Journal ofmedical ethics, 1995; 21: 239-246 J Med Ethics: first published as 10.1136/jme.21.4.239 on 1 August 1995. Downloaded from Chinese Confucian culture and the medical ethical tradition Guo Zhaojiang The Fourth Military Medical University, Xian, Shaanxi, China Abstract our system. Therefore, when trying to reform medical The Confucian culture, rich in its contents and great in practice in China, we arefaced with the urgent need to its significance, exerted on the thinking, culture and inherit and promulgate the essence of Confucian ethics - political life ofancient China immense influences, discarding its obsolete concepts - while at the same time unparalleled by any other school of thought or culture. building up the new medical ethics that can meet the Confucian theories on morality and ethics, with requirements of the outside world and the future. 'goodness' as the core and 'rites' as the norm, served as the 'key notes' of the traditional medical ethics of As the world strides into the twenty-first century, China. The viewpoints ofConfucianism on benevolence scholars around the world are contemplating, fore- and material interests, on good and evil, on casting and portraying what the future will be like. In kindheartedness, and on character cultivation were all the next century, what kind ofa world will we live in? inherited by the medical workers and thus became How will we work? What moral values shall we need copyright. prominent in Chinese traditional medical ethics. Hence, so as to co-ordinate and handle interpersonal rela- it is clear that the medical profession and Confucianism tions and man's relation to society? These questions have long shared common goals in terms ofethics. have provided much food for thought. One of the Influenced by the excellent Confucian thinking and most heated debates centres on medicine, which is a culture, a rather highly-developed system of Chinese common cause for all mankind, and medical ethics, traditional medical ethics emerged with a well-defined which concerns each and every one of us. My topic basic content, and the system has been followed and for discussion is Chinese Confucian culture and the http://jme.bmj.com/ amended by medical professionals ofall generations medical ethical tradition. I will expound on Chinese throughout Chinese history. This system, just to mention Confucian culture and its profound influences on, briefly, contains concepts such as the need: to attach and the intrinsic connection with, the medical great importance to the value oflife; to do one's best to ethical tradition in China. I will also talk about the rescue the dying and to heal the wounded; to show need for re-examining the moral values and ethical concern to those who sufferfrom diseases; to practise standards as embodied in Confucianism in order to medicine with honesty; to study medical skills meet the rapid developments in modern medicine. painstakingly; to oppose a careless style ofwork; to on September 26, 2021 by guest. Protected comport oneself in a dignified manner; to respect local customs and to be polite; to treat patients, noble or I. Confucian culture and its profound humble, equally, and to respect the academic influences achievements ofothers, etc. In the Spring and Autumn Period (770-476 BC), Ofcourse, at the same time, Confucian culture has its the slavery society in China was disintegrating and a own historical and class limitations, which exerted new culture was being conceived which would shape negative influences on traditional medical ethics. future society. In this extraordinary period of history Now, ifwe are to keep up with the development of was born an extraordinary cultural giant, Kung modern medicine, a serious topic must be addressed. Chiu, respectfully addressed by later generations as That is how to retain the essence ofour traditional Kung Fu-tse or Confucius. Confucius (551-479 medical ethics so as to maintain historic continuity and BC) was a distinguished philosopher, thinker, yet, at the same time, add on the new contents of educator and political ethicist in the late Spring and medical ethics so as to incorporate modern features into Autumn Period (1). Although he was of humble origin, he had an acquisitive mind and a contempla- tive nature even as a child. He was once a petty Key words official responsible for running a warehouse and Confucian ethical tradition; Chinese traditional medicine; raising cattle. Then he began to recruit disciples and modem medicine. to give lectures. He was the first to found a private 240 Chinese Confucian culture and the medical ethical tradition J Med Ethics: first published as 10.1136/jme.21.4.239 on 1 August 1995. Downloaded from school in China. Though he later held various high- and Buddhism. Han Yu et al tried to adapt ranking official positions in the state of Lu, he was Confucianism into a religious belief but failed (3) mainly interested in founding schools, giving while other scholars developed the early Confucian lectures and promulgating and promoting his thinking of 'valuing