The Family, Medical Decision-Making, and Biotechnology: Critical Reflections On Asian Moral Perspectives

222 Pages·2007·1.321 MB·English

by  Shui Chuen Lee (auth.)

THE FAMILY, MEDICAL DECISION-MAKING,
AND BIOTECHNOLOGY
Philosophy and Medicine
VOLUME 91
Founding Co-Editor
Stuart F. Spicker
Editor
H. Tristram Engelhardt, Jr., Department of Philosophy, Rice University,
and Baylor College of Medicine, Houston, Texas
Associate Editor
Kevin Wm. Wildes, S.J., Department of Philosophy and Kennedy Institute
of Ethics, Georgetown University, Washington, D.C.
Editorial Board
George J. Agich, Department of Bioethics, The Cleveland Clinic Foundation,
Cleveland, Ohio
Nicholas Capaldi, Department of Philosophy, University of Tulsa, Tulsa
Oklahoma
Edmund Erde, University of Medicine and Dentistry of New Jersey, Stratford,
New Jersey
Eric T. Juengst, Center for Biomedical Ethics, Case Western Reserve University,
Cleveland, Ohio
Christopher Tollefsen, Department of Philosophy, University of South Carolina,
Columbia, South Carolina
Becky White, Department of Philosophy, California State University, Chico,
California
THE FAMILY, MEDICAL
DECISION-MAKING,
AND BIOTECHNOLOGY
CRITICAL REFLECTIONS ON ASIAN
MORAL PERSPECTIVES
Editor
SHUI CHUEN LEE
NationalCentralUniversity,Chungli,Taiwan
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Table of Contents
Acknowledgements ..................................................... xi
Shui Chuen Lee
1. Medicine and the Biomedical Technologies
in the Context of Asian Perspectives.................................. 1
Shui Chuen Lee and Justin Ho
I. A View from Asia: An Introduction....................................................... 1
II. The Family and its Impact on Bioethics and Personhood..................... 2
III. Medical Decision-Making and Traditional Conception of the Family.. 4
IV. Embryonic Stem Cell Research: Confucian, Islamic,
and Western Perspectives........................................................................ 7
V. Taking the Family Seriously: Confucian Approaches
to Health Care......................................................................................... 11
VI. Conclusion............................................................................................... 13
2. Confucian Familism and its Bioethical Implications................... 15
Ruiping Fan
I. Introduction: Why Confucian Bioethics is so Different......................... 15
II. The Features of Confucian Familism..................................................... 16
III. The Power of Virtue................................................................................ 18
IV. Shared Family-Determination for Health Care....................................... 19
V. Family Responsibility for Health Care Financing.................................. 22
VI. Biotechnology and the Family................................................................ 23
VII. Concluding Remarks............................................................................... 25
3. The Family in Transition and in Authority: The Impact
of Biotechnology..................................................... 27
H. Tristram Engelhardt, Jr.
I. Introduction: In the Face of Robust Moral Pluralism
and Conflicting Metaphysical Accounts................................................. 27
II. The Family as a Major Battleground in the Culture Wars.................... 29
III. The Standard Contemporary Account: Individuals as the Source
of Decisional Authority and the Structure of the Family....................... 32
IV. Familist Accounts: Autonomy and Authority of the Family
as a Social Category................................................................................ 34
v
vi Table of Contents
V. The Persistence of Family Authority...................................................... 36
VI. ConflictingVisionsoftheFamily,theCultureWars,andtheNew
Reproductive Technologies: A Concluding Reflection.......................... 39
4. Family Life, Bioethics and Confucianism.............................. 47
Stephen A. Erickson
I. Liberal Secular Individualism and the Confucian Response
to the West’s Anomie: An Introduction................................................. 47
II. Medicine and its Threat to Human Nature: Taking Metaphysics
and Family Seriously.............................................................................. 47
III. Globalization, Americanization, and the Cardinal Place
of Confucian Thought............................................................................. 50
IV. Critical Rationality, Sentiment, and the Confucian Notion
of the Person............................................................................................ 52
V. The Tipping Point: The Infant as a Product........................................... 55
VI. Conclusion............................................................................................... 57
5. The Moral Ground of Truth Telling Guideline Development:
The Choice Between Autonomy and Paternalism...................... 59
Shuh-Jen Sheu
I. Introduction.............................................................................................. 59
II. Facing the Dilemma of Truth Telling in Terminal Cancer.................... 60
III. Guideline Development for Truth Telling in an Asian Society............. 60
IV. Dealing with Autonomy, Paternalism, or Vulnerability
of Truth Telling in Taiwan..................................................................... 61
V. Figuring Out and Reinterpreting the Meaning of Autonomy
and Paternalism....................................................................................... 63
VI. A Cultural Sensitivity and Team Work Approach
