Making Meaning in Bioethics

A central theme of this October 2022 issue of Asian Bioethics Review is the idea of the meaning of key concepts that are ubiquitous in the field of bioethics. For example, what do we mean by ‘autonomy’ in any given cultural context? Who is a ‘mother’ outside the bounds of the conventional nuclear family? What does it mean to be a ‘sibling’ and what duties are owed to someone brought into the world in that role? Each of these questions and many more are addressed in this issue.

Our October issue opens with a Letter to the Editor from Takeshita et al. [https://link.springer.com/article/10.1007/s41649-022-00219-0] who are the group of colleagues responsible for setting up the Consortium of Hospital Ethics Committees (CHEC) in Japan. As they point out, even the simple question – what is an ethics committee? – can receive multiple and varied replies. And, as is the case in most countries, the role and diversity of such committees in Japan has historically been extremely heterogeneous. Recognising this, the authors established the CHEC with the aim to contribute to the improvement of healthcare in the country, to gather evidence of the workings of the committees, and to address unmet training and skills needs within and across hospital ethics committees. The letter reports on a questionnaire involving participating facilities and the authors share their ambition to position the CHEC as a central hub from which discussion about the ideal ethics committee can emerge. Many valuable lessons can be learned both for Japan and internationally.

The importance of dialogue and making meaning is also a central concern of the paper by Akabayashi and Nakazawa [https://link.springer.com/article/10.1007/s41649-022-00213-6], which asks: what does autonomy look like in Japan? Set within an extensive literature review of this concept and against an historical account of the Japanese term Jiritsu, the authors advocate that the expression ‘a form of autonomy’ might best reflect the cultural circumstances of medical practice in Japan and in which patients and their families experience healthcare and approaches to decision-making. Indeed, the authors go further still by advocating that bioethics across the globe needs to address the question — what does autonomy mean? — and they urge scholars worldwide to share understandings through productive dialogue, all in the spirit of contributing to the progress of bioethics internationally.

To anyone outside the realm of bioethics, it might seem entirely redundant to ask a question so trite as: who is your mother? But, of course, the advent of multiple forms of artificial reproductive technologies and diverse reproductive practices means that this is far from a straight-forward question for bioethicists. Religious perspectives further add to the richness of the discussion. This is well demonstrated by the paper by Nazaria Tavakkoli [https://link.springer.com/article/10.1007/s41649-022-00217-2] in which the author explores the concept of ‘mother’ in Islamic texts, notably in the context of gestational surrogacy. The author shows how Shiʿi jurists have presented three different theories about identifying the mother of a child born by surrogacy: (i) the so-called genetic mother, (ii) the gestational mother, and (iii) the prospect that both of these persons might be the mother. In a return to first principles from the Islamic texts, the author argues that it is the first of these persons who has the prior moral and religious claim to be mother. This stands in stark contrast to many western countries where the law decrees that it is the person who gives birth who has, at least, the prima facie legal claim to motherhood.

The theme of gestational surrogacy is continued by Hibino [https://link.springer.com/article/10.1007/s41649-022-00215-4] who questions how far ‘altruistic surrogacy’ prevails in Asian countries, despite a ban on commercial surrogacy in many jurisdictions. Against the backdrop of a surge in surrogacy tourism in Asia, the author shines a critical light on efforts to establish legal relationships between commissioning parents and children born out of surrogacy arrangements, asking whether efforts to act “in the best interests of the child” do not, in fact, mask and might even promote practices that are akin to commercialisation of surrogacy itself. By these means, the author invites readers to question the true meaning of ‘altruistic surrogacy’ and to engage with the realities of surrogacy practices internationally and across borders.

And in the same way that the meaning of ‘mother’ in bioethics is fraught with difficulty, the same is also true of the term ‘sibling’. As evidence of this, Kuek and Gurmukh Singh [https://link.springer.com/article/10.1007/s41649-022-00216-3] undertake a sweeping account of the prevalent religious views in Malaysia towards the concept of saviour siblings, made possible by the emergence of a range of technologies that can type, match and select embryos to be born in the aid of a living sibling suffering from a medical illness. In the absence of any current legal framework that addresses the plethora of ethical and social issues that arise, the authors argue that religious views on the practice must form part of any social and ethical response. Moreover, this paper is an important first step in revealing the likely content of such views, made possible through an empirical qualitative study involving participants speaking from the perspectives of Islam, Buddhism, Hinduism and Christianity.

At first blush, the link between our final two papers is the COVID-19 pandemic, but from the perspective of making meaning we can go deeper — each paper, in its own way, asks the following question: what is meant by a defensible and effective strategy for dealing with a public health emergency? Thus, Piroddi [https://link.springer.com/article/10.1007/s41649-022-00212-7] explores social distancing and other non-pharmaceutical interventions as strategies both for suppressing the spread of a deadly virus but also as means to mitigate health inequalities and to promote basic social life for all citizens. Rather than casting such measures as infringements on civil liberties, the author argues that seen through the lenses of recognition and social freedom, new meanings are made about these strategies as intersubjective protections, not violations.

Our final paper from Law, Skapetis, and Rodrick [https://link.springer.com/article/10.1007/s41649-022-00214-5] offers a scoping review of literature that has engaged with the controversial topic of mandatory vaccination of healthcare workers. Here the meaning that concerns us is the legitimacy of such practices in light of the plethora of ethical issues that arise. Perhaps surprisingly, the review reveals a paucity of literature that deals with the topic, albeit that common ethical concerns are raised that run the gamut from benefits and risks, throughout effectiveness, equity and justice, and on to violations of autonomy and threats to trust. In the spirit of all true academic writing, the conclusion must be that more research is required!