pp. 86-91 in Bioethics in Asia

Editors: Norio Fujiki and Darryl R. J. Macer, Ph.D.
Eubios Ethics Institute

Copyright 2000, Eubios Ethics Institute All commercial rights reserved. This publication may be reproduced for limited educational or academic use, however please enquire with the author.

2.6. China and Eugenics - Preliminary remarks concerning the structure and impact of a problem of International Bioethics

Ole Doering.

Institute for Asian Culture, Hamburg, Germany

1. The setting

It has been argued that the human prenate in China is traditionally not accepted as a 'full human life', but valued equal to parts of the pregnant mother's body, just like her ribs and eyes (1). This corresponds with a frequent notion of Chinese moral thinkers who hold that it is chiefly the social skills, next to rational capacities, which provides the conceptual ground for the social value of a person, including related assertions such as human rights and a right to living (2), but not personal autonomy.

This line of argument has provoked various objections on all levels, reaching from harsh accusations of moral rudeness, over ignorance to cultural relativistic inspired ethical fatalism resulting in a premature end of mutual consultation. One thing regularly omitted in the efforts to accuse China for alleged bad moral habits is an organized international attempt to open the lines of demarcation, in order to get into a constructive-critical dialogue with Chinese experts and representatives. Although the prospects for such a dialogue do not favour great optimism from a political view, it is both, a requirement of prudence, and of fairness to check all options seriously first, if we discuss ethics.

What about the conceptual setting of such attempts? The present state of international scientific discussions on medical ethics issues is most vivid and stirring. The achievements of advanced biological understanding and biotechnology, in their new approaches to shape and reshape functions of life, have given occasion to contemplate over a historically new quality of ethical problems, or, at least, over the exploding quantity of their appearance. This refers to every nation worldwide, and trivially to China, too.

However, at this very moment of time no one can even make clear, whether the merits of modern medicine will, by and large, outweigh the risks for individuals and societies, or if they won't. The chief claim of human genetics, for instance, to bring about comprehensive understanding of how we function, and long term medical benefits, is yet to be confirmed. But still it does not make sense to turn our backs on these problems as if they were too delicate for philosophical scrutiny. The Pandora Box is open. As a matter of fact this new Promethean Fire is already flaring up, consuming bits and bites of traditional body concepts, attitudes and acts towards the human being. As far as philosophical ethics are concerned, this confrontation makes up for a virtual challenge. Broad moral intuitions, such as the benevolence-imperative of the Hippocratic Oath, do not satisfy the demands of ethical accuracy any more. Better help might be expected from approaches of more modest and practical interest in particularly given cases of ethical concern, and the impact of respective knowledge and skills, quite unfamiliar to many schools of ethics so far. Obviously the road to a comprehensive and global medical ethics is long, and paved with a variety of approaches and intentions, not all of them designed to cope with present and future ethical needs.

In this paper I wish to submit some suggestions concerning the structure of a modern Chinese Medical Ethics as part of the modern world, paying tribute to the extraordinary heritage of ethical thought in China. I do not intend to support devotees of ethical cultural-relativism, but in contrary, I wish to encourage an original Chinese access to the developing international debate of medical ethics. However, the ages of national isolation, of imperialism and cultural vitalism have become obsolete and, on balance, unproductive, because we are now facing challenges for the whole mankind. The weight of these challenges requires that all persons and peoples invest their very best and share it, in order to rescue peace and survival on terms of human dignity.

Some hold that modernization in a perspective of ethics simply means to adjust the standards of so-called backward nations to the more or less successful model of so-called Western normative patterns. Although no one of good intentions won't welcome an ethical orientation provided by a comprehensive paragon it is very doubtful whether and how far it is justified to follow any single given ethical approach just on its own right.

The second side of the coin is the state of the art in Europe (I am not dealing with the 'rest of the West' here). How much effort to encourage the ethical debate on a not culturally restricted but international level has been introduced by scientists of, let's say, Germany? There may be a very few pioneers, like Gerhold Becker and Hans-Martin Sass. But the mainstream discussions in Europe appear to be stuck in a sort of self-centered and self-satisfied intra-cultural perspective, which, ironically, gives evidence for arguing that there is no principal difference between intra-cultural and inter-cultural hermeneutics. If we look for the diversity of standpoints and approaches, it is just a matter of degree of complexity, not of essence, whether we include Chinese approaches or rather remain satisfied within our small familiar horizons. While there are quite considerable contacts between natural scientists at work we still miss a proper institutional cooperation on issues of medical ethics. The establishment of mutual cooperations with China and other Asian states has to be achieved yet, as far as European engagement is concerned. But what about the quality of the debate?

