- The Principlism-Confucianism Debate Continues
To some people, this might seem like a cliché already. But truly, the priciplism-Confucianism debate continues. In this issue of ABR, the academic debate rolls on with the article by Fan Ruiping. It rolls on not primarily because of the interest of academics (not that they are not interested and not that academic interest is not important), but because ordinary people have to face the debate in real life. They have to go through the debate in the clinics and hospitals, where they are faced with concrete situations and problems calling for practical and not merely conceptual solutions. In many cases, patients and/or their relatives have to struggle with these problems, looking for specific guidance in terms of applicable principles of action while seeking to be true to their Confucian way of life.
In the article, Fan points out that "Confucian morality is embedded in a way of life directed towards virtue and sustained by rituals or rites (lĭ) and that the focus is not primarily on resolving controversial cases, but instead on understanding properly what it is to live as a virtuous human". Unfortunately, patients and their families find themselves in situations where they do have to resolve difficult cases. Beyond understanding properly what it is to live as a virtuous human, they have to deal with practical healthcare issues. They have to decide whether or not to switch off a respirator; relatives have to determine whether the patient should be told the truth about his terminal condition or not; they have to choose between continuing with an aggressive approach to treatment and switching to palliative care, etc. While they try to resolve differences in those situations, they may also be trying to determine the best way to be consistent with their Confucian upbringing and understanding of a virtuous life. [End Page 1]
Thus, on the one hand, patients and/or their families could be attracted to a principlist approach that offers (when it does) a specific principle (not necessarily from Beauchamp and Childress) to support a particular decision. On the other hand, and at the same time, the same patients/families could be struggling with their internal values and looking for a way to justify bioethical decisions in the context of Confucian virtues. The point is that people who can be considered as Confucians could be trying very hard to find guidance in principles in order to make bioethical decisions. Turning to their Confucian upbringing, they soon realise that there are no readily available solutions. Fan refers to "central values embedded in Confucian virtue of dé " - such as honouring human life, cherishing harmonious human relations, and treating one another humanely, as ... embodied in both principles and rituals". However, these are hardly specific enough to be able to provide definitive guidance for bioethical decisions in healthcare situations. According to Fan himself, "this comprehensive and dialectical picture of Confucian reflective moral equilibrium keeps Confucian moral thought a far distance from the thought of principlism".
Unable to find definitive guidance in Confucian virtue ethics for particular situations, patients and/or relatives could find themselves having to invoke principles in order to "justify" decisions they have to make. The principles they invoke may have worked for others who do not have a similar ethical outlook. In a way, the same principles work for our hypothetical Confucian. He needs a basis for making a decision and a particular principle provides it under the circumstances. But does the principle truly justify the decision? There is a sense in which it does not. The consistent Confucian endeavours to find a fit not only between the principle and the particular decision that it is used to "justify" but also between the principle and the Confucian values that constitute life's flourishing. When the latter fit is absent, the principle may serve to rationalise without actually justifying. As a rationalisation, the principle may serve to explain the decision under the circumstances but it does not necessarily serve to justify in the sense of providing valid grounds that are consistent with the broader context of values that one seeks to live by. In this way, the principlism...