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·,;::t_;, 1/' t· i ·.-....-=$: 1 ~❖ :::: Chinese Moral Perspectives on and Foetal Life: An Historical Account Jing-Bao Nie, MD(tcm), MA, PhD Lecturer, Bioethics Centre, University of Otago, New Zealand Adjunct Professor, Institute of Ethics, Hunan Normal University, China

Abstract It is accepted wisdom that, at the present time as well as historically, the typical Chinese attitude toward abortion is very permissive or 'liberal'. It has been widely perceived that Chinese people usually do not consider abortion morally problematic and that they think a human life starts at birth. As a part of a bigger research project on Chinese views and experiences of abortion, this article represents a revisionist historical account of Chinese moral perspectives on abortion and foetal life. By presenting Buddhist and Confucian views ofabortion, traditional Chinese medical understandings offoetal life, the possible moral foundation ofa 'conservative' Confucian position, and some historical features ofabortion laws and policies in twentieth­ century China, this paper shows that blanket assumptions that the Chinese view of abortion has always been permissive are historically unfounded. As in the present, there existed different and opposing views about abortion in history, and many Chinese, noi only Buddhists but also Confucians, believed that deliberately terminating pregnancy is to destroy a human life which starts far earlier than at birth. The current dominant and official line on the subject does not necessarily accord with historical Chinese values and practices. )

Man [sic] has in fact no past unless he is conscious of having one, for only such consciousness makes dialogue and choice possible. Without it, individuals and societies merely embody a past of which they are ignorant and to which they are passively subject. Raymond Aron (1985, pp.153-154)

Wushang ye, Shinai Renshu ye. (Not to harm life in any form is the way and art of humanity.) Mencius

Introduction - different views and experiences - exist behind the Chinese Induced abortion is charged with seemingly unsolvable moral, silence on abortion (Nie, 2002, forthcoming). Although the social, and political controversies in the West, including New majority of people in contemporary China, especially many Zealand. It remains one of the classic and most difficult topics well-educated ones, seem to take a permissive or 'liberal' in Western bioethics and moral philosophy. In striking contrast, position on terminating pregnancy, a large number, especially Western scholars (Johnson, 1975, pp. 236-237; Potter and Potter, (but far from limited to) those believing in Buddhism and 1990,pp. 238-239;Rigdon, 1996,p.543,Jennings, 1999,p. Christianity, consider abortion is destroying human life and thus 4 75) report that the same subject - abortion - appears not to be morally problematic. seen or treated as a serious moral issue in contemporary Mainland China and Chinese people appear to be basically silent Partly due to the political and social acceptance of abortion about it. However, appearances can be deceiving. Systematic and the apparent silence on the issue in contemporary China, and in-depth study indicates that a wide range of diverse voices it is usually assumed that acceptance was the case in the past

new zealand bioethics journal october 2002 page 15 nzl0itl,etliics ' '

too. For instance, contemporary scholars generally agree that Rather, it aims to provide a preliminary but revisionist historical traditional Chinese, especially Confucian, perspectives on account of Chinese perspective on abortion and foetal life. abortion are very 'liberal' ( see Luk, 1977; Qiu, 1992; Unschuld, 1995; Qiu and Jonsen, 1995). 1 According to this Buddhist, Confucian and Pre-modem Medical view, Confucianism is perceived to tolerate and permit almost Perspectives any kind of abortion and even infanticide because Chinese, Although its frequency is difficult to ascertain, it is Confucians included, hold that the foetus is not a human life, unquestionable that abortion was practised in traditional China and certainly not a human being or person. It is assumed that for centuries for a variety of reasons - from therapeutic most Chinese would agree with the great Confucian Xun Zi purposes, to concealing illegitimate sexual behaviour, to birth (286-238 B.C.E.) that 'human life' begins at birth and ends control. In some cases, attempts to abort were successful. In with death. According to Bernard Luk (1977), in traditional the 'Biography of the Empress Dowager Xiao Muji' of the China laws referred to abortion in two situations: first in Mingshi (Official History of the Ming Dynasty, 1368-1644), 'abortion-in-assault' where abortion is induced as a result of we read: 'Concubine Wan was the emperor's favorite and she a physical attack against a woman; and second in deliberately was jealous. She made all the other concubines, whenever procured abortion that results in the mother's death. Although they became pregnant, take medicine to induce abortion' (cited it was a crime to induce abortion by assaulting a pregnant in Ma, 1994, p. 669). In the Nanshi (Official History of the woman, abortion-in-assault was never legally classified as Southern Dynasties, 420-589), we are told that an empress manslaughter or homicide. Luk concludes that, compared to wagered with Xu Wenbei, a physician, about the effectiveness the West, the ancient Chinese took 'a far more flexible and of his abortion techniques. The physician employed situational, and a far less moralistic, approach to the question acupuncture on a pregnant woman and the foetus was aborted. of abortion'. Parents were not prohibited from deliberately In other, perhaps most, cases, attempted abortion did not terminating pregnancy. Therapeutic abortion could be succeed. Again in the Nanshi, in the 'Biography of Xu Xiaoci', recommended in the absence of pressing medical reasons. In we read (Ma, 1999, pp. 668-669): other words, an ancient Chinese woman had much 'freedom' 'to dispose of the content of her womb' 'not because the foetus Xiaoci was still in his mother's womb when his father was considered a part of her body without its own soul or was murdered. At that time, his mother was quite young. viability, but because its life in its organic unity was integrated Intending to remarry, she did not want to be pregnant. So with hers and derived from her' .2 she jumped from the bed to the ground many hundreds of times, and pounded her waist with the club used for Though widely accepted, is the above view about Chinese washing clothes. She also took abortion medicine. But perspectives on abortion and foetal life valid? By presenting the foetus was even firmer [in the womb]. At birth, he Buddhist and Confucian views of abortion, traditional Chinese was given the nickname Yilu (Abandoned Slave). medical understandings of foetal life, the moral foundation of a 'conservative' Confucian position, and some historical In this story, the failure of the attempted abortion was attributed features of abortion laws and policies in twentieth-century not to the inefficacy of medicine and the other methods China, in this article I will show that blanket assumptions of a employed, but to the supernatural intervention of the gods on 'liberal' Chinese attitude on the issue are historically behalf of the child. unfounded. As in Mainland China today, there existed in the past a variety of voices on abortion, not just the permissive The question that directly concerns us is not whether and how viewpoint. So far there are no systematic modem studies on abortion was carried out in traditional China, but how the ancient the socio-cultural in China. To undertake Chinese, physicians included, saw the issue of abortion. Was such a inquiry one would need to explore an enormous range abortion treated as a serious ethical problem in China? of materials, including the official histories of the twenty-four dynasties and other classical works, medical books, and Buddhism, along with Confucianism and Daoism, was one of especially literary essays and fiction, unofficial histories, and the three major social-religious-philosophical belief systems local histories. This article by no means constitutes such a study. of traditional China. While there may be a significant

