Love and the History of Chinese Bioethics

- Zhang Daqing, M.D.
Center for History of Medicine, Beijing Medical University
Beijing, CHINA
Eubios Journal of Asian and International Bioethics 9 (1999), 47-49.

As Dr. Macer said in Bioethics is Love of Life, the concept of love in bioethics can be seen in all culture, religions, and in ancient writings from around the world. Medical ethics in China has a long tradition. Under the influence of Confucianism, Taoism, and Buddhism, the tradition of medical ethics includes the concept of love, from love of parents and children to love of patient and life. In the paper, love and the history of Chinese bioethics will be reviewed in four fields, that is, the means of love in Confucian medical tradition, Taoist medical tradition, in Buddhism medical tradition, and in modern China.

The meanings of love in Confucian medical tradition

1. Xiao (filial piety ): the origin of love

As a dominant cultural tradition in China, Confucianism have greatly influenced the Chinese medical ethics. The core of Confucianism is jen-ai (humanity), which is mainly based on the ties of family relationship. Confucius said, "Jen is to love parents." It shows that the original idea of jen-ai was the love of each other among family members. Mon Zi, who lived in War States, believed that love of each other among family members is humanity. He said, the essence of humanity is to love parents. To love parents is called Xiao (filial piety ). The love advocated by Confucianism was not indiscriminate equal love. Confucianism argued that people should love their family first and other persons to lesser degrees. So Confucius said, "the filial piety is the essence of a moral son and teaching come from it." It's the central point of the highest morality and impiety is the worst evil.

The idea of Xiao (filial piety ) extensively influenced medical ethics. It's the important intention and goal for those who studied medicine in ancient China. Many individuals studied medicine for the aim of filial piety and then became great doctors, such as Zhang Zhong-jin, whose work Treatise on Cold-Damage Disorders was one of the crux of traditional Chinese medicine, devoted himself to medicine due to cold-damage disorders of his family. Liu wan-su, Zhang Cong-zheng, Li Gao and Zhu Dan-xi, who was called the Four Great Doctors in Jin-Yuan Dynasty, began to study medicine for treating family members, too. As a moral norm, the thought of filial piety didn't only effect on doctors, but on the health care behaviors of the common people. Chu Hsi (A.D.1130-1200) a famous Confucian in Song Dynasty, said "if the parents fall ill, the sons or their wives are not allowed to leave their side without reason. They have to prepare the drugs themselves, taste them in advance, and administer them [to the sick]. If the parents are sick, it is forbidden for their sons to display carefree conduct, to have fun or to look for pleasure. All other concerns have to be given secondary importance, so that they can devote themselves especially to their duty of receiving the physician, selecting formulas for prescriptions and preparing drugs. Once the disease has been cured, the original activities may be resumed."

Although the idea of filial piety has notably impacted on medical ethics, it also induced negative influence on the medicine, such as rejecting autopsy and anatomy. On other hand it advocated the autonomy for curing parents.

2. Jen-ai in medical practice

However, the idea of Confucian Jen-ai was not limited to love of family members, but was enlarged to love all individuals, that is, to love people. Mon Zi said, "Love my parents as well as other older; love my children as well as other children. " Confucianism held love should become a universal ethical principle from loving family members to human being . The universal principle of love is enough embodied in medical practice. Sun Szu-miao (A. D. 581-682) a great doctor in Tang Dynasty, said If someone seeks help because of illness or on the ground of anther difficulty, [a great physician] should not pay attention to status, wealth or age, neither should he question whether the particular person is attractive or unattractive, whether he is an enemy or a friend, whether he is Chinese or a foreigner, or finally, whether he is uneducated or educated. He should meet everyone on equal ground. Sun's ideal was advocated by many physicians.

Jen-ai was the central point in the tradition of medical ethics in China, because healing the patient and saving life were considered as the best way loving people. It was what a lot of officers and scholars devoted themselves to in medical practice. It also was the cause of appearing Ru-yi "Confucian Physician". Ru-yi was a scholar of good family who studied medical art as an extension of philosophy in a spirit of benevolence, perhaps because he wanted to help a sick parent and to heal other sick people, but his main role in life was that of a civil servant and gentleman. Since the Song Dynasty, the number of Ru-yi increased because under the influence of idea on that if one cannot act as a good officer to serve country, he should act as a good physician to cure patient. So a lot of Confucian scholars who lost the opportunity into political circles turned to medicine, in which they realized their ideal of love.

Thus, the Confucian Physician considered medical practice as benevolent action and rejected the medical professionalism

The meaning of love in Taoist medical tradition

Taoism, another culture tradition in ancient China, had closely been keeping relation with medicine. On one hand, many Taoists devoted themselves into medical practice. While they carried a lot of methods of healing, they had been trying to find the remedies for immortality and the ways of longevity which showed their love of life. On the other hand, Taoism had profound influence on the ideas of medical ethics, for example on the concepts of health and disease, life and death, and etc.

