Confucianism, Bioethics in

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Confucianism draws its name from the latinized honorific title of its founder, Kong Chiu or Kong fuzi (562–479 B.C.E.), an independent scholar and unsuccessful political advisor who believed moral self-cultivation and the practice of ritual were the cornerstones of an ideal society. Initially espoused by no more than a few dozen students, Confucius's teachings—expanded and significantly elaborated over time— ultimately became the dominant sociopolitical ideology of much of East, Northeast, and Southeast Asia.

Other traditions, notably Mahayana Buddhism and Taoism, successfully rivaled Confucianism for state support over the centuries, but none—not even Maoist atheism in China—ever seriously threatened the Confucian tradition's pervasive cultural dominance. Carried beyond its historical Asian boundaries by merchants, laborers, and refugees, Confucianism also maintains a strong hold on diasporic Chinese, Korean, Japanese, and South-Vietnamese populations the world over.

In considering the complexities of the Confucian tradition, the following must be borne in mind:

  1. the tradition is not monolithic, that is, historical era, regional variation, and differential class appropriation inform Confucian practice;
  2. the tradition does not exist in conceptual isolation, that is, within any given local culture at any particular historical moment, Confucianism has always been practiced by individuals as part of a constellation of personal practice, including Mahayana Buddhism and local folk religions;
  3. although there is a sense of authority residing in the canonical texts and commentaries of the Confucian classics, there is no central governing body, no clergy, and no history of religious jurisprudence within the tradition to dictate orthodoxy or legislate orthopraxy;
  4. there is neither a concept of evil nor an absolute dichotomy between right and wrong as understood in Western monotheisms; rather, it is ignorance, self-delusion, and a tendency to gratify selfish desires that pose the greatest obstacles to moral improvement;
  5. Comparative discussion of certain contemporary topics, for example, human rights and abortion, is complicated by the absence of notions of individual "rights"; in the Confucian view, humans are defined by their capacity to fulfill duties and responsibilities rather than by any sense of inherent possession of rights.

Origins of the Classical Tradition

Core concepts are found in brief statements attributed to the Master himself, recorded by others in the verses of the Analects, the Great Learning, and the Doctrine of the Mean. Modern scholars, notably E. Bruce Brooks and A. Taeko Brooks in their The Original Analects, have shown these texts to contain significant interpolations and emendations. As received tradition, however, the aphorisms ascribed to Confucius and his early followers continue to exert considerable authority. At the heart of Confucius's vision was the sense that an individual can become truly human only through a deliberate process of moral education. The cultivation of virtues and their expression in ritual forms yields a gentleman (or, in current terminology, a perfected person ) who stands ready to fulfill the responsibilities of living in concert with others and of establishing a peaceful, just, and aesthetically pleasing society. Ritual without virtue is ornament without substance; virtue without ritual can lead to unbounded good intentions that may ultimately do harm.

Confucian society is built upon a set of five reciprocal relationships, each of which is characterized by particular virtues and specific responsibilities:

  1. ruler-subject;
  2. parent-child;
  3. husband-wife;
  4. older-younger (brothers); and
  5. friends.

Confucius's primary concern was with the creation of a stable and prosperous state, but he understood that it was the family that would ultimately produce the individuals dedicated to establishing his ideal society. Of the five relationships, therefore, three are located within the family; of these, by far the most important is that between parent and child. For having given life, one's parents are owed an enduring debt of gratitude—an obligation that extends even beyond the temporal boundaries of this lifetime. The practice of filiality, or filial piety, is therefore the starting point for Confucian moral cultivation, and the family is the foremost focus of religious practice.