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difference in B udd:hist Asian opinions on abortion, Buddhism years - from the time of the early Western Han Dynasty in the in general considers abortion morally problematic, if not second century B.C.E. to the early twentieth century. In definitely reprehensible (see LaFleur, 1992; Keown, 1995, pp. Confucianism abortion may at times be considered morally 91-117). It teaches that taking a life is morally wrong, that permissible, but this is definitely not always the case and the foetus is a form of life and that, therefore, abortion is happens only at some stages of pregnancy. Confucianism, morally unacceptable. along with traditional Chinese medicine, holds that the foetus is a human life and becomes a living human being at a certain Buddhist physicians or physicians influenced by Buddhism stage of pregnancy. in ancient China seemed to take this line of thinking as a given. Zhang Gao's Yi Shuo (Medical Compendium) written in the Let me start my evidence for these claims with an anecdote thirteenth century (during the Song Dynasty 960-1279) is an that has been used by contemporary Chinese scholars as important text in ancient Chinese medical ethics. It addresses evidence of Confucian acceptance of abortion. The text comes a series of moral issues in medical practice by means of twelve from Yuewei Caotang Biji (The Notes from the Reading­ anecdotes. The abortion story illustrates this 'conservative' subtlety Hut) written by Ji Jun, well-known prime minister Buddhist viewpoint vividly. It reads as follows: and writer of the Qing Dynasty (1644-1911):

In the capital city there lived a woman whose family name There was a physician who was usually prudent and kind. was Bai. She was good-looking. So people in the capital One evening an old lady came, with a golden bracelet in all called her 'Bai Mu-dan' (The White Peony). She made hand, to buy an abortion drug. The doctor was shocked a living by selling drugs. She suddenly and refused the request categorically. The next evening started to suffer from headaches. Her head became swollen the old lady came again with two pearl flowers in hand, and increased in size day by day. All the renowned in addition to the bracelet. The doctor was more physicians treated her, but no one was able to cure her. bewildered and sent her away. More than half a year later, After many days, an ulceration developed and the he dreamed of being arrested by a police officer in the offensive odor was unbearable. She cried every night and underworld. He was told that someone had accused him her crying could be heard near and far. One day she of murder. As he arrived in the nether world, a woman requested of her family members: 'Burn all the with a long red towel wrapped tightly around her neck prescriptions of abortion that I have kept.' She also was complaining about her failure to obtain the [abortion] admonished her offspring: 'Take an oath not to pass on drug from the doctor. The physician said: 'Medicine is such a trade.' Her son asked his mother: 'You have built for saving life. How could I dare to kill a person in order yourself up by this. Why do you want to give it all up?' to profit? Your committing adultery was brought to light. His mother answered, 'I dream of hundreds of infants That has nothing to do with me.' The woman answered: and small children who suck my head every night. This is 'When I asked for medicine, the foetus had not yet formed. why I cry out in pain. All this is the retribution for my By aborting it, I could have survived. An existing life could selling poisonous drugs to damage foetuses.' Immediately have been saved by destroying a piece of blood-clot that after saying this, she died. (Cited in Ma ,1994, p. 670; possesses no consciousness. Since I could not get an also in Unschuld, 1979, pp. 48-49). abortion drug, the baby had to be born. Consequently, my child was forced to endure his lot of sufferings and was The moral of the anecdote is very clear: the foetus is a human finally killed. I was left no way out except to hang myself. life and at least a potential child so that abortion is not What you did was to destroy two lives in trying to save permissible because it is equal to killing a child. Although one. If you are not to be prosecuted [for my death as well there is no hint as to the gestational period in the story, it as my child's], who else should be accused?' The judge in seems that the author, a Confucian-Buddhist physician, the nether world sighed: 'What you said takes into account believed that abortion was morally unjustifiable in general. the actual circumstances. But what he [the physician] Confucianism was the dominant moral-political philosophy adhered to is Ii ( order, reason, principle). But is he the only and official ideology in China for more than two thousand person since the Song Dynasty to adhere stubbornly to the

new zealand bioethics journal october 2002 page 17 single li regardless of circumstances in the real world?You Instead, the anecdote itself suggests a 'conservative' can stop now.' Then, the judge rapped on the table. In horror, perspective that may have been widely held at that time. The the physician awoke. (Ji, 1998, p. 200) doctor in the story makes a very strong statement in reply to the woman's charge against him by saying that 'Medicine is The message of this story seems clear: the foetus, at least up to for saving life. How could I dare to kill a person in order to a certain developmental stage, is not a human being; therefore profit?' The key term used in the original text is sharen (to abortion of the pre-formed foetus is just 'destroying a piece of kill a person or a human being, to murder). It is very clear that blood-clot that possesses no consciousness'. The author seems for the doctor the foetus is a ren ( a person or a human being) to have adopted the kind of consequentialist perspective taken and providing an abortifacient is thus tantamount to by many in the West in the contemporary ethical debate to justify committing manslaughter or murder. Ethically speaking, to the choice of abortion. In this story, abortion is seen as a moral profit from providing materials that will kill a human being necessity or at least a lesser evil. For Ji Jun, along with the makes the action even more reprehensible. In other words, woman who failed to obtain the abortion drug, the compulsory reading this anecdote from an historical perspective suggests pregnancy destroyed two lives. The moral seems clear: if a that the physician's position on abortion represented the doctor fails to give abortion medicine in such circumstances, mainstream view of the time and that Ji Jun was a critic of the his refusal would actually cause suffering and death. As a result, then widely-held standpoint.3 Of course, this claim cannot be he will be accused in the underworld; that is to say, he has to validated without further systematic historical research. defend himself in the moral court. Anyway, my point is that the opinions of ancient Chinese, Confucians included, may not have been as 'liberal' as we Since Ji Jun was the highest ranking official and Confucian have generally assumed. scholar of his time, his ideas about induced abortion have been taken to express a typical Confucian view that abortion is The ethical concerns about abortion held by ancient Chinese morally permissible and sometimes even morally necessary. laypeople and physicians alike may not directly originate in Nevertheless, we must be careful in using his anecdote to Confucianism. Their opposition to abortion was probably due generalize the traditional Confucian perspective on abortion. to the influence of imported Buddhism. On the one hand, First, Ji Jun did not directly deal with the issue of abortion. Zhang was clearly a Confucian physician (Yuyi). In the He used the anecdote mainly to criticize the moral absolutism epilogue to Zhang's collected works, a contemporary scholar of Neo-Confucianism since the Song Dynasty (960-1279) and called him 'a good example of the Confucian physician' not to attack the attitude of adhering 'stubbornly to one ii (reason, only because Zhang, contrary to the mainstream Confucianism principle) regardless of the circumstances in the real world'. that devalued medicine as 'a petty technique' , practised Second, the furthest we can go in generalizing from the medicine himself, but also because he took a position with anecdote is that, for the writer, along with the heroine of the the civil service after passing the national examination. On tragedy and the nether-world judge, abortion is morally the other hand, Zhang Gao' s ethical viewpoints on medicine permissible only at the early stage of pregnancy before the were heavily influenced by Buddhism. For instance, as the foetus has grown into a human being, when the 'thing' in the German historian of medicine Paul Unschuld (1979, p.43) womb is still a 'blood-clot' with no consciousness. Without has pointed out, Zhang 'placed the practice of medicine in a further historical evidence, one cannot conclude from the striking relationship to Buddhist ideas of rewards and anecdote that Confucianism permits abortion in general. It punishments by the powers of another world'. So we can safely may be the case that Confucianism allowed abortion, but there say that at least some Confucian physicians accepted the are two logical jumps to make before reaching that conclusion. Buddhist view of abortion. While Confucianism did not Ji Jun may have considered abortion morally permissible in oppose abortion as explicitly and strongly as Buddhism, general, but this anecdote alone is not sufficient to prove it. Confucianism was not necessarily in conflict with Buddhism Even ifhe supported abortion in general, it is another question on this issue. On the contrary, it tolerated, accepted, and even how representative his view is of Confucian attitudes to the promoted Buddhist condemnation and restriction of abortion. subject. This provides further evidence that the Confucian perspective

