There is no cultural consensus or single bioethical view on the use, donation, and destruction of human embryos and fetuses in China. With regard to the use of embryos for human embryonic stem cell (hESC) research, bioethicists in China have, since the early 2000s, called for reliable standards and the adoption of the bioethical principles of autonomy and informed consent, including the right to refuse embryo, oocyte, and sperm donation for research and the recognition that IVF patients are the legal owners of their embryos and gametes (Doering 2004; Cheng et al. 2006). However, divergent viewpoints exist with regard to the ways in which the perspectives of IVF patients (as potential donors for stem cell research) have been represented and problematized.
The influential bioethicist Renzong Qiu, for example, has stated that due to its status as a potential human being the embryo deserves due respect and that the interests and position of possible embryo donors must be well protected by regulatory safeguards (2007). However, according to Qiu there are fewer moral obstacles to the donation of human embryos for research in China than in Western and especially Christian societies (2007), where the embryo is often already seen as the carrier of a soul or spirit (Walters 2004). A central reason Qiu cites for this is the cultural influence of Confucian moral philosophy. The ethicist Yanguang Wang, a colleague of Qiu, summarized his position as follows (Wang 2003):
According to the accepted Confucian view, a person begins with birth. A person is an entity that has a body or shape and psyche, and has rational, emotional and social–relational capacity. So a human embryo is not a person, a personal life. Destroying an embryo as well as an abortion should not be taken as killing a person. However, a human embryo is a human biological life, not merely stuff, like a placenta. So it deserves due respect. If there is no sufficient reason, it won’t be permissive to manipulate or destroy it. Saving a great number of human personal lives can be a sufficient reason.
Hence, for Qiu, in line with Confucian reasoning, a fetus acquires personhood only with birth. The unborn embryo or fetus is not yet a person or a personal life, and its use for research is justified, provided there is sufficient reason. The therapeutic potential of hESC research is seen to be such a reason. Another explanation of Confucian notions of personhood has been provided by the ethicist Edwin Hui (2003). According to Hui, from a Confucian perspective, personhood is acquired gradually through social practice. It is thus not an innate or given property but develops over time through socialization and an individual’s social relations with the family and society (Hui 2003; see also Klein 2010). According to Qiu, this view has important implications for bioethical interpretations of the beginning of life and the value of unborn life. If being a person begins at birth, and personhood is acquired gradually through social behaviour, the value of unborn human life, especially at its initial stages, is low and less worthy of protection. It is a form of human biological life but not yet a person, and the destruction of a human embryo should not be taken as killing a life (Qiu 2004). According to Qiu, this is a widely held view in China and a central reason why IVF patients (in their role as potential embryo donors) can be expected to have less moral scruples or objections to the donation and use of their embryos for stem cell research (Qiu 2007; cf. Klein 2010). Yali Cong, a bioethicist from Peking University’s Health Science Centre and a former student of Qiu, reaches a similar conclusion. Cong (2008, 23–24) argues that:
[From] the mainstream of Chinese culture, that is, the tradition of Confucianism, the life of a person can be divided into two aspects: biological life and social life. Biological life does not have an inner character of “sacredness”, as the classical Confucian philosopher Xun Zi argued: the reason a person can be treated as a person is because he has yi (righteousness); otherwise, there is no difference between people and animals. […] The idea of social and moral life is so strong that people don’t take human biological life too seriously, let alone the embryo, or even the infant just after birth.
A related point is that, according to Cong, from the perspective of many people in China, “life comes from the parents, not from God.” As she points out:
This is the main reason individual persons, especially children, do not have a great deal of room for independence. Accordingly, parents have the right to make decisions for their children, even the right to decide about life. Thus, there is no obstacle for a woman who wants to stop her pregnancy, especially within the first three months. (Cong 2008, 25).
A practical problem with this view, and also with the arguments of Qiu and Hui above, is that these statements are primarily based on philosophical reasoning rather than systematic social science enquiries among Chinese citizens. As also stated above, a survey study by a team of IVF clinicians amongst almost four hundred IVF patients found that more than half (58.8 per cent) of all respondents indicated that they would refuse donation of their embryos for hESC research. A group around the Shanghai-based bioethicist and policymaker Chingli Hu arrived at similar conclusions. Based on interviews with religious and women’s organizations in China, this team concluded that a significant group of interviewees expressed moral concerns regarding the use of IVF embryos for hESC research (Hu 2009). These findings cast doubts on the Confucian-based argument that people in China generally consider the value of unborn human life low, and they indicate the need for more systematic empirical research, especially regarding the perceptions of women and couples undergoing IVF.
Bioethical Views on Abortion and the One-Child Policy
Another crucial issue in identifying the characteristics of the valuation of unborn human life forms in China is the extent to which, and the ways in which, perceptions of the use of embryos for hESC have been influenced by the legislation, discourse, and the large number of abortions that have been conducted under China’s population policy. As stated above, various authors (Mann 2003; Cookson 2005; Klein 2010) have suggested that the cultural environment created by China’s restrictive birth politics has significantly influenced public attitudes and ideas on the procuration and use of embryos for hESC research.
