Academic literature on the topic 'Bible. N.T. Luke III'

Background: Although sleep has been identified as an important modifiable risk factor for sports injury, the effect of decreased sleep on sports injuries in adolescents is poorly studied. Purpose: To systematically review published literature to examine if a lack of sleep is associated with sports injuries in adolescents and to delineate the effects of chronic versus acute lack of sleep. Methods: PubMed and EMBASE databases were systematically searched for studies reporting statistics regarding the relationship between sleep and sports injury in adolescents aged <19 years published between 1/1/1997 and 12/21/2017. From included studies, the following information was extracted: bibliographic and demographic information, reported outcomes related to injury and sleep, and definitions of injury and decreased sleep. Additionally, a NOS (Newcastle-Ottawa Scale) assessment and an evaluation of the OCEM (Oxford Center for Evidence-Based Medicine) level of evidence for each study was conducted to assess each study’s individual risk of bias, and the risk of bias across all studies. Results: Of 907 identified articles, 7 met inclusion criteria. Five studies reported that adolescents who chronically slept poorly were at a significantly increased likelihood of experiencing a sports or musculoskeletal injury. Two studies reported on acute sleep behaviors. One reported a significant positive correlation between acutely poor sleep and injury, while the other study reported no significant correlation. In our random effects model, adolescents who chronically slept poorly were more likely to be injured than those who slept well (OR 1.58, 95% CI 1.05 to 2.37, p = 0.03). OCEM criteria assessment showed that all but one study (a case-series) were of 2b level of evidence—which is the highest level of evidence possible for studies which were not randomized control trials or systematic reviews. NOS assessment was conducted for all six cohort studies to investigate each study’s individual risk of bias. Five out of six of these studies received between 4 to 6 stars, categorizing them as having a moderate risk of bias. One study received 7 stars, categorizing it as having a low risk of bias. NOS assessment revealed that the most consistent source of bias was in ascertainment of exposure: all studies relied on self-reported data regarding sleep hours rather than a medical or lab record of sleep hours. Conclusions: Chronic lack of sleep in adolescents is associated with greater risk of sports and musculoskeletal injuries. Current evidence cannot yet definitively determine the effect of acute lack of sleep on injury rates. Our results thus suggest that adolescents who either chronically sleep less than 8 hours per night, or have frequent night time awakenings, are more likely to experience sports or musculoskeletal injuries. [Figure: see text][Figure: see text][Table: see text][Table: see text][Table: see text] References used in tables and full manuscript Barber Foss KD, Myer GD, Hewett TE. Epidemiology of basketball, soccer, and volleyball injuries in middle-school female athletes. Phys Sportsmed. 2014;42(2):146-153. Adirim TA, Cheng TL. Overview of injuries in the young athlete. Sports Med. 2003;33(1):75-81. Valovich McLeod TC, Decoster LC, Loud KJ, et al. National Athletic Trainers’ Association position statement: prevention of pediatric overuse injuries. J Athl Train. 2011;46(2):206-220. Milewski MD, Skaggs DL, Bishop GA, et al. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014;34(2):129-133. Wheaton AG, Olsen EO, Miller GF, Croft JB. Sleep Duration and Injury-Related Risk Behaviors Among High School Students--United States, 2007-2013. MMWR Morb Mortal Wkly Rep. 2016;65(13):337-341. Paruthi S, Brooks LJ, D’Ambrosio C, et al. Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion. Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine. 2016;12(11):1549-1561. Watson NF, Badr MS, Belenky G, et al. Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion. Sleep. 2015;38(8):1161-1183. Juliff LE, Halson SL, Hebert JJ, Forsyth PL, Peiffer JJ. Longer Sleep Durations Are Positively Associated With Finishing Place During a National Multiday Netball Competition. J Strength Cond Res. 2018;32(1):189-194. Beedie CJ, Terry PC, Lane AM. The profile of mood states and athletic performance: Two meta- analyses. Journal of Applied Sport Psychology. 