page 18 new zealand bioethics journal october 2002 on abortion was not as 'liberal' as contemporary scholars have The Traditional Medical Understanding of Foetal portrayed it. Even though the liberal interpretation is not totally Development and the Concept of Foetal Education groundless, it is certainly wrong to generalize that people in Although physicians in ancient China never developed the traditional China, Confucians included, took a permissive kind of modem medical techniques such as B-ultrasound that attitude to abortion everywhere and always. would allow them to view foetal development directly and visually as we can do today, this did not prevent Chinese There is insufficient evidence to substantiate the claim that physicians and laypeople from discovering a great deal about abortion was morally justifiable to most pre-modem Chinese what happens in the womb after conception. By the time of medical professionals. On the other hand, we know that for the Sui Dynasty (581-618) Chinese medicine, especially the generations Chinese physicians had frequently prescribed gynaecology and obstetrics literature, already possessed , mainly herbs, and sometimes performed amazingly detailed knowledge of foetal development during abortion by other procedures such as acupuncture. The pregnancy - from conception to birth. Although I have no sixteenth-century Confucian physician, medical scholar and historical evidence on where and how this knowledge may scientist Li Shizhen listed at least seventy-two agents, derived have originated, it may well have come from both women's from animals, vegetables and minerals, under the entry of duo and physicians' empirical observation of miscarried or aborted shengtai yao (drugs for dropping the living foetus) in his foetuses. Bencao Gangmu (The Great Pharmacopoeia) - the most systematic summary of materia medica literature to appear As early as the second century B.C.E., the Daoist classic in traditional China and still the standard reference for Chinese Huananzi described the ten months of pregnancy as follows: pharmacology and medicine. Li did not raise the same Confucian ethical concerns and questions about these abortion The spirit is received from Heaven but the physical is the drugs a:s he did for those drugs derived from human body endowment of Earth. So it is said that One creates Two, parts (Nie, 1999b). In general, he opposed the many uses of Two creates Three, and Three creates myriad things. All so-called 'human drugs', but not abortion as such. things are yin behind and yang in front. With the effusion of qi they unite. So it is said that in the first month a blob For many physicians, abortion, at least in some circumstances, of fat is formed, in the second sinews, in the sixth bone. was considered morally permissible. For example, physicians In the seventh month [the foetus] is fully formed, in the in late imperial China clearly put the mother's health before eighth it is active, in the ninth it is boisterous, and in the the life of the foetus. For ancient doctors, as shown in surviving tenth it is born. (Cited in Furth, 1999, p. 101 footnote) medical case reports, when the continuation of pregnancy represented an unmistakable and severe danger to the woman· s Early physicians proposed various schemes of foetal health, abortion was definitely the lesser of two evils. However, development. Furen dachuan liangfang (The Complete as Francis Bray has pointed out, Effective Prescriptions for Women's Diseases), published in 1237, is probably the most important work on gynaecology distaste for taking life, together with the theory that the and obstetrics in Chinese history to have survived. In a section interruption of a natural process can be harmful, combined titled 'General Remarks on Pregnancy', the Southern Song to make many orthodox physicians reluctant to terminate Dynasty physician Chen Ziming ( c. 1190-1272) cited sevyr:il a pregnancy if there was a chance of saving both mother theories recorded in even older medical literature on foetal and child (1997, p.325). development, with titles such as On the Etiology and Symptomatology of Diseases, On Five Organs, and The While the mother's health was the major concern for medical Fontanelle Classic. According to Wuzang tun (On Five professionals, there were at least some Buddhist and Confucian Organs), a work that was attributed to the 'saint of medicine' physicians, like Zhang Guo and the doctor in Ji Jun's anecdote, Zhang Zhongjing (c.a. 2nd century, C.E.), the foetus grows in who opposed the practice of abortion for the sake of preserving the womb during each of ten lunar months in this way (in foetal life. Song, 1991, p. 318; also Furth, 1999, p. 104):

new zealand bioethics journal october 2002 page 19 . i1zbidetn:ics ,,

1st month: Like a pearl of dew 1st month: The beginning foetus; essence and blood 2nd month: Like a peach flower (jingxue) congeal; a pulse forms 3rd month: Male and female differentiate 2nd month: The foetus forms 4th month: Physical form is visible 3rd month: The yang spirit (shen) makes the three hun 5th month: Sinews and bones are formed souls 6th month: Hairs grow 4th month: The yin anima (ling) makes the seven po 7th month: The hun soul wanders and the child moves souls t its left hand 5th month: The Five Phases differentiate and the five 8th month: The pei soul wanders and the child moves zang organ systems receive their guardian I its right hand spirits (shen) 9th month: The thrice-turning-body moves about 6th month: The six musical notes set the six hu organs 10th month: Qi is sufficient. 7th month: Essence opens the apertures circulating light 8th month: The Primal Spirit (yuan shen) is ready; the In Zhubing Yuanhou Lun (On the Etiology and Symptoma­ true anima descends tology of Diseases) compiled by Chao Yuanfang (550-630 9th month: The 'palace chamber' [of the foetus] is A.O.) - an imperial physician of Emperor Yang of the Sui arranged for birth Dynasty-and first published in 610 A.O., the following theory 10th month: Qi is sufficient; all forms are manifest, and of foetal development was advanced (in Song 1991: 318; also the Primal Principal within the head called Furth 1999:104): the Mud Terrace gathers all the spirits together. 1st month: Called 'the beginning embryo' 2nd month: Called 'the beginning fat' To summarize the above accounts of the ten months of 3rd month: Called 'the beginning foetus' pregnancy, accounts ranging from as early as the second century 4th month: The Water Essence acts so that blood and B.C.E. and running beyond the thirteenth century, the following vessels form points are salient. First, from early times, Chinese people and physicians in particular were far from ignorant about foetal 5th month: The Fire Essence acts so that qi forms development. Here I would like to emphasize that Chen 6th month: The Essence acts so that sinew forms Ziming's Furen dachuan liangfang is probably the most 7th month: The Wood Essence acts so that bones form important gynaecological and obstetrical work and remains a 8th month: The Earth Essence acts so that skin forms part of the canon of traditional Chinese medicine today. Second, 9th month: The Stone Essence acts so that hairs form the traditional Chinese medical understanding of foetal life 10th month: All organs, joints and human spirits are distinguished between the embryo, the unformed foetus, and ready the formed foetus. Third, traditional Chinese medical understanding of foetal life is an organic part of Chinese In addition to this schema, Chao connected foetal development cosmology and human physiology. Fourth, for at least some ',,with the channel theory (or meridian system) of Chinese ancient physicians and lay people, human life was regarded as ihedicine, which is 'the theoretical basis of acupuncture. For beginning much earlier than at birth, at the very early stages l Cha(), 9uring each moQth the foetus was said to be nourished (the first month) of pregnancy, and the human being was seen sp~cifi¢ally by nine of the twelve major channels. as physically formed at some time during pregnancy. ~\