people and loving people'. In the academic views and political ambitions. Together interim, Confucianism was beginning to be merged with his disciples he journeyed through much of the with natural sciences and medicine. then politically and economically developed regions In the Song (960-1279) and the Ming of China. The journey, which lasted fourteen years, (1368-1644) dynasties, Confucianism appeared in helped him gain a deeper understanding of the then the form of 'Confucian idealist philosophy' out of prevalent academic viewpoints and political beliefs the fusion of Confucianism with Taoism and ofvarious schools as well as of social reality, through Buddhism, which later became the dominant philos- cultural exchange and observation. A unique school ophy of rulers in late feudal society (960-1840) in of Confucianism, which exerted immense influences China. These scholars were mainly concerned with on the thinking, culture and political life of ancient the philosophical problems of human nature and the China, was established by Confucius as he made way of heaven and propounded the extreme proposi- his profound inquiries into philosophical, ethical, tion of 'letting the heavenly principles live and letting political and educational problems. human desire perish'. Feudal rule in China became more oppressive spiritually. These scholars also made great efforts to annotate classical Confucian Concept of 'conscience' writings and consolidated the concept of 'national After the death of Confucius, his disciples inherited character' and the Confucian ideal of a prosperous and developed his academic thoughts. Mencius state and a humanitarian world. No noticeable (circa 390-305 BC), leader of one of the eight minor development in Confucianism occurred after the schools of thought developed from Confucianism, Ming Dynasty. politically advocated the kingly way and opposed the Confucian culture by this time was extensive and way of might, and placed moral value on righteous- wide-ranging, embracing the social, political, cultural, ness and despised profits. He was the first to formu- educational, ethical and moral aspects of life. copyright. late the concept of 'conscience' in the history of According to Confucian thinking, the ruling class Chinese ethics and he was regarded by later genera- should learn the merits and virtues of Yao and Tsun, tions as the true inheritor of Confucianism. Tsun-tse who were legendary monarchs since time immem- (circa 313-238 BC) criticized all other contending orial in China (22nd-21 st centuries, BC) and schools of thought and only revered Confucianism. imitate Emperors Zhou Wenwang and Zhou Ethically, he concretized the concept of 'morality' Wuwang (circa 11th century BC), two outstanding and raised the possibility that 'man is born evil' as emperors of the Zhou Dynasty, in the way ofgovern- http://jme.bmj.com/ opposed to the hypothesis of Mencius that 'man is ing the state. Confucianists endorsed 'ritual' and born good' (2). 'goodness and justice' and advocated 'ruling by In 213 BC, a well-known event in China's history moral force' and 'ruling by ritual'. Confucius said: took place. Emperor Qin Shihuang, who was 'If you rule the people and keep order among them offended by the political viewpoints of Confucian by punishments ... they may avoid doing what is scholars, ordered the burning of classical writings of wrong, but they will also lose self respect. If you Confucianists and the killing of over 460 Confucian guide the people by moral force and keep order on September 26, 2021 by guest. Protected scholars. The tragedy dealt a heavy blow to the among them by ritual, they will keep their self school of Confucianism and arrested its develop- respect and come to you of their own accord' (4). ment for some time. Mencius inherited Confucius's concept of benevo- In the Han Dynasty (206 BC-220 AD), the impor- lent government and promoted the kingly way of tance of the school of Confucianism's tendency to ruling people by goodness and opposed ruling support those in authority, such as monarchs, was people through might. recognised; Confucianism was for the first time crowned as the national orthodox culture when Emperor Han Wudi issued the decree 'to ban all other Profound implications schools of thought and to sanctify Confucianism'. Confucian culture is not just one academic school of Confucian scholars in the period, as represented by thought, it has profound connotations and implica- Dong Zhongsu, adapted Confucianism to form philo- tions. What is more important is that Confucius sophical theory about rulers. This promulgated the inaugurated philosophical study in China and it can concept of 'the unity of heaven and man' and sup- be said that he is the first great philosopher in China's ported absolute monarchy (3). history. He started academic debates of a philo- During the Tang Dynasty (618-907) we saw the sophical nature on man's destiny versus human emergence of Taoism and Buddhism as rivals to efforts; on rule by benevolence versus rule by law; on Confucianism.