2000;12(1):49-68. Panic N, Leoncini E, de Belvis G, Ricciardi W, Boccia S. Evaluation of the endorsement of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement on the quality of published systematic review and meta-analyses. PLoS One. 2013;8(12): e83138. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS medicine. 2009;6(7): e1000100. Watson A, Brickson S, Brooks A, Dunn W. Subjective well-being and training load predict in- season injury and illness risk in female youth soccer players. Br J Sports Med. 2016. Alricsson M, Domalewski D, Romild U, Asplund R. Physical activity, health, body mass index, sleeping habits and body complaints in Australian senior high school students. Int J Adolesc Med Health. 2008;20(4):501-512. Wells G, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp . Luke A, Lazaro RM, Bergeron MF, et al. Sports-related injuries in youth athletes: is overscheduling a risk factor? Clin J Sport Med. 2011;21(4):307-314. University of Oxford Center for Evidence-Based Medicine. Oxford Centre for Evidence-based Medicine – Levels of Evidence. 2009; https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/ . von Rosen P, Frohm A, Kottorp A, Friden C, Heijne A. Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes. Scand J Med Sci Sports. 2017;27(11):1364-1371. von Rosen P, Frohm A, Kottorp A, Friden C, Heijne A. Multiple factors explain injury risk in adolescent elite athletes: Applying a biopsychosocial perspective. Scand J Med Sci Sports. 2017;27(12):2059-2069. Picavet HS, Berentzen N, Scheuer N, et al. Musculoskeletal complaints while growing up from age 11 to age 14: the PIAMA birth cohort study. Pain. 2016;157(12):2826-2833. Kim SY, Sim S, Kim SG, Choi HG. Sleep Deprivation Is Associated with Bicycle Accidents and Slip and Fall Injuries in Korean Adolescents. PLoS One. 2015;10(8): e0135753. Stare J, Maucort-Boulch D. Odds Ratio, Hazard Ratio and Relative Risk. Metodoloski Zvezki. 2016;13(1):59-67. Watson AM. Sleep and Athletic Performance. Curr Sports Med Rep. 2017;16(6):413-418. Stracciolini A, Stein CJ, Kinney S, McCrystal T, Pepin MJ, Meehan Iii WP. Associations Between Sedentary Behaviors, Sleep Patterns, and BMI in Young Dancers Attending a Summer Intensive Dance Training Program. J Dance Med Sci. 2017;21(3):102-108. Stracciolini A, Shore BJ, Pepin MJ, Eisenberg K, Meehan WP, 3 rd. Television or unrestricted, unmonitored internet access in the bedroom and body mass index in youth athletes. Acta Paediatr. 2017;106(8):1331-1335. Snyder Valier AR, Welch Bacon CE, Bay RC, Molzen E, Lam KC, Valovich McLeod TC. Reference Values for the Pediatric Quality of Life Inventory and the Multidimensional Fatigue Scale in Adolescent Athletes by Sport and Sex. Am J Sports Med. 2017;45(12):2723-2729. Simpson NS, Gibbs EL, Matheson GO. Optimizing sleep to maximize performance: implications and recommendations for elite athletes. Scand J Med Sci Sports. 2017;27(3):266-274. Liiv H, Jurimae T, Klonova A, Cicchella A. Performance and recovery: stress profiles in professional ballroom dancers. Med Probl Perform Art. 2013;28(2):65-69. Van Der Werf YD, Van Der Helm E, Schoonheim MM, Ridderikhoff A, Van Someren EJ. Learning by observation requires an early sleep window. Proc Natl Acad Sci U S A. 2009;106(45):18926- 18930. Lee AJ, Lin WH. Association between sleep quality and physical fitness in female young adults. J Sports Med Phys Fitness. 2007;47(4):462-467. Mejri MA, Yousfi N, Hammouda O, et al. One night of partial sleep deprivation increased biomarkers of muscle and cardiac injuries during acute intermittent exercise. J Sports Med Phys Fitness. 2017;57(5):643-651. Mejri MA, Yousfi N, Mhenni T, et al. Does one night of partial sleep deprivation affect the evening performance during intermittent exercise in Taekwondo players? Journal of exercise rehabilitation. 2016;12(1):47-53. Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation’s updated sleep duration recommendations: final report. Sleep health. 2015;1(4):233-243. Dennis J, Dawson B, Heasman J, Rogalski B, Robey E. Sleep patterns and injury occurrence in elite Australian footballers. J Sci Med Sport. 