In Luxian Jing (The Fontanelle Classic) - the first systematic Based on its knowledge of foetal development, Chinese work to deal specifically with diseases of children in Chinese medicine early on developed a distinctive theory of taijiao medicine, which dates from the Tang Dynasty (618-907) - (foetal education). According to this theory, the foetus in the foetal development is described thus (in Song, 1991, pp. 318- womb can perceive and be influenced by what the mother 319; also Furth, 1999, p. 104): perceives. Not only the food the mother consumes during

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pregnancy but also the materials she listens to, sees and reads Moral Foundations of the Confucian 'Conservative' View have both direct and indirect influence upon the physical, of Abortion intellectual and moral character of her foetus. Children's The is concerned not so much with facts as education should thus start as early as pregnancy. Many medical with values. In other words, knowledge about foetal works from ancient China have detailed discussions and special development and even the belief that the foetus is a human sections on foetal education. For examplenn the section on life does not necessarily lead people to raise ethical questions pregnancy in Chao's Zhubing Yuanhou Lun discussed above, about abortion. Otherwise, by publicising pictures of foetal his explanation of the state of the foetus in the third month is development taken by modern medical technology, expanded as follows (in Song, 1991, p. 318): contemporary abortion conservatives would have long ago convinced everyone that abortion is morally unacceptable. Or At this time [third month], the blood does not move and by demonstrating the 'facts' of foetal development, the the figure begins to grow. There is no fixed form. It [the physician in Ji Jun's anecdote would have easily proven his foetus] will change along with external objects. If one innocence to the judge in the nether world. As a result of such wants the child to be dignified, one should let the mother ambiguities, a normative account of abortion ethics is needed meet noble persons, not ugly and evil people. If one prefers to illustrate why some ancient Chinese, including Buddhists, a boy, the mother should use a bow and arrow and ride Confucians and medical professionals found abortion ethically mares. Ifone prefers a girl, the mother should wear various problematic, if not always wrong. For example, a normative kinds of jewellery. If one wants the child to be beautiful, Confucian account of abortion would not only exemplify the mother should play with white jade and watch the conventional Confucian teaching on the subject and the peacock. If one wants the child to be virtuous and able, common Chinese understanding of foetal life, but more the mother should read poems and books [i.e. Confucian importantly, it would be based on the ethical ideas, ideals, · classics]. and principles of Confucian moral discourse.

The theory and practice of foetal education can be seen to It has been alleged that the permissive attitude of Confucianism derive from Confucian roots for at least two reasons. First, to abortion is not only historically true but also normatively Confucianism believes that the human nature shared by each coherent with Confucian moral philosophy. However, it seems person is identical from the beginning and that it is the to me that Confucianism contains rich moral resources which environment and acquired education that make individuals might argue for a restriction on abortion. Here I do not mean different (see, e.g. Tu, 1993). Second, in traditional China the to claim that Confucianism has ever developed a systematic materials for foetal education and the behavioural guidelines normative anti-abortion theory. Historically, this was not the for pregnant women were for the most part mainstream case. Nevertheless, I would argue that a less 'liberal' attitude Confucian. toward abortion is more logically and theoretically consistent with the Confucian moral discourse. Let me illustrate the point Foetal education as a social practice was popularised in late by focusing on the four key Confucian moral concepts and imperial and modern China. Interestingly, it has become doctrines - ancestral worship, 'xiao' (filial piety), 'cheyin' popular again in Mainland China since the 1980s. I cannot (commiseration, compassion), 'shengsheng' (to preserve and here outline more of the theory and practice of foetal education nourish life), and the relational conception ofpersonhood. in China or address any of the many ethical issues raised. The point I wish to make is that many Chinese, including 'Jia' (referring to the extended family) and 'zu' (patri-lineage) Confucians and Confucian physicians throughout history, directly associated with the family were the most significant consider that a human being is formed sometime between social institutions in traditional China. Ancestral worship was conception and birth, if not at conception itself. For the theory the most vital religious element in family life and had the and practice of foetal education are based on the fundamental central importance in Chinese culture. Confucianism upheld assumption that a foetus is a form of human life or a child - the cult of ancestor worship for many reasons. The most basic otherwise it would be absurd to see the foetus as an object of one was, as the Confucian classic Li Ji (Book of Rites) says, education.. to 'express gratitude toward the originators and recall the

new zealand bioethics journal october 2002 page 21 'rizhhhitliics ' .

beginning'. In a modem scholar's words, the ancestral cult is when the child is the only offspring or the only male offspring based on 'the principle of the fountain of the water and the in the family or patri-lineage. root of the tree' (Yang, 1961, p. 44). The ancestral cult emphasizes the physical (blood line), social (carrying on the According to Confucianism, morality originates in 'cheyin' family name) and spiritual connection of the living human (the feeling of commiseration) in every human heart. Mencius, being with the ancestors or former generations. second only to Confucius amongst Chinese sages, believed that love is an inborn moral quality of each human being. He For Confucianism, rites associated with ancestral worship are stated: essential for the individual to cultivate and develop moral characteristics, especially filial piety. The Xiao Jing (The All people have a heart which cannot bear to see the Classic of Filial Piety), an essential Confucian work, says: sufferings of others . . . If today people suddenly see a 'May you think of your ancestors, and so cultivate their virtues' young child about to fall into a well, they will without (in Chai and Chai, 1965, pp. 303-322). In the Confucian moral exception experience a feeling of alarm and distress. This and political tradition, filial piety is far from a merely domestic will not be as a way whereby to gain the favor of the virtue concerning parent-child relationship only. As the Xiao child's parents, nor whereby they may seek the praise of Jing emphasizes, filial piety is 'the basis of all virtues and the their neighbors and friends, nor that they are so because source of culture' as well as 'the basic principle of Heaven, they dislike the reputation (of being unvirtuous). (Cited the ultimate standard of earth, and the norm of conduct for in Fung, 1952, p. 120) the people'. Among the important moral duties filial piety requires individuals to fulfill is to maintain the integrity of 'Ren' (humanity, humaneness) is probably the most the body for the reason that the body is given by parents. In fundan1ental ethical concept of Confucian moral and political the Xiao Jing's words, 'The body and limbs, the hair and the thought. For Mencius, the feeling of commiseration is 'ren skin, are given to one by one's parents, and to them no injury zhi dan' (the beginning of humanity). Positively speaking, should come; this is where filial piety begins'. Another moral Mencius' conception of commiseration calls up the sense of duty is to continue one's family line. Confucianism considers virtue within everyone and aims to awaken everyone's honor having no offspring or heirs the most serious violation of filial and dignity. Negatively speaking, anyone who lacks the feeling piety. of commiseration is not human; and to say somebody is not human constitutes the most severe moral condemnation of While ancestral worship and filial piety have endowed the Confucianism. To take a life, even that in the womb, should parents witl:J_ an overwhelming authority over their children, call up the feeling of commiseration everyone has. they can also make induced abortion morally problematic. Before the foetus is formed into a human being, it is a part of 'Shengsheng' (to preserve and nourish life) is a fundamental the mother's body. Filial piety requires that no one should Confucian moral duty and principle. For Mencius, 'wushang injure his or her own body. When the foetus is formed into a ye, shinai renshu ye' (Not to harm [any life] is the way and art human being, he or. she becomes a member of the family and of humanity). In his original work on the Confucian moral atri-lineage, who pQssesses physical and spiritual connection tradition, the contemporary Chinese scholar He Huaihong · ancestors. Induced abortion after the foetus is formed (1998: 293-322) has interpreted this moral principle as i human being iJ'.thus a serious violation of the ancestral including two basic meanings - in a negative sense, not to cult;and;c;,f filial piety. According to the moral requirements harm any life; in a positive sense, to nourish life. Life is like of'ance~trlal worship and filial piety, it seems that abortion is the flame of an oil lamp. It is morally wrong both to cut or i;norally .acceptable only if the continuation of pregnancy press the lamp-wick intentionally and not to add oil to the seyerely damages the mother's health and threatens her life. lamp constantly. Confucianism does not hold that any life Fof,~ome Chinese, it is even morally acceptable to save the should be preserved and nourished always and at any price. life df;the child (usually a male child, sadly to say) if the lives For instance, it advocates that one should sometimes sacrifice ofboth,the mother and the foetus cannot be saved under some one's life for the sake of the moral values 'ren' and 'yi' situations such as difficult birth. This is the case especially (righteousness). Nevertheless, Confucianism seems to believe