An individual's relationship with people outside the family is determined by interlocking considerations of age, social and educational position, gender, and degree of professional and personal connection—all of which determine relative seniority and significance, and thus the degree of deference and potential obligation owed. However, how one acts within the resulting relationship is far more flexible and less hierarchical than might be assumed. Much has been made in Western philosophical literature about the Golden Rule found in Analects 5:12 and 12:2, but Confucius himself indicated another single thread that bound his ethical teachings (Analects 4:15). Two strands comprise the single thread, namely, chung and shu, usually translated as loyalty and reciprocity. These terms refer to a dialectical process that requires that one first center oneself in the relationship at hand, clearly understanding its attendant responsibilities and privileges. One then imaginatively takes the other's position in the relationship. Then—and only then, from this enlarged and empathetic perspective—one acts, in full awareness of the consequences for the other of one's actions.

In the centuries after Confucius's death, new questions arose to challenge the tradition. A particularly vexatious problem was how to account for people's varying capacities to learn (or even to want to learn) to become truly human. The ensuing debate was ultimately settled in favor of the view espoused by Mengzi (also latinized as Mencius, 372–289 B.C.E.). According to Mengzi, all people possess the four seeds of humaneness, righteousness or duty, propriety, and wisdom. If nourished properly through environment and education, these seeds mature into the moral attitudes and ritual behavior of true humanity. It is worth noting, however, that extrapolation from this claim yields the conclusion that those who do not exhibit these seeds or their outgrowth are not entirely human—a conclusion with potentially troubling ramifications in discussions of capital punishment, euthanasia, and human rights.

The Han Synthesis

After China was united under the relatively stable administration of the Han dynasty in 206 B.C.E., training in Confucian principles was established as the basis for participation in the state's meritocracy. Over the course of the Han rule (through 221 C.E.), Confucianism's purview expanded beyond philosophical-political discussions of virtue and ritual to encompass cosmological theories derived from ancient divination forms, and from yin-yang and the so-called Five Elements systems. The goals were to discern macrocosmic and microcosmic correspondences and then to regulate human actions to ensure harmony with heaven and earth. Although many of the theories incorporated into this syncretic Confucian cosmology are frequently associated with Taoism, they are more accurately described as belonging to a pre-sectarian worldview that underlies all Chinese religiophilosophical traditions.

The hexagrams of the I Ching (Book of Changes ) provided glimpses of the flow of natural processes, especially qi, the animating breath of the cosmos. The alternation of yin (darkness, passivity, decay, emotionality, and femininity) and yang (light, activity, growth, rationality, and masculinity) underscored notions of complementarity. The Five Elements (fire, water, wood, metal, and earth) explained a thing's inherent characteristics as well as its patterns of growth and decline. Elaborate correspondences were constructed among these classificatory systems, such that hours of the day, seasons of the year, foods and tastes, colors, sounds, organs of the body, stages of life, heavenly constellations, and virtually all human activities could be mapped and harmonized. A dislocation or inappropriate item in any one part of the schema would lead to disharmony and inauspiciousness elsewhere. In the political realm, disharmony breeds revolution; in the personal realm, disharmony breeds illness. The goal of Chinese medicine is to restore the natural balance of one's internal environment and to harmonize it with external environmental circumstances. This requires that a patient's food, medicines, and therapies be dictated not only by symptoms, but also by individual psychophysiology and local environmental factors such as season of the year. In the Confucian view, maintaining one's good health is dictated by filial responsibility, as one's parents should have no cause for worry.


After the collapse of the Han, China fragmented into several smaller kingdoms and parts of north China fell under non-Chinese rule. During the following centuries of disunion, the Confucian tradition was somewhat eclipsed by Taoist sectarian traditions and by the rise of Buddhism. Beginning in the Song dynasty (960–1279), a Confucian revitalization movement gathered momentum. Meditation, visualization, and other interior spiritual techniques were borrowed from Buddhism and Taoism, and traditional Confucian ethical concerns were now linked formally to a notion of the cosmos as inherently inclined toward moral good. Mengzi's view that human nature is essentially good was reaffirmed by the great Neo-Confucian, Zhu Xi (1130–1200). Together with the Analects, the Great Learning, and the Doctrine of the Mean, Zhu Xi promoted the Mengzi as comprising the Four Books, the basic course of education in Confucian ideology. Indeed it was Zhu Xi's editions of these and other classical Confucian texts that formed the basis for the imperial Chinese civil service examinations.

