Zeitschriftenartikel zum Thema „Celts Religious beliefs“

The purpose of the article is to reveal to which extent the Iron Age Celtic art visualized the metanarrative of the Celtic religion. The methodology is based on the applying of structural and semiotic approaches to the symbols and representations of the Celtic art, which are viewed as components of much more complicated system: the religious and mythological beliefs of the Iron Age Celts. Scientific novelty. The author puts forward an idea that the Early La Tиne, Waldalgesheim and Plastic art styles were closely connected to the Celtic beliefs in the afterlife and supranatural powers. Conclusions. The La Tиne decorated weapons, drinking vessels and personal ornaments were produced by the artisans who were closely connected to the priesthood. Such artifacts were used as apothropei in the highly ritualized spheres of social life such as war, banquet and burial rite. The author notes that the decline of the Plastic art style was simultaneous with the transformations of the Celtic burial rite which caused the disappearance of the burials during the late La Tиne period.

The origin and widespread of ethnic and cultural entities, such as the Celts, Germans, Slavs, Scythians etc. remain an essential problem for both archaeologists and linguists. The article reassesses the main concepts of the Iron Age Celtic origin, including the traditional “Celts from Central Europe” approach, “the Celts from West” hypothesis, as well as the most recent assumptions according to which the Celts were just a historiographic cliché produced by the Classical authors. It seems that neither of these concepts could be accepted as an explanation of the Celtic origin; however, it is still possible to find common ground in understanding the “Celtic phenomenon” by synthesizing the disciplines of history, linguistics, archaeology, and population genetics. First of all, the Classical authors indeed used to attach an ethnic label Celts/Galatians/Gauls to various groups of population in Europe. However, there is no doubt that most of these groups in fact used some Celtic dialects. As far as the ethnic name Celts/Galatians/Gauls comes from the Celtic languages, it is highly likely that it was used by the Celts themselves at least to some extent (for example, as a sign of belonging to certain social group). Despite the concept of the Hallstatt and La Tène cultures seems to be outdated, the archaeology still proves that most of the “Celtic tribes” shared some common features of craftsmanship, art, religious beliefs, and rituals. At the same time, genetic studies and isotope analyzes of the remains of buried at the Hallstatt and La Tène cemeteries in various regions of Europe, clearly show that there were no major migrations of population during the Iron Age which potentially could lead to the emergence of Celts as a distinct ethnic group. There were rather small-scale migrations and social contacts (i. e., marriage, fosterage etc.), as well as an exchange of goods, technologies and ideas that played a crucial role in widespread of the Celtic identity. The author puts forward an idea that the Celticness once became a prestigious cultural concept for social elite of distinct groups of the barbaric population throughout the Europe.

The article deals with the iconography of the Celtic coins which come from the South-Eastern Europe. Main attention is paid to the coins found in the Trans-Carpathian region of Ukraine. The aim of this article is to shed light on symbolism of the Celtic coins, in particular on a horse-rider figure on the reverse of these coins. Research methodology is based on the structuralist approach. The scientific novelty. The author shows how the imagery of the coins was connected to the Celtic religious beliefs and cults. The Celtic issues from the Trans-Carpathian region were derived chiefly from the coins of Philip II and Audoleon. A horse-rider image is present on almost all of the Celtic coins from the Trans-Carpathian area and nearby regions. While on most of coins the rider’s figure is highly schematized, some of them contain a detailed image of a female figure. There is no reason to suggest that the Celtic women used to lead their communities or were widely involved in the warfare as military leaders or individual fighters. At the same time, their significance in the religious and ideological spheres of warfare was great. One can assume that the horse-rider depicted on the Celtic coins was considered rather as an image of deity associated with war, fertility and horse-breeding. It is highly probable that this deity in fact was Epona or other related goddess. The coins were widely used in both trade and ritual practices. In particular, the Classical sources mention the Celtic ritual of devotion of coins to the goddess of hunting. The findings of coins with chop-marks, similar to those found in the Gallic and Gallo-Roman sanctuaries, should be mentioned in this context as well.

Stem cells can be used to replace damaged cells or regenerate organs and have broadened our knowledge of the development and progression of certain diseases. Despite significant advances in understanding stem cell biology, several problems limit their use. These problems are related not only to the growth of tumors in animal models and their rejection in transplant cases but also to ethical and social issues about the use of embryonic cells. The ethical-scientific debate on this type of cells has taken on great interest both for their application in regenerative medicine and for the potential possibilities in the field of cell and gene therapy. Different points of view often have the expression of a perception that depends on scientific goals or opportunities or on religious traditions and beliefs. Therefore, as the questions and doubts about when life begins, so do the answers for the use of these cells as therapy or otherwise. So, in addition to the origin of stem cells, there are currently some social bioethical (such as political and legislative issues) and religious dilemmas. The purpose of the study is aimed at being a narrative on the history of stem cells and the evolution of their use to date, as well as to clarify the bioethical position of the various religions today in comparison with the social ones regarding the research and use of embryonic and adult ones. Hence, their biological hypostasis regarding the concepts of “conception” and “fertilization” and their development and therapeutic use compared to those of the main theological doctrines.

The present ethnographic study aims to describe the symbolic strategies in the ritual processes of a religious congregation founded by gay men in Lima. The name of the congregation is Comunidad Cristiana Ecuménica Inclusive El Camino, founded in 2009 by gay men, first evangelicals and, later, gay Catholics. El Camino displays a system of Christian rituals symbolically overlaid with images and symbols of the LGBTI community. By means of deheterosexualized religious symbols in three key spaces, the Sunday worship, the cells and the LGBTI pride parade, they have managed to appropriate and conquer a historically hostile field for the LGBTI community. The symbolic appropriation of the religious space leads to the softening of the Christian moral framework and, specially, the reconciliation between religious beliefs and sexual orientation.

Kurdistan, centered between Asia Minor, Transcaucasia, and Iran, has frequently served as a focal point of rebellion to central governments and the main religions associated with them. As a result, despite its geographic isolation and strict ethnic boundaries, the emergence and development of Yezidism should be observed through the lens of the Middle East, which requires paying close at-tention to its possible connections to other confessions in the region, whose creed and religious practice share several elements with Yezidism. The belief in afterlife and immortality of the soul occupies a prominent place in most reli-gious doctrines. This article examines the Transcaucasian Yezidis’ ideas about the afterlife, set-ting them in these regional and historical contexts. The investigation follows the concept of “brotherhood in afterlife”, which plays an important role in Yezidi socio-spiritual hierarchy, since it is the brother or sister in the afterlife of each Yezidi who will, after death, intercede for him/her before God and guide his soul through the Salat bridge, allowing him to enter paradise. Of particu-lar interest is the belief in reincarnation existing in the Yezidi environment, metaphorically re-ferred to as “changing the shirt”, in which the soul after death may move into a body with a higher rank as a reward for righteous behavior. The Yezidis' eschatological concepts and rites were recorded and analyzed in valuable little-known field studies conducted by anthropologists and ethnographers, as well as in forgotten Sovi-et films. These documents serve as the primary sources of study in the paper.

ObjectiveHaving failed to achieve adequate influenza vaccination rates among employees through voluntary programmes, healthcare organisations have adopted mandatory ones. Some programmes permit religious exemptions, but little is known about who requests religious objections or why.MethodsContent analysis of applications for religious exemptions from influenza vaccination at a free-standing children’s hospital in Cincinnati, Ohio, USA during the 2014–2015 influenza season.ResultsTwelve of 15 260 (0.08%) employees submitted applications requesting religious exemptions. Requestors included both clinical and non-clinical employees. All requestors voluntarily identified their religious affiliation, and most were Christian (n=9). Content analysis identified six categories of reasons used to justify an exemption: risks/benefits, ethical/political, lack of direct patient contact, providence, purity and sanctity of life. Individuals articulated reasons in 1–5 (mean 2.6) categories. The most frequently cited category (n=9) was purity; the vaccine and/or its mode of administration were impure, or receiving the vaccine would make the individual impure. Two individuals asserted that the vaccine contained cells derived from aborted human fetuses. Individuals (n=6) also volunteered information supporting the sincerity of their beliefs including distress over previous vaccination and examples of behaviour consistent with their specific objection or their general religious commitment. All requests were approved.ConclusionsLess than 0.1% of employees requested religious exemptions. Partnering with religious leaders and carefully correcting erroneous information may help address requestors’ concerns.

Immune globulin for injection or infusion has been used as a prophylactic and therapeutic treatment in such diverse conditions as Kawasaki disease, idiopathic thrombocytopenic purpura, Guillain-Barré syndrome, and hepatitis B.8 Pediatricians may care for Jehovah's Witness children who have these disorders. The biological precedent of active immunoglobulin transfer during fetal life identifies immune globulin as different than red blood cells and provides a rationale for Jehovah's Witnesses to accept immune globulin therapy for their children without compromising their religious beliefs.

The widespread commercialization of cultured meat, produced from animal stem cells grown in vitro, faces significant challenges related to technical, regulatory, and social acceptability constraints. Despite advancements in knowledge, the acceptance of this innovation remains uncertain. Understanding individuals’ decision-making processes and interpretative patterns is crucial, with media framing playing a key role in shaping attitudes toward cultured meat adoption. This research, focusing on Twitter as a social media platform, examines the impact of media framing on consumer attitudes (cognitive, affective, and conative) regarding cultured meat. Qualitative (content analysis) and quantitative (MANOVA) analyses were conducted on 23,020 posts and 38,531 comments, selected based on media framing or containing relevant attitude components. This study reveals that media-framed posts significantly influence consumer attitudes compared to non-media-framed posts. While different types of media framing (ethical, intrinsic, informational, and belief) exhibit varying impacts on attitude components, posts combining ethical, intrinsic, and informational frames have a more substantial effect on cultured meat acceptability. The belief frame, particularly for the behavioral component, is equally influential. Consumer attitudes toward cultured meat are found to be ambivalent, considering the associated benefits and risks. Nevertheless, the affective component of attitude is notably influenced by posts featuring informational and ethical media frames. This study suggests implications for authorities and businesses, emphasizing the importance of differentiated education and marketing strategies. Advertising messages that combine ethical, intrinsic, and informational frames are recommended. Additionally, this study advocates for regulatory measures governing the production, marketing, and consumption of cultured meat to instill consumer confidence in the industry. By highlighting the significance of beliefs in cultured meat consumption behavior, this research points toward potential exploration of cultural and religious influences in future studies.

The analysis of the Article 31 of the Act on medical activity concerning the autopsy leads to the conclusion that it should be amended. This is due to its comparison with the provisions relating to the disclosure of medical records, medical confidentiality and the collection of cells, tissues and organs, but also it results from the Polat v. Austria judgment, in which the European Court of Human Rights ruled that an autopsy of a child in breach of religious belief was a violation of the parent’s right to respect for his private and family life and religious freedom (Articles 8 and 9 of the European Convention on Human Rights).

Objective: To describe and discuss the use of erythropoietin as a therapeutic option for treatment of severe anemia in a patient whose religious beliefs preclude the use of blood products. Case Summary: A 23-year-old male Jehovah's Witness patient presented to the emergency department with multiple fractures and significant blood loss secondary to trauma experienced in a motor vehicle accident. The patient refused transfusion because of his religious beliefs. He was given oxygen and lactated Ringer's solution, and phlebotomy was kept to a minimum. Erythropoietin was recommended to increase production of red blood cells. Review of the product information revealed that all available erythropoietin products contain human albumin as a stabilizer. After discussion with the clinical pharmacist, the patient and his family agreed to the use of erythropoietin. The patient's hematocrit and hemoglobin improved sufficiently for him to be taken to surgery on hospital day 12, and on hospital day 23 he was discharged. Discussion: Because Jehovah's Witnesses refuse to receive blood products, alternative methods for treatment of severe anemia must be used. Although some options are clearly unacceptable, certain volume expanders can be used in conjunction with oxygen and intravenous or oral iron that do not violate the patient's religious convictions. Erythropoietin is acceptable to most Jehovah's Witnesses; however, it contains human album (2.5 mg/mL), which may be of concern to some of these patients. Conclusions: Effective communication with the patient and the patient's family regarding all treatment options is required for treatment of severe anemia in the Jehovah's Witness patient. Erythropoietin, in conjunction with iron, adequate oxygenation, and good nutritional support, sometimes is an acceptable alternative in Jehovah's Witnesses.

Background: Anemia is a condition where the number of red blood cells or the capacity of red blood cells to carry oxygen is not sufficient to meet physiological needs. Factors that influence anemia are nutritional patterns where poor eating habits can cause iron deficiency. Lack of awareness or compliance with the consumption of blood supplement tablets can also predispose someone to anemia. The Health Belief Model (HBM) is a health behavior model that is used to predict behavior. HBM consists of perceived susceptibility, perceived benefits, perceived barriers, perceived severity, perceived self-efficacy and cues to action. The aim of this research is to determine the factors that influence the behavior of consuming nutrition and blood supplement tablets to prevent anemia in bridesmaids in Religious Affairs Office (KUA), Maospati District, Magetan Regency in 2024. Method: This is an observational analytical quantitative research with a sample of 31 prospective brides and grooms at religious affairs office Maospati in 2024. This research was measured using a health belief model questionnaire by distributing questionnaires to prospective brides and grooms. Data analysis uses primary data which is tested with descriptive analysis, classical assumption tests and linear regression tests. Results: Of the 6 behavioral factors studied include perceived susceptibility, perceived benefits, perceived barriers, perceived severity, perceived self-efficacy and cues to action, which is only perceived self-efficacy with a p-value of 0.000. Conclusion: The factors that influence the behavior of consuming nutrition and blood supplement tablets among prospective brides at the Maospati religious affaris office, only self-efficacy has an influence. Therefore, perceived self-efficacy needs to be prioritized.

In recent years, the extreme right in Germany has expanded, the phenomenon gaining momentum. The far-right groups and organisations in Germany were, are and will be dominated by an ideology that amalgamates religious or non-religious ideas but that defends German culture and spirituality according to its visions and objectives. Adherents of far-right ideology combine these ideas with conspiracy theories, and on such a background, some of them change their attitude towards society and become violent. For example, right-wing extremists attacked the Parliament, the symbol of democracy, for the first time in Germany, namely on 29 August 2020, and later on 6 January 2021, protesters, including right-wing extremists, attacked the Congress of the United States of America. One of the organisations, such as the Reichsbürger Movement, which means Citizens of the Reich, who reject the current borders of Germany and want the return to those established in 1871, set up cells and planned activities recently catalogued as terrorists by German prosecutors, in December 2022 and May 2023. For the Citizens of the Reich, there is no Federal Republic of Germany because this country is part of a conspiracy and part of a satanic state system, and they recognise only Imperial Germany. According to the religious beliefs of some of them, the imperial constitution was received from God and must be respected, and they are in an apocalyptic battle between good and evil. The model invoked by some of them is that of Jesus Christ who changed society, erroneously invoking biblical precepts to bolster their claims.

In recent years, the extreme right in Germany has expanded, the phenomenon gaining momentum. The far-right groups and organisations in Germany were, are and will be dominated by an ideology that amalgamates religious or non-religious ideas but that defends German culture and spirituality according to its visions and objectives. Adherents of far-right ideology combine these ideas with conspiracy theories, and on such a background, some of them change their attitude towards society and become violent. For example, right-wing extremists attacked the Parliament, the symbol of democracy, for the first time in Germany, namely on 29 August 2020, and later on 6 January 2021, protesters, including right-wing extremists, attacked the Congress of the United States of America. One of the organisations, such as the Reichsbürger Movement, which means Citizens of the Reich, who reject the current borders of Germany and want the return to those established in 1871, set up cells and planned activities recently catalogued as terrorists by German prosecutors, in December 2022 and May 2023. For the Citizens of the Reich, there is no Federal Republic of Germany because this country is part of a conspiracy and part of a satanic state system, and they recognise only Imperial Germany. According to the religious beliefs of some of them, the imperial constitution was received from God and must be respected, and they are in an apocalyptic battle between good and evil. The model invoked by some of them is that of Jesus Christ who changed society, erroneously invoking biblical precepts to bolster their claims.

In 1998, researchers established the first human embryonic stem cell line. Their scientific triumph triggered an ethics and policy argument that persists today. Bioethicists, religious leaders, government officials, patient advocates, and scientists continue to debate whether this research poses a promise, a threat, or a mixed ethical picture for society.Scientists are understandably excited about the knowledge that could come from studying human embryonic stem cells. Most of them believe these cells offer a precious opportunity to learn more about why diseases develop and how they might be prevented or attacked. In their quest to gain support for stem cell research, scientists and others have claimed that the research could generate cures and treatment for everything from heart disease to cancer.

The management of thrombotic thrombocytopenic purpura (TTP) presents a unique challenge in individuals who are unable to accept plasma due to religious beliefs, given that therapeutic plasma exchange (TPE) is the standard of care. A 61-year-old Jehovah’s Witness woman presented to our hospital with neurological symptoms and laboratory findings suggestive of TTP. On admission, she refused transfusion of blood products, specifically red blood cells, platelets, and plasma but accepted albumin and intravenous immunoglobulin (IVIG); fractions of plasma. She was started on steroids, IVIG, and TPE with albumin as replacement therapy with minimal improvement. After a detailed discussion with the patient and family, they agreed to accept cryosupernatant. The patient started TPE with cryosupernatant for replacement therapy, which resulted in clinical improvement. This case highlights the importance of an individualized approach with joint decision-making given the significant heterogeneity that exists in Jehovah’s Witnesses’ attitude toward the receipt of blood products.

Suicide terrorism seemingly employed to settled conflicts between the Shiite and the Sunnis, mixed with the Salafis ideology of violence is also seen used for demand for State of Islam, national liberation, and propagation against democracies, mis-governance, and secularism amongst others. Terror cells groups could be seen aggravating suicide terrorism by substituting suicide for martyrdom. It was against this background that this study engage religious belief hypothesis to interrogate the roles of religion in garnering social support for suicide terrorism. The study decomposes roles of religion in suicide terrorism into crises between the Shiites and the Sunnis, substitution of suicide with martyrdom. The study employed desktop research design with reliance historical and secondary data from extant literature. The study concludes that the manipulation of the religious injunctions, extremist interpretation of religious teachings, as well as advancement of religion facade for economic gains stronger motivation for people who support suicide terrorism. Finding from the study showed that there would be no successful suicide terror campaign without the support of the society where the suicide terrorists reside and whose interest they claim to be defending. The study recommends that distorted ideology driven by religion can only be countered by respected Islamic clerics and leaders, especially from the Arab world with covert Western support to circumvent the perverted narrative of martyrdom as sacrifice for the good of the land, people or God, and rather brand it as common suicide and an honourless venture.

e18032 Background: It has been well-documented that there is a severe lack of participants enrolled in the National Bone Marrow Donor registry. Even those who are registered often decline to donate at a critical juncture in the donation process due to a wide variety of misconceptions. Health care professionals should be among the most educated about the bone marrow donation process as they will often be giving advice to potential donors. Methods: We conducted an anonymous online survey of medical students, residents, fellows, and attending physicians at the University of Cincinnati Medical Center to determine the common misconceptions surrounding bone marrow donation. Results: There were a total of 187 participants (73% medical students, 23% residents/fellows, 4% attending physicians). Fifty-one percent were already bone marrow donors, while 49% were not. Forty percent of respondents believe bone marrow biopsy is necessary for donation and 10% believe CT scans are done prior to donation. Twenty-eight percent responded that bone marrow is extracted under general anesthesia, 43% responded that it is extracted not under general anesthesia, 5% responded that it is extracted via central intravenous line, and 24% responded that it is extracted via peripheral intravenous line. Thirty percent responded that they are not bone marrow donors because bone marrow donation is painful, 12% because it involves surgery, 2% because it weakens the donor, 13% because it involves a lengthy recovery process, 3% because donors have to pay for donation, 1% because of ethnic/religious/cultural beliefs, while 39% have not had the opportunity to donate but would or are planning on it. Conclusions: The majority of allogeneic transplants are performed with peripherally collected bone marrow stem cells, however, most potential donors including health care professionals do not know this. We conclude that a great deal of education surrounding bone marrow donation is still needed among healthcare workers today. Educating health care workers is of the utmost importance as they will impart this knowledge to those considering donation. Future aims of this project are to develop an educational curriculum to address the most common misconceptions, particularly in medical students, as they are in the age group most targeted in bone marrow donation and they will be the future generation of physicians to educate patients on the process.

To evaluate the Italian physicians' knowledge/information level about the therapeutic potential of stem cells, the research choice between embryonic and cordonal stem cells, and the preference between autologous and heterologous storage of cordonal stem cells, we performed a national survey. The questionnaire—distributed to 3361 physicians—involved physicians of different religious orientations and of different medical specialities. Most of the physicians involved (67%) were Catholics, and the majority were gynaecologists and paediatricians (43%) who are mainly in charge to inform future mothers about the possibility of cordonal stem cells conservation. The majority of the physicians interviewed do not have specific knowledge about stem cells (59%), most of them having only generic information (92%). The largest part of physicians prefer to use umbilical cord blood cells rather than embryonic stem cells. Nevertheless, a large percentage of physicians were in favour of embryo research, especially when embryos are supernumerary (44% versus 34%). Eighty-seven % of the physicians interviewed proved to have a general knowledge about stem cells and believe in their therapeutic potential. They prefer research on cordonal stem cells rather than on embryo stem cells. Although they are in favour of heterologous stem cells donation, they still prefer cryopreservation for personal use.

François-Vincent Raspail (1794–1878) and Theodor Schwann (1810–1882) postulated—in 1827 and 1838, respectively—that plants and animals consist of, and originate from, cells. Whereas Raspail is mainly remembered for his involvement in the revolutions of 1830 and 1848, little is known about his scientific work. Schwann, by contrast, is regarded as one of the founders of cell theory, but historians of biology have hardly taken his philosophical, religious, and political ideas into account. Paying particular attention to Schwann’s unpublished writings, this paper reconstructs the research agendas of Raspail and Schwann, and contrasts the philosophical and political beliefs and incentives behind them. Whereas Raspail was a proponent of republicanism and materialism, Schwann opposed the modernist agenda of explaining nature and humankind without God, as well a democratic reshaping of society. Contrary to the prevailing historical narrative, this paper argues that cell theory did not emerge exclusively in conjunction with the rise of liberalism and materialism. Rather, the idea of a unifying principle of organic development encompassed different and even antagonistic visions of nature, humankind, society, and the role of religion in science. This essay is part of a special issue entitled REVOLUTIONARY POLITICS AND BIOLOGICAL ORGANIZATION IN NINETEENTH-CENTURY FRANCE AND GERMANY edited by Lynn K. Nyhart and Florence Vienne.

Background HIV causes immunosuppression, which reduces the body's immunity to diseases like COVID-19 by decreasing CD4 cells. The goal of this study is to determine whether persons living with HIV/AIDS (PLWHA) who are using anti-retroviral therapy (ART) are willing to accept the Coronavirus illness 2019 vaccination and the factors that influence their decision. Method From February 15 to March 15, 2022, 332 PLWHA on ART participated in this facility-based cross-sectional study. The correlation of outcome variables with predictors was investigated using binary and multivariable logistic regression. Result Of the 332 study participants, 110 (33.1 %) and 118 (35.5 %) had poor knowledge and a negative attitude toward the COVID-19 vaccination, respectively. Approximately 31 (9.3%) of study participants believe ART medications can also prevent COVID-19 infection. The willingness to receive the COVID-19 vaccine was 66.3 % with a 95 % confidence interval (60.9, 71.5). Knowledge, attitude, educational status, marital status, residency, duration, and monthly income were all significant predictors of willingness to receive COVID-19 vaccination. Conclusion Increased sensitization regarding the necessity of vaccines and the negative consequences of diseases, particularly among PLWHA, should be emphasized in the preparation of the COVID-19 immunization campaign involving prominent individuals such as health professionals and religious leaders.

