By Nancy S. Jecker and Roger Yat-Nork Chung.

Bioethics faces challenges with respect to equity, diversity, and inclusion. As a group, we bioethicists are unrepresentative of the global population we increasingly serve. Leading bioethics scholars and institutions are situated mostly in the politically and economically dominant countries of the Global North. Within countries, bioethicists are a privileged set. For example, in the USA bioethicists tend to come from more educated families and are generally whiter, more liberal, and less religious than the overall American population.

It is therefore unsurprising that most bioethics publications emanate from a narrow slice of the global population. In a study of top cited bioethics literatures spanning four decades, 84.5% of cited papers were from the USA, UK or Canada. In another study, a similarly lopsided geographical distribution of bioethics publications was apparent. These biases persist in international bioethics conferencing.

These findings are hardly unique to bioethics. A robust body of evidence suggest that the cultural backdrop that informs many academic fields is WEIRD –Western, educated, industrialized, rich, and democratic. A problem with WEIRD approaches is that they omit large swaths of humanity.

What’s wrong with WEIRD bioethics? We argue that it undercuts the field’s ability to articulate values that can gain global traction and inspire global collective action.

These biases are on full display in international ethics guidelines. Consider personhood and its application to AI, abortion services, and environmental protection. In Confucian-influenced societies across East Asia, the superlative moral standing associated with personhood is often relationally-based. While diverse, many renderings of Confucian ethics regard the source of a persons’ moral worth to be performing well in social roles and relationships.

According to some understandings of Confucian ethics, prosocial AI could acquire personhood through AI-human relationships. By contrast, leading personhood views from the West tend to emphasize sophisticated cognitive capacities, such as being conscious, autonomous, or having interests. The sophisticated cognitive capacities view says that personhood is “Neither a relation the individual stands in…nor a capacity whose exercise requires active participation of another (e.g., the capacity to relate to others in certain mutually responsive ways).” According to leading Western views, AI would qualify as a person only if it acquired “an inner life that gave rise to a genuine interest in not being harmed.”

International ethics guidance for AI leans Western, enshrining the aforementioned Western values. The World Health Organization (WHO) Ethics and Governance of AI for Health protects individual dignity, privacy, confidentiality, and informed consent, expressing concern that they might be “dramatically redefined or undermined” by AI advances. This emphasis is fundamentally incomplete, since it neglects the relational context in which AI is deployed and the value of AI-human relationships, which figure prominently in Confucian-influenced East Asian approaches to AI. To correct this, the WHO should add to its international guidelines that AI is deployed within a social relational context in which AI-human relationships hold value.

For abortion, the most recent (2022) WHO Abortion Care Guidelines discuss the ethics of abortion services exclusively in terms of individual rights, emphasizing, for example, that unsafe abortion practices around the globe jeopardize the pregnant person’s rights to health, non-discrimination, and life. Focusing just on the rights of individuals is WEIRD, because it sidelines relational features of prenatal human life so salient in Confucian ethics, e.g., that a fetus is situated within a pregnant person’s body, and within the context of (future) family relationships. To make this right, the WHO should include relational features salient in Confucian ethics, e.g., that a fetus is situated within a pregnant person’s body, and within the context of (future) family relationships.

Finally, a 2023 report from The Intergovernmental Panel on Climate Change urges “transformative changes” to stay within the planetary boundaries required to ensure a safe operating space for humanity. Subsequent discussions of values supporting staying within planetary boundaries assume an instrumental view of nature’s value.

For example, the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services appeals to “nature’s contributions to people,” such as food, medicine, and materials required for human well-being to justify planetary boundaries. Others take a broader view, referring to international, intragenerational and interspecies justice, yet omit consideration of nature-human relationships considered crucial within a Confucian worldview. To amend this WEIRD view, international guidelines should recognize that in many societies, the planet holds relational value that spring from our interrelation with nature and the planet as a whole.

While our focus here is expanding global bioethics to include East Asian approaches, a fuller analysis would consider multiple traditions outside the West and strive to better include them.

Paper title: Lessons from Li: A Confucian Inspired Approach to Global Bioethics

Authors: Nancy S. Jecker, Roger Yat-Nork Chung

Affiliations: Nancy S Jecker: University of Washington School of Medicine; Anita Ho: Chinese University of Hong Kong Centre for Bioethics

Competing interests: None declared

Social media accounts of post authors: X: Nancy S Jecker: @profjecker; Roger Yat-Nork Chung: @rogerynchung