to Truth Telling....................................................................................... 65
VII. Conclusion............................................................................................... 68
6. Truth Telling to the Sick and Dying in a Traditional
Chinese Culture...................................................... 71
Stephen Wear
I. Case Summary......................................................................................... 73
II. Sissela Bok’s Classic Work on Lies to the Sick and Dying.................. 74
III. Concluding Remarks............................................................................... 78
7. On Relational Autonomy: From Feminist Critique
to Confucian Model for Clinical Practice ............................. 83
Shui Chuen Lee
I. Feminist Critique of the Concept of Individual Autonomy................... 84
II. From Individual to Relational Autonomy............................................... 86
Table of Contents vii
III. Philosophical Explication of Autonomy: From Kant
to Confucianism.................................................................................... 87
IV. Moral Relatedness and Family Relationship........................................ 88
V. A Confucian Model of Ethical Relational Autonomy......................... 90
VI. Some Practical Implications of Ethical Relational Autonomy:
The Role of Family in Bioethical and Medical Decisions.................. 91
8. Regulating Sex Selection in a Patriarchal Society:
Lessons from Taiwan................................................ 95
Wenmay Rei
I. Introduction........................................................................................... 95
II. Justifications for a Ban on Sex Selection: A Typology of sex
Selections.............................................................................................. 97
III. Sex Selection in Taiwan....................................................................... 100
IV. Embedded Sexism: The Social Meaning of Having
a Son in Taiwanese Society.................................................................. 101
V. ConsensusinNeed:TheProblematicLegitimacyoftheBanning
of Sex Selection in Taiwan................................................................... 104
VI. The Need to Protect Actual Women Over Possible Embryos............. 106
VII. Conclusion............................................................................................ 108
Appendix......................................................................................................... 109
9. Modern Biotechnology and the Postmodern Family.................. 113
Leonardo D. De Castro
I. Two Types of Challenge to Human Relatedness................................. 113
II. Reproductive Revolution: Extending the Frontiers
of Human Freedom............................................................................... 114
III. Organ Transplantation: Extending the Frontiers
of Human Responsibility...................................................................... 115
IV. Increasing Human Interdependence in the Area
of Organ Transplantation...................................................................... 117
V. Organ Transplantation: A Challenge to Give More............................ 118
VI. The Genetic Family as Locus of Responsibility.................................. 120
VII. Limits to Genetically Based Responsibility......................................... 121
VIII. Reciprocity and Responsibility: Transcending
Genetic Boundaries............................................................................... 122
10. The Ethics of Human Embryonic Stem Cell Research
and the Interests of the Family...................................... 127
Ruiping Fan
I. Introduction........................................................................................... 127
II. Ethical Individualism vs. Ethical Familism......................................... 129
III. One-Sided Morality on ESC Research................................................. 134
viii Table of Contents
IV. The Confucian Two-Dimensioned Moral Strategy: Not Utility
Maximization, but Virtue Pursuit............................................................ 138
V. A Confucian Moral Casuistry on ESC Research................................... 139
VI. Concluding Remarks: Liberals and Aristotle,
Abraham and Confucius.......................................................................... 144
11. A Confucian Evaluation of Embryonic Stem Cell Research
and the Moral Status of Human Embryos............................ 149
Shui Chuen Lee
I. Embryos, Personhood and Moral Status: Warren’s Multi-Criteria
Theory...................................................................................................... 150
II. Moral Community Versus Social Community........................................ 153
III. Moral Status of Various Types of Embryos for Experimentation......... 154
IV. Concluding Remarks................................................................................ 156
12. Regulations for Human Embryonic Stem Cell Research
in East Asian Countries: A Confusion Critique ...................... 159
Hon Chung Wong
I. Introduction.............................................................................................. 159
II. The Regulations for HESC Research in East Asian Countries.............. 160
III. The Similarities and Differences on Regulations for HESC
Research Between East Asian Countries and Western Countries.......... 163
IV. Confucian Critique on Regulations for HESC Research in East
Asian Countries........................................................................................ 164
