China and bioethics
In September 2021, the British Embassy in Beijing approached the Nuffield Council with a proposal to collaborate with Chinese scholars, especially those advising their Government on basic bioethics law. The intention was that those framing and drafting the law in China should benefit from the experience and knowledge of those familiar with bioethical regulation, ethics, law and policy in the United Kingdom.
To date, this collaboration has comprised two workshops – one on genome editing, and a second on issues in reproduction. In arranging these workshops, the Nuffield Council was able to draw on the expertise and experience not only of those within the organisation, but also of UK bioethicists and regulators familiar with the issues. I am hugely grateful to those who gave their time, providing carefully crafted surveys of the legal and ethical issues, as well as answering the many questions put to them. Further workshops are envisaged over the next year or so, and hopefully we can have face to face sessions.
In the first instance, the invitation from the British Embassy was tribute to the reputation and status of the Nuffield Council. Many of those participating from the Chinese side also testified to the importance and influence of our work. However, the meetings are also of great significance as evidence of the extent to which China is seeking to regulate in health practice and biomedical research. The workshops were extremely well attended, comprising both senior figures in law and bioethics as well as younger academics. Their enthusiasm and concern to make proper sense of the issues was all too evident throughout the sessions, and the resultant discussion was of the highest order.
Three things are worth emphasising:
- The first is that the collaboration – and what we learned from our Chinese colleagues – disproves the simple ‘wild east’ trope that all too often dominates European discussions of China, one in which Chinese medicine and science are completely unregulated, and where in consequence anything goes. Of course, the scandal of He Jiankui, the Chinese researcher who in November 2018 announced that he had created the world’s first gene edited babies, might seem to support the wild east view. Yet Dr He was subject to severe penal measures for what the Chinese government characterised as ‘illegal medical practice’ and leading Chinese bioethicists called for a major ‘overhaul’ of official regulation of biomedical research with harsh penalties for those violating the regulations. The fact that our Chinese colleagues chose genome editing as the topic of our first workshop, and all the signatories of the Nature open letter were present at the workshop, shows their concern both to learn from the UK and also to make clear their own commitments to the proper regulation of genomic research.
- The second thing that should be emphasised is that it would be a mistake to simply to view the workshops and any continuing cooperation as a one-way process. Certainly, the Chinese are keen to learn from us. But there is much that we can learn from them. It was interesting - as well as something of a surprise - to hear views expressed about the different motivations of women seeking to have children through a surrogate. Equally, whilst there are many in China who see bioethics – especially in the now familiar form of the ’four principles’ theory of Beauchamp and Childress – as globally uniform, there are others who will insist that there is a distinctively Chinese intellectual approach to these matters, one rooted most obviously in traditional Confucian ideas. The Nuffield Council is the UK’s foremost bioethics body seeking to ensure that ethics is embedded in all the relevant law and policy. Our work has global reach, and our publications are admired across the world. Yet modesty and humility is demanded. We should always recognise what others beyond our own shores have to contribute, and never simply assume that what we do is self-evidently right (and the best).
- The third thing that is worth emphasising is the existence of evident links between policy making, law, regulation, and academic bioethics. The latter is a comparatively young subject in China but is growing at a great rate and those who teach and research it are a younger generation, keen to learn and play their role. I hope to visit China over the next few years to meet that younger cohort of bioethicists with a view to a constructive, mutually rewarding exchange of ideas.
I have been visiting China regularly since 1988; I have participated in summer schools, conferences, and workshops, as well providing guest lectures at various Chinese universities. I count myself fortunate to enjoy the longstanding friendship of the father of Chinese bioethics, Professor Qiu Renzong. It has been astonishing to witness the pace of change in China over the last twenty-five years. China is now world-leading in many areas of science. So, it is an honour and a privilege to be - on behalf of the Nuffield Council - a very small part of the conversation about how this fast-paced science can develop with ethical thinking at its core.
In response to some of the concerns raised in comments, I thought it may be useful to respond with a few points of clarification.
This collaboration was initiated by the British Embassy in Beijing, not by the Chinese government. It was focussed on exploration of how medical and scientific research in certain areas, such as genomics, might be appropriately regulated.
The Nuffield Council on Bioethics takes seriously an obligation to understand key bioethical matters and to communicate that understanding to others, especially those in a position to make law and policy. Its recommendations have, in its thirty years of existence, been influential nationally and internationally.
The NCoB is independent in that it sets its own agenda and selects its own topics, methodologies and outputs. We do not represent any particular group or view. This project derived no financial benefit from the work.
In my view this project was both important and fruitful. We can all learn from talking across borders about how to regulate science.
Thank you for these comments. Working with Chinese colleagues on the ethical regulation of medical research is extremely important. But I do not ignore or misunderstand the challenges and difficulties it presents. It is critical to distinguish the actions of Government or State from the work of those in civil society such as academic bodies. As the blog was careful to make clear those in the latter are not uncritical of the former. What matters - and what was evident from the workshops - was the manifest commitment of those with whom we discussed issues to develop an ethical approach to the formulation and application of bioethical regulations and law.
