China Will Always Be Bad at Bioethics

This April, potential sperm donors at one of Beijing’s top hospitals found themselves facing a set of tough new standards. Listed as the first criteria, before any mention of infectious or hereditary diseases, was the requirement that potential donors have “a love for socialism and the motherland” and be “supportive of the leadership of the party.”

By itself, this would be just one more incident of political excess in a country where full-blown Chinese Communist Party ideology is making a fierce comeback. But unlike the demands that students dump “Western” textbooks or that singers parrot their love for President Xi Jinping, China’s bioethical standards are more than a curiosity for outsiders. They may shape the future of humanity.

Chinese scientists, in January, produced the world’s first cloned primates through somatic cell nuclear transfer, the same technique that created Dolly the sheep in Scotland in 1996. In the summer of 2017, the gene-editing technology CRISPR was successfully used for the first time to edit a gene associated with a disease in human embryos by an international team of scientists from the United States, China, and South Korea; that was just two years after Chinese scientists shocked the world by making the first such attempt. While the United States is just starting to look for the first patient for such studies, at least eight clinical trials are underway in China using CRISPR technology to treat cancer.

As China’s advances in biotechnology come closer to the secrets of life, they pose tantalizing prospects for the future. But when standards for research on the latest technological frontiers are being set by a government that has always prioritized power over ethics, there’s also plenty of cause for concern.

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It was not until 1998 that the Chinese Ministry of Health established an ethics committee and issued the first set of guidelines on medical ethics in China. Over the past two decades, China has made earnest efforts toward the ethical practice of biomedicine. After years of denial, the Chinese government acknowledged in 2006 its decades-long practice of harvesting organs from executed prisoners, and it has progressed toward a registry with volunteer donors. Nevertheless, many of the country’s rules and regulations, as in other fields, exist more on paper than in practice.

While the Chinese Communist Party has a branch office at every school and every hospital, the presence of ethics boards is optional. According to a presentation at the World Health Organization by one of China’s leading medical ethicists, Hu Qingli, only about half of Chinese provinces had set up ethics committees by the early 2010s; the same went for individual hospitals. Even when ethics boards exist, conflicts of interest are rife. While the Ministry of Health’s ethics guidelines state that ethical reviews are “based upon the principles of ethics accepted by the international community,” they lack enforcement mechanisms and provide few instructions for investigators. As a result, the ethics review process is often reduced to a formality, “a rubber stamp” in Hu’s words. The lax ethical environment has led many to consider China the “Wild East” in biomedical research. Widely criticized and rejected by Western institutions, the Italian surgeon Sergio Canavero found a home for his radical quest to perform the first human head transplant in the northern Chinese city of Harbin. Canavero’s Chinese partner, Ren Xiaoping, although specifying that human trials were a long way off, justified the controversial experiment on technological grounds, “I am a scientist, not an ethical expert.” As the Chinese government props up the pseudoscience of traditional Chinese medicine as a valid “Eastern” alternative to anatomy-based “Western” medicine, the utterly unscientific approach makes the establishment of biomedical regulations and their enforcement even more difficult.

The fragile bioethics system in China is further weakened by rampant corruption. In 2006, a large-scale investigation into the Chinese State Food and Drug Administration resulted in arrests and imprisonment of several of its highest officials for allegedly accepting bribes, including the administration’s Director Zheng Xiaoyu, who was ultimately executed. As with much of the anti-corruption effort in China, the crackdown started after dozens died due to unsafe drugs in highly publicized cases; the actual figures remain unknown.

And in medicine, as with much else in China, authorities will often evade laws that exist on paper if there are customers (or, in this case, patients) willing to pay. China long ago banned doctors from revealing the sex of embryos to patients, but the practice remains common and contributes to gender-based abortion. Another example is the clinical use of stem cells. The Chinese Ministry of Health classified stem cell treatments as “high risk” and banned its clinical usage without approval in 2009. However, a Nature investigation in 2012 revealed that despite increased regulatory clampdowns, stem cell clinics were still popping up across the country, charging patients thousands of dollars for unauthorized therapies.

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The willingness to overlook safety for financial gain hints at a greater challenge with bioethics in China — not just structural, but ideological. Authoritarian states naturally prioritize the strength of their own power, including the size of their economy, above all else; this runs contrary to, and inevitably undermines, the healing purpose of medicine.