2016;19(2):113-116. Bergeron MF, Mountjoy M, Armstrong N, et al. International Olympic Committee consensus statement on youth athletic development. Br J Sports Med. 2015;49(13):843-851. Riley M, Locke AB, Skye EP. Health maintenance in school-aged children: Part II. Counseling recommendations. Am Fam Physician. 2011;83(6):689-694. Spector ND, Kelly SF. Sleep disorders, immunizations, sports injuries, autism. Curr Opin Pediatr. 2005;17(6):773-786. Asarnow LD, McGlinchey E, Harvey AG. The effects of bedtime and sleep duration on academic and emotional outcomes in a nationally representative sample of adolescents. J Adolesc Health. 2014;54(3):350-356. Dahl RE, Lewin DS. Pathways to adolescent health sleep regulation and behavior. J Adolesc Health. 2002;31(6 Suppl):175-184. School start times for adolescents. Pediatrics. 2014;134(3):642-649. Bland JM, Altman DG. The odds ratio. BMJ. 2000;320(7247):1468.

The following books are reviewed: Klaus-Peter Adam, Friedrich Avemarie och Nili Wazana (red.), Law and Narrative in the Bible and in Neighbouring Ancient Cultures (Josef Forsling) Stephen P. Ahearne-Kroll, Paul A. Holloway och James A. Kelhoffer (red.), Women and Gender in Ancient Religions: Interdisciplinary Approaches (Hanna Stenström) Dale C. Allison, Volker Leppin, Choon-Leong Seow, Hermann Spieckermann, Barry Dov Walfish och Eric Ziolkowski (red.), Encyclopedia of the Bible and Its Reception, v. 3 (Göran Eidevall) Dale C. Allison, Volker Leppin, Choon-Leong Seow, Hermann Spieckermann, Barry Dov Walfish och Eric Ziolkowski (red.), Encyclopedia of the Bible and Its Reception, v. 5 (Mikael Larsson) Joseph L. Angel, Otherworldly and Eschatological Priesthood in the Dead Sea Scrolls (Torleif Elgvin) Eve-Marie Becker och Anders Runesson (red.), Mark and Matthew I: Comparative Readings: Understanding the Earliest Gospels in their First-century Settings (Tobias Hägerland) Bob Becking, Ezra, Nehemiah, and the Construction of Early Jewish Identity (Lena-Sofia Tiemeyer) April D. DeConick, Holy Misogyny: Why the Sex and Gender Conflicts in the Early Church Still Matter (Hanna Stenström) Daniel R. Driver, Brevard Childs, Biblical Theologian: For the Church’ s One Bible (LarsOlov Eriksson) Göran Eidevall och Blaženka Scheuer (red.), Enigmas and Images: Studies in Honor of Tryggve N. D. Mettinger (Stig Norin) Weston W. Fields, The Dead Sea Scrolls: A Full History (Cecilia Wassén) Miriam Goldstein, Karaite Exegesis in Medieval Jerusalem: The Judeo-Arabic Pentateuch Commentary of Yūsuf ibn Nūḥ and Abū al-Faraj Hārūn (Lena- Sofia Tiemeyer) Leif Hongisto, Experiencing the Apocalypse at the Limits of Alterity (Hanna Stenström) Jan Joosten, The Verbal System of Biblical Hebrew: A New Synthesis Elaborated on the Basis of Classical Prose (Ulf Bergström) Christos Karakolis, Karl-Wilhelm Niebuhr och Sviatoslav Rogalsky (red.), Gospel Images of Jesus Christ in Church Tradition and in Biblical Scholarship (Mikael Sundkvist) Thomas Kazen, Issues of Impurity in Early Judaism (Cecilia Wassén) Chris Keith, Jesus’ Literacy: Scribal Culture and the Teacher from Galilee (Tobias Ålöw) Anthony Le Donne, The Historiographical Jesus: Memory, Typology, and the Son of David (Jennifer Nyström) Kenneth Liljeström (red.), The Early Reception of Paul (Martin Wessbrandt) Aren M. Maeir, Jodi Magness and Lawrence H. Schiffman (ed.), ‘Go Out and Study the Land’ (Judges 18:2): Archaeological, Historical and Textual Studies in Honor of Hanan Eshel (Torleif Elgvin) David L. Mathewson, Verbal Aspect in the Book of Revelation: The Function of Greek Verb Tenses in John’s Apocalypse (Jan H. Nylund) Robert K. McIver, Memory, Jesus, and the Synoptic Gospels (Jennifer Nyström) Sun Myung Lyu, Righteousness in the Book of Proverbs (Bo Johnson) Stefan Nordenson, Genom honom skapades allt: En exegetisk studie om Kristi preexistens och medlarfunktion i Nya testamentet (Hanna Stenström) Stefan Nordgaard Svendsen, Allegory Transformed: The Appropriation of Philonic Hermeneutics in the Letter to the Hebrews (Johannes Imberg) Donna Lee Petter, The Book of Ezekiel and Mesopotamian City Laments (Lena-Sofia Tiemeyer) Stanley E. Porter, Jeffrey T. Reed och Matthew Brook O’Donnell, Fundamentals of New Testament Greek (Jan H. Nylund) Stanley E. Porter och Jeffrey T. Reed, Fundamentals of New Testament Greek: Workbook (Jan H. Nylund) Karl Olav Sandnes, The Gospel ‘According to Homer and Virgil’: Cento and Canon (Maria Sturesson) Tanja Schultheiss, Das Petrusbild im Johannesevangelium (Finn Damgaard) William A. Tooman, Gog of Magog: Reuse of Scripture and Compositional Technique in Ezekiel 38–39 (Lena-Sofia Tiemeyer) Paul Trebilco, Self-designations and Group Identity in the New Testament (Rikard Roitto) Caroline Vander Stichele och Hugh Pyper (red.), Text, Image, and Otherness in Children’s Bibles: What Is in the Picture? (Mikael Larsson) Patricia Walters, The Assumed Authorial Unity of Luke and Acts: A Reassessment of the Evidence (Carl Johan Berglund) Amanda Witmer, Jesus, the Galilean Exorcist: His Exorcisms in Social and Political Context (Jennifer Nyström)