AbstrakGejala sekularisasi organisasi pelayanan sosial semakin masif. Sekularisasi ini disebabkan karena masyarakat semakin rasional pada realitas sosial yang menuntut kualitas pelayanan sosial lebih baik. Masyarakat yang rasional adalah masyarakat yang mampu mengorganisir dan melakukan peran serta tindakan atas dasar pertimbangan logis atas realitas. Hadirnya organisasi menjadi cirri masyarakat rasional. Organisasi adalah bentukan sosial yang berisi kesepakatan gagasan pemikiran, nilai, ideologi dan tujuan. Ketika agama menjadi bagian di dalamnya, maka organisasi menjadi lebih kuat dengan tatanan nilai dan aturan-aturan yang selalu merujuk pada nilai agama sebagai dasar keyakinannya. Keyakinan pada nilai agama menjadi spirit organisasi untuk merancang dan merealisasikan tujuannya. Maka organisasi yang berbasis keagamaan memiliki sensifitas dan orientasi untuk kesejahteraan yang lebih baik. Kesejahteraan tidak hanya bagi obyek, tetapi juga bagi subyek organisasi. Tesis Weber bahwa semakin menguatnya organisasi atau lembaga formal di masyarakat justru akan mempersempit ruang-ruang keagamaan, ternyata tidaklah demikian. Justru dengan hadirnya agama dalam organisasi, maka jangkauan organisasi semakin luas, memasuki sel-sel organisasi secara lebih dalam dan manusiawi. Kata kunci: keagamaan, organisasi, strategi AbstractSymptoms of secularization of social service organizations are increasingly masiv. This secularization is caused by increasingly rational society in social reality that demands better quality of social services. A rational society is a society capable of organizing and performing action based on logical reasoning of reality. The presence of the organization became the cirri of rational society. Organization is a social form that contains agreement of ideas of thought, value, ideology and purpose. When religion becomes part of it, the organization becomes stronger with the order of values and rules that always refer to the value of religion as the basis of its belief. Confidence in the value of religion becomes the spirit of the organization to design and realize its objectives. Hence religious-based organizations have sensitivity and orientation for better welfare. Welfare is not only for the object, but also for the subject of the organization. Weber's thesis that the strengthening of formal organizations or institutions in society will actually narrow the religious spaces, it is not so. Precisely with the presence of religion within the organization, the scope of the organization increasingly widespread, entering the cells of the organization more deeply and humanely.Keywords: organization, religion, strategy

The term of 'human dignity' is not an actual and verifiable concept, but a totally subjective and metaphysical one. It means that human dignity is not the primal concern for scientists - actually, it is not their business. On the other hand, there is strong belief among the popular, especially within the religious camp, that the human dignity should be taken under no circumstances. That's why it is so difficult to dialogue between science and religion. As we are entering into new era led and controlled by genetics, it is increasingly observed that genetic researchers easily trespass on the human dignity, i.e., by naming the pre-embryo as a lump of cells not a human being. The reason why we have to limit genetic interventions for the improvement of genes is because of a danger of eugenics. In that sense, we also need to consider that it is very difficult to discern gene therapy and gene enhancement, because the former can easily fit in with negative eugenics and the latter with positive eugenics in actual fact. The human desire to have 'perfect baby' will go on well with genetic interventions, and bring into new gene-classist society in no distance future. We hope that genetics will not serve as a type of genetic Procrustean bed against which individuals will be measured; instead, it serves as the giver of benefits for all. For this end to be fulfilled, we have to make a consensus of what is human dignity and from what stage in the human developments he/she holds his/her whole personhood as a meaningful life. If we are wise enough, we can adjust our desire to intervene in our offspring's genes as well as our own to the evolutionary process of nature.

Background and Objectives: Jehovah’s Witnesses (JW) reject the transfusion of blood components based on their religious beliefs, even if they are in danger of harm or death. In cardiac surgery, this significantly reduces the margin of safety and leads to ethical conflicts. Informed consent should be carefully documented and the patient’s family should be involved. This study aims to compare the postoperative course of JW who underwent major cardiac surgery with a similar population of non-Witnesses (NW). Patients and Methods: Demographic, procedural, and postoperative data of all consecutive JW who underwent cardiac surgery at our institution were obtained from the records. They were compared with a propensity-score-matched group of NW. Anemic JW were treated with erythropoietin and/or iron as needed. Cardiac surgery was performed by experienced surgeons using median sternotomy and cardiopulmonary bypass. Common blood-sparing techniques were routinely used. Periprocedural morbidity and mortality were statistically evaluated for both groups. Results: A total of 32 JW and 64 NW were part of the matched dataset, showing no demographic or procedural differences. EPO was used preoperatively in 34.4% and postoperatively in 15.6% of JW but not in NW. Preoperative hemoglobin levels were similar (JW, 8.09 ± 0.99 mmol/L; NW, 8.18 ± 1.06; p = 0.683). JW did not receive any transfusions except for one who revoked, while NW transfusion rates were 2.5 ± 3.1 units for red cells (p < 0.001) and 0.3 ± 0.8 for platelets (p = 0.018). Postoperative levels differed significantly for hemoglobin (JW, 6.05 ± 1.00 mmol/L; NW, 6.88 ± 0.87; p < 0.001), and hematocrit (JW, 0.29 ± 0.04; NW, 0.33 ± 0.04; p < 0.001) but not for creatinine. Early mortality was similar (JW, 6.3%; NW, 4.7%; p = 0.745). There were more pacemakers and pneumonias in JW, while all other postoperative conditions were not different. Conclusions: Real-world data indicate that Jehovah’s Witnesses can safely undergo cardiac surgery provided that patients are preconditioned and treated by experienced surgeons who use blood-saving strategies. Postoperative anemia is observed but does not translate into a worse clinical outcome. This is consistent with other studies. Finally, the results of this study suggest that all patients should benefit from optimal pretreatment and blood-sparing strategies in cardiac surgery, not just Jehovah’s Witnesses.

EMERGENCE IN CONTEXT: A Treatise in Twenty-First Century Natural Philosophy by Robert C. Bishop, Michael Silberstein, and Mark Pexton. Oxford, UK: Oxford University Press, 2022. 363 pages. Hardcover; $103.65. ISBN: 9780192849786. *Reductionists dream of a day when all scientific truths can be derived from fundamental physics. Bishop, Silberstein, and Paxton show that dream is now dead, or at least it's quite ill. But what will replace it? One answer is "emergence," although that term is ambiguous. In its weak sense, it merely expresses pessimism about our ability to fully understand how microphysics produces all other phenomena. In its strong sense, it means that some entities have a kind of autonomy from physics, with their own "causal powers," including downward causation. Bishop et al. seek to replace strong and weak emergence with "contextual emergence." *Let's start with an example (sec 2.4). Rayleigh-Bénard convection occurs when a fluid is trapped between a heating plate below and a cooler one above. Convection cells emerge as warmer fluid rises toward the top and cooled fluid sinks. While molecular interactions play a part in this, sustained convection is impossible without the macroscopic plates. This behavior is not wholly determined by the fluid's constituent parts but rather by the context in which the fluid exists. *What this and scores of other examples show is that phenomena at a given scale often depend on a host of "stability conditions" at other scales--sometimes higher, sometimes lower. Contra the reductionist, the authors argue that the behavior of entities, properties, and processes at a given level is never wholly determined by events at a lower level. Macroscopic conditions (among other things) play an essential and ineliminable role. If we knew all the truths of nature, we would see that not all dependence is bottom-up. *"But the plates in your example are made of matter," says the critic, "We can reduce those to the behavior of atoms as well." A complete mathematical description without idealizations? "Well, it can be done in principle." Let's consider another example while we wait. Physicists in the Newtonian era devoted much time to the study of planetary orbits. One surprising stability condition is three-dimensional space. In four dimensions, regular orbits that resist small perturbations would be impossible (p. 29). Note that spatial dimensions are not part of the system. They are the context in which the system exists. Three dimensions are a necessary condition for stable orbits but cannot be reduced to the system's constituents even in principle. The properties of the parts do not determine the properties of the whole. This example illustrates why emergent properties are often inexplicable or unpredictable given complete knowledge of lower-level constituents: stability conditions are typically not at some lower level. While some stability conditions are causal and mechanical, like the plates in the convection examples, others are acausal, like conservation laws and least action principles. Still more are abstract properties of dimension and the geometry of mathematical spaces. Whichever the case, the authors consider those conditions to be as real or "fundamental" as anything at the level of elementary physics--something that sets this book apart from both reductionism and many other versions of emergentism. *Emergence is often associated with novelty, such as when a new and unexpected higher-level property emerges from its base. The authors believe this attention is misplaced. They focus instead on how stability conditions either open or close off areas of "possibility space." A possibility space is an abstraction in which each point represents a possible state or behavior of the system. For example, one point in the possibility space of a baseball represents its being in orbit--a possibility that will likely never be actualized. In Newtonian mechanics, the ball might also travel at the speed of light. Under special relativity, on the other hand, that part of possibility space is closed to the ball. As a result, no material object can reach that speed. The more interesting and neglected case occurs when stability conditions create access to parts of possibility space. For example, lasers do not exist in nature. Their stability conditions include the existence of a resonance cavity in which atoms can be electrically stimulated and isolated from their environment and putting those atoms in the proper state to begin the process (sec 4.9.1). When these conditions are in place, the area of possibility space representing coherent light becomes accessible. Such light has always been physically possible, but without the requisite context, it cannot become actual. *The authors make several applications to perennial questions in the philosophy of science that I do not have space to elaborate on. These include modality, dispositions/causal powers, properties, the laws of nature, causation, and determinism. Each of these has a relation to stability conditions that is often overlooked. The authors show how progress can be made on each question with less metaphysical baggage than many analytic metaphysicians assume. *Chapter 7 includes several possible objections, but one stands out. While we might need to use multiscale modeling in order to make predictions, that's because of our own epistemic limitations. Stability conditions are important, a critic might grant, but they are ultimately grounded in fundamental physics just like everything else. If we only knew enough about the system and its contexts, we would see how it's all due to the behavior of fields, particles, or whatever resides at the lowest level. *Bishop et al. reply that emergence has the evidence on its side, including an entire book with dozens of examples that cannot be reduced in the manner the critic envisions (p. 313). Nonetheless, the ontological reductionist continues to claim that while these examples have not yet been reduced to lower-level phenomena, it's just a matter of time. One wonders how long such promissory notes will be accepted. *My only concern is that contextual emergence might be too commonplace. Emergentists, especially of the strong variety, sometimes have difficulty providing convincing examples. Consciousness and quantum entanglement always make the list, but neither is fully understood. Contextual emergence, in contrast, is ubiquitous. Many examples are from biology and neuroscience, as one might expect, but most come from physics itself. Consider one more. Whether a dying star forms a white dwarf, neutron star, or black hole depends on its context, specifically how much mass the star had prior to collapse (sec 4.4). All three are therefore contextually emergent. But our hypothetical critic will surely complain that there's nothing emergent about this. The context is just mass, and mass is fundamental. Even some fellow emergentists might wonder whether calling every example that relies on necessary conditions "emergence" diminishes the significance of the term. Whatever the terminology, the book highlights a neglected aspect of what science tells us about the world. The objects and properties science studies depend on stability conditions, and those conditions are not typically found at smaller scales. Contextual emergence, therefore, stands in stark contrast to what reductionists had led us to expect. *Insofar as reductionism is incompatible with theism, this is the main takeaway for Christian academics. Science still tends to operate under a reductionist narrative that can deal with religious belief only in terms of psychological predispositions and sociological pressures. But if this narrative is false even in the physical sciences, then religious beliefs need not be restricted to such cramped corners. One might even wonder whether some of those beliefs are true. *Reviewed by Jeffrey Koperski, Professor of Philosophy, Saginaw Valley State University, University Center, MI 48710.

Embryonic stem cells (ESC) are a useful tool for studying embryonic development, cell differentiation, and genetic manipulation. Moreover, these cells can be applied in cell-based therapies and in vitro organogenesis. The research conducted with human ESC has generated many ethical, moral, and religious considerations by scientists and laymen alike. Therefore, an animal model such as the pig (Sus scrofa) is valuable in overcoming such hurdles because this species holds physiologic parameters similar to humans. In spite of the great biomedical potential of ESC, many difficulties have been faced in maintaining these cells in a pluripotent state in vitro. For this reason, studies to elucidate the mechanisms of in vitro maintenance of undifferentiated ESC are needed to improve the culture of these cells. The objectives of this study were (1) to isolate ESC from in vitro- and in vivo-produced swine blastocysts; (2) to compare 2 in vitro culture conditions to maintain isolated inner cell masses (ICM), murine embryonic fibroblasts (MEF), or Matrigel; and (3) to identify and to compare the expression of the pluripotency markers Nanog, Sox2, and FoxD3 at ESC and in vitro- and in vivo-produced swine blastocysts. In this manner, swine blastocysts were obtained by in vitro maturation and fertilization of oocytes from ovaries collected in abattoirs. Embryos were in vitro cultured for 7 days until blastocyst stage. In addition, in vivo-produced blastocysts were obtained by superovulation followed by AI of gilts (150 days of age). Embryos were collected by post-mortem uterus flushing 5 days after ovulation. In vitro- and in vivo-produced blastocysts were submitted to immunosurgery to isolate the ICM. Briefly, zona pellucida was digested with pronase solution, and embryos were incubated with anti-swine rabbit serum to remove trophoectoderm cells and with guinea-pig complement serum. Resultant ICM (14 and 66 ICM from in vitro- and in vivo-produced blastocysts, respectively) were cultured in stem cells media (GMEM added by 15% FCS, 0.1 mM β-mercaptoethanol, 1% nonessential amino acids, and 4 ng mL-1 of basic fibroblast growth factor) over monolayer of irradiated mouse embryonic fibroblasts (MEF) or Matrigel for 3 weeks. No difference was observed between the in vitro culture conditions (MEF and Matrigel) on isolated ICM adhesion. In addition, no difference was verified between in vitro- and in vivo-produced blastocysts on adhesion of cultured ICM. However, no swine ESC was obtained. Gene expression analysis was performed only with whole in vitro- and in vivo-produced blastocysts. Results showed that Nanog and Sox2 were less expressed in in vitro-produced blastocysts. However, the expression of FoxD3, demonstrated in this study for the first time, was similar between groups. Because no ESC lineage was obtained in swine until now, we believe this species has different requirements compared with murine and human. Therefore, more studies are necessary to establish protocols to isolate porcine ESC. Acknowledgments are given to FAPESP (processes 06/58507-0 and 07/51732-0).

The anthropological record clearly shows that there remains a strong political undercurrent in terms of Theravada Buddhism, spiritualism, animism, supernaturalism, and scams in Thailand. The literature review of this new anthropology provides the main academic works that have been published vis-Ã ˘a-vis the Theravada Buddhism, animism, and supernaturalism. Scams have been added to this academic paper as they are based on the former, and scams in late modernity have emerged and evolved from the new anthropology. It is a new anthropology for the following three main reasons: (1) it adopts a modern approach to understanding such cultural, social, and traditional phenomena; (2) the method involves both normative and quantitative methods used in the social and political sciences; and (3) a more objective and scientific approach is adopted in the new political tropology because of the uneven distribution of power in these cultural and social phenomena. Individuals actually have a choice to avoid being scammed. Yet, millions of people seem to prefer to be duped. People keep losing billions of dollars to scammers. Why is this so? This study seeks to explain this social phenomenon. Think of the word “scam” and what comes to mind is a wide range of scams targeting old people’s life savings; insecure women in Singapore seeking romance and erotic love from Turkish men; poor Turkish men in Singapore living off their Singaporean girlfriends and wives (they usually have one of each simultaneously); financial scams by lawyers and foreigners in Thailand; phishing scams in Malaysia; as well as gambling scams and online scams in Singapore. Millions continue to be lost in scams involving fake government agencies, including Singapore’s Income Tax Agency and Singapore’s CPF Board. While legitimate governments spend billions of dollars on countermeasures to combat these nefarious tricksters, there appears to be little to nothing that is achieved. People are very easily misled. This study focused on multimillion-dollar scammers who prey on individuals who believe in magic, ritual, occult, tradition, religion, and superstition. Ignoramuses, the mentally retarded, and simpletons are often superstitious; they are the most likely to fall for scams. Scams take place in crowded places with a high walk-in, street-level crowd, and the profits range from a few cents to thousands of dollars a second. This study concludes with a clear solution to the problems associated with superstition and scams in Southeast Asia. There is a politics to Asian scams because of the uneven distribution of power among those who believe in superstitions, animism, and religions; it is a paradox that makes many people vulnerable to being scammed.

The anthropological record clearly shows that there remains a strong political undercurrent in terms of Theravada Buddhism, spiritualism, animism, supernaturalism, and scams in Thailand. The literature review of this newanthropology provides the main academic works that have been published vis-à-vis the Theravada Buddhism, animism, and supernaturalism. Scams have been added to this academic paper as they are based on the former, and scams in late modernity have emerged and evolved from the new anthropology. It is a new anthropology for the following three main reasons: (1) it adopts a modern approach to understanding such cultural, social, and traditional phenomena; (2) the method involves both normative and quantitative methods used in the social and political sciences; and (3) a more objective and scientific approach is adopted in the new political tropology because of the uneven distribution of power in these cultural and social phenomena. Individuals actually have a choice to avoid being scammed. Yet, millions of people seem to prefer to be duped. People keep losing billions ofdollars to scammers. Why is this so? This study seeks to explain this social phenomenon. Think of the word “scam” and what comes to mind is a wide range of scams targeting old people’s life savings; insecure women in Singapore seeking romance and erotic love from Turkish men; poor Turkish men in Singapore living off their Singaporean girlfriends and wives (they usually have one of each simultaneously); financial scams by lawyers and foreigners IN Thailand; phishing scams in Malaysia; as well as gambling scams and online scams in Singapore. Millions continue to be lost in scams involving fake government agencies, including Singapore’s Income Tax Agency and Singapore’sCPF Board. While legitimate governments spend billions of dollars on countermeasures to combat these nefarious tricksters, there appears to be little to nothing that is achieved. People are very easily misled. This study focused on multimillion-dollar scammers who prey on individuals who believe in magic, ritual, occult, tradition, religion, and superstition. Ignoramuses, the mentally retarded, and simpletons are often superstitious; they are the most likely to fall for scams. Scams take place in crowded places with a high walk-in, street-level crowd, and the profits rangefrom a few cents to thousands of dollars a second. This study concludes with a clear solution to the problemsassociated with superstition and scams in Southeast Asia. There is a politics to Asian scams because of theuneven distribution of power among those who believe in superstitions, animism, and religions; it is a paradox thatmakes many people vulnerable to being scammed.

Science at the Crossroads: Fact or Fiction?Modern Academic Science is largely based on the formulation of hypotheses that are then confirmed through observations and experiments. There is little scope forcuriositythat played an important role in early Science. Results carrying negative implications are not easy to publish, and hypotheses have a tendency to take on the mantra of religious beliefs. Academic Science is facing on many fronts pressures that hardly existed in the past. Financial rewards apart from salary can be very high, in the form of fees for consultants, expert legal witnesses, patent development, and even the establishment of private companies. Commercial funding forms a significant percentage of the Total Research Budgets in Science and Medicine, but this often leads to loss of control over research protocols and freedom to communicate the results. Media attention confers fame and prestige that is assiduously sought out by some individual scientists, often supported by University resources, and Press Conferences prior to or synchronous with actual publication. Scientists have long been employed full-time by Government Departments, but research contracts are being increasingly offered by the latter to academic staff on a part-time basis. These pressures and opportunities, together with the priority given to research by most University Tenure and Promotion Committees, are tending to diminish the appetite of scientists for other important responsibilities such as teaching and administration. In a few decades, University scientists have moved from the »Ivory Tower« to the High Street, and many are serving more than one master. The above scenario may bring increased remuneration and the pursuit of research that would be too expensive without these external sources, but adverse consequences have also occurred. They may lead to the complicity of scientists, through no fault of their own, in the introduction of drugs and supplements that: a) fail to deliver the benefits claimed; b) increase the risk of some unrelated illness; c) possess dangerous side effects not known or reported at the time of introduction. Examples include hormone replacement therapy and antioxidant vitamins (A and E) to protect against Coronary Heart Disease; dietary fibre to prevent colon cancer; and arguably calcium supplements to treat osteoporosis. On occasions, academic scientists have served as fronts for the publication by the manufacturers of falsified reports minimizing the risk of serious drug side-effects to ensure Regulatory Approval, as occurred with Vioxx in the treatment of arthritis, and Seroquel for schizophrenia and bipolar depression. Individual fraud or misconduct is more frequent than suspected, because most incidents are without major impact and are suppressed by Universities and Funding Agencies. Major scandals are rare, but may have serious repercussions for the general public and bring science into disrepute. Recent examples include: the Cold Fusion controversy (Low Energy Nuclear Reaction); the link age by Andrew Wakefield of autism with Rubella vaccination; the infamous creation of stem cells by somatic cell nuclear transfer falsely reported by Hwang Woo-Suk. Fraud by commercial companies is subject to the full force of the law, but Science is treated as a self-regulating profession, and as such the punishments handed out are relatively trivial. In essence, Science prior to 1950, except in North America, proceeded along a highway that segregated the traffic into Commercial, Government and Academic streams, and passed through inspiring landscapes and green pastures. It later came to a crossroads from which the alternative road led to the Marketplace, and on which segregation into the above three streams was not enforced. It has now become the main thoroughfare for Science world-wide, but there are reasons to believe that this has increased the incidence of dangerous driving and traffic accidents in the form of conflicts of interest, unethical behaviour, misconduct and even fraud. It may be too late to return to the crossroads and continue along the original highway, but there could be considerable merit in restoring the original segregation between the three streams of Science and in developing, as well as enforcing, a stricter code of behaviour, for which some elements are proposed.