Zhu Xi further contributed to the development of Confucian practice through his preparation of detailed jiaxun, or family regulations. In addition to providing minute descriptions of ritual preparations, he admonished would-be filial sons and daughters-in-law to acquire medical knowledge adequate to the care of their parents (-in-law). Not only should they know how to prepare certain medicines, but they should also be able to select reputable physicians—practitioners who, in Zhu Xi's day, were viewed as little different from barbers and masseurs. Filial duty also entailed assumption of the primary burden of care. Down to the present, the sense that eldercare is the responsibility of the family remains deeply ingrained in Confucian societies, but with the decline of the extended family, reports of abandoned seniors are increasingly common.

New Confucianism

After the fall of the Qing dynasty in 1911, Confucianism was widely derided by Chinese intellectuals as a remnant of a feudal past that hindered China's rightful advancement into the modern world. Much of the blame for women's oppression, for example, was allocated to Confucius and Sons, and study of the canon was replaced by scientific and technical training. Nonetheless there were some scholars who believed that Confucianism, freed from its feudal origins and centuries of accreted (and erroneous) practice, could be rehabilitated. An international revitalization movement, known as New Confucianism, arose in the 1920s at Peking University under the intellectual leadership of Xiong Shili and continued to develop through the 1940s at New Asia College in Hong Kong under Tang Junyi. During the 1960s, the movement gained added momentum by the efforts of Mou Zongsan and Xu Fuguan at Tunghai University in Taiwan. These New Confucians asserted that the tradition holds spiritual resources sufficient to meet the challenges of industrialization, urbanization, and bureaucratization, and to combat the depersonalization of the modern world.

Contemporary New Confucians draw inspiration from Lee Sang-eun (South Korea), Okada Takehiko (Japan), and, especially, Tu Weiming at Harvard University. Following his teacher Mou Zongsan, Tu Weiming has championed Confucianism as a world religious tradition—its ideals and practices open not only to those of East- and Southeast-Asian ethnic background, but to anyone who shares its anthropocosmic vision. And there are many who do. RobertC. Neville, author of Boston Confucianism, is a prominent example of those who claim a dual religious orientation and who write persuasively on the significance of Confucian tradition for the West.


There is nothing in the Confucian tradition inimical to women. Confucius had little to say about women other than, like uneducated men, they "were difficult to deal with" (Analects 17: 25). It was only later, with the Han dynasty grafting of cosmological speculation onto the tradition, that women became ineluctably identified with yin and its associated qualities in a negative way. Mengzi, for example, accepted the social mores of his day but did not see women as disposable or unworthy of regard:

Chunyu Kuan asked, "In giving and receiving things, is it not the rule that men and women should not touch?"

Mengzi repled, "That is the rule."

"If my sister-in-law is drowning, then should I use my hand to save her?"

"Anyone who wouldn't is a wolf. That men and women shouldn't touch in giving and receiving things is the rule; to use your hand to save your sister-in-law transcends rules." (4A17)

Yet it was Mengzi who underscored the filial necessity of producing an heir in order to ensure the care of elderly parents and the maintenance of ancestral veneration. He said, "There are three ways to be unfilial, and the greatest of these is to be without posterity" (4A26). In the premodern world, posterity meant a son or, preferably, sons. The resultant pressures on a woman were great. She was to bear children early and often; to continue bearing children until at least one son was born; and, in cases where she failed in this requirement or seemed likely to do so, to accept divorce or the introduction of concubines into the household.

The imperative to produce a son remains strong and has had a profound impact on the growth of certain reproductive technologies. The desire for male offspring, coupled with restrictive population control measures in China, and with trends toward smaller nuclear families in the industrialized nations of Japan, Taiwan, Korea, and Singapore, has led to increased use of sonograms for fetal sex determination, often followed by elective abortion if the fetus is female. Of course, to describe abortion as elective in this context is to gloss over the many pressures—economic, spousal and familial, societal—that may accompany the decision; use of the term here indicates only that the procedure is not medically necessary.