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.

Photo by Spencer Davis on Unsplash ABSTRACT Current conceptions of solidarity impose a morality and sacrifice that did not prevail in the case of COVID-19 vaccine distribution. Notably, the vaccine distribution disparity revealed that when push came to shove, in the case of global distribution, self-interested persons reached inward rather than reaching out, prioritized their needs, and acted to realize their self-interest. Self-interest and loyalty to one’s own group are natural moral tendencies. For solidarity to be normatively relevant in difficult and emergency circumstances, solidarity scholars ought to leverage the knowledge of the human natural tendency to prioritize one’s own group. This paper recommends a nonexclusive approach to solidarity that reflects an understanding of rational self-interest but highlights commonalities among all people. A recommended task for future studies is to articulate what the account of solidarity informed by loyalty to the group would look like. INTRODUCTION The distribution of COVID-19 vaccines raises concerns about the normative relevance of the current conceptions of solidarity. Current conceptions of solidarity require individuals to make sacrifices they will reject in difficult and extreme situations. To make it more relevant in difficult situations, there is a need to rethink solidarity in ways that align with natural human dispositions. The natural human disposition or tendency is to have loyalty to those to whom one relates, to those in one’s own group (by race, ethnicity, neighborhood, socioeconomic status, etc.), or to those in one’s location or country. While some may contend that such natural dispositions should be overcome through moral enhancement,[1] knowledge about self-interest ought to be leveraged to reconceptualize solidarity. Notably, for solidarity to be more relevant in emergencies characterized by shortages, solidarity ought to take natural human behaviors seriously. This paper argues that rather than seeing solidarity as a collective agreement to help others out of a common interest or purpose, solidarity literature must capitalize on human nature’s tendency toward loyalty to the group. One way to do this is by expanding the group to the global community and redefining solidarity to include helping the human race when emergencies or disasters are global. The first section describes the current conception of solidarity, altruism, and rational self-interest. The second section discusses how the moral imperative to cooperate by reaching out to others did not lead to equitable COVID-19 vaccine distribution. The third section argues that solidarity should be rethought to align with natural human dispositions toward loyalty to groups and rational self-interest. The final section briefly suggests the global community be the group for nonexclusive solidarity. I. Solidarity: Understanding Its Normative Imperatives Solidarity literature is vast and complex, attracting contributions from authors from countries of all income levels.[2] Notably, the literature addresses how solidarity develops from interpersonal, then group to institutional, and how it is motivated and maintained at different levels.[3] Solidarity is unity among people with a shared interest or goal.[4] The term was popularized during an anti-communist labor movement in Poland.[5] While a show of solidarity traditionally meant solidarity within a group, for example, workers agreeing with and supporting union objectives and leaders,[6] it has come to include sympathy/empathy and action by those outside the group who stand with those in need. In bioethics, the Nuffield Council defines solidarity as “shared practices reflecting a collective commitment to carry financial, social, emotional, and or other ‘costs’ to assist others.”