Abstract Introduction High dose chemotherapy (HDC) followed by autologous stem cell transplant (ASCT) is considered the standard of care for patients with high-risk or relapsed lymphoma and multiple myeloma (MM). With most patients requiring both red cell transfusion ,and platelet support until marrow engraftment. Jehovah’s Witnesses (JW), based on religious convictions, refuse blood products, and therefore are frequently denied transplants in most centers, due to the presumed fear of death from bleeding and anemia. We present a series of 119 JW diagnosed with lymphoma (n= 54), (MM) (n= 63) and amyloidosis (n=2) who received treatment with HDC and ASCT without transfusion support. Methods All JW undergoing HDC and ASCT at Pennsylvania Hospital between May 1996 and March 2013 were included. Patients were primed pre-transplant with IV iron and erythropoietin to a target Hemoglobin (Hb) > 11g/dl.Cryopreservation of collected cells, was performed using normal saline and albumin instead of fresh frozen plasma. Post apheresis, HDC was delayed to allow Hb levels to rise to ≥ 11 g/dl and platelets ≥100,000. Post-transplant, patients received granulocyte colony-stimulating factor, erythropoietin and initially interleukin-11 which was later discontinued, as there was no benefit observed in the length of time to platelet engraftment. Thrombocytopenia was managed with antifibrinolytic agents (Amicar) and vitamin K, the avoidance of anticoagulation and aspirin, and rarely cryoprecipitate, desmopressin, and nasal vasoconstrictors. Results Engraftment The median number of days to neutrophil engraftment, with absolute neutrophil count ≥1,000/μL, was 10.0 days. The median Hb at the onset of chemotherapy was 11.8 g/dL, (range 7-15.3 g/dL), and the average decrease in Hb was 5.0 g/dL, with an average nadir of 6.8 g/dL. The median number of days with Hb under 8 g/dL was 5.5 days. The median platelet count at onset of chemotherapy was 148 x 103/μL (range of 65 to 502 x 103/μL). The median number of days with a platelet count under 10 x 103/μL was 3.0 days (range 0 to 14 days) with a median platelet nadir of 4.0 x 103/μL (range 1-50 x 103/μL). Patients with lymphoma experienced a lower drop in Hb post cytotoxic regimen than myeloma patients (ΔHb = 4.5g/dl for MM, 6.0g/dl for lymphoma, p < 0.05).The average length of stay (LOS) was 19.0 days. Bleeding Complications Bleeding complications were classified using the WHO criteria. Patients with platelet counts greater than 5 x 103/μl experienced no bleeding complications or death due to hemorrhage. There was one grade 4 hemorrhage, a temporal infarct leading to temporary vision loss and confusion, one grade 3 hemorrhage, a major gastrointestinal bleed, and one grade 2 hemorrhage which was hematuria. Sixteen patients experienced grade 1 bleeding episodes consisting of subconjunctival hemorrhage (n=5), epistaxis (n=6), minor vaginal bleeding (n=2), minor oral bleeding (n=1) a thigh hematoma (n=1), and a minor retinal bleed (n=1). Cardiac Complications Forty two of the one hundred and nineteen patients who underwent HDC and ASCT, experienced cardiac complications.These included new onset arrhythmias (n=19), profound hypotension (n=15), congestive heart failure (n=10) and acute myocardial infarction (n=1). The mean Hb nadir for patients who experienced a cardiac complication was 6.6 g/dL .Additionally the median age was 56 years (range 21-71years) and the average change in hemoglobin was 5.0g/dl. Mortality The 100 day transplant related mortality was 5%.The six deaths recorded were due to sepsis, multi-organ failure due to pancytopenia and cardiac events. Conclusion Based on our study we conclude that HDC followed by ASCT, can safely be performed without the need for transfusion support, with low mortality rates and low incidences of major bleeding complications .Anticipated anemia may be managed by ensuring priming of Hb with the use of IV iron and erythropoietin to Hb ≥11 g/dl, and simple patient blood management techniques. Thrombocytopenia may be managed similarly, by allowing platelet recovery post apheresis to ≥ 100, 000. We also believe that Amicar and Vitamin K offer as good and effective, an alternative to prophylactic platelet transfusion in the management of thrombocytopenia. Additionally these agents may be used to achieve homeostasis in patients who develop platelet refractoriness, and similarly the use in all transplant patients may be appropriate. Disclosures: No relevant conflicts of interest to declare.

CHASING METHUSELAH: Theology, the Body, and Slowing Human Aging by Todd T. W. Daly. Eugene, OR: Cascade Books, 2021. 307 pages, index. Paperback; $38.00. ISBN: 9781532698002. *Chasing Methuselah brings "a Christological anthropology to bear on the scientific quest to attenuate aging by manipulating the body" (p. xi). Todd T. W. Daly, who teaches at Urbana Theological Seminary, argues that faith-based lenses are integrally important for interpreting historically diverse, and mostly failed, efforts to slow human aging--an elusive goal typically pursued by biomedical professionals, technocrats, and quacks. "The idea of a significantly prolonged healthy life has captured the public's imagination," Daly states in his Introduction, but "to date, the ethics of aging attenuation contains assumptions that often go unchallenged, leaving fundamental questions unasked" (p. 11). *With bold originality and astounding erudition Chasing Methuselah fills a major gap in critical gerontology by highlighting ethical foundations and existential dilemmas that scientists and commentators have generally ignored while attempting to alter bodily homeostasis and manipulate basic processes. Blazing a terra incognita full of unfamiliar names and references, Chasing Methuselah poses questions that reframe a fundamental debate: Should healthful longevity be extended by trying to cure age-related diseases or by slowing the rate of aging? In his critique of this "two endings [that] speak of two disparate paths of old age" framework, Daly pushes gerontology's limits beyond what most researchers, teachers, and practitioners (regardless of their specialization) regard as its transdisciplinary, cross-professional domain. *Chasing Methuselah has five richly nuanced, assiduously researched chapters. Chapter 1 alone is 58 pages long with 284 footnotes. It traces "the quest for longevity [that] has moved from legend to laboratory," thereby engendering "new hope that human aging might be brought under human control" (p. 76). Daly's second chapter chronicles how certain Christian texts and doctrines have bolstered two conflicting perspectives--specifically, a secular contention that "prolonging life is unequivocally good" and an "unequivocal foreclos[ing of] all attempts to secure a longer life by slowing aging" (p. 112). *Chapter 3 examines the legacy of Francis Bacon (1561-1626). Its title, "Relief of Man's Estate: Francis Bacon and the Theological Origins of the Modern Quest to Slow Aging," pivots the book to a contrapuntal, interpretive turn wherein technological and theological pathways toward greater longevity have complemented, paralleled, or contradicted themselves for centuries. On the one hand, Daly affirms that Bacon birthed biomedical science as an indispensable approach to practical knowledge about old age and aging. On the other hand, Daly quotes Bacon's objections to the project: "Natural philosophy [the study of nature] should not be invaded by revealed theology in the Bible," declared Bacon, "but rather be bounded by it" (p. 148). *The last two chapters of Chasing Methuselah's narrative invite laboratory scientists, policy analysts, and healthcare professionals to grapple with theodicy and eschatology--subjects usually taught in seminaries, not showcased in conferences on aging. Chapter 4, entitled "Adam Again," reveals the typically unacknowledged importance of theology in reflecting and refracting scientific views on slowing bodily aging. Ascetics tried to attenuate aging to reframe Adam's Fall in Genesis. For the Desert Fathers, "Bodily practices such as fasting were viewed as the primary means by which the Christian might regain a measure of what was lost by Adam's sin, namely, a heightened degree of bodily incorruptibility allowing for the possibility of longer life" (p. 199). *Chapter 5, "The Last Adam and Slowing Aging," builds upon the connection between asceticism, fasting, and prolongation of life espoused by Saints Anthony, Athanasius, and other Desert Fathers. This chapter also considers the work of the Swiss theologian Karl Barth in particular, employing Barth's "dynamic anthropology" or "dialectical-dialogical anthropology" for framing "christologically informed discussions on the relationship between one's body and soul as it relates to slowing aging" (p. 206). By taking on "finite humanity as embodied soul and ensouled body" (p. 253), the incarnation affects our perspective on lengthening life: "In light of the real man Jesus, any use of biotechnology ... is not without risk, as it may threaten our pursuit of the proper order to body and soul" (pp. 253-54). *Reading Chasing Methuselah can be daunting. I had to Google many references, and readers without theological training may well find the discussion of Barth difficult to comprehend. I associated Daly's modus operandi with "thick description"--Clifford Geertz's method of doing cultural anthropology. This approach gathers biographical details, historical milieus, and societal belief systems to contextualize actors' symbols, legends, and rituals, thereby explicating individual worldviews and collective behaviors. Geertz (omitted in the 34-page bibliography) used reams of data to synthesize and interpret what he observed being enacted ethnographically. *Daly, in contrast, offers a "conclusion" to each chapter, but rejects narrative foreclosure. To wit: The last sentence of Chasing Methuselah's four-page Conclusion, which begins "Perhaps the best question is whether the use of such biotechnology will help or hinder our pursuit of Jesus" (p. 258), requires readers to formulate their own answer to what Daly implicitly articulates. This tack leaves loose ends unresolved--perhaps frustrating for scientists accustomed to explicit, straightforward conclusions. That Daly chose not to bridge two specific cultures (humanities and science) diminishes his argument's impact. Reviewing this as an historian of aging, a religious/spiritual believer, and a critical gerontologist, I opt for more transparency. *I commend Daly for invoking Tom Cole and Gerald Gruman, whose histories of science, theology, and myth orchestrated early parts of Chasing Methuselah. I am dismayed, however, that the book does not sufficiently acknowledge two fierce competitions raging for decades: (1) turf wars over intramural status and extramural authority within the Gerontological Society of America (GSA); and (2) ideological and methodological rivalries that have pitted GSA advocates against experts in the American Academy of Anti-Aging Medicine (4AM). *For example, the pro-longevity claims made by David Sinclair and Valter Longo, 4AM stalwarts whom Daly frequently cites, are important and pertinent. Nonetheless, their research does not enclose the vast array of theories advanced and debunked by specialists and emerging professionals within GSA. That strand of historical gerontology was evident in the early twentieth-century pathological model of aging (articulated by Elie Metchnikoff) and its physiological counterpart (presented by I. L. Nascher, the father of US cross-disciplinary geriatrics). Similarly, Daly's historiography could have paid more attention to Clive McCay's caloric-reduction experiments (replicated persistently for 90 years) and to Roy Walford's fasting regimen in Biosphere 2. *This Episcopalian wanted more exegesis in Chasing Methuselah. How do women's opinions about slowing human aging compare with those of male theologians and mystics? Doesn't Daniel Callahan merit more than a footnote citing his claim that "'national necessity' [is] another way of saying 'research imperative'" (p. 12)? Might assessments of non-Christian or agnostic ethicists have sharpened Daly's focus on a faith-based lens? *As a critical gerontologist, I was frustrated at the outset by the phrase, "slowing human aging." What does Daly intend this wording to encompass and exclude? Is it the equivalent of "the scientific quest to attenuate aging by manipulating the body" (p. 15)? Is "limiting caloric intake [which] reduces oxidative stress, allowing DNA to repair damage suffered by cells" (p. 54) a modern-day version of "holy anorexia" practiced by prayerful nuns during the Middle Ages? *This critique of flaws hardly lessens my admiration and respect for what Daly contributes. Rarely, in fifty years of evaluating multidisciplinary books on old age and longevity, have I so willingly engaged dialogically with an author. Addressing questions raised in Chasing Methuselah prompted rethinking the dialectical symbiosis of religion and science. Many of my colleagues in age studies will dismiss this book as an outlier, I suspect, because Daly's Christological anthropology turns them off. That is a pity, if so: The debate and search for meanings embodied in Chasing Methuselah advances what truly matters in anchoring the aging enterprise. *Reviewed by W. Andrew Achenbaum, Professor Emeritus of History and Gerontology, Texas Medical Center, Houston, TX 77054.

Stem cell research holds the promise of treatments for many disorders resulting from disease or trauma where one or at most a few cell types have been lost or do not function. In combination with tissue engineering, stem cells may represent the greatest contribution to contemporary medicine of the present century. Progress is however being hampered by the debate on the origin of stem cells, which can be derived from human embryos and some adult tissues. Politics, religious beliefs and the media have determined society's current perception of their relative value while the ethical antipathy towards embryonic stem cells, which require destruction of a human embryo for their derivation, has in many countries biased research towards adult stem cells. Many scientists believe this bias may be premature and basic research on both cell types is still required. The media has created confusion about the purpose of stem cell research: treating chronic ailments or striving for immortality. Here, the scientific state of the art on adult and embryonic stem cells is reviewed as a basis for a debate on whether research on embryonic stem cells is ethically acceptable.

Abstract Background The use of human embryonic stem cells (ES cells) for the development of medical therapies is surrounded with moral concerns. The aim of this study was to assess the public’s attitudes toward the use of ES cells for treatment of Parkinson’s disease (PD) and other diseases, what factors are most important to consider when using ES cells for drug development, and if there is an association between religious beliefs and attitudes toward using ES cells for medical treatment. Methods A randomly selected sample of the Swedish public, aged 18–87-years-old, completed an online survey (n = 467). The survey assessed socio-demographics, religious views, perceived moral status of the embryo, and attitudes toward using ES cells for medical treatment of PD and other diseases. Adjusted odds ratios (ORs) and 95% confidence intervals (CI) for positive vs. negative attitude toward using ES cells for drug development were computed using logistic regression. Results The respondents were positive about using ES for treatment; specifically, 70% totally agreed that it is acceptable to use ES cells for treatment of PD, while 40% totally agreed that it is acceptable to use ES cells for treatment but induced pluripotent cells is just as efficient. Religion being of little importance in one’s life was associated with a positive attitude toward using ES cells for treatment of PD (adjusted OR 6.39, 95% CI 2.78–14.71). The importance of being able “to access new, effective treatments against diseases that do not have any treatment available” was ranked as the most important factor to consider when using ES cells for drug development. Conclusion Most respondents are positive about using ES cells for drug development, and making effective treatments accessible to those who do not have any. However, these attitudes are influenced by the specific disorder that the drug development is intended for, as well as the religious views and perceived moral status of the early embryo.

Abstract Objective Ethnic disparity persists despite equal access to health care in Singapore, with Malay-Muslim women having the lowest mammogram uptake rate and highest breast cancer mortality rate. We sought to understand barriers to and facilitators for mammogram uptake in this community. Methods We used a sequential mixed-methods design to first explore reasons for screening and not screening for breast cancer, then determine factors associated with screening and regular screening in a survey. We used maximum variation sampling for semi-structured in-depth interviews to select screeners and non-screeners of diverse ages and educational levels. Twenty-three Malay-Muslim women aged 40–69 years old were interviewed. Themes were categorized using thematic analysis. For the survey, we applied the Health Belief Model, Social Ecological Model, as well as themes from the interviews and findings from previous studies on factors influencing screening in Muslim women to guide questionnaire design. We surveyed 271 Malay-Muslim women aged 50–69 years old in a nationally representative sample. Multivariable logistic regression was used to determine factors associated with ever gone for mammogram and regular mammogram uptake. Results Through in-depth-interviews, we found perceived benefits of saving lives and breasts from early detection, reminders from doctors and husbands, symptoms, perceived test from God, and personal responsibility to care for one’s health facilitated screening. Barriers were perceived low susceptibility, inconvenience, cost, negative psychological effects, misinformation on mammogram triggering cancer cells, religious beliefs, perceived negative outcomes from mammography and distrust of doctor. From the survey, we found cues from health care professionals and needing symptoms before deciding to go for mammogram to be significantly associated with ever gone for mammogram and regular mammogram. Factors associated with ever gone for mammogram only included age, perceived benefits of saving lives from early detection, perceived importance of mammogram, Punishing Allah Reappraisal, and modesty. Factors associated with regular mammogram only included household income, perceived structural barriers to screening and perceived susceptibility to breast cancer. Conclusions Mammogram uptake is affected by multiple levels of influence. Interventions to promote screening should be designed with multiple stakeholders including doctors, religious leaders and women who had attended screening.

Islamic religion spreading was influenced by the different local traditions among which Sufism, a religious mysticism (tasavvuf) organized under the institutions of tariqa emerged. This was followed by the emergence of as a place where divisions (orders) members were gathered known under names of tekke, zaviye, hankâh, ribat and a dervish lodge. This study elaborates several tekkes established by the Ottomans in the Balkans. Building style of the tekkes varied according to the procedures as well as manners of the order. Tekkes, which have a simple appearance, generally consist of a mosque, semahane, cellar, kitchen, cells, çilehane, selâmlık and harem. However, most of the buildings within the tekke are constructed over a large span of time. The aim of this study is to better understand the spatial setup of this organizational structure, which directly contributed to the conquest in the Balkans through the janissary corps and to the futuwwa (a set of religious and moral vocational norms) through the ahis (religious and moral vocational chamber). For this purpose, the locations of the tekkes and their architectural features, which were established successively one after the other with the conquests, have been analyzed. In final, the architectural typological of the tekkes is obtained according to the belief tradition, positioning, foundation schemes and special plans of the early period structures set within the tekke.

Islamic religion spreading was influenced by the different local traditions among which Sufism, a religious mysticism (tasavvuf) organized under the institutions of tariqa emerged. This was followed by the emergence of as a place where divisions (orders) members were gathered known under names of tekke, zaviye, hankâh, ribat and a dervish lodge. This study elaborates several tekkes established by the Ottomans in the Balkans. Building style of the tekkes varied according to the procedures as well as manners of the order. Tekkes, which have a simple appearance, generally consist of a mosque, semahane, cellar, kitchen, cells, çilehane, selâmlık and harem. However, most of the buildings within the tekke are constructed over a large span of time. The aim of this study is to better understand the spatial setup of this organizational structure, which directly contributed to the conquest in the Balkans through the janissary corps and to the futuwwa (a set of religious and moral vocational norms) through the ahis (religious and moral vocational chamber). For this purpose, the locations of the tekkes and their architectural features, which were established successively one after the other with the conquests, have been analyzed. In final, the architectural typological of the tekkes is obtained according to the belief tradition, positioning, foundation schemes and special plans of the early period structures set within the tekke.

The teaching of the medical career is based on dogmas, as in religions. It is a dogma very rooted the wrong belief that our body obtains the oxygen it contains from the air we breathe. Plants, which do not absorb atmospheric oxygen, expel it but they obtain it from the dissociation of the water molecule through chlorophyll. It is another false belief that the oxygen that plants expel, they do it for the benefit of the animal kingdom, because supposedly said oxygen is absorbed through the pulmonary alveoli into the bloodstream, to distribute it to the cells of the organism, which use it to generate energy by combining it with glucose, something like controlled combustion. However, 95% of biochemical reactions that try to concatenate the combination of this atmospheric oxygen with glucose and the energy our body requires are theoretical. It is not possible to consistently explain that the human body consumes and recycles about 150 kg of ATP daily.

Getting a house of our wishes within our budget in a residential area of our customization is quite a tedious process. In order to overcome this, we have developed a model to get a houses of our interest with religious belief and budget this Implemented model is of linear regression and k nearest neighbor’s algorithm with gradient descent optimization to make an optimal model for predicting house prices using the dataset. Performed feature engineering and selection using lasso and ridge penalties to eliminate features which had little or no impact on the residual sum of squares error. Then exposes Jupyter notebook cells as REST Endpoints to make prediction with new information. Finally, we are trying to send email alert to the concern user to give alert of the house price

The hESC research with recent developments has become one of the most desirable research fields for the scientist. The reason behind such an approach is basically the great potential to treat and cure the human race of very incurable diseases. Countries around the world have amended their policies with regards to stem cells in such a way as to enhance the advantage as the stem cell market is a trillion-dollar market. The research procedure involving patentable invention is time-consuming and requires many expenses, so the investor is always keener to know if they will get any monetary benefit. Though the medical field promises about importance of stem cell and biotechnological research, there are concerns in some countries, such as India, about potential policy implications that would affect the patenting innovations in this industry. As India lacks a coherent legislative policy regarding stem cell patenting, it is creating more confusion for research in stem cell research. Often, researchers do not want to be involved in the said research because India lacks any specific laws in said fields apart from so-called guidelines provided in 2017 with an amendment to Drug and Cosmetic Act in 2019. Patent laws play a vital role in industrial advancement, thus helping a country's economy. To enter the race of development, countries worldwide have developed their patent laws so that they achieve maximum benefits out of it. In India, with patent laws, moral, cultural and religious beliefs also play a vital role in granting a patent, specifically in the Human Embryonic Stem Cell patent. The Article discusses topics that a researcher must be familiar with when discussing patentability issues. A few of these topics include the morality debate, stem cell and biotechnological research, and Stem cell research's patentability. Additionally, this Article identifies the discrepancies between the laws governing stem cell research within India.

Abstract Countries have reported that people's attitudes towards organ donation are influenced by knowledge, education and religion. In Ecuador, more than 800 patients are on the waiting list for an organ; likewise, the population does not recognize the importance of the donation. Although, since 2011, the Organic Law of Donation and Transplantation of Organs, Tissues and Cells states that all Ecuadorians are donors, but still, the high number of people on the waiting list is not well understood. The purpose of this study is to determine the factors towards organ donation of students and lecturers of the Pontifical Catholic University of Ecuador. This is a cross-sectional study, and the universe was the entire population; however, only 469 (students) and 321 (lecturers) answered, despite our efforts. We applied an anonymously validated questionnaire, and we sent it for five months by email. 89.8% of students and lecturers agreed with the donation; however, 10.2% of the students refused, and 14.6% of lecturers were undecided (p &lt; 0.001). The highest hesitation was found in the age group between 36-64 years (14.2%), while the most refusal was found in the young adult, 9.4%. 40.1% of them alluded to have regular knowledge, while 27.9% claimed to have low knowledge about organ donation (p = 0.016). Based on their opinion, 65.9% said that a person with brain death could not recover, although 26.9% did not know (p = 0.023). 38.9% affirmed they did not know if their religions agreed with the donation. 78.5% claimed the best methods could increase the number of donors is education. Public health in Ecuador does not have sufficient regulations through its state policies that should favour recipients. If each citizen knows that their organs save lives, the waiting list will decrease, and state expenditures will reduce. However, the populations' beliefs are still related to an abuse of authority to donate organs without the consent of relatives. Key messages With better strategies to increase awareness of the importance of organ donation, great results. It will increase survival rates, improve quality of life and decrease health expenses.

Abstract Background New disease-modifying ways to treat Parkinson’s disease (PD) may soon become a reality with intracerebral transplantation of cell products produced from human embryonic stem cells (hESCs). The aim of this study was to assess what factors influence preferences of patients with PD regarding stem-cell based therapies to treat PD in the future. Methods Patients with PD were invited to complete a web-based discrete choice experiment to assess the importance of the following attributes: (i) type of treatment, (ii) aim of treatment, (iii) available knowledge of the different types of treatments, (iv) effect on symptoms, and (v) risk for severe side effects. Latent class conditional logistic regression models were used to determine preference estimates and heterogeneity in respondents’ preferences. Results A substantial difference in respondents’ preferences was observed in three latent preference patterns (classes). “Effect on symptoms” was the most important attribute in class 1, closely followed by “type of treatment,” with medications as preferred to other treatment alternatives. Effect on symptoms was also the most important attribute in class 2, with treatment with hESCs preferred over other treatment alternatives. Likewise for class 3, that mainly focused on “type of treatment” in the decision-making. Respondents’ class membership was influenced by their experience in treatment, side effects, and advanced treatment therapy as well as religious beliefs. Conclusions Most of the respondents would accept a treatment with products emanating from hESCs, regardless of views on the moral status of embryos. Preferences of patients with PD may provide guidance in clinical decision-making regarding treatments deriving from stem cells.