Abortion itself is condemned within the Confucian tradition as a mutilation of familial flesh. Buddhist notions of karma and the Buddhist prohibition against the taking of life compound the sense that a fetus should be protected. However, there is widespread ambiguity in the popular imagination about the ontological status of the fetus, as noted in studies of fetus-ghost appeasement rituals in Japan and Taiwan, conducted by William LaFleur, Helen Hardacre, and Marc Moskowitz. Most people believe the fetus to have a soul at conception, yet there is also the belief that this soul is not solidly anchored, meaning that it is extremely susceptible to fright—and flight—during the first 100 days of infancy. A soul that escapes its body in this way will likely make its way to another, but the specter of a free-floating vengeful spirit has fueled a lucrative fetal-ghost appeasement industry.

It must also be noted that nominally Confucian cultures have long embraced a pragmatic ethical relativism, sometimes attributed to Taoism, which seeks to maximize personal and familial benefit while avoiding inauspicious residual effects. In late-twentieth-century China, an alternative to abortion and female infanticide has emerged: After birth unwanted infant females are anonymously left at local orphanages or social welfare offices, or else they are quickly sold to baby brokers who then deliver them to state facilities. In this way, the state has found itself with a seemingly inexhaustible supply of a highly desirable commodity: infant girls for the international adoption market.

In some areas the male-female sex ratio of recorded live births is severely and increasingly skewed in favor of males. In Korea use of ultrasound screening to determine fetal sex is illegal but widely practiced. In China the overall male-female ratio of recorded births is between 117:100 and 120:100, whereas the average should be 105:100. In certain rural areas, the ratio rises to 144:100, the highest imbalance in the world. It is impossible to know with certainty the exact percentages of the missing girls who were aborted or were victims of infanticide, or the number of girls who were born and kept by their families but whose births were not recorded on official rosters. What is known is that decades of increasingly unbalanced male-female ratios have given rise to kidnappings, mail order marriages of children, and wholesale trafficking in women (Rosenthal, Eckholm).

Ownership of the Body

Of particular relevance to bioethics is the Confucian understanding of ownership of the body. Confucian tradition holds that one's body is not truly one's own; rather, it is held in custody for one's parents and ancestors. In a particularly gendered illustration of this notion, the historical records contain many examples of filial daughters and daughters-inlaw who, charged with the care and feeding of parents and parents-in-law, cut flesh from their arms or legs in order to make nourishing broth in times of war or famine. In other circumstances, however, to harm or mutilate one's body might render it insufficient to its purpose of care for preceding generations. To a Confucian, therefore, preserving the integrity of the body is of great importance. This holds true even after death, for although the deceased becomes an ancestor him- or herself, he or she remains at the service of still earlier generations.

Here too, the complexity of Confucian interaction with other traditions becomes apparent: Internal organs are only valued for their functions, and thus the donation of a sample of bone marrow or of a single kidney would seem permissible. However, the general Confucian sense of the body remaining intact in order to serve one's family is compounded by the popular Buddhist notion that a body must be complete in order to move through its karmic destiny. For many people in Confucian cultures, therefore, the combination of these beliefs has precluded acceptance of organ donation and transplantation up until quite recently.

