Bioethics with Chinese characteristics: cultural contexts and modern trends

In chapter II we saw that approaches of historians, philosophers and sociologists (in our case they are those who construct Confucian and Taoist bioethics), from one side, and physicians (Shi Weixing), from another side are quite different. Scholars focus on �Chinese characteristics�: they criticize Western notions of �individualism� and �human rights�, promote very personal relationships between actors of bioethics, high value of moral traditions and traditional medicine. They say that Chinese culture, if properly studied, can give an alternative to its Western version (which cannot be relevant for Asian societies), and also enrich it. At the same time, they sometimes implicitly, sometimes explicitly repeat the criticism of alternative approaches of Western bioethics, for example, feminist approach. They propose to find a fundamental source of �love� in Chinese culture (it is xiao, of filial piety), which is, in my opinion, is a rather Christian-like question, or use methods very similar to allegoric interpretation of religious texts in working with Confucian texts. And Shi Weixing, who has an academic background in healthcare, for example, says in his book dedicated to biomedical ethics that China lacks bioethics in general, not in its Chinese version. He does not insist on its creation, but still, much of what he says is very different from what I have read in Western bioethics textbooks. Thus, in many respects he unconsciously introduces an authentic bioethics with Chinese characteristics.

So, bioethics is not only the discipline, but also people's ways of thinking, perception of their own bodies, believes, superstitions and decision-making. It is not only a personal deal: the way society operates affects policies, regulations and, for example, development of biotechnologies. In China we see, that sustainable preferences of male children obliges the state to prohibit physicians from informing parents of fetuses' gender; traditional vision of the body can bring some specific bias against organ transplantation; and science-oriented ideology and booming market can lead to multiplication of experimental laboratories.

Government ideology is an important driver in bioethics, as much depends on laws and regulations in the field. Our study has shown that bioethical policies of Chinese government are formed, among other things, by the will to have good international reputation and rivalry of states for superiority in high technologies. The ways regulations are applied are of major importance. In China state control over biotechnologies is not so strict, as in European countries and the US, and that is why not only Chinese scientists conduct their bold experiments and cutting-edge research here, but also foreigners come to the country for this purpose. The system changes over time, but at the moment this trend is still in force.

To resume the accomplished work, I will briefly enlist my major findings.

- In the sense of general methodology, Chinese Bioethics can be classified as consequentialist and virtues-oriented. Historically and ideologically, it does not attach much importance to principles of autonomy and human rights and encourage paternalism in doctor-patient relationships. But we should also mention, that at the level of rhetoric, Chinese doctors are trying to follow international bioethical standards. Chinese government appoints new bioethical commissions and promises to control their operations.

- At the legislative level, the regulation of bioethical issues in China has no fundamental differences with Western practices. There are some exceptions such as birth policy, but here China is moving towards world standards, as well. What makes the system different, is the specificity of application of relevant regulations.

- Chinese scholars construct Confucian bioethics using methods similar to the interpretation of religious texts, as, for example, in the case of Islamic bioethics. They have to do it because of the main challenge of the whole enterprise: Confucious and his followers said almost nothing about life (non-social one), death and health issues. From time to time, scholars address to Taoism to fill this gaps.

- Chinese folk culture and language have intrinsic features that determine the attitude to some bioethical issues. Some words in Chinese have a completely different context of use compared to European languages, some of them give answers and imperatives to certain bioethical questions.

- We examined in detail different topics and problems in bioethics, comparing approaches to them in the West and in China. In most cases the latter shows a significant shift in attention towards the social issues and, particularly, to the family, although in the West the family is not so common in the discourse of bioethics.

- At the moment, there were no large-scale public opinion polls regarding reproductive and genetic technologies in China. However, a study of media materials and discussions on social networks showed that most of the Chinese have a negative attitude to experiments in the field of biotechnologies. People in academia show double-edged approach: they severely condemn those scientists who conduct bold experiments (for example, in the field of creating human-animal hybrids or head transplantation), but do not condemn the experiments as is and relevant fields of research.

Have the author confirmed her hypothesis? I will cite it one more time: Chinese bioethics presents a multi-composite compound of intrinsic cultural features, �reinvented� Confucian and Taoist cultures, politically determined principles and specificity of operation of biotechnology regulatory system.

My analysis approved that all these phenomena determine the current state of bioethics and will definitely affect it in the future. To be more precise and give a more full picture, these drivers are:

1. Scientism, or science orientation as a part of Chinese politics;

2. Efforts to construct Confucian bioethics;

3. Specific body perception, linguistic and other intrinsic features of Chinese culture;

4. Market factor (in China both supply and demand for biomedical technologies is rather high) and lack of regulation in the field;

5. The importance of China's international reputation.

Qiu Renzong, Fan Ruiping, Edwin Hui and other enthusiasts of construction of Chinese bioethics are right: this culture that is several thousand years old have much recourses to invent its bioethical system. There are a lot of notions in Confucianism that correspond to even very sophisticated principles and methods in general bioethics - for example, the term quan (?) that, among other options, can be translated as �to weight the circumstances� (Chinese words are highly homonymous) and compared to �double effect� method that helps to make a decision in case of confronting principles (discussed in the chapter I). The question is only how successfully Chinese bioethics will interact with the reality: can its highly personal, value- and virtue-based approaches be applied in a country with almost 1.4 billion population and co-exist with non-Confucian and non-Chinese bioethical systems in the globalized world.

Since most of the drivers and characteristics of Chinese bioethics are actually authentic and specific, it can be assumed that in the future it will have a number of distinguishing features and influence both global standards and local bioethics in countries politically and culturally connected to China.

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