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07/16/2015

On the Origins of Research Ethics: China and the West

by Craig Klugman, Ph.D

When I was a graduate student, I was fortunate to be one of five students chosen by the China Medical Board to attend an international bioethics conference between the U.S. and China in Beijing. We listened to talks on the philosophical bases of ethics in each country and culture. The U.S. laid its philosophical history on the doorsteps of the ancient Greek traditions such as Plato and Aristotle as well as later European thinkers such as Kant, Mill, and Bentham. The Chinese delegates talked of Confucius and Lao Tzu. We toured a hospital and a medical school. I still have a black plastic plate with the image of the medical college drawn in a gold color that was a gift to us guests.

I was assigned to a break out session where both countries were supposed to talk about values of medical ethics in the hopes of crafting an international and intercultural code of medical ethics. As a graduate student I asked the too-wise-for-my-britches question, “How can we create an international code of ethics when we are only two countries?” I was quickly quieted as the chair, an illustrious scholar, said, “Privacy. We can agree that privacy is important, correct.” There was a lot of chatter and head nodding. Another American student sitting next to me, whispered in my ear, “I don’t know all of what they said in Chinese, but the last part was, ‘Don’t translate this for the Americans’.” The interpreter then said out loud, “Yes, we can agree to privacy.”

Two days later at the closing ceremony, a written document was placed before the head of each delegation. A list of agreed upon values and ideas was read to the audience. A pen was handed to each leader. The Chinese leader stopped and after a brief statement, the interpreter said, “We cannot sign this. We do not agree with it.” What had been lost in cultural translation was that in China, one does not contradict a guest and we were the guests.

I relay the story because of a recent New York Times article, “A Scientific Ethical Divide Between China and the West.” The article talks about the efforts of China to become a world leader in biomedical research. The World Bank states that from 2010-2014, China spent nearly 2% of its GDP on research and development, an increase from 1.84 in the previous five-year period. The United States spends 2.79 up only .03 from the previous period. China has built new laboratories, recruited their scientists to come back home and created a system of incentives for publishing and filing patents.

China’s rapid ascent into biomedical research has led to a different treatment of ethical issues. Whereas the Western world has adopted a moratorium (for now) on gene editing with CRISPR technology, Chinese scientists published their work on altering diseased genes in 86 unviable embryos.

The New York Times article reports that China follows global guidelines, but that Chinese culture is based on a different philosophy than the West and not all agree that these foreign ideas should be used in China. For example, a committee reviewing the CRISPR research allegedly said it was okay, because the embryos were not being used for procreation. While experimenting on and even manipulating embryos in the West is controversial because some religious and philosophical traditions hold that life starts at conception, Chinese philosophy has a different position. All life is sacred in Buddhist and Daoist traditions, but at least in the former, this life is one of many, so death is not seen as an end, but rather a new beginning. A newborn would often not be named until it survived a full moon, and in some traditions was not considered as being in this world until a full year had passed.

Chinese researchers are also paid differently than U.S. scholars. They receive financial bonuses for publishing in international journals. There is also pressure to succeed and to progress beyond the West in research and development. Nearly 9.5% of all articles in the Science Citation Index are from Chinese researchers—that’s 1 million articles between 2002-2012.

The question that the New York Times article inadvertently raises, is why should China follow Western philosophy and religion? The article reports on some in China who want to follow Chinese values that would allow them to move forward in gene editing whereas Western ones suggest adopting a moratorium. This may sound like the old argument of relativism versus universalism: are morals true for all people in all places or do they differ by culture or nation. What one is shown in such discussions is that a relativistic sense of morality means that anyone can do anything to anyone and no one can be an outside judge of those actions. The idea being that a civilized world cannot function in a relativistic world. There is also a notion that relative morals are arbitrary and somehow lesser than universal ones.

But this is more than that. This is a question of what should the basis of one’s research ethics? In the West, it derives from Greek, Roman, and European philosophy, Catholicism, and is influenced by a history of human subjects research abuse. Should these ideas be considered the universal ones? Does that mean they are true—part of the bedrock foundation of the universe, or is true simply because the West agreed to them and as the historical leaders in science (at least since the 1600s) we make the rules? Forcing a culture with different philosophical and religious traditions to abide by those could be seen as cultural colonialism.

As someone trained in medical anthropology, I may view this issue differently than someone who comes out of a degree in European or American philosophy, but it seems that there is a legitimate question here as to why China, with a very rich-and-older-than-the-West tradition of religion and philosophy should abide by the West’s version. It seems to me that China may have and should continue to develop a rich research ethics from its own traditions, which may differ from what we have in the U.S.

At the very least, there needs to be a conversation between the perspectives. Gene editing, which has the potential to change the human gene pool forever, are certainly beyond the purview of a single nation since this pool belongs to all of humanity (despite what any filed patents may claim). But to assume that the Western view is the “right” one is a display of cultural arrogance.

And this time, the conversation should a true one. Not a host showing regard for his or her guests. But a real, vibrant philosophical debate on what our global research ethics ought to be to which we can all agree or at least abide.

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