Advance Directives in Palliative Care in Mainland China: Confucian Bioethics, Practice, and Policy


Student thesis: Doctoral Thesis

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Awarding Institution
Award date4 Jan 2021


Advance directives (ADs) are an important tool for documenting the wishes of end-of-life (EOL) patients who are no longer in a position to take decisions relating to their medical care. However, little research has been conducted into ADs within the particular context of Chinese culture. This thesis examines the debatable ethical issues associated with ADs in mainland China, addressing the following questions: Who should have the moral authority to formulate an AD? How should ADs regarding withholding/withdrawing life-sustaining treatments (LSTs) be implemented? Why should active euthanasia not be included in an AD? As Confucian ethics has had the greatest impact on shaping the culture of East Asia and constitute the foundation of Chinese medical ethics, this thesis offers particular Confucian perspectives on matters such as health, virtues, the human body, and life and death in order to analyze the ethical issues associated with ADs highlighted in the three research questions. This research adopts a qualitative method with in-depth interviews to provide and explore insights into the role of three parties—patients, family members, and physicians—in relation to ADs. The study firstly suggests that both patients and family members should have shared moral authority in regard to formulating an AD. Then, it further recommends that two ethical standards—respecting the patient’s AD and acting in the patient’s best interests—should be followed to address three practical scenarios which may be encountered when implementing a patient’s AD regarding withholding/withdrawing LSTs. The study finally concludes that active euthanasia should not be included in an AD since the act of withholding/withdrawing treatment and active euthanasia are conceptually and ethically different and the latter cannot be defended by Confucians ethics. Finally, the thesis provides recommendation regarding the way to promote a Confucian-oriented AD policy, provide ethical and practical training about ADs for medical professionals, and improve public awareness of ADs.

    Research areas

  • Advance directives, Withholding and withdrawing life-sustaining treatments, Confucian ethics, Palliative care, Medical decision-making