Much discussion and debate have taken
place after the publication of Principles of Biomedical Ethics,
co-authored by Georgetown University’s bioethicists, Beauchamp and Childress
who implied that the four principles they promoted reflect not only the common
concerns of the world but also are trans-cultural in nature. In other
words, these four principles, based on common morality theory, can be
universally valid.
At first glance, one cannot but agree with this argument. But on a
closer examination, one will notice that these four principles are more western
than eastern, let alone universally functional despite the fact that Asian
religious and philosophical thought share similar concerns.
Biomedical ethics have been guided by
a few broad principles, at least from the perspective of principle-ism which,
though questioned by some has gradually been accepted by most bioethicists.
Some biomedical ethicists list seven, veracity, autonomy, beneficence,
nonmaleficence, fidelity, confidentiality and justice, but Beauchamp and
Childress listed only four and see the other three as derivatives. Beauchamp and Childress have argued that these principles are
trans-cultural in nature, yet Asians have different understandings of their
implications. Confucianism, one of the dominate thinking’s in Asia will be selected
as an example to illustrate the similarities and differences in the
interpretation of these principles.
no harm” hence became the healthprofessionals’ obligation. If a physician cannot benefit someone, at least
he/she should do no harm to them. Beneficence is the positive dimension of
nonmaleficence. This principle claims that physicians have the duty to help
others further their interests. It refers to a positive duty of promoting the
health and welfare of patients above all other considerations.
These principles of “do good and do
no harm” reflect Confucian teachings. “Do good” is the positive aspect of Jen,
the foundation of Confucian ethics. “Do to others what you wish for yourself”
is called by Confucius as Chung, or conscientiousness to others. “Do no
harm” is the negative aspect -- “do not do to other what you do not wish
yourself” which is called Shu, the way to practice Jen.
Furthermore, nonmaleficence and beneficence are understood not
only as duties but also as inborn natures of man. Mencius, the second sage in
Confucianism, believes that all men are endowed with a concern toward others.
In his word: “All men have the mind which cannot bear to see the suffering of
others”. He further explained: “When I say that all men have the mind which
cannot bear to see the suffering of others, my meaning may be illustrated thus:
now when men suddenly see a child about to fall into a well, they all have a
feeling of alarm and distress, not to gain friendship with the child’s parents,
nor to seek the praise of their neighbors and friends, nor because they dislike
the reputation of lack of humanity if they did not rescue the child”. From
such a case, we see that beneficence and nonmaleficience are expressions of the
feeling of commiseration which Mencius asserted as the beginning of humanity.
From this, we see that Confucian thought regards beneficence and malificence as
more than principles to be promoted. They are part of human nature.
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