China: Moral Puzzles

Abstract

This is the first of a set of three articles concerned with "bioethics on the Pacific Rim." The author, vice president of Beijing Medical University and vice chairman of the Beijing Academic Association for Morality, identifies population control, euthanasia, and the allocation of health care resources as bioethical issues of current interest in his country. Population policy in China is grounded in public welfare arguments. The idea of a right to choose one's death is found in Chinese philosophy, although Chinese legal experts believe that euthanasia is not compatible with present criminal, civil, or family law. Allocation of health resources remains a problem in China, even throughout the free medical service that serves a small portion, largely composed of government employees, of the country's population of 1.08 billion.The systematic study of modern medical ethics and bioethics in China began in the early 80s, although medical moral theory dates back to 475 B.C. In October l988 the 1st Chinese bioethics association was founded. The most popular topics for their symposia include: population control, euthanasia, and the allocation of health care resources. Birth control and population policy in China are both attempting to slow the 15 million annual increase in population. Family planning services are available for all married couples that seek it including sterilization and abortion. The current policy is that families should have only 1 child; ethnic minorities and rural residents are exempt. All policies on population control, abortion, and contraceptives are grounded in public welfare arguments. What they oppose is a long tradition in Chinese culture of large families. Euthanasia in China is an old topic with traditional wisdom stating that each person should have the right to chose their means of death. However for medical personnel it provides 2 dilemmas. 1st, the deontological position that doctors have a duty to both saving a patient's life and relieving pain. The doctor can not forsake one for the other. 2nd, the patient's personal benefits may conflict with the family's or society's overall benefits. Legal experts in China feel that euthanasia is incompatible with Chinese marriage law which prohibits the mistreatment or abandonment of family members. Allocation of medical resources is another issue because 800 million Chinese are not covered under the state's free medical care. Of those who are, there is limited capacity and the issue of who gets care is currently being debated.