Istighathah, on the day before UN, has been a religious culture in SMAN 1 Mojo.This istighathah is supported by various parties ranging from the school, the viceprincipal, the teachers, the UN committee and all UN participants. This existence,for Sufi Psychology, which contains dhikir (remembrance) reading and prayer cannormalize function of neural network systems, cells and organs throughout thebody. In the world of Sufism, istighathah with remembrance has an importantposition in an effort to draw closer to Allah SWT. And this istighathah has becomeroutine annually before the administration of UN. This is because istighathah ashield that can provide encouragement for every human being to be serious intrying and praying and not easily discouraged when facing failure in UN. Theresults of this study are, first, istighathah at SMAN 1 Mojo has become routinebefore UN, either daily or collectively. There is a belief possessed by most studentsof SMAN 1 Mojo that can reduce the anxieties in which the result can producecalmness physically and mentally when they are facing UN.Key words: Istighathah, Students, National Exam

A public manifestation is a showing of passion or feeling, or it might be the exercise of an idea. Although it supernatural is regarded to be a surprise when it becomes real, illumination has its roots in religions and philosophy. All facets of life are now included in the word's usage. This expressing procedure entails compiling a list of gratitude’s. Your outlook improves when you are grateful for what you have. For of this, thanking others is a common manifesting journaling technique. For illustration, I am appreciative of my company's assistance when I learn new abilities at work. Emphasis on exposures, according to specialists, can hurt us faster than it can help. Thinking we have authority over things we don't can negatively alter how we view the universe and oneself. People may feel guilty after missing to communicate change. As an identity technique, manifestation is concentrating your attention on a desired result and making an effort to make it come true through techniques like concentration, visualizing, and meditation. Fundamentally, you believe that you have objectives. All eyes, HIV-negative eyes, HIV-positive eyes, p-value. Evaluation option: Anterior, Intermediate, Posterior, Anterior chamber cells, Pan uveitis. “From the result it is seen that Pan uveitis and is got the first rank whereas is the Anterior chamber cells got is having the lowest rank”. The value of the dataset for Range of manifestation in WSM (Weighted sum model) method shows that it results in Pan uveitis and top ranking

Photo ID 158378414 © Eduard Muzhevskyi | Dreamstime.com ABSTRACT There is a debate about the ethical implications of using human embryos in stem cell research, which can be influenced by cultural, moral, and social values. This paper argues for an adaptable framework to accommodate diverse cultural and religious perspectives. By using an adaptive ethics model, research protections can reflect various populations and foster growth in stem cell research possibilities. INTRODUCTION Stem cell research combines biology, medicine, and technology, promising to alter health care and the understanding of human development. Yet, ethical contention exists because of individuals’ perceptions of using human embryos based on their various cultural, moral, and social values. While these disagreements concerning policy, use, and general acceptance have prompted the development of an international ethics policy, such a uniform approach can overlook the nuanced ethical landscapes between cultures. With diverse viewpoints in public health, a single global policy, especially one reflecting Western ethics or the ethics prevalent in high-income countries, is impractical. This paper argues for a culturally sensitive, adaptable framework for the use of embryonic stem cells. Stem cell policy should accommodate varying ethical viewpoints and promote an effective global dialogue. With an extension of an ethics model that can adapt to various cultures, we recommend localized guidelines that reflect the moral views of the people those guidelines serve. BACKGROUND Stem cells, characterized by their unique ability to differentiate into various cell types, enable the repair or replacement of damaged tissues. Two primary types of stem cells are somatic stem cells (adult stem cells) and embryonic stem cells. Adult stem cells exist in developed tissues and maintain the body’s repair processes.[1] Embryonic stem cells (ESC) are remarkably pluripotent or versatile, making them valuable in research.[2] However, the use of ESCs has sparked ethics debates. Considering the potential of embryonic stem cells, research guidelines are essential. The International Society for Stem Cell Research (ISSCR) provides international stem cell research guidelines. They call for “public conversations touching on the scientific significance as well as the societal and ethical issues raised by ESC research.”[3] The ISSCR also publishes updates about culturing human embryos 14 days post fertilization, suggesting local policies and regulations should continue to evolve as ESC research develops.[4] Like the ISSCR, which calls for local law and policy to adapt to developing stem cell research given cultural acceptance, this paper highlights the importance of local social factors such as religion and culture. I. Global Cultural Perspective of Embryonic Stem Cells Views on ESCs vary throughout the world. Some countries readily embrace stem cell research and therapies, while others have stricter regulations due to ethical concerns surrounding embryonic stem cells and when an embryo becomes entitled to moral consideration. The philosophical issue of when the “someone” begins to be a human after fertilization, in the morally relevant sense,[5] impacts when an embryo becomes not just worthy of protection but morally entitled to it. The process of creating embryonic stem cell lines involves the destruction of the embryos for research.[6] Consequently, global engagement in ESC research depends on social-cultural acceptability. a. US and Rights-Based Cultures In the United States, attitudes toward stem cell therapies are diverse. The ethics and social approaches, which value individualism,[7] trigger debates regarding the destruction of human embryos, creating a complex regulatory environment. For example, the 1996 Dickey-Wicker Amendment prohibited federal funding for the creation of embryos for research and the destruction of embryos for “more than allowed for research on fetuses in utero.”[8] Following suit, in 2001, the Bush Administration heavily restricted stem cell lines for research. However, the Stem Cell Research Enhancement Act of 2005 was proposed to help develop ESC research but was ultimately vetoed.[9] Under the Obama administration, in 2009, an executive order lifted restrictions allowing for more development in this field.[10] The flux of research capacity and funding parallels the different cultural perceptions of human dignity of the embryo and how it is socially presented within the country’s research culture.[11] b. Ubuntu and Collective Cultures African bioethics differs from Western individualism because of the different traditions and values. African traditions, as described by individuals from South Africa and supported by some studies in other African countries, including Ghana and Kenya, follow the African moral philosophies of Ubuntu or Botho and Ukama, which “advocates for a form of wholeness that comes through one’s relationship and connectedness with other people in the society,”[12] making autonomy a socially collective concept. In this context, for the community to act autonomously, individuals would come together to decide what is best for the collective. Thus, stem cell research would require examining the value of the research to society as a whole and the use of the embryos as a collective societal resource. If society views the source as part of the collective whole, and opposes using stem cells, compromising the cultural values to pursue research may cause social detachment and stunt research growth.[13] Based on local culture and moral philosophy, the permissibility of stem cell research depends on how embryo, stem cell, and cell line therapies relate to the community as a whole. Ubuntu is the expression of humanness, with the person’s identity drawn from the “’I am because we are’” value.[14] The decision in a collectivistic culture becomes one born of cultural context, and individual decisions give deference to others in the society. Consent differs in cultures where thought and moral philosophy are based on a collective paradigm. So, applying Western bioethical concepts is unrealistic. For one, Africa is a diverse continent with many countries with different belief systems, access to health care, and reliance on traditional or Western medicines. Where traditional medicine is the primary treatment, the “’restrictive focus on biomedically-related bioethics’” [is] problematic in African contexts because it neglects bioethical issues raised by traditional systems.”[15] No single approach applies in all areas or contexts. Rather than evaluating the permissibility of ESC research according to Western concepts such as the four principles approach, different ethics approaches should prevail. Another consideration is the socio-economic standing of countries. In parts of South Africa, researchers have not focused heavily on contributing to the stem cell discourse, either because it is not considered health care or a health science priority or because resources are unavailable.[16] Each country’s priorities differ given different social, political, and economic factors. In South Africa, for instance, areas such as maternal mortality, non-communicable diseases, telemedicine, and the strength of health systems need improvement and require more focus[17] Stem cell research could benefit the population, but it also could divert resources from basic medical care. Researchers in South Africa adhere to the National Health Act and Medicines Control Act in South Africa and international guidelines; however, the Act is not strictly enforced, and there is no clear legislation for research conduct or ethical guidelines.[18] Some parts of Africa condemn stem cell research. For example, 98.2 percent of the Tunisian population is Muslim.[19] Tunisia does not permit stem cell research because of moral conflict with a Fatwa. Religion heavily saturates the regulation and direction of research.[20] Stem cell use became permissible for reproductive purposes only recently, with tight restrictions preventing cells from being used in any research other than procedures concerning ART/IVF. Their use is conditioned on consent, and available only to married couples.[21] The community's receptiveness to stem cell research depends on including communitarian African ethics. c. Asia Some Asian countries also have a collective model of ethics and decision making.[22] In China, the ethics model promotes a sincere respect for life or human dignity,[23] based on protective medicine. This model, influenced by Traditional Chinese Medicine (TCM), [24] recognizes Qi as the vital energy delivered via the meridians of the body; it connects illness to body systems, the body’s entire constitution, and the universe for a holistic bond of nature, health, and quality of life.[25] Following a protective ethics model, and traditional customs of wholeness, investment in stem cell research is heavily desired for its applications in regenerative therapies, disease modeling, and protective medicines. In a survey of medical students and healthcare practitioners, 30.8 percent considered stem cell research morally unacceptable while 63.5 percent accepted medical research using human embryonic stem cells. Of these individuals, 89.9 percent supported increased funding for stem cell research.[26] The scientific community might not reflect the overall population. From 1997 to 2019, China spent a total of $576 million (USD) on stem cell research at 8,050 stem cell programs, increased published presence from 0.6 percent to 14.01 percent of total global stem cell publications as of 2014, and made significant strides in cell-based therapies for various medical conditions.[27] However, while China has made substantial investments in stem cell research and achieved notable progress in clinical applications, concerns linger regarding ethical oversight and transparency.[28] For example, the China Biosecurity Law, promoted by the National Health Commission and China Hospital Association, attempted to mitigate risks by introducing an institutional review board (IRB) in the regulatory bodies. 5800 IRBs registered with the Chinese Clinical Trial Registry since 2021.[29] However, issues still need to be addressed in implementing effective IRB review and approval procedures. The substantial government funding and focus on scientific advancement have sometimes overshadowed considerations of regional cultures, ethnic minorities, and individual perspectives, particularly evident during the one-child policy era. As government policy adapts to promote public stability, such as the change from the one-child to the two-child policy,[30] research ethics should also adapt to ensure respect for the values of its represented peoples. Japan is also relatively supportive of stem cell research and therapies. Japan has a more transparent regulatory framework, allowing for faster approval of regenerative medicine products, which has led to several advanced clinical trials and therapies.[31] South Korea is also actively engaged in stem cell research and has a history of breakthroughs in cloning and embryonic stem cells.[32] However, the field is controversial, and there are issues of scientific integrity. For example, the Korean FDA fast-tracked products for approval,[33] and in another instance, the oocyte source was unclear and possibly violated ethical standards.[34] Trust is important in research, as it builds collaborative foundations between colleagues, trial participant comfort, open-mindedness for complicated and sensitive discussions, and supports regulatory procedures for stakeholders. There is a need to respect the culture’s interest, engagement, and for research and clinical trials to be transparent and have ethical oversight to promote global research discourse and trust. d. Middle East Countries in the Middle East have varying degrees of acceptance of or restrictions to policies related to using embryonic stem cells due to cultural and religious influences. Saudi Arabia has made significant contributions to stem cell research, and conducts research based on international guidelines for ethical conduct and under strict adherence to guidelines in accordance with Islamic principles. Specifically, the Saudi government and people require ESC research to adhere to Sharia law. In addition to umbilical and placental stem cells,[35] Saudi Arabia permits the use of embryonic stem cells as long as they come from miscarriages, therapeutic abortions permissible by Sharia law, or are left over from in vitro fertilization and donated to research.[36] Laws and ethical guidelines for stem cell research allow the development of research institutions such as the King Abdullah International Medical Research Center, which has a cord blood bank and a stem cell registry with nearly 10,000 donors.[37] Such volume and acceptance are due to the ethical ‘permissibility’ of the donor sources, which do not conflict with religious pillars. However, some researchers err on the side of caution, choosing not to use embryos or fetal tissue as they feel it is unethical to do so.[38] Jordan has a positive research ethics culture.[39] However, there is a significant issue of lack of trust in researchers, with 45.23 percent (38.66 percent agreeing and 6.57 percent strongly agreeing) of Jordanians holding a low level of trust in researchers, compared to 81.34 percent of Jordanians agreeing that they feel safe to participate in a research trial.[40] Safety testifies to the feeling of confidence that adequate measures are in place to protect participants from harm, whereas trust in researchers could represent the confidence in researchers to act in the participants’ best interests, adhere to ethical guidelines, provide accurate information, and respect participants’ rights and dignity. One method to improve trust would be to address communication issues relevant to ESC. Legislation surrounding stem cell research has adopted specific language, especially concerning clarification “between ‘stem cells’ and ‘embryonic stem cells’” in translation.[41] Furthermore, legislation “mandates the creation of a national committee… laying out specific regulations for stem-cell banking in accordance with international standards.”[42] This broad regulation opens the door for future global engagement and maintains transparency. However, these regulations may also constrain the influence of research direction, pace, and accessibility of research outcomes. e. Europe In the European Union (EU), ethics is also principle-based, but the principles of autonomy, dignity, integrity, and vulnerability are interconnected.[43] As such, the opportunity for cohesion and concessions between individuals’ thoughts and ideals allows for a more adaptable ethics model due to the flexible principles that relate to the human experience The EU has put forth a framework in its Convention for the Protection of Human Rights and Dignity of the Human Being allowing member states to take different approaches. Each European state applies these principles to its specific conventions, leading to or reflecting different acceptance levels of stem cell research. [44] For example, in Germany, Lebenzusammenhang, or the coherence of life, references integrity in the unity of human culture. Namely, the personal sphere “should not be subject to external intervention.”[45] Stem cell interventions could affect this concept of bodily completeness, leading to heavy restrictions. Under the Grundgesetz, human dignity and the right to life with physical integrity are paramount.[46] The Embryo Protection Act of 1991 made producing cell lines illegal. Cell lines can be imported if approved by the Central Ethics Commission for Stem Cell Research only if they were derived before May 2007.[47] Stem cell research respects the integrity of life for the embryo with heavy specifications and intense oversight. This is vastly different in Finland, where the regulatory bodies find research more permissible in IVF excess, but only up to 14 days after fertilization.[48] Spain’s approach differs still, with a comprehensive regulatory framework.[49] Thus, research regulation can be culture-specific due to variations in applied principles. Diverse cultures call for various approaches to ethical permissibility.[50] Only an adaptive-deliberative model can address the cultural constructions of self and achieve positive, culturally sensitive stem cell research practices.[51] II. Religious Perspectives on ESC Embryonic stem cell sources are the main consideration within religious contexts. While individuals may not regard their own religious texts as authoritative or factual, religion can shape their foundations or perspectives. The Qur'an states: “And indeed We created man from a quintessence of clay. Then We placed within him a small quantity of nutfa (sperm to fertilize) in a safe place. Then We have fashioned the nutfa into an ‘alaqa (clinging clot or cell cluster), then We developed the ‘alaqa into mudgha (a lump of flesh), and We made mudgha into bones, and clothed the bones with flesh, then We brought it into being as a new creation. So Blessed is Allah, the Best of Creators.”[52] Many scholars of Islam estimate the time of soul installment, marked by the angel breathing in the soul to bring the individual into creation, as 120 days from conception.[53] Personhood begins at this point, and the value of life would prohibit research or experimentation that could harm the individual. If the fetus is more than 120 days old, the time ensoulment is interpreted to occur according to Islamic law, abortion is no longer permissible.[54] There are a few opposing opinions about early embryos in Islamic traditions. According to some Islamic theologians, there is no ensoulment of the early embryo, which is the source of stem cells for ESC research.[55] In Buddhism, the stance on stem cell research is not settled. The main tenets, the prohibition against harming or destroying others (ahimsa) and the pursuit of knowledge (prajña) and compassion (karuna), leave Buddhist scholars and communities divided.[56] Some scholars argue stem cell research is in accordance with the Buddhist tenet of seeking knowledge and ending human suffering. Others feel it violates the principle of not harming others. Finding the balance between these two points relies on the karmic burden of Buddhist morality. In trying to prevent ahimsa towards the embryo, Buddhist scholars suggest that to comply with Buddhist tenets, research cannot be done as the embryo has personhood at the moment of conception and would reincarnate immediately, harming the individual's ability to build their karmic burden.[57] On the other hand, the Bodhisattvas, those considered to be on the path to enlightenment or Nirvana, have given organs and flesh to others to help alleviate grieving and to benefit all.[58] Acceptance varies on applied beliefs and interpretations. Catholicism does not support embryonic stem cell research, as it entails creation or destruction of human embryos. This destruction conflicts with the belief in the sanctity of life. For example, in the Old Testament, Genesis describes humanity as being created in God’s image and multiplying on the Earth, referencing the sacred rights to human conception and the purpose of development and life. In the Ten Commandments, the tenet that one should not kill has numerous interpretations where killing could mean murder or shedding of the sanctity of life, demonstrating the high value of human personhood. In other books, the theological conception of when life begins is interpreted as in utero,[59] highlighting the inviolability of life and its formation in vivo to make a religious point for accepting such research as relatively limited, if at all.[60] The Vatican has released ethical directives to help apply a theological basis to modern-day conflicts. The Magisterium of the Church states that “unless there is a moral certainty of not causing harm,” experimentation on fetuses, fertilized cells, stem cells, or embryos constitutes a crime.[61] Such procedures would not respect the human person who exists at these stages, according to Catholicism. Damages to the embryo are considered gravely immoral and illicit.[62] Although the Catholic Church officially opposes abortion, surveys demonstrate that many Catholic people hold pro-choice views, whether due to the context of conception, stage of pregnancy, threat to the mother’s life, or for other reasons, demonstrating that practicing members can also accept some but not all tenets.[63] Some major Jewish denominations, such as the Reform, Conservative, and Reconstructionist movements, are open to supporting ESC use or research as long as it is for saving a life.[64] Within Judaism, the Talmud, or study, gives personhood to the child at birth and emphasizes that life does not begin at conception:[65] “If she is found pregnant, until the fortieth day it is mere fluid,”[66] Whereas most religions prioritize the status of human embryos, the Halakah (Jewish religious law) states that to save one life, most other religious laws can be ignored because it is in pursuit of preservation.[67] Stem cell research is accepted due to application of these religious laws. We recognize that all religions contain subsets and sects. The variety of environmental and cultural differences within religious groups requires further analysis to respect the flexibility of religious thoughts and practices. We make no presumptions that all cultures require notions of autonomy or morality as under the common morality theory, which asserts a set of universal moral norms that all individuals share provides moral reasoning and guides ethical decisions.[68] We only wish to show that the interaction with morality varies between cultures and countries. III. A Flexible Ethical Approach The plurality of different moral approaches described above demonstrates that there can be no universally acceptable uniform law for ESC on a global scale. Instead of developing one standard, flexible ethical applications must be continued. We recommend local guidelines that incorporate important cultural and ethical priorities. While the Declaration of Helsinki is more relevant to people in clinical trials receiving ESC products, in keeping with the tradition of protections for research subjects, consent of the donor is an ethical requirement for ESC donation in many jurisdictions including the US, Canada, and Europe.[69] The Declaration of Helsinki provides a reference point for regulatory standards and could potentially be used as a universal baseline for obtaining consent prior to gamete or embryo donation. For instance, in Columbia University’s egg donor program for stem cell research, donors followed standard screening protocols and “underwent counseling sessions that included information as to the purpose of oocyte donation for research, what the oocytes would be used for, the risks and benefits of donation, and process of oocyte stimulation” to ensure transparency for consent.[70] The program helped advance stem cell research and provided clear and safe research methods with paid participants. Though paid participation or covering costs of incidental expenses may not be socially acceptable in every culture or context,[71] and creating embryos for ESC research is illegal in many jurisdictions, Columbia’s program was effective because of the clear and honest communications with donors, IRBs, and related stakeholders. This example demonstrates that cultural acceptance of scientific research and of the idea that an egg or embryo does not have personhood is likely behind societal acceptance of donating eggs for ESC research. As noted, many countries do not permit the creation of embryos for research. Proper communication and education regarding the process and purpose of stem cell research may bolster comprehension and garner more acceptance. “Given the sensitive subject material, a complete consent process can support voluntary participation through trust, understanding, and ethical norms from the cultures and morals participants value. This can be hard for researchers entering countries of different socioeconomic stability, with different languages and different societal values.[72] An adequate moral foundation in medical ethics is derived from the cultural and religious basis that informs knowledge and actions.[73] Understanding local cultural and religious values and their impact on research could help researchers develop humility and promote inclusion. IV. Concerns Some may argue that if researchers all adhere to one ethics standard, protection will be satisfied across all borders, and the global public will trust researchers. However, defining what needs to be protected and how to define such research standards is very specific to the people to which standards are applied. We suggest that applying one uniform guide cannot accurately protect each individual because we all possess our own perceptions and interpretations of social values.[74] Therefore, the issue of not adjusting to the moral pluralism between peoples in applying one standard of ethics can be resolved by building out ethics models that can be adapted to different cultures and religions. Other concerns include medical tourism, which may promote health inequities.[75] Some countries may develop and approve products derived from ESC research before others, compromising research ethics or drug approval processes. There are also concerns about the sale of unauthorized stem cell treatments, for example, those without FDA approval in the United States. Countries with robust research infrastructures may be tempted to attract medical tourists, and some customers will have false hopes based on aggressive publicity of unproven treatments.[76] For example, in China, stem cell clinics can market to foreign clients who are not protected under the regulatory regimes. Companies employ a marketing strategy of “ethically friendly” therapies. Specifically, in the case of Beike, China’s leading stem cell tourism company and sprouting network, ethical oversight of administrators or health bureaus at one site has “the unintended consequence of shifting questionable activities to another node in Beike's diffuse network.”[77] In contrast, Jordan is aware of stem cell research’s potential abuse and its own status as a “health-care hub.” Jordan’s expanded regulations include preserving the interests of individuals in clinical trials and banning private companies from ESC research to preserve transparency and the integrity of research practices.[78] The social priorities of the community are also a concern. The ISSCR explicitly states that guidelines “should be periodically revised to accommodate scientific advances, new challenges, and evolving social priorities.”[79] The adaptable ethics model extends this consideration further by addressing whether research is warranted given the varying degrees of socioeconomic conditions, political stability, and healthcare accessibilities and limitations. An ethical approach would require discussion about resource allocation and appropriate distribution of funds.[80] CONCLUSION While some religions emphasize the sanctity of life from conception, which may lead to public opposition to ESC research, others encourage ESC research due to its potential for healing and alleviating human pain. Many countries have special regulations that balance local views on embryonic personhood, the benefits of research as individual or societal goods, and the protection of human research subjects. To foster understanding and constructive dialogue, global policy frameworks should prioritize the protection of universal human rights, transparency, and informed consent. In addition to these foundational global policies, we recommend tailoring local guidelines to reflect the diverse cultural and religious perspectives of the populations they govern. Ethics models should be adapted to local populations to effectively establish research protections, growth, and possibilities of stem cell research. For example, in countries with strong beliefs in the moral sanctity of embryos or heavy religious restrictions, an adaptive model can allow for discussion instead of immediate rejection. In countries with limited individual rights and voice in science policy, an adaptive model ensures cultural, moral, and religious views are taken into consideration, thereby building social inclusion. While this ethical consideration by the government may not give a complete voice to every individual, it will help balance policies and maintain the diverse perspectives of those it affects. Embracing an adaptive ethics model of ESC research promotes open-minded dialogue and respect for the importance of human belief and tradition. By actively engaging with cultural and religious values, researchers can better handle disagreements and promote ethical research practices that benefit each society. This brief exploration of the religious and cultural differences that impact ESC research reveals the nuances of relative ethics and highlights a need for local policymakers to apply a more intense adaptive model. - [1] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice. Orthopedic reviews, 14(3), 37498. https://doi.org/10.52965/001c.37498 [2] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice. Orthopedic reviews, 14(3), 37498. https://doi.org/10.52965/001c.37498 [3] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities. International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk; Kimmelman, J., Hyun, I., Benvenisty, N. et al. Policy: Global standards for stem-cell research. Nature 533, 311–313 (2016). https://doi.org/10.1038/533311a [4] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities. International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk [5] Concerning the moral philosophies of stem cell research, our paper does not posit a personal moral stance nor delve into the “when” of human life begins. To read further about the philosophical debate, consider the following sources: Sandel M. J. (2004). Embryo ethics--the moral logic of stem-cell research. The New England journal of medicine, 351(3), 207–209. https://doi.org/10.1056/NEJMp048145; George, R. P., & Lee, P. (2020, September 26). Acorns and Embryos. The New Atlantis. https://www.thenewatlantis.com/publications/acorns-and-embryos; Sagan, A., & Singer, P. (2007). The moral status of stem cells. Metaphilosophy, 38(2/3), 264–284. http://www.jstor.org/stable/24439776; McHugh P. R. (2004). Zygote and "clonote"--the ethical use of embryonic stem cells. The New England journal of medicine, 351(3), 209–211. https://doi.org/10.1056/NEJMp048147; Kurjak, A., & Tripalo, A. (2004). The facts and doubts about beginning of the human life and personality. Bosnian journal of basic medical sciences, 4(1), 5–14. https://doi.org/10.17305/bjbms.2004.3453 [6] Vazin, T., & Freed, W. J. (2010). Human embryonic stem cells: derivation, culture, and differentiation: a review. Restorative neurology and neuroscience, 28(4), 589–603. https://doi.org/10.3233/RNN-2010-0543 [7] Socially, at its core, the Western approach to ethics is widely principle-based, autonomy being one of the key factors to ensure a fundamental respect for persons within research. For information regarding autonomy in research, see: Department of Health, Education, and Welfare, & National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1978). The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research.; For a more in-depth review of autonomy within the US, see: Beauchamp, T. L., & Childress, J. F. (1994). Principles of Biomedical Ethics. Oxford University Press. [8] Sherley v. Sebelius, 644 F.3d 388 (D.C. Cir. 2011), citing 45 C.F.R. 46.204(b) and [42 U.S.C. § 289g(b)]. https://www.cadc.uscourts.gov/internet/opinions.nsf/6c690438a9b43dd685257a64004ebf99/$file/11-5241-1391178.pdf [9] Stem Cell Research Enhancement Act of 2005, H. R. 810, 109th Cong. (2001). https://www.govtrack.us/congress/bills/109/hr810/text; Bush, G. W. (2006, July 19). Message to the House of Representatives. National Archives and Records Administration. https://georgewbush-whitehouse.archives.gov/news/releases/2006/07/20060719-5.html [10] National Archives and Records Administration. (2009, March 9). Executive order 13505 -- removing barriers to responsible scientific research involving human stem cells. National Archives and Records Administration. https://obamawhitehouse.archives.gov/the-press-office/removing-barriers-responsible-scientific-research-involving-human-stem-cells [11] Hurlbut, W. B. (2006). Science, Religion, and the Politics of Stem Cells. Social Research, 73(3), 819–834. http://www.jstor.org/stable/40971854 [12] Akpa-Inyang, Francis & Chima, Sylvester. (2021). South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study. BMC Medical Ethics. 22. 10.1186/s12910-021-00678-4. [13] Source for further reading: Tangwa G. B. (2007). Moral status of embryonic stem cells: perspective of an African villager. Bioethics, 21(8), 449–457. https://doi.org/10.1111/j.1467-8519.2007.00582.x , see also Mnisi, F. M. (2020). An African analysis based on ethics of Ubuntu - are human embryonic stem cell patents morally justifiable? African Insight, 49(4). [14] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324 [15] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324 [16] Jackson, C.S., Pepper, M.S. Opportunities and barriers to establishing a cell therapy programme in South Africa. Stem Cell Res Ther 4, 54 (2013). https://doi.org/10.1186/scrt204; Pew Research Center. (2014, May 1). Public health a major priority in African nations. Pew Research Center’s Global Attitudes Project. https://www.pewresearch.org/global/2014/05/01/public-health-a-major-priority-in-african-nations/ [17] Department of Health Republic of South Africa. (2021). Health Research Priorities (revised) for South Africa 2021-2024. National Health Research Strategy. https://www.health.gov.za/wp-content/uploads/2022/05/National-Health-Research-Priorities-2021-2024.pdf [18] Oosthuizen, H. (2013). Legal and Ethical Issues in Stem Cell Research in South Africa. In: Beran, R. (eds) Legal and Forensic Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32338-6_80, see also: Gaobotse G (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [19] United States Bureau of Citizenship and Immigration Services. (1998). Tunisia: Information on the status of Christian conversions in Tunisia. UNHCR Web Archive. https://webarchive.archive.unhcr.org/20230522142618/https://www.refworld.org/docid/3df0be9a2.html [20] Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [21] Kooli, C. Review of assisted reproduction techniques, laws, and regulations in Muslim countries. Middle East Fertil Soc J 24, 8 (2020). https://doi.org/10.1186/s43043-019-0011-0; Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [22] Pang M. C. (1999). Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. Journal of medical ethics, 25(3), 247–253. https://doi.org/10.1136/jme.25.3.247 [23] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences, 8(1). https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199 [24] Wang, Y., Xue, Y., & Guo, H. D. (2022). Intervention effects of traditional Chinese medicine on stem cell therapy of myocardial infarction. Frontiers in pharmacology, 13, 1013740. https://doi.org/10.3389/fphar.2022.1013740 [25] Li, X.-T., & Zhao, J. (2012). Chapter 4: An Approach to the Nature of Qi in TCM- Qi and Bioenergy. In Recent Advances in Theories and Practice of Chinese Medicine (p. 79). InTech. [26] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students. Stem cells international, 2021, 6667743. https://doi.org/10.1155/2021/6667743 [27] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students. Stem cells international, 2021, 6667743. https://doi.org/10.1155/2021/6667743 [28] Zhang, J. Y. (2017). Lost in translation? accountability and governance of Clinical Stem Cell Research in China. Regenerative Medicine, 12(6), 647–656. https://doi.org/10.2217/rme-2017-0035 [29] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences, 8(1). https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199 [30] Chen, H., Wei, T., Wang, H. et al. Association of China’s two-child policy with changes in number of births and birth defects rate, 2008–2017. BMC Public Health 22, 434 (2022). https://doi.org/10.1186/s12889-022-12839-0 [31] Azuma, K. Regulatory Landscape of Regenerative Medicine in Japan. Curr Stem Cell Rep 1, 118–128 (2015). https://doi.org/10.1007/s40778-015-0012-6 [32] Harris, R. (2005, May 19). Researchers Report Advance in Stem Cell Production. NPR. https://www.npr.org/2005/05/19/4658967/researchers-report-advance-in-stem-cell-production [33] Park, S. (2012). South Korea steps up stem-cell work. Nature. https://doi.org/10.1038/nature.2012.10565 [34] Resnik, D. B., Shamoo, A. E., & Krimsky, S. (2006). Fraudulent human embryonic stem cell research in South Korea: lessons learned. Accountability in research, 13(1), 101–109. https://doi.org/10.1080/08989620600634193. [35] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 [36]Association for the Advancement of Blood and Biotherapies. https://www.aabb.org/regulatory-and-advocacy/regulatory-affairs/regulatory-for-cellular-therapies/international-competent-authorities/saudi-arabia [37] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 [38] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 Culturally, autonomy practices follow a relational autonomy approach based on a paternalistic deontological health care model. The adherence to strict international research policies and religious pillars within the regulatory environment is a great foundation for research ethics. However, there is a need to develop locally targeted ethics approaches for research (as called for in Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6), this decision-making approach may help advise a research decision model. For more on the clinical cultural autonomy approaches, see: Alabdullah, Y. Y., Alzaid, E., Alsaad, S., Alamri, T., Alolayan, S. W., Bah, S., & Aljoudi, A. S. (2022). Autonomy and paternalism in Shared decision‐making in a Saudi Arabian tertiary hospital: A cross‐sectional study. Developing World Bioethics, 23(3), 260–268. https://doi.org/10.1111/dewb.12355; Bukhari, A. A. (2017). Universal Principles of Bioethics and Patient Rights in Saudi Arabia (Doctoral dissertation, Duquesne University). https://dsc.duq.edu/etd/124; Ladha, S., Nakshawani, S. A., Alzaidy, A., & Tarab, B. (2023, October 26). Islam and Bioethics: What We All Need to Know. Columbia University School of Professional Studies. https://sps.columbia.edu/events/islam-and-bioethics-what-we-all-need-know [39] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics. Research Ethics, 17(2), 228-241. https://doi.org/10.1177/1747016120966779 [40] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics. Research Ethics, 17(2), 228-241. https://doi.org/10.1177/1747016120966779 [41] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [42] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [43] The EU’s definition of autonomy relates to the capacity for creating ideas, moral insight, decisions, and actions without constraint, personal responsibility, and informed consent. However, the EU views autonomy as not completely able to protect individuals and depends on other principles, such as dignity, which “expresses the intrinsic worth and fundamental equality of all human beings.” Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3 [44] Council of Europe. Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164) https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164 (forbidding the creation of embryos for research purposes only, and suggests embryos in vitro have protections.); Also see Drabiak-Syed B. K. (2013). New President, New Human Embryonic Stem Cell Research Policy: Comparative International Perspectives and Embryonic Stem Cell Research Laws in France. Biotechnology Law Report, 32(6), 349–356. https://doi.org/10.1089/blr.2013.9865 [45] Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3 [46] Tomuschat, C., Currie, D. P., Kommers, D. P., & Kerr, R. (Trans.). (1949, May 23). Basic law for the Federal Republic of Germany. https://www.btg-bestellservice.de/pdf/80201000.pdf [47] Regulation of Stem Cell Research in Germany. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-germany [48] Regulation of Stem Cell Research in Finland. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-finland [49] Regulation of Stem Cell Research in Spain. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-spain [50] Some sources to consider regarding ethics models or regulatory oversights of other cultures not covered: Kara MA. Applicability of the principle of respect for autonomy: the perspective of Turkey. J Med Ethics. 2007 Nov;33(11):627-30. doi: 10.1136/jme.2006.017400. PMID: 17971462; PMCID: PMC2598110. Ugarte, O. N., & Acioly, M. A. (2014). The principle of autonomy in Brazil: one needs to discuss it ... Revista do Colegio Brasileiro de Cirurgioes, 41(5), 374–377. https://doi.org/10.1590/0100-69912014005013 Bharadwaj, A., & Glasner, P. E. (2012). Local cells, global science: The rise of embryonic stem cell research in India. Routledge. For further research on specific European countries regarding ethical and regulatory framework, we recommend this database: Regulation of Stem Cell Research in Europe. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-europe [51] Klitzman, R. (2006). Complications of culture in obtaining informed consent. The American Journal of Bioethics, 6(1), 20–21. https://doi.org/10.1080/15265160500394671 see also: Ekmekci, P. E., & Arda, B. (2017). Interculturalism and Informed Consent: Respecting Cultural Differences without Breaching Human Rights. Cultura (Iasi, Romania), 14(2), 159–172.; For why trust is important in research, see also: Gray, B., Hilder, J., Macdonald, L., Tester, R., Dowell, A., & Stubbe, M. (2017). Are research ethics guidelines culturally competent? Research Ethics, 13(1), 23-41. https://doi.org/10.1177/1747016116650235 [52] The Qur'an (M. Khattab, Trans.). (1965). Al-Mu’minun, 23: 12-14. https://quran.com/23 [53] Lenfest, Y. (2017, December 8). Islam and the beginning of human life. Bill of Health. https://blog.petrieflom.law.harvard.edu/2017/12/08/islam-and-the-beginning-of-human-life/ [54] Aksoy, S. (2005). Making regulations and drawing up legislation in Islamic countries under conditions of uncertainty, with special reference to embryonic stem cell research. Journal of Medical Ethics, 31:399-403.; see also: Mahmoud, Azza. "Islamic Bioethics: National Regulations and Guidelines of Human Stem Cell Research in the Muslim World." Master's thesis, Chapman University, 2022. https://doi.org/10.36837/ chapman.000386 [55] Rashid, R. (2022). When does Ensoulment occur in the Human Foetus. Journal of the British Islamic Medical Association, 12(4). ISSN 2634 8071. https://www.jbima.com/wp-content/uploads/2023/01/2-Ethics-3_-Ensoulment_Rafaqat.pdf. [56] Sivaraman, M. & Noor, S. (2017). Ethics of embryonic stem cell research according to Buddhist, Hindu, Catholic, and Islamic religions: perspective from Malaysia. Asian Biomedicine,8(1) 43-52. https://doi.org/10.5372/1905-7415.0801.260 [57] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [58] Lecso, P. A. (1991). The Bodhisattva Ideal and Organ Transplantation. Journal of Religion and Health, 30(1), 35–41. http://www.jstor.org/stable/27510629; Bodhisattva, S. (n.d.). The Key of Becoming a Bodhisattva. A Guide to the Bodhisattva Way of Life. http://www.buddhism.org/Sutras/2/BodhisattvaWay.htm [59] There is no explicit religious reference to when life begins or how to conduct research that interacts with the concept of life. However, these are relevant verses pertaining to how the fetus is viewed. ((King James Bible. (1999). Oxford University Press. (original work published 1769)) Jerimiah 1: 5 “Before I formed thee in the belly I knew thee; and before thou camest forth out of the womb I sanctified thee…” In prophet Jerimiah’s insight, God set him apart as a person known before childbirth, a theme carried within the Psalm of David. Psalm 139: 13-14 “…Thou hast covered me in my mother's womb. I will praise thee; for I am fearfully and wonderfully made…” These verses demonstrate David’s respect for God as an entity that would know of all man’s thoughts and doings even before birth. [60] It should be noted that abortion is not supported as well. [61] The Vatican. (1987, February 22). Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation Replies to Certain Questions of the Day. Congregation For the Doctrine of the Faith. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html [62] The Vatican. (2000, August 25). Declaration On the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells. Pontifical Academy for Life. https://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/rc_pa_acdlife_doc_20000824_cellule-staminali_en.html; Ohara, N. (2003). Ethical Consideration of Experimentation Using Living Human Embryos: The Catholic Church’s Position on Human Embryonic Stem Cell Research and Human Cloning. Department of Obstetrics and Gynecology. Retrieved from https://article.imrpress.com/journal/CEOG/30/2-3/pii/2003018/77-81.pdf. [63] Smith, G. A. (2022, May 23). Like Americans overall, Catholics vary in their abortion views, with regular mass attenders most opposed. Pew Research Center. https://www.pewresearch.org/short-reads/2022/05/23/like-americans-overall-catholics-vary-in-their-abortion-views-with-regular-mass-attenders-most-opposed/ [64] Rosner, F., & Reichman, E. (2002). Embryonic stem cell research in Jewish law. Journal of halacha and contemporary society, (43), 49–68.; Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [65] Schenker J. G. (2008). The beginning of human life: status of embryo. Perspectives in Halakha (Jewish Religious Law). Journal of assisted reproduction and genetics, 25(6), 271–276. https://doi.org/10.1007/s10815-008-9221-6 [66] Ruttenberg, D. (2020, May 5). The Torah of Abortion Justice (annotated source sheet). Sefaria. https://www.sefaria.org/sheets/234926.7?lang=bi&with=all&lang2=en [67] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [68] Gert, B. (2007). Common morality: Deciding what to do. Oxford Univ. Press. [69] World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 Declaration of Helsinki – WMA – The World Medical Association.; see also: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. U.S. Department of Health and Human Services. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html [70] Zakarin Safier, L., Gumer, A., Kline, M., Egli, D., & Sauer, M. V. (2018). Compensating human subjects providing oocytes for stem cell research: 9-year experience and outcomes. Journal of assisted reproduction and genetics, 35(7), 1219–1225. https://doi.org/10.1007/s10815-018-1171-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063839/ see also: Riordan, N. H., & Paz Rodríguez, J. (2021). Addressing concerns regarding associated costs, transparency, and integrity of research in recent stem cell trial. Stem Cells Translational Medicine, 10(12), 1715–1716. https://doi.org/10.1002/sctm.21-0234 [71] Klitzman, R., & Sauer, M. V. (2009). Payment of egg donors in stem cell research in the USA. Reproductive biomedicine online, 18(5), 603–608. https://doi.org/10.1016/s1472-6483(10)60002-8 [72] Krosin, M. T., Klitzman, R., Levin, B., Cheng, J., & Ranney, M. L. (2006). Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa. Clinical trials (London, England), 3(3), 306–313. https://doi.org/10.1191/1740774506cn150oa [73] Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. Georgetown University Press, 2012. [74] Msoroka, M. S., & Amundsen, D. (2018). One size fits not quite all: Universal research ethics with diversity. Research Ethics, 14(3), 1-17. https://doi.org/10.1177/1747016117739939 [75] Pirzada, N. (2022). The Expansion of Turkey’s Medical Tourism Industry. Voices in Bioethics, 8. https://doi.org/10.52214/vib.v8i.9894 [76] Stem Cell Tourism: False Hope for Real Money. Harvard Stem Cell Institute (HSCI). (2023). https://hsci.harvard.edu/stem-cell-tourism, See also: Bissassar, M. (2017). Transnational Stem Cell Tourism: An ethical analysis. Voices in Bioethics, 3. https://doi.org/10.7916/vib.v3i.6027 [77]Song, P. (2011) The proliferation of stem cell therapies in post-Mao China: problematizing ethical regulation, New Genetics and Society, 30:2, 141-153, DOI: 10.1080/14636778.2011.574375 [78] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [79] International Society for Stem Cell Research. (2024). Standards in stem cell research. International Society for Stem Cell Research. https://www.isscr.org/guidelines/5-standards-in-stem-cell-research [80] Benjamin, R. (2013). People’s science bodies and rights on the Stem Cell Frontier. Stanford University Press.