If we browse through the debates over medical ethics we encounter a conceptual deadlock as soon as we try to make sense of the underlying principles. For example, it is far from satisfying to envisage the inconsistent treatment of the prenatal. While anti-abortionists of the Vatican are still engaged in crusades against contraception, let alone any active pre-natal interference, on the one hand, the objections and arguments turn out helpless and run out of self-confidence, on the other hand, if it comes to the routinized and legal, but deadly unfreezing of embryos, produced in the labs of our fertilizing industries. And, another example, how can we seriously discuss cloning in a way which anticipates the cloning of human twins, for purposes of organ/tissue banking or transplantation? The respective European discussions, be it pro or against cloning, seem to ignore that both approaches in effect reduce the human being to material devices. A common opinion here seems to ignore that every human being has innate dignity, disregarding how ever he or she may have been fertilized. Maybe, one time, we might rather have to get used to it, like we obviously have done in case of IVF children. However, this attitude reminds of exactly the same biologistic-reductive attitude towards fresh human life which I have mentioned above and which has been accused to be rude, as far as Chinese opinions were addressed. And it is completely unprepared for the uncomfortable questions of distributive justice, although we have reason to expect more significant hints for ethics in this line of investigation.

This biased view may be understood as an expression of metaphysical and counter-metaphysical concepts predominant in the modeling processes of prescriptive norms in the so-called Christian parts of the world. It may also be ascribed to mighty schools of liberalism and a sort of 'property-individualism' which seem to weigh the individual's interest superior to family or social interests. The impact of this inner-European struggle on international affairs shows two lines of arguments. One has its roots within the ethical concerns of the human rights debate with its implications for medical ethics, and is relying on postulates of essential cultural differences in the conception of ethics. The other is related to certain metaphysics of Western countries. For example there is a refined notion of the holiness of human life as an untouchable sacred ground moulded solely in the hands of god. This can be easily related to Christian cultures and certain historical circumstances. In language and stile, some of these traditional patterns are very hard to be maintained under conditions of a modernized society, and even harder to be transferred into the cultural ciphers of, let's say, China. Still there is lots of evidence for a common notion of universal ethical basics, such as the dignity of life and an also consensual awareness of a peculiar value of the human being.

An early example is found in the works of the philosopher Xun (Xun Zi, 310-230) of the classical period of Chinese philosophy, who, in one passage of his famous chapter 'On Kingly Government', gives a clear account of the setting and ethical determination of mankind. After having discussed that it is specific for humans to have a capacity for moral differentiation (Chapter V) Xun Zi introduces the chief ethical principle of righteousness (Yi) which includes respect for the other and for 'Heaven and Earth':

"Water and fire have vital energy, but they do not have life. Greens and woods have life, but they do not have knowledge. Birds and beasts have knowledge, but they do not have (the moral principle of) righteousness. (It is only man, who) has vital force, life and knowledge, as well as righteousness. Therefore he is the most distinguished being in the world." (Chapter IX.12)

This is just one of uncountable examples proving that one may not talk about a reductionist body concept in the Chinese tradition. In contrary, we can show numerous cases in which human dignity or even exclusivity is taken for granted, but written down in other than Western terms. Our concerns of prenatal medicine could not have bothered the sophistication of traditional ethicists, neither in Europe nor in China. Still it is thrilling, especially from a view educated within the frameworks of western philosophies, to observe philosophical approaches which view man as creature of highest dignity, by his capacity of being a moral person, without at the same time being urged to open a principal ontological or metaphysical gap between humanity and the world.

Although cultural explanations bear some plausibility and may provide a convenient blueprint for populist purposes, they are far too unbalanced and superficial to contribute much to a comprehensive understanding and the discussion of ethics. They are under criticism not only from Asians but definitely from the Europeans themselves. Anyway, we should not focus primarily on the voices of the past. Partners in any business are well advised not to stop short of recognizing respective differences but to help one another to overcome internal constraints, be them material or conceptional.

An issue of serious concern is to distinguish arguments from tradition from arguments in the name of tradition. While the first is merely historically descriptive, the latter also makes prescriptive claims of a value of tradition as such. We ought to make sure in all of our discussions that we exclusively rely on good and reasonable arguments which can be subjected to scientific scrutiny and constructive criticism, regardless of who formulated them in the first place, and within which traditional background they appear, except, maybe, for the great and diverse tradition of mankind. Arguments in the name of any particular tradition are virtually predesigned not to be understood and communicated among people from different cultural or traditional origin, which is an effect no one can desire.

This is a reason to call Chinese and other Asian ethicists to take pains in a constructive and well informed criticism, not just on their own given conditions, but also on shortcomings of a 'Western' provenience or on any other international scale. Colleagues dedicated to substantial progress in medical ethics are very likely to welcome such an engagement. Still, such an undertaking requires great improvements in knowledge supply and ethical scholarship, including the separation of ethics from all sorts of ideology, corresponding to a standard of international debate we all have not reached yet. Modernity, in its strict sense, is a programmatic endeavor, no existing nation can honestly claim to be engaged in.

