An Asian Perspective of Western or Eastern Principles in a Globalised Bioethics

There are ways of greeting when two friends meet; for instance, in the west, two good friends will hug while others may just shake hands. In the east, the most common way of greeting is to bow to each other. Which greeting way is a better way? Of course, they are all good because they are the cultural customs handed down from generation to generation. In medical ethics, how will the west and the east handle a similar ethical dilemma? In western society, the patient's autonomy is emphasised while in the east, especially those regions influenced by Confucian teaching, an individual is regarded as a smaller self within a larger self, namely, the family; therefore a decision is made from the family's perspective because any decision made effects not only patient himself, but the whole family, especially when the matter has to do with the issue of life and death.

Modern advances in medical technology introduced to Asia in the early 20th century undoubtedly challenged the family-based decision-making model but a century has elapsed and this familial decision-making model is still safely in place. Even the four principles of medical ethics as taught in medical schools in Asia in the last 20 years that stresses autonomy as a priority in decision-making cannot shake this model. People still feel that the family is the centre of human fabric and the well-being of whole family must be recognised and considered when making a decision. The following two cases may give us a clue as to how people perceive the notion of autonomy in a Confucian society.

An 80-year-old patient suffered from cerebral hemorrhage and fell, and the Glasgow Coma Scale was down to 3. He had previously expressed that if anything should ever happen to him, where a full recovery was in doubt, he wished to pass on peacefully without any effort to keep him alive. The family was aware of his wish but is wife who was 73 years old refused to give up and said she was still young, healthy and willing to look after him even if he became vegetated. She said that she would follow him, if he was allowed to die. The family decided that efforts should be attempted to rescue him because his existence gave meaning to his wife and children. This old man was kept alive for the sake of his family.

A well-known scientist in Taiwan collected some tissue from volunteers in an aboriginal village for research. After explaining to the volunteers the nature and purpose of the research, the majority of the villagers signed the consent forms and donated their blood. When the elders of the village heard the news, they opposed the project, saying that unless the aboriginal community consented, this research project must be scrapped. After many runs of dialogues, this scientist had to destroy all the sample tissue she had collected from the villagers and apologised. The incident is not about a clinical decision but about a community that demanded that any research related to the well-being of the community must be approved by the community and not only by the volunteer himself.

Though the wish of an individual is gradually being taken into consideration when a vital decision has to be made, the family or collective agreement often still plays a key role.

What is the Nature of Confucian Bioethics?

Family coherence was the utmost important social system within a Confucian society. Out of the five traditional Confucian social relationships,¹ which are those between the ruler and subject, father and son, elder and younger brother, husband and wife, and friend and friend, three are family relationships. The remaining two, though not family relationships, should be understood in terms of the family system; that ruler and subject is a relationship like that of father and son and the relationship of friend and friend is like that between an older and younger brother. This relationship of close ties eventually developed into a typical Confucian ritual of ancestral worship which...