One organization that has been working to change this view is the Tzu Chi Buddhist Compassion Foundation, a lay organization that claims 4 million members worldwide. Founded in rural Taiwan in 1966 by Dharma Master Cheng Yen, a self-ordained nun, the Tzu Chi Foundation exhorts women to fulfill their traditional Confucian role of dutiful wife and mother—even as it promotes women's volunteer efforts outside the home, particularly in medical care and disaster relief. In 1994 Tzu Chi established a bone marrow registry, the third largest in the world in 2003. Tzu Chi encourages organ and tissue donation (and even body donation for the training of medical students) as examples of Buddhist compassion. Although these teachings are at odds with traditional Confucian-Buddhist attitudes toward the body, Master Cheng Yen emphasizes the interconnectedness of all beings and the importance of practicing compassion to save lives. At Tzu Chi hospitals, hospices, free clinics, and medical and nursing schools, healthcare workers are trained to view patients holistically and humanely, seeing them as teachers and as providers of opportunities to serve.

Current Directions of Contemporary Scholarship

For scholars of Confucianism, the implications of studying Confucianism as a world religion are that its texts and interpretive traditions are open to literary critical study; its history is scrutinized for gender, class, and other biases; its ideal figures are analyzed with historical, sociological, and psychological tools; and its entire ethos is set in a comparative framework. The profoundly transformative aspects of its humanistic project can be appreciated as overtly religious, and discussions of Confucian spirituality are increasingly common.

For scholars in the tradition, new questions abound. What is the Confucian response to environmental degradation? Can traditional relationships be recast to address new configurations of the nuclear family, for example, same-sex unions, one (female)-child households, or blended families? What is the nature of lateral relationships, that is, what is one's relationship to other members of a civil society? What is the Confucian perspective on various reproductive technologies, or on genetic screening? Such issues are fraught with ambiguity.

For people in cultural China, Korea, Japan, and Vietnam, Confucianism is perhaps best understood as providing a substratum of belief, complementing or complicating other beliefs and values, whether sectarian or secular. Although scholars can debate Confucian responses to any issue, a single Confucian judgment is probably impossible to construct. In the syncretic and diasporic world of Confucian cultures, a Korean Christian Confucian may hold one opinion, a Japanese Buddhist Confucian another, and a Boston Confucian may hold yet another view altogether.

vivian-lee nyitray

SEE ALSO: Aging and the Aged: Old Age; Beneficence; Buddhism, Bioethics in; Daoism, Bioethics in; Death: Eastern Thought; Feminism; Medical Ethics, History of South and East Asia: China; Paternalism; Trust; Women, Historical and Cross-Cultural Perspectives


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Eckholm, Erik. 2002. "Desire for Sons Drives Use of Prenatal Scans in China." The New York Times, June 21, Late Edition— Final, A: 3.

Furth, Charlotte. 1998. A Flourishing Yin: Gender in China's Medical History: 960–1665. Berkeley: University of California Press.

Hardacre, Helen. 1997. Marketing the Menacing Fetus in Japan. Berkeley: University of California Press.

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Koh, Byong-ik. 1996. "Confucianism in Contemporary Korea." In Confucian Traditions in East Asian Modernity: Moral Education and Economic Culture in Japan and the Four Mini-Dragons, ed. Wei-ming Tu. Cambridge, MA: Harvard University Press.

LaFleur, William R. 1993. Liquid Life: Abortion and Buddhism in Japan. Princeton, NJ: Princeton University Press.

Moskowitz, Marc L. 2001. The Haunting Fetus: Abortion, Sexuality, and the Spirit World in Taiwan. Honolulu: University of Hawaii Press.

Neville, Robert C. 2000. Boston Confucianism: Portable Tradition in the Late-Modern World. Albany: State University of New York Press.

Nyitray, Vivian-Lee. 2001. "The Single Thread of a New Confucianism: Public Virtue and Private Responsibility." In Taking Responsibility: Comparative Perspectives, ed. Winston B. Davis. Charlottesville: University Press of Virginia.

Rosenthal, Elisabeth. 2001. "Harsh Chinese Realities Feed Market in Women." The New York Times, June 25, Late Edition— Final, A: 8.

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Taylor, Rodney L. 1990. The Religious Dimensions of Confucianism. Albany: State University of New York Press.

Yao, Xinzhong. 2000. An Introduction to Confucianism. Cambridge, England: Cambridge University Press.