I do not have to explain the problems of ethical education and of a free ethical debate in China now, which belong to the intricate whole-scale situation of developing China. At the same time we might view the disadvantages of the present Chinese low level and insider discussion in different light, utilizing the lack of discourse experience as also bearing a chance for a new and less culturally preoccupied orientation for the world wide debate. China may enter the debate in a more scientific and less biased condition, if it once decides to modernize its society comprehensively.

2. Medical Ethics versus Eugenics in China

What has the 'Foundation of Asian or Chinese Bioethics' to do with 'China and Eugenics'? What has the survival struggling China of our days to deal with Bioethics anyway? There is a lot of arguing that, to take part in such an 'academic' kind of debate is a nice but infertile effort, and this argument is also being raised within China.

Let us observe one concrete example for the irritating current appearance of medical ethics awareness in China. Although it belongs to the field of politics and justice rather than into sciences, it can serve as a case for ethics. I am aiming at the 'Mothers and Infants Health Care Law' of 1995. This law has been under attack as purportedly favouring purposes of a 'Eugenics Law', which had actually been the official English translation of an earlier draft version's title (3). The yet unsolved conflict between good intentions, as claimed by the legislators, and the bad, i.e. active eugenic purposes, as suspected by critics, has manifested a constant obstacle for international communication about medical ethics. The International Genetics Federation may withdraw its plans to hold the 1998 International Congress of Genetics in Beijing as a consequence. There is some bad irony in the prospect that Beijing now might feel inclined to instrumentalize the international pressure to cancel the Ethics-panel of this Congress which Chinese colleagues have been pushing forward energetically.

The critical impact of the law is seen in some of its formulations. Many international critics, however, do not seem to have studied thoroughly even the English translation. One wonders, why there has not been any similar objection against the Taiwanese 'Eugenics Health Care Law' of 1984 ('Yousheng baojian jiating jihua fa'), which rather deserves its name, not to mention the remnants of eugenics laws in some 'Western' states. This stands in the way of a fair and balanced judgment, and it definitely does not help Chinese physicians and patients any step further. What is in fact new and encouraging in the law are passages, inventing new standards for medical personnel, stipulating patient's informed consent, and forbidding sex-related abortion in China. I quote the official English translation (emphasizes are by the author, O.D.):

'Article 26 Personnel engaged in medical technical appraisement must have adequate clinical experience and medical knowledge and the professional title of a physician-in-charge or above that title.' In addition says

'Article 34 Personnel engaged in the health-care services for mothers and infants shall strictly abide by professional ethics and keep the secrets of the individuals concerned.' Further, the state is even committed to actively stop anyone without the relevant qualification to engage in any kind of pre-marital or prenatal check-up, diagnosis, appraisment or operation (Article 35).

Article 32 stipulates that 'Sex identification of a fetus by technical means shall be strictly forbidden, except that it is positively needed on medical terms'. In the light of medical ethics concerns, this might be the decisive article of the whole law:

'Article 19. Any termination of pregnancy or application of litigation shall be agreed and signed by the person concerned. If the person has no capacity for civil conduct, it shall be agreed and signed by the guardian of the person.' (Informed consent).

Comments in the international discussion, which would fully acknowledge these passages as real advances and milestones for China, and which would highlight them as reference points for a constructive criticism. Still, it is obvious that these legal standards content improvements which have been long demanded out of ethical reasons, and which may be read as part of the recent Chinese efforts to develop a legal system, overruling the Maoist campaign and ideology politics. The current practical effect of this law raises different questions.

This positive interpretation is strengthened by the introductory paragraphs which define the main purpose of the law, i.e. that it has been

'... formulated in accordance with the Constitution with a view to ensuring the health of mothers and infants and improving the quality of the newborn population' (Article 1).

'The state shall develop the health-care undertakings for mothers and infants and provide necessary conditions and material aids so as to ensure that mothers and infants receive medical and health-care services. The state shall assist outlying and poverty-stricken areas in their efforts to develop the health-care undertakings for mothers and infants.' (Article 2)

Article 3 is demanding all government levels to make health-care for mothers and infants a chief issue in their efforts of developing economy and society. Not at least, (in Article 5) it obliges the state to 'encourage and support education and scientific research in the field of health care for mothers and infants'.