The theory of Taoism formed in East-Han Dynasty (1st-3rd centuries A. D.). But the origin of the school came mainly form the ideas of Lao Zi and Chuang Chou, such as advocating to follow the law of nature, to moderate one's desire and lust in order to longevity. Guo Hong, a famous philosopher and physician, summarized a lot of theories and practices which were used by Taoists and physician in Bao Pu Zi published in the 3rd century. He developed a series of theories and methods how to longevity. Gou's ideas had greatly impact on traditional Chinese medicine.

The influence of Taoism on medical ethics includes three fields, that is, on the ideas of health and disease; on the ideas of life and death; the idea of sexual morality. First, Taoism held that health depended on the maintain of the natural instincts of human being. Chuang Chou (369-286 B. C.) said, "Keeping tranquil mind and controlling desire are accordance with the virtue of the Heaven." Diseases are due to bad or immoral life-style and behaviors. And the life-style in accordance with the morality and nature can be benefit for peoples' health. Second, Taoism was desirous of longevity and loath to death. Taoists developed a set of techniques of prolonging life in order to achieve the goal of immortality for the physical form of existence which shows the love of life. Lastly, Taoism claimed that sexuality was necessary for person's health, but it should be moderated, if not, it should be harmful to individual. So a variety of sexual techniques were developed for maintaining males' essence and longevity.

Absorbed the thoughts of retribution of Buddhism, Taoism admitted that a person's pleasure and disaster, health and disease, longevity and death-young were closely linked with his behaviors. Therefore, a person should do good work and store up his virtue for his health and longevity.

The meaning of love in Buddhist medical tradition in China

Like Confucianism and Taoism, Buddhist ethical thoughts had importantly impacted on medical ethics in ancient China.

Buddhism held that when a physician treats diseases he had to develop first of all a marked attitude of compassion. He should commit himself firmly to the willingness to take the effort to save every living creature. In Buddhism, love means to love all living creatures. So Sun Si-miao, a famous physician in Tang Dynasty, criticized physician to use living creatures as a drug. He said, "From early time famous persons frequently used certain living creatures for the treatment of diseases, in order to thus help others in situations of need." To be sure, it is said, "little esteem for the beast and high esteem for man," but when love of life is concerned, man and animal are equal. Sun stated, "Whoever destroys life in order to save life places life at an even greater distance. This is my good reason for the fact that I do not suggest the use of any living creature as medicament in the present collection of prescriptions."

Under the title of "Yi Gong Bao Yinq's retributions for medical services", Zhang Gao placed the practice of medicine in a striking relationship to Buddhist ideas of rewards and punishments by the powers of another world.

It should be noted that the impact of Confucianism, Taoism and Buddhism on medical ethics is complex in ancient China. A lot of statements and ideas on medical ethics in ancient writings show the integration of these schools, such as in On the Absolute Sincerity of Great Physicians, Sun Si-miao considered compassion (ci) and humanity (jen) as the basis of values of medicine, which are taken from the Confucianism and Buddhism. He also referred back to a statement by the founder of Taoism, Lao Tzu, in order to depict an incentive for rewards which was to render material desires unnecessary.

The meaning of love in modern Chinese bioethics

1. from love of the people to love of the nation

After the nineteenth century, the majority of people lived in squalid conditions that were overcrowded and unhygienic in China, because China was still a traditional peasant society. As the central government weakened and local corruption made the peoples' life more difficult and general standard of living deteriorated with the impact of frequent wars and natural disasters. The Japanese invasion had a devastating effect on China. Under the background, a lot of physicians who were adhering to an ancient tradition: "The superior doctor serves the nation, the middle doctor the individual, and the inferior doctor treats physical ailments." turned his love from the people to the nation, such as Sun Yat-sen, Lu Xun and Guo Muo-ruo. However, more physicians devoted themselves into the reform of the social health in order to realize their love of people.

2. "Bethune's spirits" the love of selflessness

Dr. Norman Bethune was a Canada surgeon who worked in the guerilla-base area in China during the Anti-Japanese War and died of septicemia from an infected cut caused whilst performing emergency surgery. Dr. Bethune was praised by Mao Ze-dong, a Communist Party leader, because he worked hard and healed patients wholeheartedly. Mao applauded Bethune as a person of selflessness and appealed to all people to learn from him. So the love of selflessness was considered as a moral code in medical profession, that is "Bethune's spirits". The "Bethune's spirits" has important effects on the physician in China still now.

However, "Bethune's spirit" is challenged now due to the impact of market economy in China. Some physicians turned their love from the patients to the money. Fortunately, most of doctors still think the love of people as very important in medical services.

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