Diversified and in Harmony, but not Identical (和而不同): Harmonising International Guidelines with Cultural Values and National Traditions

The Richnesses of Cultural Traditions in Harmony

Modern medical ethics globally has been promoted and is supportive of the four principles (autonomy, nonmaleficence, beneficence, justice) which were first described in Western cultures over the last 40 years. We have empirical evidence that these four principles are accompanied by Asian values in our medical practice, such as medicine is the Art of ren (humaneness), compassion with the patient, a moral duty in being professional, i.e., to practise medicine and nursing at the highest professional standard, and an involvement of family or family values in preparing or implementing decisions, if this is according to the wishes and values of the patient. These values play an important role in day-to-day clinical practice and are addressed in clinical consultation boards globally, not just in Asian cultures. Thus, cultural traditions and those in healthcare ethics must learn from each other.

Character cultivation for all healthcare professionals is also important and an issue not to be a neglected; Confucian physician Yang Chuan recommended centuries ago that patients only trust doctors "who have a heart of humanness and compassion, are clever and wise, sincere and honest". Thus, the respect for individual values and wishes of the patient — expressed by the term "autonomy" should be valued and valid in all healthcare cultures. Similarly, the professional empathy and personal commitment to the patient — expressed by the term "compassion" — should be an essential part of healthcare ethics on a global scale. Eastern and Western traditions, principles and traditional virtues can and must learn from each other. They can and must be harmonised, where they are different. But different cultures have their own identity, including their specific traditions in the care for health and for the sick and frail, but they should not be made totally identical and similar, just as two people cannot and should not be made totally identical, which would take away the dignity and authenticity of both of them.

Confucius has an answer to harmonise the conflict between international guidelines deriving from one culture (Western) and other cultures with strong and well established moral and legal traditions (such as in Asia). His answer is: 和而不同 he er bu tong (Lun Yu, Chapter 13, paragraph 23). Bioethics, healthcare ethics, healthcare law and regulations all over the world — in China and elsewhere — should and must be "in harmony but not identical"; "in harmony as well as diversified".

International Guidelines, National Cultures and Legal Traditions

Principles and goals of international guidelines, such as the Helsinki Declaration, Council for International Organization of Medical Schools/World Health Organization (CIOMS/WHO) International Ethical Guidelines, etc., need to be recognised when new national regulations are written. However, inflexible and rigid guidelines, which are not sensitive to cultural and legal diversities, may clash with moral and legal traditions in countries with established "native resources" of culture and law elsewhere, including China. This is a challenge to both sides and shows in many disciplines of the humanities and social sciences, such as economics, law, science, political sciences and others, as well as in national legal traditions.

The concept of "native resources" in the legal context means those standards shaped on the basis of traditional norms, well accepted state laws, common laws, village rules, community rules, civil conventions, business rules, religious rules, and family traditions, etc. For example, values in native resources of China and most Asian countries of similar culture include being community-oriented, giving priority to community interests over individual interests, respect for authority, not favouring change and reform, stress on harmony and not favouring disagreement, stress on proprieties, not favouring law.

Human rights, utility, justice, equality, liberty and democracy are universal values. These universal principles should not be seen to be in conflict or in competition with original native resources. Rather, they should use original native cultural and moral resources to support and implement the goals of utility, justice, equality, liberty, and civil rights and democracy. However, it does not mean that the native resources would be dominant without regard for universal values and decide everything. This...