Abstract The need for standard surgical resection in esophageal cancer patients after neoadjuvant chemoradiotherapy (nCRT) is subject of debate. Possibly, active surveillance (AS) is an option for patients with a clinically complete response (cCR), in whom no vital tumor cells are detected after nCRT. In a large Dutch multicenter randomized trial (SANO trial), standard surgery is compared to AS in patients with a cCR. Within this trial, we performed a side-study on patient treatment preferences. Methods Esophageal cancer patients, who declined participation in the SANO-trial due to a strong treatment preference for either AS or surgery were included. In-depth interviews were held on patient’s motives for their treatment choice. First, personal motives were addressed in an open manner, and later specific topics were addressed: earlier experiences with illness and health care, future health expectations, emotional motives, religious or spiritual believes and values in life. Data was recorded, transcribed verbatim and qualitatively analyzed according to the grounded theory principles. In addition, questionnaires on health literacy, coping, anxiety and decision regret were administered at two time points. Results Forty patients participated: twenty preferred AS and twenty standard surgery. The central principle for all patients is striving for safety while dealing with the threat of cancer. However, patients express different coping strategies in dealing with this threat. Patients preferring AS rely on trusting their bodies and good outcomes, while questioning the need for surgery. Patients preferring surgery try to minimize insecurity by eliminating the source of the cancer, while arguing that chances for undergoing surgery are high anyway. Interestingly, for either treatment option comparable arguments were used, with the most striking one of wishing ‘not to become a patient’. Conclusion Patients’ preferences in the treatment of esophageal cancer are determined by the way they cope with the threat of cancer. Since the arguments given for either AS or standard surgery can be comparable or even similar, the need for healthcare professionals to discuss what truly matters to their patients is of high importance. Subsequently, attuning to the personal needs of esophageal cancer patients will benefit the decision making process on future treatment.

Over the past 35 years, an epidemic in diabetes has caused a spike in health and cardiovascular complications worldwide, impacting especially our most vulnerable populations. An accumulation of lipids in cells plays an important role in the development of Type 2 Diabetes (T2D), a chronic condition that affects the way the body processes blood sugar. The pathology of T2D is marked by an increased deposition of lipids with subsequent decreases in insulin sensitivity. This lipid-induced hepatic insulin resistance, however, is difficult to target because the molecular mechanisms regarding the pathogenesis of T2D have remained elusive. Despite this, there is reason to believe that Indole-3 carbinol (I3C),which regulates the expression and activity of enzymes involved in the metabolism and elimination process of organic compounds, may therefore provide a valuable therapeutic strategy against the lipid accumulation associated with T2D. This study investigates the effect of the antioxidant I3C as a prospective novel treatment to reduce lipid accumulation, thus countering the progression of T2D. The purpose of this study was to test if exposing a model organism to varying amounts of I3C would lead to a decrease in lipid levels. Using transgenic Caenorhabditis elegans (Strain LIU1) to model T2D, this study found a correlation between an I3C high diet and decreased lipid accumulation, suggesting that it may be an effective treatment.

