Abstract
There exists a serious shortage of organs for transplantation in China, more so than in most Western countries. Confucianism has been commonly used as the cultural and ethical reason to explain the reluctance of Chinese and other East-Asian people to donate organs for medical purposes. It is asserted that the Confucian emphasis on xiao (filial piety) requires individuals to ensure body intactness at death. However, based on the original texts of classical Confucianism and other primary materials, we refute this popular view. We base our position on the related Confucian norms of filial piety and ren (humaneness, humanity or benevolence), the tension between differentiated love and universal love, and belief in the goodness of human nature. In light of this, we argue that the Confucian ethical outlook actually calls for organ donation at an individual level, and supports an opt-out (presumed consent) system at the level of social policy. Furthermore, because the popular view is based on a number of dominant but misleading modes of thinking about cultural differences, our revisionist account of Confucian moral duties regarding organ donation has implications for developing a more adequate transcultural and global bioethics. These will be discussed and expanded upon.
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Notes
Literature on Jewish ethics is vast and there are always disagreements, just as it is the case with Confucian ethics or any other major moral tradition. According to Tana D’Bei Eliyahu 27, “If a person has enough food in their house and wishes to use it for charitable purposes to support others, they should first support their father and mother; if there is anything left, they should support their brothers and sisters; if there is anything left, they should support other relatives; if there is anything left, they should support their neighbor; if there is anything left, they should support those who live on the same street. Thereafter, they should distribute charity liberally to the rest of Israel.” And according to Babylonian Talmud Bava Metzia 71a, “Rabbi Yosef taught [about the verse in the Torah that says]: ‘If you lend money to any of my people that are poor with you.’ [This verse teaches that if you have to choose between:] a Jew and a non-Jew, give to the Jew first; a poor person and a rich person, give to the poor person first; a poor relative and poor people in your town, give to your poor relative first; poor people in your town and poor people in another town, give to the poor people of your own town first.” There are of course critical voices within Judaism: Arukh HaShulkhan Yoreh Deah 251:4 questions the above moral position by pointing out that the consequence is that “those poor who have no wealthy relatives will starve” and advocates instead that “Every wealthy man or householder must allocate a portion to poor who are not his relatives, but he should give a larger allocation to those who are his relatives; other categories of priority should be treated the same way.” (Bar-Ilan 2000).
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Acknowledgements
Thanks to Arthur Kleinman and David Jones, the paper was presented (by Nie) at the Department of the History of Science, Harvard University, in September 2018. The comments and questions from the audience proved stimulating for the revision of this paper. We thank Ted Kaptchuk and Rabbi Dani Passow for the material on Jewish ethics. The advice by the anonymous reviewer of this journal has also been helpful for revising this paper.
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Nie, JB., Jones, D.G. Confucianism and organ donation: moral duties from xiao (filial piety) to ren (humaneness). Med Health Care and Philos 22, 583–591 (2019). https://doi.org/10.1007/s11019-019-09893-8
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DOI: https://doi.org/10.1007/s11019-019-09893-8