Ritualized relational autonomy in Chinese end-of-life care: balancing Confucian benevolence and individual rights

This article develops a hypothesis-and-theory framework for ethical tensions in contemporary Chinese end-of-life care and family mourning. It examines the relationship between Confucian ren'ai (benevolence), expressed through embodied familial care, and modern rights-based commitments to bodily autonomy, dignity, and informed choice. The article offers a conceptual and normative analysis informed by interpretive cultural inquiry and existing empirical research on family-centered decision-making, advance care planning, caregiver burden, and hospice and palliative care in China. It argues that the body is the key site at which benevolence and rights intersect: in Confucian ethics, the body is the medium of care, devotion, and mourning, while in modern bioethics it is the bearer of autonomy and consent. On this basis, the article proposes a framework of ritualized relational autonomy, structured through three stages: care agreements, family meetings, and care-termination rituals. This framework aims to prevent benevolent care from hardening into unlimited liability while also avoiding an atomized model of autonomy detached from family life. The article further argues that this framework has practical significance for public health ethics in aging societies by clarifying how family care, patient dignity, caregiver support, and bereavement may be more effectively coordinated under contemporary Chinese conditions.