13. Stem Cell Research: An Islamic Perspective.......................... 167
Sahin Aksoy, Abdurrahman Elmali and Anwar Nasim
14. Why Western Culture, Unlike Confucian Culture, is so Concerned
About Embryonic Stem Cell Research: The Christian Roots
of the Difference.................................................... 175
H. Tristram Engelhardt, Jr.
I. Why the West is so Different.................................................................. 175
II. Jerusalem, Athens, and QOFU................................................................ 177
III. A Concluding Puzzle: Identifying the Moral Resources
of Confucianism....................................................................................... 179
15. Confucian Healthcare System in Singapore: A Family-Oriented
Approach to Financial Sustainability ................................ 183
Kris Su Hui Teo
I. Introduction.............................................................................................. 183
II. Hong Kong Healthcare System............................................................... 184
III. Singapore Healthcare System.................................................................. 185
IV. Hong Kong and Singapore Healthcare System Compared..................... 187
Table of Contents ix
V. Singapore System: Confucian Healthcare? A Moral Point of View...... 190
VI. Conclusion............................................................................................... 193
16. Respect for the Elderly and Family Responsibility: Confucian
Response to the Old Age Allowance Policy in Hong Kong............ 197
Erika H. Y. Yu
I. Introduction.............................................................................................. 197
II. The Old Age Allowance in Hong Kong................................................. 198
III. The Confucian Notion of XIAO (Filial Piety)........................................ 199
IV. The Implications of XIAO on the Old Age Allowance Policy............... 201
V. Concluding Remarks................................................................................ 203
17. Is Singapore’s Health Care System Congruent with Confucianism?... 207
Justin Ho
I. Some Central Tenets of Confucianism................................................... 208
II. Evaluating Singapore’s Healthcare System............................................ 210
III. Some Possible Rejoinders....................................................................... 212
IV. Concluding Remarks................................................................................ 213
Index................................................................... 217
ACKNOWLEDGEMENTS
This book grows out from the proceedings of the Third International Conference
of Bioethics on The Ethical, Legal and Social Implications of Human Pluri-potent
Stem Cells held on June 24–28, 2002 and the Fourth International Conferences
of Bioethics on Biotechnology, Family and Community on June 24–26, 2004 at
National Central University and National Taiwan University, Taiwan. They were
jointly organized by the Graduate Institute of Philosophy of National Central
University and the Medical School of National Taiwan University, the Center for
ELSI Research in Taiwan, the Project for the Enhancement in the Humanities and
SocialSciences,AdvisoryOffice,MinistryofEducation.Theconferencesaregener-
ouslysupportedinfundingbytheNationalScienceCouncil,theHealthDepartment,
the Ministry of Education, the National Research Program for Genomic Medicine,
NationalScienceCouncil,theMainlandAffairsCouncil,theChineseDevelopment
Fund, the National Health Research Institutes Forum, and the National Central
University Foundation.
ThefirstInternationalConferenceofBioethicswasfirstproposedbytheGraduate
Institute of Philosophy of National Central University in 1998 and received
continued support both from local and overseas institutes. Our first local co-
organizer, the Graduate Institute of Philosophy of Nanhua University of Chia-Yi;
and overseas institutes: Institut für Asienkunde, Hamburg, Germany; the European
AcademyforEnvironmentandEconomy,Hamburg,Germany;andtheGovernance
inAsiaResearchCentre(formerlyCentreforComparativePublicManagementand
Social Policy) of Hong Kong, City University of Hong Kong; have been offering
generousandcontinuingsupportthroughouttheyears.Localandoverseasscholars
fromeverypartoftheworldwhojoinedandcontributedintheseconferenceshave
greatly enriched our exchanges, especially on topics and differences between the
East and West on bioethics. The conference logistics are mostly carried out by a
distinctivegroupofgraduatestudentsledbyMr.HonChungWongoftheGraduate
InstituteofPhilosophy,andtheirselflessdevotionwaswhatmadetheseconferences
successful and fruitful as they were. The proceedings were edited again with the
help of Mr. Hon Chung Wong and others throughout the years.
Thanks are due to the speakers and authors of the papers of the conferences and
many of the revised papers collected here have benefited from the participators of
these conferences. Special thanks must go to Professor H.T. Engelhardt, Jr., who
isnotonlyoneofthekeynotespeakersofourlastfourconferences,butisalsothe
benefactor of the editing of this volume. It is his suggestions for the preliminary
planning of the book and his endless effort to push the editing process that makes
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