We are proud to present our October 2022 issue, the fourth and last issue of this year’s volume 14. A central theme of this issue 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.
We open with a Letter to the Editor from Takeshita et al. who have set 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. 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, 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.
To anyone outside the realm of bioethics, it might seem entirely redundant to ask a question so trite as: who is your mother? The paper by Nazari Tavakkoli 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) both. In a return to first principles from Islamic texts, the author argues that it is the first one who has the prior moral and religious claim to be mother. This stands in stark contrast to many other 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 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 travel 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 undertake a sweeping account of the prevalent religious views in Malaysia towards the concept of saviour siblings. 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.
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 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 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.
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Editorial – Free Access
Making Meaning in Bioethics
Graeme T. Laurie
October 2022 – 14(4): 303-305 – doi: 10.1007/s41649-022-00220-7
Letter to the Editor – Free Access
Report on the Establishment of The Consortium for Hospital Ethics Committees in Japan (CHEC) and the First Collaboration Conference of Hospitals Ethics Committees
Kei Takeshita, Noriko Nagao, Hiroyuki Kaneda, Yasuhiko Miura, Takanobu Kinjo, and Yoshiyuki Takimoto
October 2022 – 14(4): 307-316 – doi: 10.1007/s41649-022-00219-0
Original Article – Open Access
Autonomy in Japan: What does it look like?
Akira Akabayashi, and Eisuke Nakazawa
October 2022 – 14(4): 317-336 – doi: 10.1007/s41649-022-00213-6
Original Article – Free2Read
The Status of “Mother” in Gestational Surrogacy: The Shiʿi Jurisprudential Perspective
Saeid Nazari Tavakkoli
October 2022 – 14(4): 337-348– doi: 10.1007/s41649-022-00217-2
Free Access from 1 October 2023 via PMC9530084
Perspective Article – Open Access
Ongoing commercialization of gestational surrogacy due to globalization of the reproductive market before and after the pandemic
Yuri Hibino
October 2022 – 14(4): 349-361 – doi: 10.1007/s41649-022-00215-4
Original Article – Free2Read
Conception of Saviour Siblings: Religious Views in Malaysia
Chee Ying Kuek, and Sharon Kaur Gurmukh Singh
October 2022 – 14(4): 363-377 – doi: 10.1007/s41649-022-00216-3
Free Access from 1 October 2023 via PMC9530092
Original Article – Open Access
Non-pharmaceutical interventions and social distancing as intersubjective care and collective protection
Corrado Piroddi
October 2022 – 14(4): 379-395 – doi: 10.1007/s41649-022-00212-7
Original Article – Free Access
A Scoping Review of Ethical Considerations of Mandatory COVID-19 Vaccination of Healthcare Workers
Constance Law, Tony Skapetis, and Rohan Rodricks
October 2022 – 14(4): 397-408 – doi: 10.1007/s41649-022-00214-5
Asian Bioethics Review 