China’s record attests to this. Claiming the “great rejuvenation of the Chinese people” as its ultimate mission, the Chinese government has conducted massive social engineering campaigns to control and “improve” its population. The one-child policy was carried out with forced abortions, compulsory sterilization, and female infanticide, leading to an aging population and severe gender imbalance. Faced with the resulting demographic crisis, the Chinese government has now turned to campaigns encouraging “the right quality” of women — namely younger, urban women with a college education — to have more children, while imposing constraints on reproduction for ethnic minorities and in particular the Uighurs. The Maternal and Infant Health Care Law of 1995, initially named the “Eugenics and Health Protection Law” with the explicit purpose to “prevent new births of inferior quality,” effectively mandated childlessness for people with genetic disorders, certain infectious diseases, and mental illness.

Communism bases much of its legitimacy on its claims of resting on a foundation of science — but its understanding of science centers far more on authority than skepticism. “Scientific” in China’s party editorials is virtually synonymous with “politically approved.” The party’s journals are filled with glowing evaluations of Mao Zedong’s “scientific” legacy. The constitution’s latest addition, Xi Jinping Thought, lists early in its 14-point manifesto “adopting science-based ideas” for development. The suggestion is that if a government is “scientific,” then the state’s grasp on power must be as absolute and above criticism as the laws of the universe — even when that power is used to persecute scientists and crush entire branches of research considered contrary to political ideology, as the Chinese government has repeatedly done.

When science is used in service of legitimizing an authoritarian system, the resulting research, however successful it might appear to be, inevitably abandons cosmopolitan ideals. The first two monkey clones born in a Chinese lab in January were named Zhong Zhong and Hua Hua; zhonghua means the Chinese nation and its people. The macaque twins were not just portrayed as the product of science, but of Chinese science.

This politicized approach to science also abets the trampling of ethical boundaries. Communism emphasizes the idea of “constant struggle,” not only between classes, but also against nature. China, like the Soviet Union before it, has already paid a harsh environmental cost for this approach to development policy. During the Great Leap Forward, sparrows were initially listed among the “four pests” to be extinguished, and the drastic reduction in sparrow population led to an increase in crop pests that worsened ongoing famine.

Most concerning of all is how the Chinese state’s understanding of science discounts the autonomy of an individual body for the collective notion of a strong national body. The legacy of social Darwinism still permeates China, evident in the government’s swift and brutal campaign this past winter to rid the city of Beijing of its migrant workers and their families, callously referred to in official documents as the “low-end population.”

But the justification of individual sacrifice for the greater good is contrary to any principle-based bioethics framework. When Jesse Gelsinger died at the University of Pennsylvania as the first casualty of gene therapy in 1999, the tragedy halted this type of experimental treatment on humans for several years in the United States, and it still serves as a somber reminder for the medical community. Had the death occurred in China, it would most likely have been either covered up or turned into propaganda depicting Gelsinger as a national martyr.

With the Chinese government’s intensifying explicit push for “civil-military fusion,” one should also take it at its word and assume any of its new technology will be dual-use — with military uses applying both to national defense and internal suppression. The Chinese government is already collecting DNA samples among other biometrics data in its far-west province of Xinjiang, where ethnic minorities like the Uighurs are already subject to systematic discrimination, and building up a massive surveillance state using artificial intelligence.

The introduction of AI into health care in China, spearheaded by Chinese tech giants including Tencent and Alibaba, can help with an overburdened hospital system, but it also raises serious privacy concerns in a state where data privacy is nonexistent. Biotechnology will become a powerful tool in the Chinese security state.

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In ninth-century China, Taoist alchemists searching for the elixir of life found a dark mixture that was highly combustible. They named it huoyao, “fire medicine.” In the pursuit of immortality, the Chinese invented gunpowder.

In the face of China’s advances in biotechnology today, the world must be vigilant. At the same time, paranoia can, and should, be avoided; the correct approach is principled engagement, not isolation. A secure future demands that all stakeholders come together in good faith to reach a collective agreement in the development and utilization of biotechnology.

The International Summit on Human Gene Editing in 2015 — co-hosted by the National Academy of Sciences and the National Academy of Medicine in the United States, the Royal Society in the United Kingdom, and the Chinese Academy of Sciences — and the National Academies of Science and Medicine’s 2017 report by 22 science and ethics experts from multiple countries laying out guidelines for human genome editing are both encouraging examples in the direction toward global governance and shared responsibility.

Biological threats recognize no human borders. Disparity in bioethics anywhere weakens bioethics everywhere. Liberal democracies must take advantage of the openness of their system to educate the public, live up to the highest ethical standards in protecting human rights and safeguarding the environment, and make such standards the bedrock of universal principles. China is most likely to abide by such standards when its membership in the global political and scientific community depends on it — in other words, when it has no other choice.