In the West, “justice” is a complex ethical principle, with meanings that range from the fair treatment of individuals to the equitable allocation of healthcare resources. Justice in bioethics is perhaps the most contested and controversial principle. This paper argues that the Confucian notion of justice is neither rights-based nor distributive; rather, it is based on the virtues of humanness and benevolence (ren), correct behavior and propriety (li), and uprightness and appropriateness (yi). Those virtues cherished in the Confucian tradition constitute what can be called a Confucian concept of justice, the primary principle of which is to respect human life. This means that in the healthcare system, the Confucian idea of justice is approached from the perspective of equality and fairness. On the one hand, the government should provide basic care for all persons according to the virtue of humanness/benevolence; on the other hand, the government should allow for diversity and differences in medical treatment and healthcare resource allocation according to the virtues of propriety and appropriateness, given that medical resources are limited and China supports a huge population. In other words, the government has the responsibility of providing public health care to those who cannot afford to pay for their own basic healthcare needs. At the same time, the government should allow for alternatives and should permit people to choose between ways of dealing with their medical issues.
Clearly, the language of “rights” is absent from the Confucian tradition. However, this essay argues that because the Western notion of justice, particularly in the legal sense, does not take into account what is good, the Confucian virtue-based justice better fits the cultural milieu of medical practice in China. From the standpoint of Confucianism, healthcare and bio-medical ethics should be more concerned about what is good for society, family, and the individual than about absolute equality or the principle of fair equality, which engender both moral and economic hazards.