[7] As conceptualized currently, solidarity prescribes a morality of cooperation and may incorporate altruism. Solidaristic actions like aiding others or acting to enhance the quality of others’ lives are often motivated by emotive connections/relations. For this reason, Barbara Prainsack and Alena Buyx define solidarity as “a practice by which people accept some form of financial, practical, or emotional cost to support others to whom they consider themselves connected in some relevant respect.”[8] Although this description has been critiqued, the critics[9] do not deny that sympathy and understanding are the bases for “standing up beside” or relating to others. Political solidarity is a “response to injustice, oppression, or social vulnerability”[10] and it entails a commitment to the betterment of the group. “Rational self-interest” describes when parties behave in ways that make both parties better off.[11] They may be partly motivated by their own economic outcome. It may be that when some regions or groups act solidaristically, they are also motivated by shared economic goals.[12] Rational self-interest is not always opposed to the commitment to collectively work for the group’s good. Rational self-interest can intersect with collective action when parties behave in ways that make both parties better off. For example, one study found that individuals are willing to bear the burden of higher taxes in favor of good education policies that significantly increase their opportunities to have a good life.[13] Rationally self-interested persons may be partly motivated by their own economic outcome. It may be that when some regions or groups act solidaristically, they are also motivated by shared economic goals.[14] Specifically, individuals, organizations, and governments are driven to positively identify with or aid others because they feel connected to them, share the same interest, or would benefit from the same action. Cooperating with others on this basis guarantees their interests. Individuals will be less likely to help those with whom they do not feel connected. Respect, loyalty, and trust among solidary partners are equally grounded in this belief. “[S]olidarity involves commitment, and work as well as the recognition that even if we do not have the same feeling, or the same lives, or the same bodies, we do live on common grounds.”[15] Although individuals are more likely to exhibit solidarity with those to whom they feel connected, their lives and interests are still different. Some African philosophers describe solidarity as entailing reciprocal relations and collective responsibility.[16] The bases for positively acting to benefit others are communal relations and individual flourishing, similar to solidarity as it is described in the global literature. Common motifs and maxims typify this belief: the West African motifs like the Siamese Crocodile and the African maxims like “the right arm washes the left hand and the left arm washes the right arm”, and the Shona phrases “Kukura Kurerwa” and “Chirere chichazo kurerawo” ­– both meaning the group’s development is vital for the individual’s development.[17] As a reciprocal relation, solidaristic actions are instrumentalized for one’s self-affirmation or self-emergence. This view underlies practices in Africa like letsema, which is an agricultural practice where individuals assist each other in harvesting their farm produce. It is also the animating force underlying a favorable disposition towards joint ventures like the ajo (an African contributing saving scheme whereby savings are shared among contributors by rotation).[18] Furthermore, as entailing collective ownership, solidaristic actions become ways of affirming each other’s destiny because it is in one’s best interest to cooperate with them this way or help others realize their life goals given the interconnectedness of lives. One advantage of forming solidary union that reaches out to others is that they possess qualities and skills that one lacks. This application of solidarity is more localized than solidarity among countries or global institutions. Furthermore, solidarity also entails altruism, an idea that is particularly common in the philosophical literature of low-income countries. On this account, solidarity implies a voluntary decision to behave in ways that make individuals better off for their own sake. Here, it matters only that some have thought about solidarity this way. Moreover, this belief informs pro-social behaviors – altruism is acting solely for the good of others.