Abstract 摘要

This paper attempts to analyze four major arguments in favor of the moral acceptability of voluntary euthanasia (including physician-assisted-suicide) as found in the West, and tries to assess these arguments through Chinese Confucian ethics and its perspectives on life and death. Through such a cross-cultural dialogue the author concludes that there is some similarity as well as difference in Chinese and western values. The western moral values appealed to in advocating voluntary euthanasia, to a certain extent, can strike an echoing chord in Confucian ethics. In other words, though the debate on euthanasia is a contemporary phenomenon, the arguments and their underlying values in favor of its moral acceptability are not entirely foreign to premodern Confucian ethics. This resonance notwithstanding, the Confucian echoes are also limited. Behind some general agreements are some significant disagreements as well. Hence this cross-cultural dialogue can reveal in a clearer manner the salient traits and possible flaws of the western moral arguments in favor of euthanasia, and can contribute to a multicultural reflection on some contemporary moral controversies.

This paper begins by clarifying the etymological meaning of "anle si," the phrase for "euthanasia" in Chinese as well as in Japanese. The root of the phrase can be traced to either Mencius or Pure Land Buddhism. The latter possibility seems more probable, and "anle si" then means a death or dying free of suffering. In this paper, I shall restrict the term "anle si" or "euthanasia", to voluntary, active euthanasia and physician-assisted-suicide.

The first common western argument in favor of euthanasia is the argument of mercy. For some patients the dying process is accompanied by such excruciating pain that euthanasia is a good way of release from suffering. Since the patient is on the way to die anyway, such suffering is pointless and is not worth-enduring. Euthanasia for such dying patients is to spare them from such pointless suffering and is therefore a manifestation of mercy. This argument can find an echo in Confucian ethics. The fundamental value in Confucianism is "ren," and one of its meanings is benevolence. According to Mencius, the root of "ren" or benevolence lies in compassion, i.e., feeling intense pain in seeing others suffer. Traditional Chinese medicine also adopts this cardinal Confucian virtue as its fundamental guiding norm, hence the dictum that medicine is "renxin renshu" (benevolence and benevolent art). Thus if the premise "Euthanasia is the only way or best way to eliminate pain in the dying process" is empirically true, one can infer that euthanasia can be justified by Confucian ethics of ren. However, in light of the recent progress in palliative medicine and hospice care, the aforementioned premise can be empirically true only in very limited circumstances, which are analogous to a torture scene in the recent Chinese novel, then turned into movie, The Red Sorghum. (The author also observes that the hospice philosophy is more in consonance with the Taoist philosophy of Zhuangzi.)

The second common western argument in favor of euthanasia is the argument of the quality of life. It has been argued that some sufferers of disease and accidents do not want to live anymore not because of intractable pain, but because of the irreversible and unacceptable low level of the quality of life (e.g., in Alzheimer’s disease, Parkinson’s disease, ALS, MS, quadriplegic, etc.). Since the condition is incurable, and the persons involved would rather die than to endure this "living hell," euthanasia is liberation from this bondage. Confucianism does not subscribe to the doctrine of the sanctity of biological life either, and places heavy emphasis on the quality of life, to be defined with reference to ren and yi (i.e., in the wide sense of supreme virtue), rather than on the quantity of life (i.e., longevity). To live out one's life to its natural limit is not in itself desirable. In order to secure a high quality of life, in some circumstances, one has to be prepared to die, even by taking matters into one’s hand, lest what is going to transpire in the natural life span will decrease the quality of life. However, the limit of the Confucian echo is that Confucianism cares largely the moral quality of life, and cares very little about the biological quality of life. As long as the low quality of biological life is not to affect adversely one’s moral quality of life, there is no good reason to terminate one’s biological life.

The third common western argument in favor of euthanasia is the argument of death with dignity. According to this argument, our biological condition can be so bad (e.g., loss of control, being brought back to the infant condition, in a state of zombie) that it is a humiliation to our sense of dignity. Such an assault on our dignity can be more intolerable than physical pain. Euthanasia can therefore deliver us from such an undignified state of existence. In Confucianism, especially since the Han Dynasty, to commit suicide in order to avoid humiliation, disgrace, and dishonor is not only desirable, but also obligatory. Such an idea of "a man of integrity prefers death to humiliation" is even accepted by a number of Chinese intellectuals during the so-called "Cultural Revolution." However, historically the Confucian endorsement of death with dignity is largely limited to the cases in which the assault on human dignity came from an external source (from enemies, emperor, government), and such an assault is not a universal predicament. Furthermore, in those circumstances in which to commit suicide is the only way to avoid humiliation it happens because one’s destiny is controlled by hostile forces; there is no friendly force at hand to make one feel better. In the contemporary case of euthanasia, in contrast, the assault on human dignity comes from an internal source (disease, old age, bodily and mental decay all stem from our mortal and corruptible body) and is therefore a universal human phenomenon. Unless we conceive disease and sickness as an enemy, Confucian ethics would not view our deteriorating biological condition as an assault on human dignity. If we accept that our mortal embodied life is a part of our human condition, we can hardly say that bodily and mental decay is undignified. Besides, especially when palliative and hospice care are available, a patient is not captured and isolated in a maleficent environment, but is surrounded by health care professionals who are there to help us. After all, one purpose of hospice care is to help patients to maintain their dignity while they are travelling in this last stage of the journey of life. Hence the Confucian endorsement of euthanasia as death with dignity is quite limited.

The fourth common western argument in favor of euthanasia is the argument of self-determination. According to the cherished western value of autonomy, an individual should be given the liberty to decide on things that matter much to him or her. Like the decisions relating to marriage, procreation, contraception, education, etc., the decision on how and when to die is one of the most intimate and personal choices a person may make in a lifetime. Hence we have the right to die; some even claim that this is a human right, both a negative right (whose correlative duty is nonintervention in suicide attempts) and a positive right (whose correlative duty is suicide assistance). After all, whose life is it anyway? In Confucian values, individual autonomy has never been a cherished value; nor has there been any human rights thinking. That one can decide on the time and circumstances of one’s death is only implied. According to Confucian values one should choose a good death (good in the moral sense) even by actively bringing it about. Since "ought" implies "can," that in some circumstances a person ought to commit suicide implies that the person is morally permissible to commit suicide. However, the Confucian echo of pro-euthanasia argument is the weakest here. The western argument is concerned with the permissibility of suicide and euthanasia, whereas Confucian ethics is concerned with the impermissibility of not committing suicide. In other words, the western argument is concerned with the permissibility of all suicide, regardless of its worth. Confucian ethics, on the other hand, is concerned with only the permissibility of some suicide, those that are deemed morally worthy. The western argument is concerned with the right of euthanasia, but Confucian ethics is only concerned with the rightness, the right conduct, or the right exercise of the right, of euthanasia. Furthermore, the ideas of self-ownership and individual sovereignty are entirely foreign to Confucian values.

To conclude, the Confucian echo of these four western arguments varies. The resonance is most prominent in the first argument and weakest in the last argument. This cross-cultural comparison should be instructive to Chinese as well as to the people in the West because it shows which values are universal and which are not. For example, the western society has the tendency to view the value of autonomy as self-evident ("We hold these truths to be self-evident......"), but this value is obviously not self-evident to the Confucian mind. Who is right, and who is wrong? That the Confucian endorsement of euthanasia is only limited should give something to every member of the global village to ponder about.