It's the beginning of 2000 and the 21st century is all mapped out. Since we've just had that time at the end of a decade (not to mention the end of the century, as well as the Christian calendar "millennium"), when all the pundits came out to review where we had been and forecast where we are going, we should have expected a profundity of future-casting. But neither the familiar prognostications of the coming apocalypse spewing forth from the Religious Right, nor the usual statistical projections made by "experts" on such things as population growth, world politics, economic cycles, new products and shifting job markets, etc. will provide any help in reading the map we have already drawn up, or translating the directional signs. The future is now. It occupies the same domain as the past. Both are inhabitants of the present moment. History, memory, desire, imagination, the creative instinct, and the impetus to act, unfold and are realised as the future becomes the present. We cannot help but tinker with the universe. The future is what we make it and there are an infinite number of possible timelines. Or maybe not. It's the beginning of 2000 and the 21st century is all mapped out. The Human Genome Project1 is about to decode our physiology. We are preparing for the next evolution of the species. The battle between the cyberneticists and the geneticists for a new and improved version of homo sapiens version 3.0 has just begun. The question of where it will lead is open-ended. Will the insatiable quest for self-improvement lead to enlightenment -- a world with less suffering, hunger, disease, violence, and greed? Or, will we be the makers of our own extinction, and end up as a version of Star Trek's Borg -- the ultimate consumers, assimilating automatons devouring everything they encounter, and utterly devoid of the qualities that make us human? As an example of a hypothetical biological and social future the Borg are an interesting model -- a synthesis of a utopian socialist dream and the capitalist imperative of acquisition in the information age. As organic/cybernetic humanoid machines with one unified mind, equal and undifferentiated, untroubled by ego or id, individual ambitions, desires or passions, loneliness, alienation, or imagination they are the ultimate homogeneous collective. At the same time they are both the perfect corporate entity -- masters of the merger, the hostile takeover ("resistance is futile"), and a mindless population programmed to consume and continually upgrade each and every new technology and product. But the Borg don't invent; they only appropriate. Postmodern androids to the core! And we are presently very busy making new discoveries, creating and inventing, and transforming theories into things which tell us not only what is possible, but probable. One of the determining factors in the course of our future is whether or not our belief in technology over other values turns us into the puppets instead of the puppeteers, slaves to masters of our own invention -- be it HAL, Dr. Frankenstein's monster, or the Terminator. Let us consider some possible future scenarios, based not on fiction, but on what already exists, or is about to do so. Facts No one now disputes that the transformation of stem cells into new body parts, cloning technology, genetic engineering, nanotechnology, and microchip replacements not only could, but will dramatically change medicine and extend life in the coming century. In strictly medical terms, the implementation of all these technologies will bring about extraordinary relief of both the physical and psychological pain and suffering caused by debilitating, disabling, or disfiguring disease or injuries, not to mention the lives saved, and the genetic diseases prevented. Current research has found that not only stem cells taken from human embryos or fetuses could be directed to grow replacements for ailing hearts, livers or other organs, but that some stem cells taken from adult tissue could be converted into other types of cells -- brain cells becoming blood cells, or bone marrow becoming liver. The application of this technology is dazzling -- transformative biology, and it is just over the horizon2. Recently, scientists announced the creation of the first artificial cornea made from human cells. It could help restore the sight of those with certain kinds of eye damage. At the same time cybernetics is playing an equally important part. In development is a mini-computer that essentially takes over damaged visual functions and projects them onto a screen. One model expected to be ready for market within three years is a version of Geordie's visor in Star Trek: Next Generation. Another is a microchip that is inserted behind the eye3. In his newest book Fuzzy Future: From Society and Science to Heaven in a Chip, University of Southern California electrical engineering professor Bart Kosco, author of Fuzzy Thinking (1993), projects his theories onto everything from smart machines, the politics of genomes (who owns you, your genetic material, that is) and the environment (who owns the sea, or for that matter the air) to the problem of human mortality. Kosco foresees the day when we may be able to download our brains onto a microchip, thus achieving digital immortality via a gradual (fuzzy) transformation in which the brain's "meat" is replaced piece by piece with nanochips that work ever faster, better, and more creatively than old-fashioned neurons and synapses. The use of microchips to repair or replace damaged cells or portions of the brain is one thing, but as a means to greatly increase mental capacity, and gain everlasting life by "leaving your gray matter pickled in a jar" in favour of a computer in your skull is another. Would you still be you? While researchers have currently found new molecules in the brain that play a role in creating memories and learning, it does not ensure wisdom in how we put our knowledge to work. That great benefits await us, in the prevention and treatment of disease and the disintegration due to aging, is not in dispute. Nor is the enhanced capacity of a healthier society in body and mind. What constitutes the latter is. We are still left with ethical questions about the uses of technology, and spiritual and philosophical questions about what it means to be human. What are the political and social ramifications of biotechnology? British television playwright Dennis Potter's last work Cold Lazarus represents the ethical dilemmas of a future world capable of robbing a man's soul against his will. Scientists, whose funding is controlled by one or another governing media megalomaniac, seek to experience the 20th century through the genuine memories of the late Daniel Feeld, whose frozen head they have obtained. Their biochemical experiments are no less despicable than the CEO who wants to broadcast Feeld's "consciousness" worldwide twenty-four hours a day. Political opposition exists only in the form of a clandestine "terrorist" organization known as R.O.N. (Reality Or Nothing). If we were to base our forecasts on the patterns of history, just such a techno-fascist corporate future awaits us. If we are to judge by the dominant values of the present, the economic priorities of the marketplace will overpower the dissenting voices, placing not only the natural environment at risk, but our social environment as well. What will such a society do about the underclasses when smart machines have taken over their work, and they haven't the means to buy our goods, only consume precious resources; that is, when they are no longer "necessary" to the economic system. Will they be technologically phased out or upgraded? Fast Forward Let's not jump too far ahead. Maybe just to 2050. You can grow your own body part replacements, not just internal organs, but muscle, nerve tissue, skin. You can rejuvenate. Living to 120 or longer will not be unusual. The manufacture of body parts will be a big biotech business. Invest now! But will this technology be available to anyone and everyone, or only those who can afford it? Will we have parts kept in cold storage ready and waiting? Organs grown from extractions of our own foetal tissue perhaps. If it is a right not a privilege, how will our society deal with the problems of overpopulation? Will only those over a certain age -- say 80 -- who are viewed as "contributing" or "productive" members of society be eligible for new organs? Or will your lifestyle and health habits be a factor? No new livers for recalcitrant unreformed alcoholics? Will there be a ranking system of qualifications? Who will decide what they will be? Never mind arms and drugs. Consider this black market in the making! Subterranean high-tech operating rooms, organ factories, contraband stem cells, DNA, "smart" nanochips. Fast Forward And what about those microchips for brain functions? Not just for disease but for self-improvement. You might be able to improve your personality the way you can have a face-lift or breast implants. Then again, microchips could replace both pharmacology and psychotherapy in the treatment of mental disease, or merely antisocial or criminally aberrant behaviour, a new form of rehabilitation. As for sheer brain power, there would be no end to your capacity to absorb information, memorize and catalogue it, or to calculate stock market transactions. And just think of the lawsuits bound to jam up the courts, should someone have the misfortune to get a faulty chip, or even one that doesn't live up to expectations. Advertising is bound to promise you the answer to your dreams. The insertion of these parts by choice is one thing, but suppose it is forced on you by a government or a corporation. Or even by a parent while you are too young to fight back, the ones who want their offspring to be a math genius, Olympic athlete, or musical prodigy. Then again, genetic engineering may take care of some of that. Babies to order. By the end of this century you might not even have to have one the old messy way. Or you might not even be allowed to. Your genetically selected child might be grown in a computer-controlled organic womb. No more unwanted pregnancies. No more crack babies, or Downs Syndrome, or spina bifida4. We've been messing around for quite some time with a lot of things we don't know or haven't considered the consequences of in terms of the long term ecological balance of life and all its interdependent systems: cross-species genetic implants in plants and animals; plants altered to kill insects that are food for another creature on the food chain. And so on up the ladder: tomatoes that only look like tomatoes, but aren't really tomatoes any more. A perfect example of surface over substance. While we are so sure of our technological mastery, the actual "apocalypse" may well be of our own making when the forces of nature wreak havoc and pay us back for our abuses and arrogance. Or perhaps it will be nature's way of resetting the balance of things by greatly reducing the human population. Or it just might turn out this way. The newly evolved, genetically and cybernetically enhanced humanoids 3.0 survive and adapt (to 3.5), while the great mass of old humans become an endangered species like the Siberian tiger. Present Tense If you think this is all just science fiction, consider this. Already a number of young men in Silicon Valley or at M.I.T. walk around all day every day with one eye and ear always focused on the little headset computer screen that keeps them perpetually "on-line", plugged in. Do they look a little like the Borg? Well yes. Or, think about this. About a year ago a bill came up in the California state legislature proposing that a microchip be inserted in all newborn infants, like the ones you can put in your dog so you can track her if she gets lost or stolen. Same principle with babies. The bill was defeated. But very soon we will all be locatable, "on-line". No chance of disappearing in the 21st century when the wilderness is about to become another "theme" park, and when, at this very moment, you can be traced every time you use a plastic card or make a phone call. What a scary thought for dissidents, revolutionaries, battered women, or anyone who just wants to "get away from it all". In the 21st century, Huxley's "savages" would have as hard a time surviving or avoiding capture as a wolf in Arizona. How will our civil rights, our human rights be affected at the present rate of invasion into our privacy. Is your body your own? And what about your mind? What exactly will the "right to your life" mean? Will "smart" machines have that right? How will we define a sentient being? And so here we are. The 21st century is all mapped out. Maps can be misread. Maps can be wrong. The place that has been charted can be changed. By a force of nature, or an act of will. Or better still, by an act of conscience or consciousness, for it is an energy force with transformative powers. We could become better in our hearts and souls. We could use our knowledge with grace. Now go out and draw a new map(s). Happy New Century! Footnotes Huge advances in genomics, the science of deciphering the basic genetic pattern of life, were made in 1999, including the complete gene sequence for three microbes, a third of the base pairs in human DNA, along with one complete chromosome, number 22, and a rough draft of the entire human genome is expected by March 2000. For more about the Human Genome Project check out the following Website: http://www.ornl.gov/hgmis/ and all its links. Also http://www.turbulence.org/ for Bionet :: Recombinant by Eugene Thacker, an artist's "attempt to assemble a body of discourse surrounding contemporary molecular genetics and biotechnology at the end of the millenium". Science journal editor Floyd E. Bloom optimistically predicts that "although much remains to be done to convert today's results into tomorrow's treatments and tools, the likelihood of success seems high". Researchers in this field are: May Griffith, Research Scientist, University of Ottowa Eye Institute, Professor, Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario Gislin Dagnelie, Researcher, Lions Vision Research and Rehabilitation Center, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland Dr. Thomas Friberg, Professor, Ophthalmology, Chairman, Department of Ophthalmology, Director of Retina and Vitreous Service, The Eye and Ear Institute of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania Dr. Terry Ernest, Professor, Chairman, Ophthalmology and Visual Science, University of Chicago Medical Center, University of Chicago, Chicago, Illinois A congenital cleft of the vertebral column with hernial protrusion of the meninges (membranes that envelop the brain and spinal cord). Citation reference for this article MLA style: Jacki Apple. "Some Speculation on the Future of the Body and Soul." M/C: A Journal of Media and Culture 2.9 (2000). [your date of access] <http://www.uq.edu.au/mc/0001/body.php>. Chicago style: Jacki Apple, "Some Speculation on the Future of the Body and Soul," M/C: A Journal of Media and Culture 2, no. 9 (2000), <http://www.uq.edu.au/mc/0001/body.php> ([your date of access]). APA style: Jacki Apple. (2000) Some speculation on the future of the body and soul. M/C: A Journal of Media and Culture 2(9). <http://www.uq.edu.au/mc/0001/body.php> ([your date of access]).

Photo by 187929822 © Victor Moussa | Dreamstime.com INTRODUCTION The nonconsensual taking of a human organ to use in transplantation medicine violates ethical principles, including autonomy, informed consent, and human rights, as well as criminal laws. When such an organ harvesting is not just nonconsensual, but performed in a way that causes a death or uses the pretense of brain death without meeting the criteria, it also violates the dead donor[1] rule.[2] The dead donor rule is both ethical and legal. It prevents organ retrieval that would predictably cause the death of the organ donor.[3] Retrieval of a vital organ is permissible only after a declaration of death.[4] Forced organ harvesting may breach the dead donor rule as it stands. A reimagined, broader dead donor rule could consider a larger timeframe in the forced organ harvesting context. In doing so, the broad dead donor rule could cover intent, premeditation, aiding and abetting, and due diligence failures. A broad definition of forced organ harvesting is ‘‘the removal of one or more organs from a person by means of coercion, abduction, deception, fraud, or abuse of power. . .’’[5] A more targeted definition is “[t]he killing of a person so that their organs may be removed without their free, voluntary and informed consent and transplanted into another person.”[6] In the global organ harvesting context, forced organ harvesting violates the World Health Organization (WHO) Guiding Principle 3, which says “live organ donors should be acting willingly, free of any undue influence or coercion.”[7] Furthermore, WHO states live donors should be “genetically, legally, or emotionally” attached to the recipient. Guiding Principle 1 applies to deceased donors, covers consent, and permits donation absent any known objections by the deceased.[8] Principle 7 says, “Physicians and other health professionals should not engage in transplantation procedures, and health insurers and other payers should not cover such procedures if the cells, tissues or organs concerned have been obtained through exploitation or coercion of, or payment to, the donor or the next of kin of a deceased donor.”[9] There are underground markets in which organ hunters prey on the local poor in countries with low wages and widespread poverty[10] and human trafficking that targets migrants for the purpose of organ harvesting.[11] This paper explores forced harvesting under the backdrop of the dead donor rule, arguing that a human rights violation so egregious requires holding even distant participants in the chain of events accountable. By interfering with resources necessary to carry out bad acts, legislation and corporate and institutional policies can act as powerful deterrents. A broader dead donor rule would highlight the premeditation and intent evidenced well before the act of organ retrieval. I. Background and Evidence In China, there is evidence that people incarcerated for religious beliefs and practices (Falun Gong) and ethnic minorities (Uyghurs) have been subjects of forced organ harvesting. A tribunal (the China Tribunal) found beyond a reasonable doubt that China engaged in forced organ harvesting.[12] Additionally, eight UN Special Rapporteurs found a system of subjecting political prisoners and prisoners of conscience to blood tests and radiological examinations to determine the fitness of their organs.[13] As early as 2006, investigators found evidence of forced organ harvesting from Falun Gong practitioners. [14] Over a million Uyghurs are in custody there, and there is ample evidence of biometric data collection.[15] An Uyghur tribunal found evidence of genocide.[16] “China is the only country in the world to have an industrial-scale organ trafficking practice that harvests organs from executed prisoners of conscience.”[17] Witnesses testified to the removal of organs from live people without ample anesthesia,[18] summonses to the execution grounds for organ removal,[19] methods of causing death for the purpose of organ procurement,[20] removing eyes from prisoners who were alive,[21] and forcing live prisoners into operating rooms.[22] The current extent of executions to harvest organs from prisoners of conscience in China is unknown. The Chinese press has suggested surgeons in China will perform 50,000 organ transplants this year.[23] Doctors Against Forced Organ Harvesting (DAFOR) concluded, “[f]orced organ harvesting from living people has occurred and continues to occur unabated in China.”[24] China continues to advertise in multiple languages to attract transplant tourists.[25] Wait times for organs seem to remain in the weeks.[26] In the United States, it is common to wait three to five years.[27] II. The Nascent System of Voluntary Organ Donation in China In China, throughout the 1990s and early 2000s, the supply of organs for transplant was low, and there was not a national system to register as a donor. A 1984 act permitted death row prisoners to donate organs.[28] In 2005, a Vice Minister acknowledged that 95 percent of all organ transplants used organs from death row prisoners.[29] In 2007 the planning of a voluntary system to harvest organs after cardiac death emerged. According to a Chinese publication, China adopted brain death criteria in 2013.[30] There had been public opposition due partly to cultural unfamiliarity with it.[31] Cultural values about death made it more difficult to adopt a universal brain death definition. Both Buddhist and Confucian beliefs contradicted brain death.[32] Circulatory death was traditionally culturally accepted.[33] The Ministry of Health announced that by 2015 organ harvesting would be purely voluntary and that prisoners would not be the source of organs.[34] There are cultural barriers to voluntary donation partly due to a Confucian belief that bodies return to ancestors intact and other cultural and religious beliefs about respect for the dead.[35] An emphasis on family and community over the individual posed another barrier to the Western approach to organ donation. Public awareness and insufficient healthcare professional knowledge about the process of organ donation are also barriers to voluntary donation.[36] Although the Chinese government claims its current system is voluntary and no longer exploits prisoners,[37] vast evidence contradicts the credibility of the voluntary transplant program in China.[38] III. Dead Donor Rule: A Source of Bioethical Debate It seems tedious to apply this ethical foundation to something as glaring as forced organ harvesting. But the dead donor rule is a widely held recognition that it is not right to kill one person to save another.[39] It acts as a prohibition on killing for the sake of organ retrieval and imposes a technical requirement which influences laws on how death is declared. The dead donor rule prevents organ harvesting that causes death by prohibiting harvesting any organ which the donor agreed to donate only after death prior to an official declaration of death. There is an ongoing ethical debate about the dead donor rule. Many in bioethics and transplant medicine would justify removing organs in specific situations prior to a declaration of death, abandoning the rule.[40] Some use utilitarian arguments to justify causing the death of someone who is unconscious and on life support irreversibly. Journal articles suggest that the discussion has moved to one of timing and organ retrieval.[41] Robert Truog and Franklin Miller are critics of the dead donor rule, arguing that, in practice, it is not strictly obeyed: removing organs while a brain-dead donor is still on mechanical ventilation and has a beating heart and removing organs right after life support is removed and cardio-pulmonary death is declared both might not truly meet the requirement of the dead donor rule, making following the rule “a dubious norm.”[42] Miller and Truog question the concept of brain death, citing evidence of whole body integrated functions that continue indefinitely. They challenge cardio-pulmonary death, asserting that the definition includes as dead, those who could be resuscitated. Their hearts could resume beating with medical intervention. Stopping life support causes death only in those whose lives are sustained by it. Some stipulate that the organ retrieval must not itself cause the death. Some would rejigger the cause of death: Daniel Callahan suggests that the underlying condition causes the death despite removal of life support.[43] But logically, a person could continue life support and be alive, so clearly, removing life support does cause death. Something else would have caused brain death or the circumstance that landed the person on mechanical ventilation. To be more accurate, one could say X caused the irreversible coma and removing life support caused the death itself. Miller and Truog take the position that because withdrawal of life support does cause death, the dead donor rule should be defunct as insincere. To them, retrieving vital organs from a technically alive donor should be permissible under limited conditions. They look to the autonomous choices of the donor or the surrogate (an autonomy-based argument). They appreciate the demand for organs and the ability to save lives, drawing attention to those in need of organs. Live donor organ retrieval arguably presents a slippery slope, especially if a potential donor is close to death, but not so close to label it imminent. They say physicians would not be obligated to follow the orders of a healthy person wishing to have vital organs removed, perhaps to save a close friend or relative. Similarly, Radcliffe-Richards, et al. argue that there is no reason to worry about the slippery slope of people choosing death so they can sell their vital organs, whether for money for their decedents or their creditors.[44] The movement toward permissibility and increased acceptance of medical aid in dying also influence the organ donation arena. The slippery slope toward the end of life has potential to become a realistic concern. Older adults or other people close to death may want to donate a vital organ, like their heart, to a young relative in need. That could greatly influence the timing of a decision to end one’s life. IV. Relating the Dead Donor Rule to Forced Organ Harvesting There is well documented evidence that in China organs have been removed before a declaration of death.[45] But one thing the dead donor rule does not explicitly cover is intent and the period prior to the events leading to death. It tends to apply to a near-death situation and is primarily studied in its relationship to organ donation. It is about death more than it is about life. Robertson and Lavee investigated data on transplantation of vital organs in China and they document cases where the declaration of death was a pretense, insincere, and incorrect. Their aim was to investigate whether the prisoners were in fact dead prior to organ harvesting.[46] (The China Tribunal found that organs have been removed from live prisoners and that organ harvesting has been the cause of death.) They are further concerned with the possible role of doctors as executioners, or at least as complicit in the execution as the organ harvesting so closely follows it. V. A Broader Dead Donor Rule A presumed ethical precursor to the dead donor rule may also be an important ethical extension of the rule: the dead donor rule must also prohibit killing a person who is not otherwise near death for the purpose of post-death organ harvesting. In China, extra-judicial killings of prisoners of conscience are premeditated ― there is ample evidence of blood tests and radiology to ensure organ compatibility and health.[47] To have effective ethical force, the dead donor rule should have an obvious application in preventing intentional killing for an organ retrieval, not just killing by way of organ retrieval. When we picture the dead donor rule, bioethicists tend to envision a person on life support who will either be taken off it and stop breathing or who will be declared brain dead. But the dead donor rule should apply to healthy people subject to persecution at the point when the perpetrator lays the ground for the later killing. At that point, many organizations and people may be complicit or unknowingly contributing to forced organ harvesting. In this iteration of the dead donor rule, complicity in its violations would be widespread. The dead donor rule could address the initial action of ordering a blood or radiology test or collecting any biometric data. Trained physicians and healthcare technicians perform such tests. Under my proposed stretch of the dead donor rule, they too would be complicit in the very early steps that eventually lead to killing a person for their organs. I argue these steps are part of forced organ harvesting and violate the dead donor rule. The donor is very much alive in the months and years preceding the killing. A conspiracy of indifference toward life, religious persecution, ethnic discrimination, a desire to expand organ transplant tourism, and intent to kill can violate this broader dead donor rule. The dead donor rule does not usually apply to the timing of the thought of organ removal, nor the beginning of the chain of events that leads to it. It is usually saved for the very detailed determination of what may count as death so that physicians may remove vital and other organs, with the consent of the donor.[48] But I argue that declaring death at the time of retrieval may not be enough. Contributing to the death, even by actions months or years in advance, matter too. Perhaps being on the deathbed awaiting a certain death must be distinguished from going about one’s business only to wind up a victim of forced organ harvesting. Both may well be declared dead before organ retrieval, but the likeness stops there. The person targeted for future organ retrieval to satisfy a growing transplant tourism business or local demand is unlike the altruistic person on his deathbed. While it may seem like the dead donor rule is merely a bioethics rule, it does inform the law. And it has ethical heft. It may be worth expanding it to the arena of human trafficking for the sake of organ removal and forced organ harvesting.[49] The dead donor rule is really meant to ensure that death was properly declared to protect life, something that must be protected from an earlier point. VI. Complicity: Meaning and Application Human rights due diligence refers to actions that people or institutions must take to ensure they are not contributing to a human rights violation. To advise on how to mitigate risk of involvement or contribution to human rights violations, Global Rights Compliance published an advisory that describes human rights due diligence as “[t]he proactive conduct of a medical institution and transplant-associated entity to identify and manage human rights risks and adverse human rights impacts along their entire value and supply chain.”[50] Many people and organizations enable forced organ harvesting. They may be unwittingly complicit or knowingly aiding and abetting criminal activity. For example, some suppliers of medical equipment and immunosuppressants may inadvertently contribute to human rights abuses in transplantation in China, or in other countries where organs were harvested without consent, under duress, or during human trafficking. According to Global Rights Compliance, “China in the first half of 2021 alone imported ‘a total value of about 24 billion U.S. dollars’ worth of medical technology equipment’, with the United States and Germany among the top import sources.”[51] The companies supplying the equipment may be able to slow or stop the harm by failing to supply necessary equipment and drugs. Internal due diligence policies would help companies analyze their suppliers and purchasers. Corporations, educational institutions, and other entities in the transplantation supply chain, medical education, insurance, or publishing must engage in human rights due diligence. The Global Rights Compliance advisory suggests that journals should not include any ill-gotten research. Laws should regulate corporations and target the supply chain also. All actors in the chain of supply, etc. are leading to the death of the nonconsenting victim. They are doing so while the victim is alive. The Stop Forced Organ Harvesting Act of 2023, pending in the United States, would hold any person or entity that “funds, sponsors, or otherwise facilitates forced organ harvesting or trafficking in persons for purposes of the removal of organs” responsible. The pending legislation states that: It shall be the policy of the United States—(1) to combat international trafficking in persons for purposes of the removal of organs;(2) to promote the establishment of voluntary organ donation systems with effective enforcement mechanisms in bilateral diplomatic meetings and in international health forums;(3) to promote the dignity and security of human life in accordance with the Universal Declaration of Human Rights, adopted on December 10, 1948; and(4) to hold accountable persons implicated, including members of the Chinese Communist Party, in forced organ harvesting and trafficking in persons for purposes of the removal of organs.[52] The Act calls on the President to provide Congress a list of such people or entities and to sanction them by property blocking, and, in the case of non-US citizens, passport and visa denial or revocation. The Act includes a reporting requirement under the Foreign Assistance Act of 1961 that includes an assessment of entities engaged in or supporting forced organ harvesting.[53] The law may have a meaningful impact on forced organ harvesting. Other countries have taken or are in the process of legal approaches as well.[54] Countries should consider legislation to prevent transplant tourism, criminalize complicity, and require human rights due diligence. An expanded dead donor rule supports legal and policy remedies to prevent enabling people to carry out forced organ harvesting. VII. Do Bioethicists Mention Human Rights Abuses and Forced Organ Harvesting Enough? As a field, bioethics literature often focuses on the need for more organs, the pain and suffering of those on organ transplant waitlists, and fairness in allocating organs or deciding who belongs on which waitlist and why. However, some bioethicists have drawn attention to forced organ harvesting in China. Notably, several articles noted the ethical breaches and called on academic journals to turn away articles on transplantation from China as they are based on the unethical practice of executing prisoners of conscience for their organs.[55] The call for such a boycott was originally published in a Lancet article in 2011.[56] There is some acknowledgement that China cares about how other countries perceive it,[57] which could lead to either improvements in human rights or cover-ups of violations. Ill-gotten research has long been in the bioethics purview with significant commentary on abuses in Tuskegee and the Holocaust.[58] Human research subjects are protected by the Declaration of Helsinki, which requires acting in the best interests of research subjects and informed consent among other protections.[59] The Declaration of Helsinki is directed at physicians and requires subjects enroll in medical research voluntarily. The Declaration does not explicitly cover other healthcare professionals, but its requirements are well accepted broadly in health care. CONCLUSION The dead donor rule in its current form really does not cover the life of a non-injured healthy person at an earlier point. If it could be reimagined, we could highlight the link between persecution for being a member of a group like Falun Gong practitioners or Uyghurs as the start of the process that leads to a nonconsensual organ retrieval whether after a proper declaration of death or not. It is obviously not ethically enough to ensure an execution is complete before the organs are harvested. It is abuse of the dead donor rule to have such a circumstance meet its ethical requirement. And obviously killing people for their beliefs or ethnicity (and extra-judicial killings generally) is not an ethically acceptable action for many reasons. The deaths are intentionally orchestrated, but people and companies who may have no knowledge of their role or the role of physicians they train or equipment they sell are enablers. An expanded dead donor rule helps highlight a longer timeframe and expanded scope of complicity. The organ perfusion equipment or pharmaceuticals manufactured in the United States today must not end up enabling forced organ harvesting. With an expanded ethical rule, the “donor is not dead” may become “the donor would not be dead if not for. . .” the host of illegal acts, arrests without cause, forced detention in labor camps, extra-judicial killings, lacking human rights due diligence, and inattention to this important topic. The expanded dead donor rule may also appeal to the bioethics community and justify more attention to laws and policies like the Stop Forced Organ Harvesting Act of 2023. - [1] The word “donor” in this paper describes any person from whom organs are retrieved regardless of compensation, force, or exploitation in keeping with the bioethics literature and the phrase “dead donor rule.” [2] Robertson, M.P., Lavee J. (2022). Execution by organ procurement: Breaching the dead donor rule in China. Am J Transplant, Vol.22,1804– 1812. doi:10.1111/ajt.16969. [3] Robertson, J. A. (1999). Delimiting the donor: the dead donor rule. Hastings Center Report, 29(6), 6-14. [4] Retrieval of non-vital organs which the donor consents to donate post-death (whether opt-in, opt-out, presumed, or explicit according to local law) also trigger the dead donor rule. [5] The Stop Forced Organ Harvesting Act of 2023, H.R. 1154, 118th Congress (2023), https://www.congress.gov/bill/118th-congress/house-bill/1154. [6] Do No Harm: Mitigating Human Rights Risks when Interacting with International Medical Institutions & Professionals in Transplantation Medicine, Global Rights Compliance, Legal Advisory Report, April 2022, https://globalrightscompliance.com/project/do-no-harm-policy-guidance-and-legal-advisory-report/. [7] WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation, as endorsed by the sixty-third World Health Assembly in May 2010, in Resolution WHA63.22 https://apps.who.int/iris/bitstream/handle/10665/341814/WHO-HTP-EHT-CPR-2010.01-eng.pdf?sequence=1. [8] WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation (2010). [9] WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation (2010). [10] Promchertchoo, Pichayada (Oct. 19, 2019). Kidney for sale: Inside Philippines’ illegal organ trade. https://www.channelnewsasia.com/asia/kidney-for-sale-philippines-illegal-organ-trade-857551; Widodo, W. and Wiwik Utami (2021), The Causes of Indonesian People Selling Covered Kidneys from a Criminology and Economic Perspective: Analysis Based on Rational Choice Theory. European Journal of Political Science Studies, Vol 5, Issue 1. [11] Van Reisen, M., & Mawere, M. (Eds.). (2017). Human trafficking and trauma in the digital era: The ongoing tragedy of the trade in refugees from Eritrea. African Books Collective. [12] The Independent Tribunal into Forced Organ Harvesting from Prisoners of Conscience in China (China Tribunal) (2020). https://chinatribunal.com/wp-content/uploads/2020/03/ChinaTribunal_JUDGMENT_1stMarch_2020.pdf [13] UN Office of the High Commissioner, Press Release, China: UN human Rights experts alarmed by ‘organ harvesting’ allegations (UN OTHCHR, 14 June 2021), https://www.ohchr.org/en/press-releases/2021/06/china-un-human-rights-experts-alarmed-organ-harvesting-allegations. [14] David Matas and David Kilgour, Bloody Harvest. The killing of Falun Gong for their organs (Seraphim Editions 2009). [15] How China is crushing the Uyghurs, The Economist, video documentary, July 9, 2019, https://youtu.be/GRBcP5BrffI. [16] Uyghur Tribunal, Judgment (9 December 2021) (Uyghur Tribunal Judgment) para 1, https://uyghurtribunal.com/wp-content/uploads/2022/01/Uyghur-Tribunal-Judgment-9th-Dec-21.pdf. [17] Ali Iqbal and Aliya Khan, Killing prisoners for transplants: Forced organ harvesting in China, The Conversation Published: July 28, 2022. https://theconversation.com/killing-prisoners-for-transplants-forced-organ-harvesting-in-china-161999 [18] Testimony demonstrated surgeries to remove vital organs from live people, killing them, sometimes without ample anesthesia to prevent wakefulness and pain. China Tribunal (2020), p. 416-417. https://chinatribunal.com/wp-content/uploads/2020/03/ChinaTribunal_JUDGMENT_1stMarch_2020.pdf; Robertson MP, Lavee J. (2022), Execution by organ procurement: Breaching the dead donor rule in China. Am J Transplant, Vol.22,1804– 1812. doi:10.1111/ajt.16969. [19] Doctors reported being summoned to execution grounds and told to harvest organs amid uncertainty that the prisoner was in fact dead. China Tribunal (2020), p. 52-53. [20]In testimony to the China Tribunal, Dr. Huige Li noted four methods of organ harvesting from live prisoners: incomplete execution by shooting, after lethal injection prior to death, execution by removal of the heart, and after a determination of brain death prior to an intubation (pretense of brain death). China Tribunal (2020), pp. 54-55. https://chinatribunal.com/wp-content/uploads/2020/03/ChinaTribunal_JUDGMENT_1stMarch_2020.pdf [21] A former military medical student described removing organs from a live prisoner in the late 1990s. He further described his inability to remove the eyes of a live man and his witnessing another doctor forcefully remove the man’s eyes. China Tribunal (2020), p. 330. [22] In 2006, a nurse testified that her ex-husband, a surgeon, removed the eyes of 2,000 Falun Gong practitioners in one hospital between 2001 and 2003. She described the Falun Gong labor-camp prisoners as being forced into operating rooms where they were given a shot to stop their hearts. Other doctors removed other organs. DAFOH Special Report, 2022. https://epochpage.com/wp-content/uploads/sites/3/2022/12/DAFOH-Special-Report-2022.pdf [23] Robertson MP, Lavee J. (2022), Execution by organ procurement: Breaching the dead donor rule in China. Am J Transplant, Vol.22,1804– 1812. doi:10.1111/ajt.16969. [24] DAFOH Special Report, 2022. https://epochpage.com/wp-content/uploads/sites/3/2022/12/DAFOH-Special-Report-2022.pdf; DAFOH’s physicians were nominated for a Nobel Prize for their work to stop forced organ harvesting. Šućur, A., & Gajović, S. (2016). Nobel Peace Prize nomination for Doctors Against Forced Organ Harvesting (DAFOH) - a recognition of upholding ethical practices in medicine. Croatian medical journal, 57(3), 219–222. https://doi.org/10.3325/cmj.2016.57.219 [25] Robertson and Lavee (2022). [26] Stop Organ Harvesting in China, website (organization of the Falun Dafa). https://www.stoporganharvesting.org/short-waiting-times/ [27] National Kidney Foundation, The Kidney Transplant Waitlist – What You Need to Know, https://www.kidney.org/atoz/content/transplant-waitlist [28] Wu, Y., Elliott, R., Li, L., Yang, T., Bai, Y., & Ma, W. (2018). Cadaveric organ donation in China: a crossroads for ethics and sociocultural factors. Medicine, 97(10). [29] Wu, Elliott, et al., (2018). [30] Su, Y. Y., Chen, W. B., Liu, G., Fan, L. L., Zhang, Y., Ye, H., ... & Jiang, M. D. (2018). An investigation and suggestions for the improvement of brain death determination in China. Chinese Medical Journal, 131(24), 2910-2914. [31] Huang, J., Millis, J. M., Mao, Y., Millis, M. A., Sang, X., & Zhong, S. (2012). A pilot programme of organ donation after cardiac death in China. The Lancet, 379(9818), 862-865. [32] Yang, Q., & Miller, G. (2015). East–west differences in perception of brain death: Review of history, current understandings, and directions for future research. Journal of bioethical inquiry, 12, 211-225. [33] Huang, J., Millis, J. M., Mao, Y., Millis, M. A., Sang, X., & Zhong, S. (2015). Voluntary organ donation system adapted to Chinese cultural values and social reality. Liver Transplantation, 21(4), 419-422. [34] Huang, Millis, et al. (2015). [35] Wu, X., & Fang, Q. (2013). Financial compensation for deceased organ donation in China. Journal of Medical Ethics, 39(6), 378-379. [36] An, N., Shi, Y., Jiang, Y., & Zhao, L. (2016). Organ donation in China: the major progress and the continuing problem. Journal of biomedical research, 30(2), 81. [37] Shi, B. Y., Liu, Z. J., & Yu, T. (2020). Development of the organ donation and transplantation system in China. Chinese medical journal, 133(07), 760-765. [38] Robertson, M. P., Hinde, R. L., & Lavee, J. (2019). Analysis of official deceased organ donation data casts doubt on the credibility of China’s organ transplant reform. BMC Medical Ethics, 20(1), 1-20. [39] Miller, F.G. and Sade, R. M. (2014). Consequences of the Dead Donor Rule. The Annals of thoracic surgery, 97(4), 1131–1132. https://doi.org/10.1016/j.athoracsur.2014.01.003 [40] For example, Miller and Sade (2014) and Miller and Truog (2008). [41] Omelianchuk, A. How (not) to think of the ‘dead-donor’ rule. Theor Med Bioeth 39, 1–25 (2018). https://doi-org.ezproxy.cul.columbia.edu/10.1007/s11017-018-9432-5 [42] Miller, F.G. and Truog, R.D. (2008), Rethinking the Ethics of Vital Organ Donations. Hastings Center Report. 38: 38-46. [43] Miller and Truog, (2008), p. 40, citing Callahan, D., The Troubled Dream of Life, p. 77. [44] Radcliffe-Richards, J., Daar, A.S., Guttman, R.D., Hoffenberg, R., Kennedy, I., Lock, M., Sells, R.A., Tilney, N. (1998), The Case for Allowing Kidney Sales, The Lancet, Vol 351, p. 279. (Authored by members of the International Forum for Transplant Ethics.) [45] Robertson and Lavee, (2022). [46] Robertson and Lavee, (2022). [47] China Tribunal (2020). [48] Consent varies by local law and may be explicit or presumed and use an opt-in or opt-out system and may or may not require the signoff by a close family member. [49] Bain, Christina, Mari, Joseph. June 26, 2018, Organ Trafficking: The Unseen Form of Human Trafficking, ACAMS Today, https://www.acamstoday.org/organ-trafficking-the-unseen-form-of-human-trafficking/; Stammers, T. (2022), "2: Organ trafficking: a neglected aspect of modern slavery", Modern Slavery and Human Trafficking, Bristol, UK: Policy Press. https://bristoluniversitypressdigital.com/view/book/978144736. [50] Do No Harm: Mitigating Human Rights Risks when Interacting with International Medical Institutions & Professionals in Transplantation Medicine, Global Rights Compliance, Legal Advisory Report, April 2022, https://globalrightscompliance.com/project/do-no-harm-policy-guidance-and-legal-advisory-report/. [51] Global Rights Compliance, p. 22. [52] The Stop Forced Organ Harvesting Act of 2023, H.R. 1154, 118th Congress (2023). https://www.congress.gov/bill/118th-congress/house-bill/1154. [53] The Stop Forced Organ Harvesting Act of 2023, H.R. 1154, 118th Congress (2023), https://www.congress.gov/bill/118th-congress/house-bill/1154. [54] Global Rights Compliance notes that Belgium, France (passed law on human rights due diligence in the value supply chain), United Kingdom, United States, Canada, Australia, and New Zealand have legal approaches, resolutions, and pending laws. p. 45. [55] For example, Caplan, A.L. (2020), The ethics of the unmentionable Journal of Medical Ethics 2020;46:687-688. [56] Caplan, A.L. , Danovitch, G., Shapiro M., et al. (2011) Time for a boycott of Chinese science and medicine pertaining to organ transplantation. Lancet, 378(9798):1218. doi:10.1016/S0140-6736(11)61536-5 [57] Robertson and Lavee. [58] Smolin, D. M. (2011). The Tuskegee syphilis experiment, social change, and the future of bioethics. Faulkner L. Rev., 3, 229; Gallin, S., & Bedzow, I. (2020). Holocaust as an inflection point in the development of bioethics and research ethics. Handbook of research ethics and scientific integrity, 1071-1090. [59] World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects, adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, and amended multiple times, most recently by the 64th WMA General Assembly, Fortaleza, Brazil, October 2013. https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/