page 22 new zealand bioethics journal october 2002 that life is intrinsically valuable and good in itself. This On the other hand, running parallel with the human-centered philosophy of life has been transformed into the popular and this-worldly feature, the spiritual dimension of Chinese saying, 'A good death is not as good as a bad life'. Confucianism is also striking. Here let me mention two viewpoints of the Confucian vision of the spirituality and To respect life; including the life of plants, animals and human sacredness of human existence. First, the human body is seen beings, is a central value in Confucianism. A king was not sure as united and deeply interwoven with Heaven, Earth and 'the whether he would be able to govern his kingdom well and asked myriad things'. As the great contemporary Confucian Tu Wei­ Mencius. Mencius answered yes. The reason Mencius gave was ming (1992, p. 98) interprets it, a Confucian perspective on that the king had let go an ox that would have been killed for a embodyment holds: sacrificial rite because he could not bear the ox's frightened appearance. For Mencius, this is an indicator of the feeling of (1) the body is a vehicle by which we, as Heaven's co­ commiseration and compassion in the king's heart and the creators, participate in the great transformation as feeling of commiseration is the starting point of ren and humane responsive and responsible agents; (2) the body is an governing. Some Song Dynasty Neo-Confucians such as Zhou attainment by which we, as beneficiaries of Heaven, Earth, Maoshou, Chen Daoming and Chen Yichuang objected to the and the myriad things, sustain and enrich nature as filial harming of even grass and other plants unless good reasons children and conscientious guardians; (3) the body is a could be given, whether the perpetrator of the harm was an conduit through which we communicate with all ordinary person or the emperor himself. In medical ethics, the modalities of vital energy in order to realize the ultimate great Confucian-Buddhist physician Sun Simiao expressed this meaning of life in ordinary human existence. moral idea in his famous treatise 'Dayi Jingcheng' (On the Absolute Sincerity of Great Physicians) - which is, in respect Second, Confucius saw the human being as a holy vessel, the of itsjnfluence, the Chinese equivalent of the Hippocratic secular as sacred because of his or her direct participation in Oath): 'Whoever destroys life in order to save life places life at Ii (rite, ceremony). A disciple of Confucius once asked his an even greater distance' (in Unschuld, 1979, p. 31). If for Master about who and what a person was. The Master Confucians the animal and the plant should not be harmed answered that a person was 'a utensil', 'a sacrificial vase of without moral justification, then, the human life in the mother's jade'. For Herbert Fingarette (1972, pp. 75-76), a utensil is womb should be treated with even more care and love since 'sacred not because it is useful or handsome but because it is human beings are considered more precious and valuable than a constitutional element in ceremony. It is sacred by virtue of other living things by Confucianism. its participation in rite, in holy ceremony'. The individual human utensil 'has ultimate dignity, sacred dignity by virtue On one hand, a Confucian approach to abortion and foetal of his role in rite, in ceremony, in Ii'. Fingarette further said: life is humanistic. With regard to when a human life begins, unlike Judeo-Christianity and Islam that usually consider It is not the individual existence per se, nor is it the ensoulment or animation (the time when the soul is being existence of a group per se that is the condition sufficient infused into the embryo or foetus) the crucial factor, to create and sustain the ultimate dignity of man. It is the Confucianism emphasizes when the physical form takes on a ceremonial aspect of life that bestows sacredness upon human appearance. Unlike Judeo-Christianity and Islam that persons, acts, and objects which have a role in the believe human beings are created in the image of a supernatural performance of ceremony. and transcendental being, Confucianism stresses the social and relational nature of human existence and as a In a word, Confucianism sees secular human relations and continuing process of learning to be. Actually, Confucianism everyday life having the elements to be sacred, individual is characterized by its humanistic orientation, though 'not human being with a unique dignity and intrinsic value deriving the humanism that denies or slights a Supreme Power, but from and embedded in Ii. All this may put further moral one that professes the unity of man and Heaven' (Chan, 1963, restriction on killing human life in general and taking a foetal pp. 1, 15; see also Chai and Chai, 1965). life in particular.

new zealand bioethics journal october 2002 page 23 , iizhioediios "'

In contemporary Western bioethics discourse, the abortion and Buddhism as usually assumed. Yet, the ethical reasons debate has been closely associated with the discussion of for the Confucian 'conservative' view may be very different personhood. What is the Confucian perspective (more from those of other religious-moral traditions. What is greatly probably, perspectives) on personhood? Do these perspectives needed is more in-depth normative exploration of the place restrictions on abortion? The Chinese-Canadian Confucian perspective on abortion and foetal life in theologian and philosopher Edwin Hui (2000) has offered a comparison with other religious-moral traditions. marvelous analysis on this topic. For Hui, the foundational Confucian concept 'jen' suggests and emphasizes the dynamic Abortion Laws and Policies in the Twentieth Century process of 'person-making· or the relational basis of In her well-known work on the social history of in personhood in Confucianism. A 'person-in-relation' also has the U.S., Linda Gordon has pointed out that 'birth control has sacred and transcendent dimensions. Confucius· teaching of always been primarily an issue of politics, not of technology' 'ren' is indeed rooted in a religious-faith system embodied in ( 1977, p. xii). This is especially the case with respect to fertility the beliefin 'The Great Plan'. Hui, 2000, pp. 115-116) states: control and abortion in twentieth-century China. Among the major social-political forces that shaped Chinese abortion laws [I]n Confucius and later in Mencius, when ordinary people and policies in the past century are the Western influence, the practice jen through keeping Ii (humanity's way), they change of governments, and the introduction and development are simultaneously fulfilling Heaven's way. Chinese of the national birth control program. personhood understood in the context of Confucian jen implies relationality with fellow human beings as well as No law regulated performance of and access to abortion prior the heavenly deity. In that sense, jen is both a relational to the nineteenth century (the late Qing Dynasty). But the and transcendental concept and provides an ontological flexibility of traditional Chinese laws regarding abortion 'was foundation for a unique Chinese conception. swept away by the Western impact of the 19th century' (Luk, 1977). The Daqing xin xinglu (The New Criminal Code of That is to say, the Confucian conception is very similar to the the Great Qing) promulgated in 1910 was the first Chinese Christian theological understanding of personhood. Hui, 2000, law clearly prohibiting induced abortion in general. This code p. 116) concludes: was drafted by two Japanese advisors trained in German law, and its regulations on abortion closely paralleled those in The Confucian concept of jen and the Christian concept contemporaneous German and Japanese law. The Criminal of perichoresis both have much to contribute to modify Code called the act of abortion 'cruel to humanity, damaging the narrowly psychological and individualistic to [social] order and contrary to public interest'. Claiming to understanding and the rights-based ethics derived from it follow the 'provisions common to Europe, America, and currently prevalent in the West. Japan', it stipulated that any woman who procured an abortion with drugs or other measures, anyone who caused a woman Moreover, to have an abortion, and any physician, midwife, pharmacist or herb dealer who assisted a woman in having an abortion A relational understanding of personhood would question would be sentenced to penal servitude. For Luk, the cultural whether it would b entirely a matter of a woman's right foundation for this historic change in Chinese or autonomous choice to abort a foetus when the was laid by the acceptance of Western values such as the personhood of the foetus could very well have been equality of humans (whether they were infants, children, established by the maternal-foetal relation. wives, or concubines) and the sanctity of human life.

