Exploring Chinese bioethics through the practice of palliative care

Abstract

This research explores the ethical challenges arising in palliative care in the Western (Anglo-Saxon) context and the Chinese context. In each context, the history, key values, terminology, care delivery models and training schemes of palliative care are traced.

Both the East and the West apparently confront similar difficulties regarding conceptional tensions and inadequate resourcing. However, palliative care has a shorter history in China, and these difficulties appear most pronounced in Chinese contexts.

Similarities and differences can also be detected in the palliative care ethics that underpins practice in each context. In the West, palliative care ethics is firstly shaped by Christian ethics and then guided by the dominant ethical theory of ‘principlism’, which is particularly committed to respect for individual autonomy. In contrast, a distinct ‘palliative care ethics’ is less detectable in Chinese contexts. Nevertheless, the indigenous philosophy of Confucianism appears to be relevant and applicable to the practice of palliative care. In apparent contrast to principlism, Confucianism is distinctive by virtue of its relational nature and commitment to familism and thus family autonomy.

Although the ethical underpinnings vary, common ethical challenges nevertheless appear to arise in palliative care practice in both contexts. Ten common challenges are identified from the literature, with two – medical futility and truth-telling – investigated in-depth. To address such challenges, healthcare professionals in the West and East are trained under homogeneous pedagogies and adopt similar bioethical deliberation tools and clinical responses.
Irreconcilable ideological differences nevertheless remain. Confucianism’s family autonomy cannot be neatly squared with the individualistic orientation of Western principlism. Such fundamental variations, in turn, cast doubt on what counts as an ‘ethical challenge’in these different contexts. This project concludes that, in order to identify the actual ethical challenges arising in palliative care in China (and responses thereto), ‘empirical bioethics’ research is now needed.

Date of Award	27 Sept 2022
Original language	English
Awarding Institution	University of Bristol
Supervisor	Richard Huxtable (Supervisor) & Giles M Birchley (Supervisor)