Introduction Animals have a significant presence in human lives, with many human interactions involving animals. This role of animals in social life, however, has largely been ignored and marginalised. In the words of Tovey (197), “to read most sociological texts, one might never know that society is populated by non-human as well as human animals”. Human-animal relations are evident in everyday human uses of animals as companions, pets, meat sources, and entertainment. This list is by no means exhaustive, but it does demonstrate how humans create and perpetuate systems of human/animal difference which are, at times, contradictory and ambivalent. There are no consistencies in how humans view and understand animal bodies. These differences matter, as they have serious consequences for how humans view and treat animals. It also has dire consequences for animals. While humans and animals are different species, we still live together, co-evolve, and create shared histories. We are, in the words of Haraway, companion species. This exposes that animals are not just nature, but culture. It is often forgotten that one of the everyday uses of animals is as testing and experimental models in medical and scientific research. Hidden away in laboratories, these animals remain invisible, only to be discovered when the histories of innovations and breakthroughs are unravelled. Animals are veiled behind dissection, vaccinations, pharmaceuticals, insulin injections, deep brain stimulation, and so on. Of interest in this paper is one potential medico-scientific innovation that cannot disguise the animal body as it is central for the success of the technology, xenotransplantation (XTP; animal-to-human transplantation). This refers to “any procedure that involves transplantation, implantation or infusion into a human recipient of cells, tissues or organs from a nonhuman animal source” (Xenotransplantation Working Party 22, original emphasis). While many animals have been used historically in XTP, the choice animal source is currently pigs. In order for xenotransplants to perform the required functions in a human body, the fragments of the pig’s body must remain living. This fuses the living pig part and living human body intimately, where the embodiment and functionality of each relies on the other. Such practices theoretically break down the traditional dualisms between humans/pigs and self/other. However, XTP raises a number of scientific, ethical, and social hurdles that must be addressed. As Bijker, Hughes and Pinch indicate, technical innovations are not simply scientific endeavours but sociocultural issues where usage, design, and content can be contentious. In the case of XTP this relates to, amongst other issues, the explicit physical breakdown of the human/pig divide, yet boundary work still occurs in an attempt to symbolically maintain the divisions between self/other. Drawing on the work of various cultural theorists, this paper presents a sociocultural approach to examine how XTP and the associated manufacturing of pigs, demonstrates the fluidity of science and culture. This is achieved by incorporating theoretical frameworks inspired by Durkheimian thought, such as the sacred and profane, and Douglas’ use of pollution and dirt. This analysis reveals how classificatory systems of culture, such as the sanctity of the body and its boundaries, are powerful obstacles to the cultural acceptance of XTP. The Sacred Body In the work of Durkheim and his Année Sociologique colleagues, the sacred and the profane are distinct classifications attached to material objects. These binary constructs are the basis for religious life, as argued in The Elementary Forms of Religious Life. The Durkheimian tradition also argues that these building blocks of religion are apparent in secular cultural life. The world (the profane) drives people to engage with the sacred or those places, objects, and people that are collectively valued with high esteem. In contrast, the profane is marginalised. The narratives/myths which underpin the sacred provide a type of collective fervour that stands in opposition to the mundane flows of the everyday. Through this process, high or low social value is attributed. Durkheim later considered that this duality also existed within the human. Individuals experience a double-being, where the mind (soul) and the body are, repeating Cartesianism, radically different, opposed, and independent substances. The soul holds sacred qualities “that has always been denied the body” (Durkheim, The Dualism of Human Nature and its Social Conditions, 150-1), which renders the body profane and the soul divine. In the contemporary West, however, there has been a significant shift away from the soul and towards the body. Turner argues that we have become a “somatic society”, where increasingly this once profane site has become a cultural obsession. The body has become a site of performance and consumption, where the self is realised and practiced. This has lead to intense rituals, such as disciplining the body through fitness training (Sassatelli) to personal grooming practices (Goffman), that seek to separate the body from polluting or profane influences. The body is no longer approached as sinful and demeaning to the soul. It has become culturally conceived as collectively sacred. At the same time, certain attributes of the body can and do signify disgust or profane qualities. As Kendall and Michael have argued, the body is a site of order and disorder. While our best efforts are implemented to ensure that the body’s biological, social, and cultural features remain ordered, the natural processes of excretion, decay, disease, and other undesirable disorders, consistently impinge on and challenge the sacred body. Significant effort ensures, as Goffman argues, that these undesirable attributes are hidden or removed from public view through secular rituals of purification. We can relate this to the prominent use in the West of anti-ageing products to the compulsion to institutionalise the ill, diseased, and elderly. Douglas follows this Durkheimian inspired tradition, utilising concepts such as purity, pollution, and danger. These are theoretically similar to the sacred/profane distinction, which we believe lends significant insight into the dialectic of human/animal bodies in XTP. To illustrate this further, we will briefly touch upon her contribution to cultural theory that serves as the basis for our arguments here. Purity, Danger and XTP: Being ‘Out of Order’ In her significant work, Purity and Danger, Douglas exposes the deeply embedded systems of classification that underpin social life. To exemplify this, she examines ‘dirt’ and questions why we feel it necessary to clean. Her answer is that dirt reflects a “systematic ordering and classification of matter”, that is “matter out of place” (35). In other words, our social lives are ordered according to those ‘matters’ classified as belonging or coherent in the flows of everyday life. Dirt transcends this ‘ordering’ and creates disorder. This then requires action on behalf of the individual to ‘reorder’ their surrounds through purification rituals. Douglas is able then to extract this theoretical point into various examples, such as the cultural classifications and uses of pigs. Culture categorises animals in relation to how they are to be consumed or enjoyed, as already stated. A range of relatively recent sociological projects, such as Zerubavel’s cognitive sociology program, are revealing how the animal world is culturally determined. For instance, Zerubavel demonstrates that repulsion towards certain foods, especially animal, may cause physical distress to the individual. This is not linked to our gastronomies, but sociocultural perceptions embedded in our individual minds (cf. Bourdieu’s ‘habitus’). This is also demonstrated by how classificatory systems deny the human consumption of certain animals. For instance, the taboo on consuming pork for Israelites rests for Douglas on the inability for the pig to be classified as a normal farm animal because it has cloven hooves and does not chew cud. Through this cultural perception, the pig is defined as pollution, impinging on the sanctity of the soul and sitting uncomfortably in collective thought. It resides on the margins and threatens our social order. In other words, what is safe and what is dangerous are differentiated culturally. What a pig represents in one culture can differ dramatically from the next. In the world of XTP, similar impressions remain embedded in the cognitive processes of individuals, thus creating conflict between cultural norms and values, and that of science (cf. Alexander and Smith). A further important point needs to be considered before discussing XTP explicitly. As suggested earlier, Douglas argues that some of the most dangerous cultural artefacts/objects to our sense of order are those which impinge on the pure through their unclassifiable nature. However, partial objects from these polluted things can also cause distress. Contemporary examples are bodily fluids, excretions, and other naturally occurring by-products of the body. These are generally held as disgusting within cultural contexts once removed from the body. Douglas explains this through their symbolic connection to a ‘human’ identity. She writes that these mundane objects remain “dangerous; their half identity still clings to them and the clarity of the scene in which they obtrude is impaired by their presence” (160). Fluids, such as mucus, when found in the home or other ‘ordered’ situations are considered most disgusting not because of the substance itself, but because it remains connected to the embodiment and identity of the other. Until that substance is cleansed from view, or reordered, it impinges on order in the most dangerous ways because of its ‘half identity’. It is still connected to its host. From this perspective, we can begin to envisage why the consumption of animals is closely governed by specific classificatory systems. The presentation of whole animals cooked, with head and limbs attached, may invoke disgust through the inability to completely remove the animal’s identity. Whole ducks, fish, or pigs presented at the dinner table, with their eyes gazing at the diners, can cause significant distress. The identity of the animal is reaffirmed and a reaction of disgust can occur. The reappropriation of animals as cuts of meat and meat-based products, can strip away the identity of the animal by dividing it into parts. This reordering makes it appropriate and pure for human consumption. By carving the body of an animal into pieces, it becomes a product that is removed from the living being. This is extended through ‘meat discourses’; the pig becomes pork, ham and bacon, and an anaemic calf becomes veal. It is meat; just another object in the cultural universe. In viewing XTP as a cultural artefact, these significantly stringent classifications of the pure and polluting remain deeply embedded and potent. Pig organs such as the heart remain, despite any cleansing processes undertaken by science and unlike the reappropriation of animals for consumption, linked to the pig’s embodiment. The removal of this body part does not remove it from the pig’s identity. It remains connected, clinging to its ‘half identity’. Furthermore, unlike the meat industry or various other medico-scientific uses of animals, it is vital that the pig’s body parts remain living. Xenotransplants would not function without, for example, the pig’s heart continuing to beat, pumping blood around the new human body it inhabits. This creates cultural barriers that go beyond the ordered animal products that currently exist, which serves to threaten the acceptance and successful appropriation of XTP amongst society. There is then a culturally perceived taboo on combining the self and other in XTP. Pig bodies must somehow be ‘cleansed’ by science, although, as we alluded to previously, this is not necessarily successful. These rituals of purification by science are undertaken for scientific and cultural reasons. For example, Cook outlines that scientists working in XTP go to great lengths to justify why the polluting other, the pig, can and should be used as the source animal. This involves a complex narration on the differences and similarities between humans and animals. Significantly, XTP relies on and perpetuates the differential cultural worth that is placed on human life (high value) and animal life (low value), in order to justify XTP procedures. However, pig parts need to become worthy of being harvested for human bodies, meaning that pigs must be elevated from their lowly status to that worthy of being human. This leads science to engage in, according to Cook, a complex interweaving of desirable-similarity, desirable-dissimilarity, undesirable-similarity, and undesirable-dissimilarity, to establish continuities and disparities between pig and human bodies. This functions not only for the purposes of science, but to culturally justify the practices and artefacts of XTP. While XTP involves intimately mixing humans and pigs, these “science stories” (Cook) additionally work to maintain species divides. Simultaneously, these processes operate to justify that it is appropriate for humans to embody pigs. Hence, science attempts to mould the social into desirable ways of thinking about XTP, thus supporting it and the science behind it. This includes the experimental and therapeutic sacrifice of pigs. At the same time, science cannot avoid that the practice and delivery of XTP involves the culturally pure/sacred human body coming into conflict with the polluted/dangerous ‘other’, pig part/s. The genetic engineering of pigs to express select human complementary regulatory proteins, which inhibit self-damage when the immune system reacts to the presence of a foreign body such as a transplanted organ, somewhat disintegrates the human/animal divide within the pig body itself. It is becoming human. However, science still faces a significant hurdle. Namely, “How can we physically mix (natural-technical discourse) if we’re so different (social-moral discourse)?” (Brown 333). Pig parts in human bodies, and pigs genetically engineered to be more ‘human like’, still involve pig parts being out of place and therefore disgusting. Despite the rituals employed by science to draw similarities between humans and pigs (and genetically engineered pigs), there remain cultural classification systems that compromise the normalisation of XTP. Hence, crossing the species divide in XTP is scientifically unproblematic (though getting XTP to work is another matter), but the fusing of human and pig bodies may still be culturally dangerous. In other words, cultural classifications may render pigs as incompatible with humans, despite any social constructions attempted by science. The body expresses these social values. In XTP, porcine genetics cannot be physically separated from their social and genetic being. Incorporating this with the human can cause disgust, even amongst those who have received xenotransplants: “I wonder how much from an animal can be introduced into my body before my humanity vanishes” (porcine cellular xenotransplant recipient qtd. in Lundin 150). While science may reduce the body to mechanistic functioning and seek to objectify it, the body, be it human or pig, possesses material-semiotic importance. The heart is not simply a pump; it is symbolically powerful. A xenotransplanted pig heart challenges the sanctity of the human body and how the human body and its parts are culturally constructed. However, the potentiality of XTP to save a life may trump any individual concerns, even if an individual may reject it culturally (Lundin). There still remains another dilemma that cannot be subsumed by such negotiations—the potentiality of cross-species viral infections (zoonosis) that could result from the embodied fusion of living pig parts and living human bodies. While a detailed examination of this is beyond the scope of this paper, it is worth noting that the social fears of zoonosis, such as avian influenza (bird flu) and swine influenza, have resulted in increased international collaborative efforts to study and halt the global spread of contagion. While there are a number of differences between these zoonotic infections and any unforeseen zoonotic consequences of XTP, what is of significance is the boundary pollution. That is, all forms of animal-to-human zoonosis involve a violation of the sacred human body by the dirty and profane other. For example, the recent outbreaks of swine influenza involved disparate species coming into contact with each other through disgusting body products, namely contaminated droplets emitted by infected individuals sneezing or coughing. The physical bodies of humans and animals, however, still remain differentiated even if zoonosis symbolically challenges such classifications. XTP, on the other hand, is an intimate physical and symbolic fusion of these bodies. The human and the animal can no longer be separated as independent beings. Thus, the potential of pollution from XTP moves beyond the fear of the symbolically disgusting pig body and the symbolism of particular body parts, to include what the pig parts may actually physically carry with them. As a result, the cultural dangers of transplanted pig parts and their potential violations are not just symbolic, but also materially ‘real’. Conclusion By categorising animals as a lower species, humans enable their exploitation and use in a multitude of ways. This process of cultural classification in the contemporary West means that we attribute a sacred, high value to human bodies, and a low, profane quality to animal bodies. While the scientific intermingling of human and pig bodies in XTP could be seen to present a cultural challenge to these species dualisms, it does not overcome such cultural classifications. That is, the interests and social constructions of pigs by science cannot overpower or suppress the sociocultural. The removal of pig parts from the pig’s body does not eliminate its ‘half identity’. It is still a living product from an animal’s body. Unlike other pig products, life cannot be removed from the pig parts for XTP, as this is the vital function required for xenotransplants to (potentially) work. A heart needs to beat. Any purification rituals undertaken by science, such as using pigs genetically engineered with human proteins, cannot overcome this cultural construction. While it may be argued that XTP will become culturally acceptable with time, this disrespects how social knowledges are as equally important as the scientific. This further disavows that cultural concerns over mixing pig and human bodies are as viable as scientific constructions. This is perhaps most potently highlighted by zoonosis. Thus, the pigs used in XTP have cultural-technical bodies that are materially and symbolically significant, which science cannot purge. References Alexander, J. C. and P. Smith. “Social Science and Salvation: Risk Society as Mythical Discourse.” Zeitschrift für Soziologie 25 (1996): 251-262. Bijker, W.E., T.P. Hughes and T. Pinch. Eds. The Social Construction of Technological Systems: New Directions in the Sociology and History of Technology. Cambridge: MIT Press, 1989. Bourdieu, P. Distinction: a Social Critique of the Judgement of Taste, London: Routledge, 1986. Brown, N. “Xenotransplantation: Normalizing Disgust”. Science as Culture 8 (1999): 327-55. Cook, P.S. “Science Stories: Selecting the Source Animal for Xenotransplantation.” Social Change in the 21st Century 2006 Conference Proceedings. Eds. C. Hopkinson and C. Hall. Centre for Social Change Research, School of Humanities and Human Services, Queensland University of Technology, Brisbane, 2006. 6 Aug. 2010. Douglas, M. Purity and Danger, London: Routledge and Keegan Paul, 1976[1966]. Durkheim, E. The Elementary Forms of Religious Life, New York: The Free Press, 1995[1912]. Durkheim, E. “The Dualism of Human Nature and its Social Conditions.” Emile Durkheim on Morality and Society: Selected Works. Ed. R. Bellah. Chicago: University of Chicago Press, 1973[1914]. Goffman, E. The Presentation of the Self in Everyday Life. Harmondsworth: Penguin, 1971. Haraway, D. J. The Companion Species Manifesto: Dogs, People, and Significant Otherness. Chicago: Prickly Paradigm Press, 2003. Kendall, G. and M. Michael “Order and Disorder: Time, Technology and the Self.” Culture Machine, Interzone, Nov. 2001. 6 Aug. 2010 .Lundin, S. “Understanding Cultural Perspectives on Clinical Xenotransplantation.” Graft 4.2 (1999): 150-153. Sassatelli, R. “The Commercialization of DIscipline: Keep-fit Culture and its Values.” Journal of Modern Italian Studies 5.3 (2000): 396-411. Tovey, H. “Theorising Nature and Society in Sociology: The Invisibility of Animals.” Sociologia Ruralis 43.3 (2003): 196-215. Turner, B.S. The body and society: explorations in social theory. Second Ed. London: Sage, 1996. Xenotransplantation Working Party. Animal-to-Human Transplantation Research: How Should Australian Proceed? Canberra: Commonwealth of Australia, 2003. Zerubavel, E. Social Mindscapes: An Invitation to Cognitive Sociology. Cambridge: Harvard University Press, 1997.

