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Values, Principles, Perspectives and Attitudes in Bioethics

The importance of seeking out, and seeking to understand, diverse perspectives in bioethics is the common theme uniting the papers in this July 2002 issue of Asian Bioethics Review. Our first three papers demonstrate how a commitment to Islamic principles and values brings insights into very different fields of bioethics; being neuroethics, the reproductive health and choices of adolescents, and the appropriateness of incentive measures in organ donation in a Muslim-majority country. And while organ donation debates have raged for decades, we also examine new arguments about the defensibility of mandated choice to address the globally stubborn problem of organ shortage. Returning to reproductive ethics from another perspective, our penultimate paper examines feminist arguments about the acceptability (or otherwise) of altruistic surrogacy practices in the light of the recent Surrogacy (Regulation) Act 2021 in India. This law now makes such practices the only lawful basis for a surrogacy arrangement on the sub-continent. Finally, to continue the interdisciplinary contributions of this journal to tackling the on-going COVID-19 pandemic, our last paper examines public attitudes in Japan towards vaccination, deploying robust social science methods of public engagement to reveal new insights into public values, perspectives and concerns regarding one of the biggest ethical issues of our times.

As with our April 2022 issue, we are pleased to open the current issue with a contribution from our student cohort of authors. We wish to signal our commitment to supporting the upcoming generation of bioethics scholars and to showcase their work. Thus, for this issue, we present the work of Noorina Noorfuad who highlights the paucity of religious perspectives relating to neuroethics, in particular from a standpoint of Islamic principles [https://link.springer.com/article/10.1007/s41649-022-00203-8]. Drawing on the work of contemporary Muslim scholars in the field of bioethics more generally, as well as the contributions of biomedical neuroscientists, Noorfuad reveals a pathway for beginning to tackle the ethical issues that arise from neuroscience from a perspective that is firmly rooted within the Islamic faith.

A similar contribution is offered by Akrami, Zali, and Abbasi [https://link.springer.com/article/10.1007/s41649-021-00200-3] in their paper that examines adolescent sexuality, reproductive choices and the regulation of access to reproductive health services. As with the previous article, a first principles analysis is offered from the perspective of Islam to develop a framework approach to determining how to proceed in this sensitive area of human development. Five principles or universal rules are identified that are used to advance a normative argument that supports access based on an interpretation of the no harm precept. The paper is also valuable for comparative purposes and with regard to its construction of adolescent best interests in the context of growing autonomy of young persons within a particular cultural and religious environment.

Our third paper offers further valuable insights from a Muslim-majority country, this time in the context of Bangladesh and the issue of the acceptability of offering financial incentives to promote organ donation. A law to regulate organ donation has existed in Bangladesh since 1999, and this was recently revised in 2018. In this article, Siraj subjects these regulations to critique using two key approaches: (I) a return to first principles of Islam to tease out what is ethically at stake and of value, and (ii) a comparative exercise examining the legal and ethical position in Iran, which operates an incentive scheme that has recorded success in both practical and socially acceptable terms [https://link.springer.com/article/10.1007/s41649-022-00208-3]. Through this method, the author makes an argument for reform of the law in Bangladesh to allow a restricted and highly regulated bare minimum financial incentive scheme to a defined group of extended family members, all with the objective of addressing organ shortfall in that country.

Following from the last paper, the contribution from Symons and Poulden [https://link.springer.com/article/10.1007/s41649-022-00206-5] revisits the long-standing question of mandated consent for organ donation. The context for the discussion is the current ethical and legal framework in Australia, and the argument is made that the normative model offered in this article would be ethically preferable to the current arrangements and could go a long way to driving the availability of organs for transplant. The authors also make strong efforts to address likely objections to the model that is proposed, acknowledging prior treatment of this topic in the bioethical literature.

As noted at the start of this editorial, the central theme of this issue relates largely to values and perspectives. The principal way in which any country expresses values for its society and on ethical issues is through legislation and the courts. But, as has been well rehearsed elsewhere, the moral compass of governments, legislatures and the judiciary can often be open to serious critique when examined from wider socio-legal and bioethical perspectives. This is the approach of Nisha [https://link.springer.com/article/10.1007/s41649-022-00205-6] in an examination of the provisions on the new Surrogacy (Regulation) Act 2021 in India. This Act reduces the lawful basis for surrogacy in India to altruistic practices on the government’s express concern to avoid exploitation of women in vulnerable circumstances. Nisha explores such provisions through a feminist lens and examines arguments across the ethical spectrum of whether a vulnerability narrative is acceptable or sustainable in the particular context of surrogacy and women’s choices about what to do with their bodies. Ultimately, the author promotes an argument in favour of motherhood as empowerment, which, if accepted, would require a fundamental revision of India’s new law and, arguably, a revisitation of core values at the heart of Indian society as expressed through its government and its current laws.

Our final paper presents empirical evidence about public attitudes towards COVID-19 vaccination in Japan. This paper by Nakada et al. [https://link.springer.com/article/10.1007/s41649-022-00207-4] is further evidence of the importance of data-driven insights in bioethics, demonstrating how robust social science methods of public engagement can reveal an evidence base to evaluate both past practices—such as mass vaccination programmes—and future policies and actions designed to tackle major health, well-being, equality and ethical issues. We invite readers to explore the findings for themselves, but the pertinence of diverse attitudes among different age groups and the implications of this for the future should not be lost on any law or policy makers.

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Correspondence to Graeme T. Laurie.

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Laurie, G.T. Values, Principles, Perspectives and Attitudes in Bioethics. ABR 14, 213–215 (2022). https://doi.org/10.1007/s41649-022-00209-2

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