Bioethical positions in China have generally endorsed the population policy. In line with the policy’s rationale, the large number of abortions that were conducted in the context of the policy were seen as justified for the common good, as overpopulation and rapid population growth in China threatened the whole society (Jiang and Liu 2016). Nonetheless, bioethicists such as Renzong Qiu have repeatedly pointed to some of the problematic aspects of the one-child policy, such as sex-selective abortion and the lack of systematic controls on policy implementation at the level of villages and towns (Nie 2011). Despite the widespread support for abortion under the one-child policy, it would be misleading to assume, as the demographer Yaqiang Qi (referred to already above) has claimed, that “abortion […] has never been seen as wrong in Chinese society” (Qi quoted in Mann 2003). This is not true. During both the late Qing Dynasty (from c. 1880–1911) and the Republican years of China (1912–1947) abortion was prohibited, criminalized, and in some provinces equated with killing (Long 2012). The eminent ethical scholar of the Republican period, Guobing Song, suggested in 1933 that “the human fetus from the moment of its formation has its life and human rights, and the entitlement to be protected” [tai’er zi jie tai yihou, ji you qi shengming yu renquan, qie you qi baozhang shengming zhi quanli] (Song 1933, in Long 2012, 98).
While abortions were still carried out during this time, most abortions were conducted secretly, and physicians worked under the risk of being criminally convicted (Long 2012). Abortion only became legal after the foundation of the People’s Republic of China in 1949 when they were allowed as a part of family planning on a voluntary basis and since the 1980s as a central element of the country’s one-child policy (1980–2015). According to China’s Ministry of Health, reportedly 336 million abortions have been conducted in China since 1971, the majority on account of the one-child policy (Moore 2013). Since the early 2000s, an increasingly critical body of bioethical literature has emerged on China’s birth politics. These studies have pointed in particular to the individual and social suffering caused by the policy. This is best epitomized by the bioethicist and social scientist Jingbao Nie’s study Behind the Silence. As Nie states: “the one-child policy and the application of the authoritarian model have instead caused massive suffering to Chinese people, especially women, and made them victims to state violence” (Nie 2005). The awareness of the human cost of the policy, together with the reduction of China’s birth rate and a rapidly ageing society, have resulted in the gradual softening of the policy in recent years and in the transition towards a two-child policy since January 1, 2016 (Tian 2015). In legislation, unborn human life (up to the later stages of fetal development) was primarily seen as a biological entity that could be separated and destroyed without much ethical consideration. In legal terms, the ownership of unborn “surplus babies” (unborn babies of families that had already one child) was transferred from the parents to the state, which had the authority to enforce abortion and to execute sanctions if people resisted the policy.
As developments in other jurisdictional domains in China show, however, this “cold” or “pragmatic” view on unborn life forms has not been automatically transferred to other policy areas. In Chinese patent law, for instance, a completely different ethical discourse on the valuation of prenatal human life forms has recently emerged (Jiang 2016). As Article 18.104.22.168 in Part Two of the 2010 Chinese Guidelines for Patent Examination state: “The human body at various stages of its formation and development, including a germ cell, an oosperm, and embryo and an entire human body, shall not be granted the patent right.”Footnote 1 This prohibition to patent unborn human life or other parts and tissues of human bodies is explained by a morality clause (in the above guidelines), which states that: “when the commercial or industrial use of an invention is unacceptable to the public and not recognized by common moral standards, a patent right cannot be granted” (Jiang 2016).
Hence, in contrast to the “cold” logic of dispossession of the population policy (which legitimizes individual suffering by promoting the interests of society as a whole), patent law, and also the law for artificial reproductive technologies (ART law), and the regulations for hESC research––all emphasize the protection of interests and rights of individual citizens.
In the context of the donation and transfer of human embryos and gametes for reproductive purposes (as defined in ART law) and for research purposes (as defined in the hESC regulation) both the biological originators and the embryos (and gametes) themselves are seen as requiring special protection and are granted rights that prevent unauthorized removal, irresponsible use, and commodification.
In light of this conflicting and changing legal situation, it is extremely difficult to assess the impact of China’s population policy on the valuation of embryonic life forms in the context of embryo donation for hESC research. While we can assume that thirty-five years of population control have left a mark, one has to be careful not to overestimate the influence of the population policy or to confuse official policy positions and discourse with the opinions and perceptions of ordinary people, physicians, and scientists. As our empirical findings in the next sections show, the perceptions and ascribed value of human embryos are diversified and complex. For many of our respondents, the donation of human embryos for research or commercial purposes seems unthinkable. It seems misleading and wrong to assume that—as a result of the impact of the one-child policy—human embryos are generally seen as being of low value in Chinese society.
Our empirical data suggest that a conflation of the moral positions embedded in the population policy (in which prenatal human life has been portrayed as mere “biological matter” that could be disowned and destroyed without many ethical concerns) with the attitudes and perceptions of ordinary people is misleading. As the findings from our study suggest, forms of embryonic life in China are entangled in a rich web of overlapping and sometimes contradictory layers of meaning, values, emotions, and social relations, of which analysts, policymakers, researchers, and clinical staff should well be aware.
While our survey data and other studies (Jin et al. 2013; Mitzkat, Haimes and Rehmann-Sutter 2010) indicate that this is likely the case for a large proportion of the general public, this seems especially true for IVF patients, for whom embryos and gametes are of particular significance because they embody the hope for a child after a lengthy and often painful period of infertility. Indeed, it is a significant shortcoming that bioethics discourses in China (and many other countries) have for a long time approached the moral questions and perceptions of potential embryo donors as a more abstract problem, which has been discussed in terms of broader moral and cultural categories and assumptions, rather than with regard to the specific context of IVF and the perceptions of IVF patients. As this article and many others (Haimes 2008; Scully, Rehmann-Sutter, and Porz 2010) have shown, the valuation of human embryos and gametes has very particular characteristics in the IVF clinic. The context of infertility and hope, and also the technical process of IVF—in which human embryos are produced outside the human body, become visible through imaging technology, and are assessed in terms of their reproductive quality—create specific forms of valuation, emotions, and affective bonds that differ from a “normal” pregnancy and that remain unaccounted for in the context of a hypothetical evaluation of embryo donation by non-IVF patients.