In summary, while Confucianism does not hold an absolute Abortion laws passed in the Republican Period ( 1911-1949) prohibition on abortion as does the Roman Catholic Church, continued to reflect this legal change. During these years, in the general attitude of Confucianism toward abortion is not general abortion was illegal and a crime. Punishment of as significantly different from those of other major world medical professionals who practiced abortion or assisted a religious-moral traditions such as Judeo-Christianity, Islam, woman in pursuing an abortion was rather severe. For instance,

page 24 new zealand bioethics journal october 2002 ' ~~ ~ , " n~½~i~,edii~s, ,: "" ,~;1 :: ,'.0 '

even publicly showing the methods and instruments of or other causes (in Peng ,1997, p. 59; pp. 889-890). abortion by words or pictures or any other means was categorized as an offence. Nevertheless, therapeutic abortion The regulations went on to stipulate that the violator - the in the cases of disease and other dangers to the mother's life physician or the woman - would be punished for performing was complicitly legally permitted in 1935 for the first time, or having an illegal abortion. In 1954 and 1956 the Ministry although pregnancy following rape was not included. of Health extended the circumstances in which abortion was permissble to include many more diseases in the mother such Why did modem Chinese laws prohibit abortion? Attempts as hypertension, epilepsy, nervous and mental diseases, to follow the Western example constitute only one of the pernicious pregnant vomiting, lack of a limb, blindness of reasons. Legislators consistently appealed to 'the good of both eyes; requirements of special occupational or educational society', to 'maintaining good social custom', and to tasks (the actress who will go to perform abroad, or a woman 'protecting the public interest'. The Chinese objection to who is about to study abroad); living difficulties due to too abortion and the reasons for prohibiting it were clearly set out many children (defined as four or more), or becoming pregnant in the words of the legislation (cited in Luk, 1997, p. 388): again within four months after giving birth (in Peng, 1997, pp. 889-891 ). Nevertheless, all regulations from 1950 through The objective of the nation is to multiply into strength. 1956 required strict administrative procedures to obtain an But multiplying and strengthening depends on the people. induced abortion. Except for emergencies, applications for Unless abortion is severely prohibited, it runs counter to an abortion had to be agreed to and signed by both the husband the national objective. Therefore, to say that abortion and the wife, certified by the physician, permitted by the leader protects primarily the foetus is too restricted a view. at the work unit where the woman was employed, and finally, approved by the hospital. As the following presentation will show, these prohibitive abortion laws were not replaced by permissive policies until Among the major reasons that the Ministry of Health restricted early 1960s, more than ten years after the establishment of abortion and prohibited unauthorized abortion was the safety the People's Republic of China in 1949. Ironically, in the PRC and health of the mother. It was always emphasized that the same utilitarian concerns and 'sacred' aim - the good of abortion, especially an illegal abortion, would impair the society and the interest of the nation - were repeatedly used mother's health and could result in life-long disease and as a major reason for both prohibiting and relaxing the legal suffering, and even put the woman's life in danger. Abortion prohibition on abortion. was believed to be especially harmful and risky to the woman if her pregnancy was the first. Though not articulated in the Since 1949 the abortion policies of the Chinese Communist above regulations, a political motive also served to restrict Party (CCP) and the government have undergone a radical abortion: i.e., then, a large population was seen as a good change - from restrictive to permissive (Peng 1997, Savage thing for national economic development and for China·s 1988).4 In the early 1950s government policy greatly restricted national power.6 Besides, one document mentioned that abortion along with sterilization and artificial contraceptive abortion should be prohibited as a means to 'guaranteeing the drugs and instruments. Two regulations by the Ministry of life of next generation'. Health and by the Culture and Education Committee in 1950 and 1953 made abortion impermissible in general. Abortion As early as the 1950s, some scholar-officials and scholars put was permitted only under one of the following three situations: forward the proposal that population growth should be 1. When the pregnant woman suffered from tuberculosis, heart controlled. Ma Yinchu was the spokesperson for this. Although disease, kidney disease, pernicious anemia, or other serious Ma, for political reasons, explicitly distanced his idea from diseases so that continuing the pregnancy would threaten the the classic thought of Malthus, his rationale was Malthusian mother's life and seriously damage her health; 2. When drugs - China's material production was not able to keep pace with administered 'to secure and quiet the foetus' 5 had no effect and human reproduction. Especially noteworthy is the fact that, spontaneous abortion occurred; or 3. When the woman had had even though Ma advocated controlling fertility and checking two or more Cesarean births due to narrow pelvis, deformity, population inflation, he strongly opposed the use of abortion

new zealand bioethics journal october 2002 page 25 -· ·f-i~i°,idetliios ,.,. ' "

as a method of birth control. For Ma, to disseminate operations 'as soon as possible' if the woman asks for one contraception widely was 'the best and most effective and and there was no medical contraindication. In response to important method' and abortion 'must be avoided by all means' abortion requests, hospitals should manage 'not to pile up and (in Peng, 1997, pp. 551-556). Ma considered abortion im­ not to postpone abortion cases in order to satisfy the needs of permissible unless the mother's health was too compromised the masses' (in Peng, 1997, p. 895). Generally, terminating for pregnancy and childbirth. His reasons against abortion pregnancy within three months was the most appropriate included his beliefs that abortion was 'killing a life' and that procedure, but terminating the pregnancy beyond three months it 'damaged the woman's health and made her suffer from and within five months was declared permissible. No various diseases in her life'. Ma held that, as soon as the child prohibition on terminating the pregnancy beyond five months is formed in the mother's body, it has shengming zhuan (the was mentioned. Like all previous regulations, the 1963 right to life). Two other reasons against abortion Ma mentioned regulation emphasized that abortion must be performed by included to reduce the people· s attention to and concentration specified and authorized personnel - the physician of an on contraception and to increase the work burden of doctors obstetrics and gynaecology or urological department, or a who had many other healing tasks. surgeon, or a specially-trained midwife.

