Abstract
The “Proposed outline for a report on respect for human vulnerability and personal integrity”, which tries to interpret the principle of human vulnerability, begins with the following observations.
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Notes
- 1.
Though this version of liberal individualism is not robust in this IBC document, an examination of full-fledged liberal, individualistic bioethics would be helpful so that we know the benchmark.
- 2.
Within the confine of this paper the present author cannot fully articulate the Confucian social-political vision. Suffice to say that some fine scholars agree that it is unfair to characterize Confucian social thought as collectivistic. See Zhongfang 1993, pp. 321–434; Jin 1992, pp. 1–16. Some scholars prefer to use the term “holism” rather than “collectivism” as the self-community relationship is conceived in a part-whole manner; see Munro 1985.
- 3.
Alasdair MacIntyre puts it aptly, “In many pre-modern, traditional societies it is through his or her membership of a variety of social groups that the individual identifies himself or herself and is identified by others. I am brother, cousin and grandson, member of this household, that village, this tribe. These are not characteristics that belong to human beings accidentally, to be stripped away in order to discover ‘the real me’. They are part of my substance, defining partially at least and sometimes wholly my obligations and my duties.” (Macintyre 1981).
- 4.
It seems that the moral equation between autonomy and dignity is prevalent only in the English-speaking world. Contemporary Germany has respecting the dignity of the human person written into the constitution, but the argument of individual autonomy is not that prevalent in that country.
- 5.
This saying is an abbreviation of famous passage in the first chapter of the Xiao Jing (孝 經), The Classic of Filial Piety: “When we have established our character by the practice of the (filial) course, so as to make our name famous in future ages, and thereby glorify our parents: this is the end of filial piety,” King 1966, p. 466.
- 6.
Joseph Chan puts it well when he explains the Confucian concept of freedom, “Confucians would justify freedom only on the ground that it allows people to pursue the good. That we should be free to do X is because X is good, and not because freedom expresses or realizes personal autonomy. The Confucian justification for the freedom to do X is always content-dependent; that is, it depends on whether X is valuable,” Chan 2002, p. 300.
- 7.
- 8.
The following three observations are summary. For the textual discussion, see Lo 2010, pp. 71–72.
- 9.
This modern version of Confucian thought is my re-construction, and the mechanism of family co-determination is admittedly not neat and tidy. “Family meetings” after dinner or before bed time are usually the occasions for deliberation and decision together. There is no strict mechanism of one family member, one vote. Family co-determination of course includes self-determination, but the weight of one’s voice varies in different stages of life. In general, we can say that as a small child one’s voice carries some weight, but in a smaller way. Family co-determination in this stage is largely, but not entirely, parent- determination. As a teenager and young adult, one’s voice in family deliberation grows much stronger. Family co-determination in this stage is largely individual self-determination. When one is married, and especially after having children, one’s individual autonomy decreases again. Family co-determination is largely deliberation together with one’s spouse and taking seriously the opinions of one’s children. Joseph Chan also explains this well on Confucianism and personal autonomy, “Personal autonomy admits of degree—one can be more or less autonomous, and its value need not be absolute,” Chan 2002, p. 301.
- 10.
Joseph Chan helpfully distinguishes between moral autonomy and personal autonomy and argues persuasively that classical Confucianism’s concern is with the former. “The ideal of moral autonomy is that moral agents can make moral decisions that they reflectively endorse, and be able to act on this basis. Conceptually, it is possible to be morally autonomous without having valuable options concerning career, marriage, and so forth. Moral autonomy is compatible with a narrow range of life choices,” Chan 2002, p. 299.
- 11.
Some modern Confucian thinkers do acknowledge the limit of the family, and even acknowledge sometimes family is the source of problem rather than the solution to the vulnerability of family members. I cannot go into this broad topic in this short article.
- 12.
For a wonderful discussion on family co-determination in Chinese medical ethics, see Fan 1997, pp. 309–322. Fan’s phrase is “family-determination,” but I think “family co-determination” is a more accurate description. Fan’s paper uses Chinese as well as Japanese sources for his argument. Family co-determination certainly includes the patient himself or herself. When there is disagreement within the family concerning whether or not to consent a proposed treatment, Hong Kong public hospital doctors will hold family meetings to resolve the disagreement.
- 13.
To steer clear of liberal individualism, the word “individuals” should be replaced by “persons.”
- 14.
In an earlier article James Nelson correctly observes, “Both theoretical medical ethics as now most widely understood and medicine’s own ethical tradition are ruggedly individualist: the interests of the individual patient, in splendid isolation from her social context, are to a considerable extent privileged”. To be sure, there are powerful reasons for this focus, rooted in our concern about defending the vulnerability and privacy of patients. Yet there is increasing reason to believe that this intensity of focus on patient interests—considered as the interests of splendidly isolated individuals—reflects a kind of moral obtuseness, and that we would do better to design a system of medical decisionmaking sensitive to a broader range of values, Nelson 1992, p. 7.
- 15.
“Similarly, an advance directive, if I really wanted to make one, should not be regarded as solely a means for me to exercise my self-determination, but should also be used to express my concern for my kin and my commitment to their well-being when I become incompetent. The directive is a means of helping them to know my voice and of facilitating the ongoing dialogue with them when I lapse into incompetency. My family members would then try to talk to me as if I were competent, but the whole point of the dialogue is not so much to figure out what I would have wanted for myself (my counterfactual choice) but to arrive at a family decision with my counterfactual participation. The prior directive only encodes my initial voice, and my voice, along with those belonging to my significant others, is likely to be transformed as the dialogue goes along. So, the final decision need not be dictated entirely by the literal meaning of my advance directive, however clear and specific it is, though it is nevertheless an important reference for my family in the decision making process.” Chan 2004, pp. 96–97.
- 16.
Alastair Campbell argues cogently in one article that dependency is not the enemy of autonomy. For an individual ever to attain autonomy, dependency may be a vital stage in his or her progress to full autonomy. Every adult at stages in his or her life will need and desire to be dependent on others. Autonomy embraces the choice to be dependent when dependency is essential to full health and well-being. As he puts it, “But we must also accept that for some of us all of the time and for all of us some of the time the maintenance of autonomy will not be the major issue. Instead we need to know that we are responded to, loved, protected by people we can trust” Campbell 1991, p. 111.
- 17.
The Hospital Authority of Hong Kong understands advance care planning as “a process of communication among patients, their health care providers, their families, and important others regarding the kind of care that will be considered appropriate when the patient cannot make decisions.”
- 18.
I want to thank the anonymous reviewer for pointing this out to me.
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Lo, P. (2014). Family as First Bulwark for the Vulnerable: Confucian Perspectives on the Anthropology and Ethics of Human Vulnerability. In: Tham, J., Garcia, A., Miranda, G. (eds) Religious Perspectives on Human Vulnerability in Bioethics. Advancing Global Bioethics, vol 2. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-8736-9_7
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