Much could be said of the 'Georgetown mantra'. But that is for another blog! I commend reading Professor Qiu's extremely interesting comment for its understanding of how one should do good bioethics, and how one could easily overstate the alleged gap between Chinese or Confucian and Western approaches to bioethics.
Our workshop discussions suggested we have a lot in common, and that what is crucial is clarity, rigour, and robust argument in exploring what we can agree on and where our differences lie.
No word can be used to express the feeling of my gratitude, agreement and pleasure when I read Dave's splendid blog "China and Bioethics". I first met Dave in 1988 at the first session of Sino-British Summer School with the topic of Analytical Philosophy and Philosophical Analysis at Tsinghua University, Beijing, China. A funny story is that at that time philosophers all over the world would like to go to Brighten to listen Sir Peter Strawson's lecture at the World Philosophy Congress, however, beyond expectation Peter (then he was the President of the Summer School) was at Tsinghua. Then I first met Dave and was filled with the admiration of Dave's lecture which is embedded in so clear conceptual analysis and so convincing philosophical arguments. In collaboration with Nick Bunnin, Jon Cohen, Tim O'Hagan, Mary Tiles, and other British colleagues and under the support from Royal Institute of Philosophy and British Academy, Dave is one of the mainstay leaders to build the edifice of Sino-British collaboration in philosophy including bioethics. For me bioethics is not a philosophy with only concern with speculation or empty talk. Instead, it is a practical ethics which intend to change the existing world and improve human existence on the matters of health care, health-related research and public health. Under the support of my colleagues, we uphold that publishing papers or books is not the final goal of our endeavor bioethics, but on the basis of our biomedical research the academic results should be translated into ethical norms, administrated regulations or laws. In our efforts British colleagues, the Department of Science and Technology at British Embassy in Beijing, and Nuffield Council on Bioethics gave us conscientious and generous help. I was particularly impressed by Dave's point on collaboration in his blog. I was educated in a Confucian primary school. The Analects of Confucius and Mencius are required courses we must recited each day no matter you understand or not. However, later I felt I greatly benefited from Confucian teachings on how to become a moral person from a biological being. But with the time passing I felt it is not sufficient for me to limit myself on Confucian teachings, especially in the efforts to institutionalize bioethics. When I visit UK, I learnt a lot from British philosophers, such as Francis Bacon, Jeremy Bentham, John Stuart Mill, John Locke, Adam Smith, William David Ross, and other writings of contemporary British philosophers. Reading their writings widened my vision, and trained my capabilities to analyze and solute philosophical/ethical issues raised in health care, biomedical research and public health. Reading Confucian writing did not make me a Confucian, nor reading the writings of British philosophers made me a utilitarian or Lockean. I still keep my own independent philosophical/moral judgment.
I am always encouraged by these interactions. I taught Ethics in Science and Pharmaceuticals for several years at Zhejiang University of Technology in Hangzhou. The engagement was rich and beneficial, and I enjoyed my colleagues and students immensely. The one caveat is that it was made clear that no criticism of the government would be permitted (of course, I had already known this). However, it made topics like the use of prisoners as organ "donors" quite an intellectual dance. Bets wishes with this endeavor....
It is touching to read that the Nuffield Council considers itself so incredibly good and important and apparently also considers itself superior to urgent bioethical issues that concern citizens. However, when I think of an article titled China and Bioethics, I think of an article that argues that a discussion of bioethics in China cannot be separated from China's biopolitics. Bioethics is, of course, never a neutral regulation of biotechnological and medical research, but always linked to cultural, social and political views on the fortunes of citizens' bodies in a state; what citizens may or may not do with their own bodies. This is so urgent in the case of China because China uses AI-driven surveillance technology like no other country to teach, direct, correct, punish and suppress its population, i.e., the body of every individual citizen. There is an unbridled collection and storage of digital and bio-data, by means of surveillance cameras with facial recognition technology and so-called emotion detection. There is massive storage of DNA and other biodata in biobanks. A variety of tracking technologies are used, such as apps, that allow the government to monitor the contents of mobile phones. There is a social credit system that judges people on socially desirable behavior. With a low score, people can be denied access to certain areas and the use of transport options. Contributing to bioethics that only concerns biomedical and biotechnological research by the biotech industry in a country that very violently violates the human dignity and bodily integrity of its own citizens, means that the Nuffield Council believes that the violence exerted on Chinese bodies - and on much larger scale on the bodies of Muslim minorities - should not be discussed as a bioethical issue. Apparently, the Nuffield Council understands the purpose of bioethics to be that bioethics should only serve the biotech industry and not that bioethics should primarily serve the much broader interests and rights of society and its citizens.
Interesting contribution. The Georgetown Mantra is merely an heuristic, a partial exploration of ethics in the humaist tradition applied to a limited set of circumstances. Is there ny such heuristic in the Confucian tradition?
That were very impressive discussion between British and China. Looking forward to more avtiivies between two side.
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