Even though Ma's thought on population control was seriously Many social factors contributed to this dramatic historical criticized and repressed by the Party in the 1957 'Anti-rightist transformation - political, cultural, technological and economic. Movement', a political campaign aimed at eliminating critical For instance, the continued improvement of medical ( surgical) and dissidents opinions among Chinese intellectuals, the idea techniques for performing abortion made early abortion safer, of controlling population was gradually adopted by the at least less harmful, and later abortion possible without great government anyway. Late in 1957, the government started danger to the women involved. In fact, historical-sociological tentatively to encourage people to practice birth control. Some study indicates that the 'dynamics of the rise of abortion in programs were initiated to advocate contraception, spread the modem China' is an 'outcome of both individual volition and knowledge, provide the techniques, and carry out research government intervention' because the abortion rate was raised related to birth control. Restrictions on abortion and before the arrival of the organized government sterilization were relaxed correspondingly. According to a program (Wang, forthcoming). Yet, without question, the most 1957 regulation by the Ministry of Health, a woman could significant factor for legalizing abortion in China stemmed from have an abortion just because of 'certain difficulties' which the introduction of the national birth control program. The 1963 made her not want to continue her pregnancy. Abortion was circular of the Ministry of Health explicitly stated that the permitted as long as the physician ensured that the pregnancy purpose of revising the previous regulation was to 'further put had not progressed beyond three months, that no second into effect' the 'Instruction on Advocating Family Planning abortion occurred within one year, and that no contraindication Conscientiously' given by the Party and central government to abortion was present. Other requirements, such as the (in Peng, 1997, p. 895). approval from the work unit leader, were no longer stated. After the late 1970s, the family planning program was carried In the early 1960s, abortion and sterilization policy in China out in a far more thorough-going way. 7 An event of great was further relaxed. The Central Committee of CCP and the significance in the whole history of family planning in China, State Council released the first specific document on family as well as in the world, was the appearance and implementation planning in 1962, which ordered the departments of medicine of the 'one-child-per-couple' policy, officially announced in and health to 'work out the concrete methods and energetically 1980 in an open letter by the Central Committee of CCP to create the conditions to help the masses to have abortion or the youth of the country. The term 'one-child' policy, though sterilization operations' (in Peng, 1997, p. 5). The document widely known and used, is misleading because it allows many also stressed the necessity of letting the masses know about exceptions, even several general categories of exclusions the harms and dangers of abortion as well as the importance according to the area of residence, employment and ethnicity and preferred advantages of contraception. It required hospitals of individuals. Nevertheless, restrictive abortion policies in and other relevant clinics to undertake to do abortion the first decade of PRC were obviously detrimental to

page 26 new zealand bioethics journal october 2002 promoting this national program. Instead, state-directed since some pregnant women will do their utmost to continue abortion policies became a critical dimension for the national the unauthorized pregnancy as soon as they know the foetus birth control policy of reversing China's high population is male. Second, prenatal screening will lead many female growth. Even persuaded or coerced abortion became an foetuses to be aborted, thus causing an unbalanced male-to­ inevitable part of this 'great social project'. female sex ratio. This unbalanced male-to-female sex ratio will create serious social problems in the future and endanger The government insists that abortion is never advocated as a the long-term interests of the people and the stability of the method of family planning and population control. Abortion nation. Third, the physician who uses medical techniques to is just a 'remedial measure' or 'back-up method'. As the perform prenatal sex diagnosis for the woman seriously Chinese Government's White Paper on human rights violates medical morality. What medical-moral violations are conditions in China states, China's family planning involved is not articulated.

has persistently given first place to contraception and to The government has clearly stated that the national family the protection of women's and the children's health ... planning program will continue. Official documents and the The government resolutely opposes any form of coerced speeches of top national leaders repeatedly emphasize that abortion. Abortion is only a remedial measure when implementing family planning is a long-term and fundamental contraception fails. It is performed under voluntary and strategic policy to help solve the China's overpopulation safe and secure conditions (in Peng, 1997, p. 116). problem. Actually, a new law, 'Law on Population and Family Planning', came into force in I September 2002. Recently, The White Paper on China's family planning and population official statements have started to shift in the direction of policy points out that while the birth rate has greatly decreased, enhancing the quality of population by eugenic measures - the annual rate of abortion numbers in relation to the number 'yousheng youyu' (superior birth and superior raising). For of births in China remains approximately at 0.3:1. The White example, in 1994, the second meeting of the Eighth National Paper asserted that, compared to rates of abortion in all other People's Congress passed a law on the health care of the countries in the world, the Chinese rate of abortion was roughly mother and the infant (in Peng, 1997, pp. 54-56). This law in the middle (in Peng, 1997, p. 123 ). Official publications do was originally called and is usually known as the 'law on not entirely deny the existence of . but they ·. The fourteenth article of the law refers to the care completely reject the notion that coerced abortion has anything of the foetus as 'to guard the growth and development of the to do with the national policy (for ethical issues of forced foetus and to provide consultation and medical instruction·. abortion in China, see Nie, 1999). Article Eighteen of the law stipulates that the physician should 'give the medical opinion of terminating the pregnancy· if in The problem of selective abortion by modem prenatal sex the pre-natal medical examination the professional finds that diagnosis has already stirred up the attention of the public any of the following conditions exist: The foetus suffers from and concerned authorities in China. Since the middle 1980s, serious genetic diseases; The foetus is seriously deformed; the Ministry of Health and the National Committee of Family The woman suffers from serious diseases such that continuing Planning have issued several regulations to prohibit prenatal the pregnancy is likely to threaten her life or seriously damage sex diagnosis (in Peng, 1997, pp. 939,959,984). As a rule, no her health. hospital, no clinic, and no physician is allowed to use modem biomedical technology such as the B-ultrasonic detector to Induced abortion as a social practice is not new to determine the sex of the foetus on demand from the pregnant contemporary Chinese. What is new and historically woman, except for the eugenic purpose of diagnosing sex­ unprecedented is that abortion has become an indispensable related genetic diseases. These regulations have given three measure of the national population control agenda. In order rationales for this prohibition. First, through pandering to some to control the rapid growth of the population, the Chinese individuals' outmoded notion of 'valuing the man and government started to advocate population control in the early disvaluing the woman·, prenatal sex diagnosis will hamper 1960s and has been carrying out the most rigorous, the smooth implementation of the family planning program comprehensive, and ambitious family planning program in

