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Soc Sci Med. 2013 Feb;78:125-9. doi: 10.1016/j.socscimed.2012.12.001. Epub 2012 Dec 12.

The ongoing westernization of East Asian biomedical ethics in Taiwan.

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Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan, ROC.


Family autonomy/family-determination (FA/FD) is deeply rooted in Confucianism, and is an important core value in East Asian biomedical ethics. Individual autonomy/self-determination (IA/SD) did not originate in East Asia, and is the most important core value of Western biomedical ethics. IA/SD and FA/FD are different from each other not only because of where they originated but also in their general sense and moral foundations. We investigated the influence of Western biomedical ethics on the Eastern hemisphere. We examined the secular trends of IA/SD use in ethics and biomedical ethics articles published in Taiwan from 1991 to 2010. The published articles were collected from a popular online library called the Chinese Electronic Periodical Services. A total of 1737 articles were associated with ethics, and 300 of them were associated with biomedical ethics. The total number of times IA/SD was used in each ethics and biomedical ethics article was calculated. The secular trends were plotted graphically and analyzed by time series linear regression analysis. The results showed that the secular trend of the proportion of the yearly total of biomedical ethics articles to the yearly total of ethics articles was significantly increasing (p = 0.007). The secular trends of the average of times IA/SD showed that one unit of yearly increase was associated with an increment of 0.056 IA/SD use per ethics article (p < 0.001), and 0.331 IA/SD use per biomedical ethics article (p = 0.027), respectively. These findings suggest that Western biomedical ethics have become increasingly influential in Taiwan over the past two decades. Thus, assuming that FA/FD takes priority over IA/SD in an East Asian medical encounter is too simplistic. Whether FA/FD or IA/SD takes priority in a medical encounter should be carefully evaluated.

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