While the wording of the law at least justifies modest encouragement, some people on the other hand have been very suspicious about the unspoken dimensions and pointed at a number of hints for ill-minded policy among peculiar terms. They suspect an invitation of abuse, if not a plain eugenics intention. (Among the terms and formulations subject to critical investigation there is the core statement of 'improving the quality of the newborn population'. (Improving stands for the Chinese Tigao (increase) , while 'quality' is not for the more technical term Caineng or Zhiliang one would expect, but for Suzhi (literally the congenital disposition). This refers to the collective, and it allows both interpretations, the eugenic and the plain imperative to increase the level of health. As to the individuals the first commission according to the law is to 'ensuring the health of mothers and infants'. This is quite literally translated from 'Wei le baozhang muqin he yinger jiankang'.) Most concern has been mobilized against the following articles. Because regretfully I may not carry out an in depth analysis of these passages here, I will simply quote them and make no further comment, except that there is some obvious need for a revision. We may find occasion to discuss this later.

'Article 10: Physicians shall, after performing the pre-marital physical check-up, explain and give medical advice to both the male and the female who have been diagnosed with certain genetic disease of a serious nature which is considered inappropriate for child-bearing from a medical point of view: the two may be married only if both sides agree to take long-term contraceptive measures or to take a ligation operation for sterility. (...)'

'Article 16: If a physician detects or suspects that a married couple in their child-bearing age suffer from disease of a serious nature, the physician shall give medical advice to the couple, and the couple in their child-bearing age shall take measures in accordance with the physician's medical advice.'

'Article 18 The physician shall explain to the married couple and give them medical advice for a termination of pregnancy if one of the following cases is detected in the prenatal diagnosis: (1) the fetus is suffering from genetic disease of a serious nature; (2) the fetus is with defect of a serious nature; and (3) continued pregnancy may threaten the life and safety of the pregnant woman or serious impair her health due to the serious disease she suffers from.'

Article 38 defines: '"Genetic diseases of a serious nature" refer to diseases that are caused by genetic factors congenitally, that may totally or partially deprive the victim of the ability to live independently, that are highly possible to recur in generations to come, and that are medically considered inappropriate for reproduction. (...)

"Prenatal diagnosis" refers to the fetus regarding its congenital defect and hereditary diseases.'

There are two more issues of concern in the 'Health-Care Law'. Firstly it might be intended not to improve the health care sector in particular, but to fill the legislative and structural gaps on the field of population-policy, which is a special problem of China and other overpopulated nations. Secondly there is no clean cut borderline between eugenics and preventive measures against diseases (4).

This is a general problem of medical ethics which is as old as medicine herself. It should be regarded helpful for Chinese and other Asian Medical Ethicists to study thoroughly the sad lessons Western societies have experienced under the influence of ill minded or poorly educated Eugenics, not only, but particularly under Nazi rule in Germany. This might prepare our Asian colleagues to receive a detailed figure of the problematic impact of eugenics and to understand with more sympathy the sometimes overexcited criticism. And this might be an issue for future conferences about Medical Ethics as well.

3. The common ground

Finally I would like to remind the audience of the strong common basis of philosophical awareness of the peculiar dignity of human life and its associated responsibility, at least shared by Chinese and European traditions. This common ground can certainly be found all over the world, as a constant ethical concept of mankind, articulated in different modes of writing and saying.

I hold that, although it is useful, we are just not forced to return to Xun Zi, Meng Zi, Lu Xiangshan or Wang Yangming, to quote some great names of traditional Chinese ethical thinking. This is not only because these thinkers could not have had an idea of the medical ethics problems we are facing today, but more, because we are obliged to provide our own access to the ethical troubles of our time, on the highest degree of insight available and with the mankind project of modernity in mind, for the benefit of our children and the future of our planet.

To call for a more comprehensive Chinese engagement in bioethics does not automatically lead to an 'ethical downsizing' of standards, as many people in Europe suspect. The problems of and with China are to a great deal owing to considerable historical and technical problems, including the poor situation in education and infrastructure (5). If we look at the whole scale of the quality of the international ethical debate, Europe, America, Australia, the Asian regions, including China, do not show up too far apart from a common level. An 'Asian Bioethics' ought to be founded under the 'no-clash' maxim of international communication and agreement, just the same way as a 'European Bioethics' and a 'World Bioethics' ought to be designed. This means to anticipate the coming era of global responsibility for all nations.

This is an aim yet. Today it seems to be quite a long way until all of us will have been enabled to mobilize and organize all of the relevant human and material capacities, and until Europe has taken its leave from self satisfaction. But it's the right time to support international communication, cooperation and meetings like this one. It is also right to be grateful for the fine part the EAAB, the EUBIOS Institute and UNESCO are contributing to this process of ethical development by making our meeting possible. Finally, it is now time for me to thank Professor Okamoto, Professor Fujiki, Professor Sakamoto, Professor Macer and our colleagues cordially for making this aim a step less far away (6). Constructive criticism is welcome.

Please send comments to Email < asianbioethics@yahoo.co.nz >.

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