new zealand bioethics journal october 2002 page 27 the world since the late 1970s. Under this strict program, late millennia has placed as much emphasis on the value of marriage, contraception, sterilization, and abortion have all human individual life as has Western culture. Keeping in been employed. Abortion, therefore, has become an ultimate mind that in German history we have experienced only and significant method of birth control, even though it is half a century ago a period where traditional cultural officially and euphemistically called a 'remedial' measure. values were turned upside down, the findings by [contemporary scholars] and the medical media report Conclusions on human right violation in contemporary China may lead In spite of its sketchy nature, this historical account of Chinese us to conclude that the phenomena described by these ethical perspectives on abortion and foetal life not only raises findings and reports have their origin in a difficult many questions but also leads to some conclusions. Firstly, there contemporary situation; they are definitely not intrinsic has never been a single Chinese understanding of abortion, elements of Chinese culture. neither at the present time nor historically. It is certainly wrong to treat the official and dominant 'liberal' position in This statement sounds very bold and provocative. As a general contemporary Mainland China as the particular Chinese view thesis, its validity apparently needs more detailed and thorough on abortion. On the one hand, it is true that abortion had not Chinese-Western comparative historical studies. Nevertheless, provoked much explicit discussion in pre-modem Chinese my historical account about Chinese perspectives on abortion philosophical, political, literary, and medical works. On the other and foetal life, though rather sketchy, does support this thesis. hand, historical records show that the question of whether abortion was morally right had concerned and puzzled Chinese It is illustrative to point out the striking differences between people for centuries. As I have shown, there existed different the contemporary official line and traditional views on the and opposing views about abortion in spite of a lack of moral status of the foetus in China. In the current dominant systematic analysis or serious debate on the issue. For instance, discourse, the foetus carries little moral weight in the face of even though Confucianism did not oppose abortion as explicitly the need for the national population program - a perceived as Buddhism, this does not mean that Confucianism permitted significant social good - and other interests of adults. Even abortion under any circumstances or approved abortion in when abortion was legally prohibited, the main reasons were general. Historically speaking, it is simply wrong to assume not for the sake of the foetus or for respect for human life, but that it has been the Chinese way to believe in birth as the starting for other utilitarian reasons. But in traditional Chinese point of human life and the general acceptance of abortion in discourse, those who opposed abortion, like the doctor in Ji any condition or stage of pregnancy. The current 'liberal' Jun's story, opposed it because the foetus is ren (a person, a interpretation of Confucian or Chinese perspectives on abortion human being, a human life) and abortion is thus sharen (killing seems to be a product both of the contemporary socio-cultural a person, destroying a human life, or murdering) and demands acceptance of abortion in China and the lack of systematic moral justification. discussion in Chinese materials on the subject. In other words, it is wrong to see the current dominant discourse Secondly. the predominant silence on abortion in on foetal life in Mainland China as the necessary historical contemporary Mainland China, along with the official line on development or logical continuation of traditional Chinese the subject (permitting abortion at any stage of pregnancy perspectives. To a great degree, more traditional Chinese values without raising ethical questions), does not necessarily accord and practices remain in Taiwan, even including Hong Kong, with historical Chinese values and practices. In one of his than in Mainland China. A recent fascinating ethnography recent papers, the prominent German historian of medicine reveals that, as a result of Japanese influence and traditional in China Paul Unschuld (2000) has questioned the commonly Chinese ideas, in modem Taiwan belief in foetus ghosts and accepted idea that individual human life is less respected in foetus demons is prevailing and the aborted foetuses are often Chinese culture than in the West. He concludes that: 'memorized' in Buddhist temples for appeasement (Moskowitz, 2001). Though being obviously at odds with the dominant from studying the history of medicine and medical ethics discourse in present Mainland China, this Taiwanese belief and in China it is obvious Chinese culture for at least two practice seems to perfectly fit into the traditional Chinese

page 28 new zealand bioethics journal october 2002 understanding of foetal life presented in this article. 2. Luk (1977) further points out, the woman's freedom to abort was far from 'absolute' because the Chinese woman 'was subject to her husband and to her mother-in-law (if she was a concubine, then also to the wife), Thirdly, this historical account also bears some implications and she owed an obligation to her husband's ancestors to procreate'. on how to conduct cross-cultural medical ethics research fruitfully. In this age of multiculturalism and globalization, 3. One other issue raised by this anecdote should be mentioned here. Justice, bioethics as an academic field and a public discourse as well, is or yi (righteousness) to use the Confucian term, is not served in this story. The real cause of the woman's and her child's death was not the paying more and more attention to the importance of culture doctor's action - refusing to give the requested drug - but the social and cultural practice in its inquiries into various issues. Certainly, environment that left the woman and her child no 'way out' except death. bioethical discussions which fail to address the multi-faced It was understandable for the woman to blame the doctor for what dimensions of culture miss something vital. Yet, there exist some happened because, for her, abortion was probably the easiest way out. But it was not just to accuse and punish the doctor for the tragedy. Ji widespread misconceptions on and misuses of culture in Jun's main purpose in writing the anecdote is to criticize the then popular bioethics. One of them is the assumption of a homogenous or doctrine of Ii developed from the official ideology ofNeo-Confucianism single culturally distinctive medical ethics in every society and of the Song and Ming Dynasties. It should also be noticed that, against the subsequent dichotomous Western and Non-Western medical conventional Confucian morality and the doctor's position implied in the anecdote, Ji Jun did not condemn the adulterous sex of the woman. ethics. Another is that the present mainstream or standard viewpoint or practice in a particular culture or society is often 4. The following presentation on abortion policies in PRC draws on those treated as representing the particular way in the culture and primary materials collected and reprinted in Zhongguo Jifa Shengyu society as a whole. I believe that that my account of the historical Chuanshu (Complete Book of Family Planning in China) edited by Peng Peiyun and published by China's Population Press in Beijing in 1997. changes of Chinese perspectives on abortion offers a compelling This volume is the most authoritative and most comprehensive example of how misleading and distorting these two information book on family planning in China. The entire work has nearly misconceptions about and misuses of culture could be. As I 1,500 pages and over 33 million Chinese characters. It includes almost have argued elsewhere (Nie, 2000), a hermeneutic or all relevant national laws and policies of abortion and population control from 1949 to the first half of 1996. It also collects the most important interpretative approach can be an effective antidote to these relevant speeches of top national leaders, editorials of official newspapers, sorts of ways of thinking about culture and do cross-cultural significant semi-official articles and research papers. This work can be medical ethics. I hope that I have illustrated this argument here seen as a recent official expression of population control policy, since the since any hermeneutic approach must be first of all historical. chief editor himself is a top national leader and the chairman of the National Committee of Family Planning - the top administrative body responsible In other words, it is essential for cross-cultural bioethics to avoid for population control. Jiang Zeming, the current President of China and over-generalizations on cultural ideas and practices as much as the general secretary of the Central Committee of CCP, Li Peng, then possible, to acknowledge and take seriously the plurality, Prime Minister and the current head of People's Congress, and several diversity, flux, changeability, historical complexity, local other top national leaders have inscribed words for this work. Jiang wrote: 'Carrying out fanuly planning is a long-term and fundamental national richness, openness to new possibilities, and contradictory policy of our country'. elements of any culture on any bioethical issue. 5. In traditional Chinese medicine, there exists a series of methods, drugs, Acknowledgements and prescriptions to secure and 'quiet' the foetus if the foetus moves so much in the mother ·s womb that there is a tendency to have a spontaneous This article is basically the third chapter of a forthcoming book, abortion. tentatively titled Voices Behind the Silence: Chinese Views and Experiences ofAbortion, currently in contract with the American 6. The above two motivations for making abortion illegal are similar to publisher Roman & Littlefield. I am very grateful to Prof Harold rationales under which the medical profession in nineteenth-century America launched and won the crusade for prohibiting abortion except Vanderpool, Dr Faith Legay, Prof Mark Selden, Dr Paul Sorrel, for therapeutic purposes. For American doctors of that period involved Dr Neil Pickering, Dr Brian Moloughney and Dr Arthur in the undertaking, the health of women and racial imbalance of Kleinman for their generous help. population were two of the most significant concerns (Mohr, 1978).

Notes 7. There is an enormous number of articles and books in the English 1. I myself used to accept and promote the view that abortion in general language that focus on the Chinese population control program (see, was morally acceptable for Confucianism, in particular, and Chinese e.g., Croll, Davin and Kane, 1985: Banister, 1987; Kane, 1987; Aird, people, in general (Nie, 1999:469). 1990; Tien, 1991; Poston and Yankey, 1992; and Milwertz, 1997).

new zealand bioethics journal october 2002 page 29 ' / nzhitletiiics ..,::,<' , ':. ' > ,.

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