A Confucian reflection on genetic enhancement

This essay explores a proper Confucian vision on genetic enhancement. It argues that while Confucians can accept a formal starting point that Michael Sandel proposes in his ethics of giftedness, namely, that children should be taken as gifts, Confucians cannot adopt his generalist strategy. The essay provides a Confucian full ethics of giftedness by addressing a series of relevant questions, such as what kind of gifts children are, where the gifts are from, in which way they are given, and for what purpose they are given. It indicates that Confucians should sort out different types of enhancement and bring them to the test of the Confucian values in terms of both Confucian virtue principles and specific ritual rules. It concludes that Confucians can accept some types of enhancement but must reject others.

[The impact of the study of contemporary and Confucian comments on the classic Neijing (Internal Classic) and its commentary and subcommentary]

The argumentation between the contemporary and old Confucian classics schools had a profound and lasting impact on the Traditional Chinese Academy, so as to evolve into two kinds of attitude towards the scholarship which influenced TCM which was based on traditional Chinese culture. These impacts reflected in the following three aspects: first, the differences between the words of different versions of Neijing (Internal Classic); second, the formation of some theories of Neijing (Internal Classic) such as the attachment of five zang-organs and five phases; third, the annotated methods for (Neijing (Internal Classic) of the physicians of past generations.

Role of children in end-of-life treatment planning among Korean American older adults

Three focus groups (n = 23) with Korean American older adults explored the role of culture in end-of-life decision making. No participants had completed an advance directive and few had discussed end-of-life treatment preferences. Focus group themes addressed: (a) whether children are resistant or receptive to discussing their parents' end-of-life treatment preferences; (b) whether the older adults or their children should make decisions about end-of-life treatment; (c) whether decision making should be the responsibility of the eldest son or of all the children; and (d) whether children would implement the parent's preferences for end-of-life treatment. Understanding the role of children in end-of-life decision making among Korean American older adults is important for culturally competent care.

"Enhancing life?" Perspectives from traditional Chinese value-systems

The author explores bioethics and "life enhancing" technology from the perspective of traditional Chinese value systems.

Application of mental illness stigma theory to Chinese societies: synthesis and new directions

The rapidly-evolving literature concerning stigma towards psychiatric illnesses among Chinese groups has demonstrated pervasive negative attitudes and discriminatory treatment towards people with mental illness. However, a systematic integration of current stigma theories and empirical findings to examine how stigma processes may occur among Chinese ethnic groups has yet to be undertaken. This paper first introduces several major stigma models, and specifies how these models provide a theoretical basis as to how stigma broadly acts on individuals with schizophrenia through three main mechanisms: direct individual discrimination, internalisation of negative stereotypes, and structural discrimination. In Chinese societies, the particular manifestations of stigma associated with schizophrenia are shaped by cultural meanings embedded within Confucianism, the centrality of "face", and pejorative aetiological beliefs of mental illnesses. These cultural meanings are reflected in severe and culturally-specific expressions of stigma in Chinese societies. Implications and directions to advance stigma research within Chinese cultural settings are provided.

Corrupt practices in chinese medical care: the root in public policies and a call for Confucian-market approach

This paper argues that three salient corrupt practices that mark contemporary Chinese health care, namely the over-prescription of indicated drugs, the prescription of more expensive forms of medication and more expensive diagnostic work-ups than needed, and illegal cash payments to physicians-i.e., red packages-result not from the introduction of the market to China, but from two clusters of circumstances. First, there has been a loss of the Confucian appreciation of the proper role of financial reward for good health care. Second, misguided governmental policies have distorted the behavior of physicians and hospitals. The distorting policies include (1) setting very low salaries for physicians, (2) providing bonuses to physicians and profits to hospitals from the excessive prescription of drugs and the use of more expensive drugs and unnecessary expensive diagnostic procedures, and (3) prohibiting payments by patients to physicians for higher quality care. The latter problem is complicated by policies that do not allow the use of governmental insurance and funds from medical savings accounts in private hospitals as well as other policies that fail to create a level playing field for both private and government hospitals. The corrupt practices currently characterizing Chinese health care will require not only abolishing the distorting governmental policies but also drawing on Confucian moral resources to establish a rightly directed appreciation of the proper place of financial reward in the practice of medicine.

