparative assessment.

Nie’s ambition is not only to provide us with a nuanced picture of medical ethics in China and a corrective to certain well-entrenched opinions about its characteristic features. His ambition is to develop a theoretical framework for cross-cultural ethics in general, based on his study of medical ethics in China. This framework has the following elements: each culture possesses a plurality of different moral viewpoints, with both similarities and differences compared with other cultures, and giving rise to complex interactions between cultures; effective dialogue is possible between different cultures; and, in spite of these differences, normative judgements about right and wrong ultimately determine what is right and wrong. Nie aims to contribute to all three of these elements.

The first element, that of the plurality of moral viewpoints and the complexity of interactions between cultures, is the least controversial, especially today. Nie is rightly critical of the very common view that Western ethics, implicitly interpreted as US or at most Anglophone ethics, is individualistic and Chinese is communitarian. This myth has been perpetuated partly based on the early scandalously superficial analyses by scholars such as Tristram Engelhardt and Renee Fox. Nie recognises the complexity of bioethics, both in the West and in China, making it impossible to justify any simple generalisations about the overarching values in any particular tradition or country or time period. He points out the obvious fact that there are communitarian streams within US medical ethics. More importantly, he shows that this is also true for China.

One of the cases he examines in more detail is the issue of attitudes to abortion. Some have claimed that abortion has not been seen as morally problematic in the same way as it has in the West, partly because of the fact that the foetus has not been seen as a person. Based on his own survey and interviews conducted about a decade ago, and published in a previous book, he shows that the situation in China is much more complex. Both historically and in contemporary China, there are many views regarding the status of the foetus and the morality of abortion. This, however, is hardly novel in and of itself; others have made the same point about China in general and about abortion policy in China in particular. The abortion issue involves...