Photo by Sangharsh Lohakare on Unsplash ABSTRACT The public should debate the ethical and social challenges arising from heritable human genome editing (HHGE). The notorious case involving He Jiankui may have led to the disfavor of gene editing and a precautionary approach. While the de facto global moratorium on HHGE is clearly justified considering our current inability to implement it safely and effectively, the difficult ethical considerations should be addressed prior to the ability to initiate widespread HHGE. This piece argues that prospective patients and other members of society beyond the scientific community must be included in the conversation. It emphasizes the potential role of those not directly participating in HHGE science, calling the broader academic community not simply to wait for scientists’ results and only afterward react. Pointing to key historical examples, I contend that scientific progress is intrinsically linked with the surrounding societal discussion and that it is not only scientists who can influence where the HHGE story ends. INTRODUCTION l. Rogue Scientists Chinese biophysicist He Jiankui announced the world’s first genetically modified babies in 2018. Naturally, the treatment aroused the attention of the world’s media, which focused on He’s reckless actions. Indeed, in setting up and carrying out the procedure in question, he flouted norms of good scientific practice on a range of levels—errors paid with time in prison. Since the He controversy, few scientists have aggressively approached heritable human genome editing (HHGE) and challenged the current research norms. The most outspoken exception is the Russian molecular biologist Denis Rebrikov of the Pirogov Russian National Research Medical University. He publicly declared his intention to apply clustered regularly interspaced short palindromic repeats (CRISPR) to embryos to help couples avoid passing serious medical conditions to their children. However, Rebrikov met fierce opposition both inside and beyond Russia and, with leading CRISPR scientists and bioethicists abroad describing him as a “cowboy” who had “weak data” and was trying to “grab some attention.”[1] So far, Rebrikov’s plans have failed to come to fruition. Although there are 126 entries listed in a registry of HHGE research recently created by the World Health Organization (WHO),[2],[3] it seems that clinical HHGE has been paused for the time being. ll. Steering the Conversation A section of the scientific community has been trying to steer the ethical debate on HHGE away from the actions of rogue scientists and back to an issue that is central to the matter—the interests of patients. The majority would agree that the most compelling potential application of germline genome editing is for the prevention of devastating genetic conditions, for example, when both parents carry Huntington’s disease, for which “genome editing offers the only prospect of bearing a healthy, genetically related child.”[4] Despite such justification for scientists to continue pursuing research in the area, there has been a notable reticence in the wider academic community regarding making the ethical case for HHGE and clarifying in which medical situations such a technique might be reasonably applied. Even among those who recognize that the HHGE cases' controversies should not be a reason for panic over designer babies, some believe that starting the ethical debate is premature. A key part of the argument is that the current technological and scientific knowledge available is far from ready to deliver on treatments. A similar stance preventing debate in the wider society is that “difficult questions” about cost, accessibility, and social justice remain.[5] Whether intended or not, the implication is that the position of wider society in the HHGE story should be a reactive one, namely waiting to see what the scientists throw at them and then dealing with it. I argue that there is not only an immediate need for broader academic and societal input on the ethical and social aspects of the HHGE debate but that there is a deep symbiosis between scientific progress and its surroundings, whereby science both shapes and is shaped by the societal environment in which it takes place. The WHO published a position paper, recommendations, and a framework for governance. The framework for governance describes global standards for the governance and oversight of HHGE.[6] The position paper emphasized the importance of global and inclusive dialogue,[7] and many other boards have also called for broad public engagement.[8] It is imperative that WHO’s governance framework meets everyone’s needs. After all, as with any medical treatment, it is not the scientist who developed the treatment or the doctor who delivers it that is most important– that honor falls to the patient. In the case of HHGE, the beneficiaries include those members of society who hope to reproduce. Yet HHGE has the potential to impact society. We all should have an opportunity to be a part of world-changing decisions that lead to the creation are made and feel a responsibility to participate. lll. Shutting Down the Academic Debate At the 30th Annual Conference of the Japanese Association for Bioethics, which took place in late 2018 after He’s experiment, the discussion about HHGE was shut down quickly. Notwithstanding the understandable issues raised with He’s case, one participant after another stood up to voice support for an outright and complete ban on the use of CRISPR.[9] The ban was based on the grounds that editing the human genome would result in a cascade of unforeseen and irreversible consequences for future generations. One participant forcefully argued that “the deoxyribose nucleic acid (DNA) rubicon should never be crossed for above all, it was deeply immoral to do so when there was no way of obtaining the consent of those who would actually stand affected—our descendants.”[10] Another saw it as putting humanity on a slippery slope toward enhancements, and some feared the catastrophic mistakes that might result from their use.[11] While the above event provides just one snapshot of the debate that was taking place around the world at the time, it captures the strong reservations in the scientific community. It is a common view, not only in Japan, that the human genome is something sacred, a relic handed down from generations, that we ought to treasure and preserve. In support of such a view, religious and other more pragmatic reasons are offered. For example, some may fear the disasters that might befall us if we choose to intervene in the process through which we pass our genetic code from one generation to another. Such arguments are certainly still at the heart of the ethical debate, but the foundations upon which they are built are by no means universally accepted. Stanford University bioethicist Henry Greely writes, “the human germline genome” does not exist; instead, each of us has a unique genome.[12] Greely argues that HHGE is no different from the changes our genomes have undergone through numerous medical interventions. For example, synthetic insulin has increased the number of people with DNA variations that lead to diabetes. Those with this condition would have died as a child in the past. However, now they live long enough to be able to reproduce. Similarly, the transition from hunting to farming centuries ago resulted in a greater number of copies in our gene pool of starch-digesting genes. Yet Greely suggested that, practically, HHGE is “not very useful in the near- to midterm” (by which he means “the next several decades”)[13] “mainly because other technologies can attain almost all the important hoped-for benefits of [HHGE], often with lower risk,” citing embryo selection and somatic gene editing as two alternative options. Greely argued that applying HHGE for enhancement beyond disease prevention and is currently not a realistic option because we lack the necessary knowledge. In Greely’s opinion, “how worried should we be [about HHGE]…? A bit, but not very and not about much.”[14] Greely’s assertions that other scientific debates should take precedence and that the concerns are not ripe for debate yet are concerning. lV. Why Shutting Down the Debate Might Not be a Good Idea First, the timeframe described by Greely seems somewhat out of line with that described by leading scientists. As far back as 2018, at the same Summit where He made his revelations, George Q. Daley stressed that HHGE is scientifically feasible here and that the ethical considerations can no longer be put off: “…a number of groups have applied gene editing now to human embryos in the context of in vitro fertilization and attempting to determine variations of a protocol that would enhance the fidelity and reduce mosaicism. I think there has been an emerging consensus that the off-target problem is manageable, and in some cases even infinitesimal. There are some interesting proofs of principles, like diseases such as beta-thalassemia that could potentially be approached with this strategy.”[15] It would also be possible to challenge Greely on various other aspects. One of which would be the number of cases to which HHGE would be relevant and the kinds of moral allowances that might be made, and each case concludes that more urgency is required in the ethical debate. Greely suggests that most people can use preimplantation genetic testing (PGD), which is the embryo selection process, and that perhaps HHGE could apply to couples where both have the same autosomal recessive gene.[16] Greely rules out considering HHGE in cases where PGD is applicable. Greely concedes PGD does not already represent the answer on this topic, as it often fails to provide couples with enough healthy embryos to transfer. As a resolution to this issue, he points to the creation of eggs using induced pluripotent stem cell (iPSC) techniques, whereby eggs can potentially be created from other cells.[17] However, given the extremely limited success of iPSCs in the clinical arena to date, in vitro gametogenesis is a highly speculative solution. Certainly, the progress of iPSC research is not such a safe bet that placing all our hopes on it at the expense of HHGE techniques is currently justified. (Also, it should be noted that making eggs using the iPSC technique is hardly an ethical problem-free area itself.) In summary, the cases of couples looking to conceive that Greely rules out by pointing to PGD should be kept on the HHGE table, as various other scholars have suggested.[18] Many of us debating HHGE are not scientists, so the best we can do is draw from the information we glean from those more technically capable. As a society, we are not just passive observers of science; we should have influence over decisions that impact society. Indeed, even if the available science is not yet at a place where we should be worried about large-scale ethical and social concerns, the story will continue to unfold in the future. While Greely is happy to see the human race “muddle through” the ethical challenges of scientific breakthroughs, such a position fails to recognize that society at large is far from powerless. V. Society Influencing Scientific Progress There are some notable examples of society’s impact on scientific progress. For example, political policies led to the development of nuclear technology for war and strategic deterrence, despite societal objections seen through demonstrations of people protesting using the slogan “no nukes.” Furthermore, the Bush administration drastically limited the use of embryonic stem cells in the 2000s due to a strong religious and cultural influence on policy.[19] Societal debate potentially serves as a powerful factor in guiding science. Where societal acceptance is ambiguous, science tends to operate on its own. But where science would impact life’s fundamental issues like war, how embryos should be valued, or the end of life, society should weigh in and influence the role of science. Societal views on the current global moratorium on HHGE could lead to a ban, as has been advocated.[20] On the other hand, societal views that value HHGE as a way to expand reproductive autonomy may justify permitting its use. Opening an ethics debate about it would enable scientists to pursue technologies that society deems justifiable as well as set limits for where they should stop. Making this process more difficult, the He affair has clearly colored public discourse on HHGE in a way that inhibits debate. In Japan, a sequence of questionnaires in 2016, 2018, and 2019 showed that the widely publicized HHGE scandal led to a significant decline in the acceptance of genome editing technology in general, particularly for human reproduction. Specifically, the surveys revealed a stark rise in disapproval of the technology’s use on fertilized human eggs—from 12 percent in 2018 to 29 percent in 2019.[21] The three scientists that conducted these surveys suggested that “the news of the twin babies in China had a substantial influence on the Japanese public,” damaging the reputation of HHGE.[22] It seems likely that the public distaste for HHGE was prompted by He’s research rather than considerations about the scientific potential of HHGE The change in public opinion may also make politicians and scientists more hesitant when it comes to taking the lead in the HHGE debate. Ultimately, this can restrict the public discussion of the central ethical challenges of the technology and hinder efforts to determine whether there is a responsible path forward other than an outright ban. Stressing the importance of the issue again to potential patients and failing to engage further with the HHGE debate is surely not something society should allow. While there are many important ongoing debates about genetics, like biohacking and DIY hobbyists, HHGE deserves attention as well. In fact, attention to the ethics of HHGE should help — more awareness of how these tools can be applied and what germline genome editing is will make people more alert to the existing danger and better understand how to mitigate it. Perhaps more importantly, a clear message from society to researchers about what objectives are reasonable to pursue regarding the HHGE technologies will facilitate good science. Having a publicly determined criterion would allow scientists to not live in fear that they might be blacklisted for seeking progress in grey areas and instead confidently chase progress where it is allowed. Vl. What Now? HHGE is here (or will be soon) and brings many ethical and social challenges. However, the challenges should not be left to individual scientists and couples in desperate situations to manage alone. Moving toward how these challenges can be met practically, it is helpful to draw a parallel with the issue of implementing human rights. In the early 21st century, political philosopher Michael Freeman of the University of Essex lamented that implementing human rights had been left to lawyers. Although legal experts were clearly essential in putting together the global human rights framework, Freeman’s concern was that they were not best placed to understand implementing human rights in various contexts. Setting out a broader, interdisciplinary approach, he called for social scientists to tackle these difficult questions, ultimately moving human rights forward around the world. Similarly, in medical technology like HHGE, scientists are crucial to the story, but at the same time, they are not trained to deal with all the accompanying challenges. Bioethicists are also important, clarifying the arguments that society needs to resolve. There is a need for even wider input from across the scholarly community. For instance, as with human rights, international and domestic regulation is required, and clearly, the legal community has a role here. Moreover, as described by Freeman, since all law is political in its creation and has impacts across society, political scientists and sociologists can provide impactful input. CONCLUSION We are in it together, and we have roles to play in the discussion of HHGE. Societal discourse does not always trail the scientific reality, but rather, it can condition the path that science will follow. Given the importance of what is at stake, not only for the potential patients, but for humanity, we should not leave the HHGE debate only to scientists, and we should not leave it until later. - [1] Cohen J. “Embattled Russian scientist sharpens plans to create gene-edited babies,” Science, 21 Oct. 2019. doi:10.1126/science.aaz9337. [2] World Health Organization. “WHO issues new recommendations on human genome editing for the advancement of public health,” News release, 12 July 2021, www.who.int/news/item/12-07-2021-who-issues-new-recommendations-on-human-genome-editing-for-the-advancement-of-public-health. [3] World Health Organization. “Human Genome Editing Registry,” https://www.who.int/groups/expert-advisory-committee-on-developing-global-standards-for-governance-and-oversight-of-human-genome-editing/registry. [4] Daley GQ, Lovell-Badge R, and Steffann J. “After the Storm–A Responsible Path for Genome Editing,” New England Journal of Medicine 380, no. 10 (2019): 897-9. doi:10.1056/NEJMp1900504. [5] Daley GQ, Lovell-Badge R, and Steffann J. “After the Storm–A Responsible Path for Genome Editing,” New England Journal of Medicine 380, no. 10 (2019): 897-9. doi:10.1056/NEJMp1900504 [6] World Health Organization. “WHO issues new recommendations on human genome editing for the advancement of public health,” News Release, July 12, 2021, www.who.int/news/item/12-07-2021-who-issues-new-recommendations-on-human-genome-editing-for-the-advancement-of-public-health. [7] WHO 2021. Human Genome Editing: Position Paper, WHO Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing. [8] Daley GQ, Lovell-Badge R, and Steffann J. “After the Storm–A Responsible Path for Genome Editing,” New England Journal of Medicine 380, no. 10 (2019): 897-9. doi:10.1056/NEJMp1900504. [9] 30th Annual Conference of the Japanese Association for Bioethics, 8-9 Dec. 2018, Kyoto Prefectural University, Kyoto. [10] 30th Annual Conference of the Japanese Association for Bioethics, 8-9 Dec. 2018, Kyoto Prefectural University, Kyoto. [11] 30th Annual Conference of the Japanese Association for Bioethics, 8-9 Dec. 2018, Kyoto Prefectural University, Kyoto. [12] Greely HT. “Why the Panic Over ‘Designer Babies’ Is the Wrong Worry,” LeapsMag, 30 Oct. 2017, leapsmag.com/much-ado-about-nothing-much-crispr-for-human-embryo-editing; Greely HT. “CRISPR’d babies: human germline genome editing in the ‘He Jiankui Affair’,” Journal of Law and the Biosciences 2019; 6(1): 111–83. doi: 10.1093/jlb/lsz010; Greely HT. CRISPR People: The Science and Ethics of Editing Humans (Massachusetts: Massachusetts Institute of Technology Press, 2021). [13] Greely HT. “Why the Panic Over ‘Designer Babies’ Is the Wrong Worry,” LeapsMag, 30 Oct. 2017, leapsmag.com/much-ado-about-nothing-much-crispr-for-human-embryo-editing. [14] Greely HT. “Why the Panic Over ‘Designer Babies’ Is the Wrong Worry,” LeapsMag, 30 Oct. 2017, leapsmag.com/much-ado-about-nothing-much-crispr-for-human-embryo-editing. [15] Daley, G. (n.d.). Genome-editing-pathways to Translation. Transcript of the Human-Genome Editing Summit 2018 Hong Kong. Retrieved March 17, 2022, from https://diyhpl.us/wiki/transcripts/human-genome-editing-summit/2018-hong-kong/george-daley-genome-editing-pathways-to-translation/ [16] Greely HT. “CRISPR’d babies: human germline genome editing in the ‘He Jiankui affair’,” Journal of Law and the Biosciences 2019: 6(1): 111–83. doi:10.1093/jlb/lsz010. [17] Greely HT. CRISPR People: The Science and Ethics of Editing Humans (Massachusetts: Massachusetts Institute of Technology Press, 2021). [18] Rasnich R. “Germline genome editing versus preimplantation genetic diagnosis: Is there a case in favour of germline interventions?.” Bioethics 2020; 34(1): 60–9. [19] Murugan, Varnee. “Embryonic stem cell research: a decade of debate from Bush to Obama.” The Yale journal of biology and medicine vol. 82,3 (2009): 101-3. [20] Lander E, Baylis F, Zhang F, et al. “Adopt a moratorium on heritable genome editing,” Nature 2019; 567(7747): 165–8. pmid:30867611. [21] Watanabe D, Sato Y, Tsuda M, and Ohsawa R. Increased awareness and decreased acceptance of genome-editing technology: The impact of the Chinese twin babies. PLoS ONE 2000; 15(1): 1-13. doi:10.1371/journal.pone.0238128. [22] Watanabe D, Sato Y, Tsuda M, and Ohsawa R. Increased awareness and decreased acceptance of genome-editing technology: The impact of the Chinese twin babies. PLoS ONE 2000; 15(1): 1-13. doi:10.1371/journal.pone.0238128.