Learning the available and supplied religious facilities for inpatient services: an example of Taiwan's hospital environment

Holistic nursing care is typically defined to include the assessment and support of a patient's religious background to respect his/her beliefs and promote coping with illness, rehabilitation, and/or dying. An assessment of Taiwanese hospitals reveals variation in the policies and environment supporting religious practices. The survey of nursing executives revealed that only 40% of hospitals had any facilities for religious service or prayer and only 4% employed a chaplain or recruited volunteers to provide religious support. Approximately 20% of hospitals did provide a room for special ceremonies, often used for rituals after patient death.

Chinese widowers' self-perception of growth: an exploratory study

Presence of growth after traumatic events was introduced to the academic community about a decade ago (Tedeschi & Calhoun, 1995). From the conventionally neglected perspective of Chinese widowers, this paper reports seventeen Chinese widowers' views on growth after conjugal loss. Findings seem to suggest that Chinese widowers would define growth as human learning, a definition probably influenced by Confucian teachings. Furthermore, contrary to claims made by Tedeschi and Calhoun (2004), it was found that growth may occur for some individuals without the presence of distress if the individuals have either a stable philosophy of life and death or optimism to buffer their distress or a sense of responsibility to suppress their distress.

Confucian bioethics and cross-cultural considerations in health care decision-making

This article discusses the similarities and differences between Beauchamp and Childress's principlism and Confucian bioethics in terms of autonomy, beneficence, nonmaleficence, and justice. The author presents sensitive approaches for culturally diverse groups in health care areas and cautions against dichotomy in cross-cultural studies, which ignores the dynamic nature and intravariations of cultures. As a way of health care providers to become engaged in cultural diversity in nursing practice and research, the author suggests that they do not only have a general knowledge about the theoretical differences among groups through "normative analysis" but also learn to appreciate each individual's particular beliefs and values through narratives of morality. Health care providers as well as legal professionals need to cultivate "cultural humility," which is the willingness to explore the similarities and differences between their own and each client's priorities and values and to develop courses of action with patients.

Towards a Confucian virtue bioethics: reframing Chinese medical ethics in a market economy

This essay addresses a moral and cultural challenge facing health care in the People's Republic of China: the need to create an understanding of medical professionalism that recognizes the new economic realities of China and that can maintain the integrity of the medical profession. It examines the rich Confucian resources for bioethics and health care policy by focusing on the Confucian tradition's account of how virtue and human flourishing are compatible with the pursuit of profit. It offers the Confucian account of the division of labor and the financial inequalities this produces with special attention to China's socialist project of creating the profession of barefoot doctors as egalitarian peasant physicians and why this project failed. It then further develops the Confucian acknowledgement of the unequal value of different services and products and how this conflicts with the current system of payment to physicians which has led to the corruption of medical professionalism through illegal supplementary payments. It further gives an account the oblique intentionality of Confucian moral psychology that shows how virtuous persons can pursue benevolent actions while both foreseeing profit and avoiding defining their character by greed. This account of Confucian virtue offers the basis for a medical professionalism that can function morally within a robustly profit-oriented market economy. The paper concludes with a summary of the characteristics of Confucian medical professionalism and of how it places the profit motive within its account of virtue ethics.

Bioethics: a search for moral diversity

The concept of global, Asian and Chinese bioethics are discussed in this paper and the difficulty in applying universal bioethics within different cultures and countries is addressed. The traditional beliefs and values in China are described with particular reference to medicine, and the implications for bioethics and research ethics within the country are considered.

Cultural values embodying universal norms: a critique of a popular assumption about cultures and human rights

In Western and non-Western societies, it is a widely held belief that the concept of human rights is, by and large, a Western cultural norm, often at odds with non-Western cultures and, therefore, not applicable in non-Western societies. The Universal Draft Declaration on Bioethics and Human Rights reflects this deep-rooted and popular assumption. By using Chinese culture(s) as an illustration, this article points out the problems of this widespread misconception and stereotypical view of cultures and human rights. It highlights the often ignored positive elements in Chinese cultures that promote and embody universal human values such as human dignity and human rights. It concludes, accordingly, with concrete suggestions on how to modify the Declaration.