<p>The language of principlism seems to have emerged as the predominant guiding framework in teaching, research and even legislation within contemporary Chinese bioethics. This essay reveals the dissonance between the individualistic orientation of this theoretical language and the familist features of Chinese clinical practice by considering the principle of respect for autonomy and its discordance with the Confucian tradition of virtue ethics and medical rituals. Several representative clinical cases in mainland China are presented to illustrate the incongruity between the current state of Confucian medical rituals and the language game of the principle of respect for autonomy. While there is a recognized need in contemporary Chinese medical practice to promote patient involvement in decision-making in the cases of terminal illness, we argue that this approach should be implemented in alignment with Confucian virtue ethics and medical rituals. Resolving the linguistic discordance between Chinese bioethics and principlism should not entail a shift towards principlism.</p>