[19] Altruistic behaviors are motivated by empathy, which is an acknowledgement of individuals who require aid, and sensitivity, which is a thoughtful response to individuals in need of help. Solidarity can seem to be a call to help strangers rather than a genuine feeling of uniting with people for a common cause. Altruism and solidarity appear similar although they are distinct in that solidarity is not merely helping others. It is helping others out of a feeling of unity. In some cultures in Africa, an indifference to the needs of others or a failure to act solely in ways that benefit others or society are often considered an exhibition of ill will.[20] Precisely, the phrases “Kukura Kurerwa” and “Chirere chichazo kurerawo” among the Shona people in Southern Africa morally compel one to play an active role in the growth and improvement of others. “The core of improving others’ well-being,” as explained, “is a matter of meeting their needs, not merely basic ones but also those relevant to higher levels of flourishing, e.g. being creative, athletic, theoretical.”[21] On this basis, self-withdrawal, self-isolation, and unilateralism, would be failures to be solidaristic. II. COVID-19 Vaccine Distribution Disparity And The Imperative To Reach Out The strength and benefits of cooperation are well documented. COVID-19 vaccine distribution did not reflect solidarity despite the use of rhetoric suggesting it. COVID-19 vaccine distribution disparity exemplifies how solidarity requires individuals to make sacrifices that they will refuse under challenging circumstances. Solidaristic rhetoric was not uncommon during the COVID-19 pandemic. This was expressed through maxims like “Stronger together”, “No one is safe until everyone is safe”, “We are all in this together”, and “Flatten the curve”, as well as cemented through actions like physical distancing, mask-wearing, travel restrictions, and limits on social gatherings. Before the pandemic, solidarity rhetoric informed alliances like the Black Health Alliance that was created to enable Black people in Canada to access health resources. This rhetoric and the global recognition of the vital importance of exhibiting solidarity had little if any impact on preventing vaccine distribution disparity. Notably, the World Health Organization set a goal of global vaccination coverage of 70 percent. The 70 percent figure was recognized as key for ending the pandemic, preventing the emergence of new variants, and facilitating global economic recovery.[22] The solidaristic rhetoric that no country was safe until all countries were safe did not result in enough vaccine distribution. Nor did the rational self-interest of common economic goals. The economic impact of the pandemic has been huge for most nations, costing the global community more than $2 trillion.[23] Vaccine distribution disparity across countries and regions undermined international efforts to end the COVID-19 pandemic. The disparity revealed that self-interested persons, organizations, and countries reached inward, prioritized their needs, and acted to realize their own self-interest. Empirical studies confirmed the disparity at the macro and micro levels. Some of the findings are worth highlighting. The number of vaccine doses injected in high-income countries was 69 times higher than that in low-income countries.[24] In fact, the UK had doubly vaccinated about 75 percent of its adult population by February 2022, while more than 80 percent of African nations had not received a single dose of the vaccine.[25] Precisely, the national uptake of vaccines in Uganda (which is a low-income economy without COVID-19 production capacity) was “6 percent by September 2021 and 63 percent by June 2022. The vaccination coverage in the country was 2 percent by September 2021 and 42 percent by June 2022. Yet both the national COVID-19 vaccination uptake and coverage were far below WHO targets for these dates.[26] Although a report which assessed the impact of COVID-19 vaccines in the first of year of vaccination showed that about 19 million COVID-19-related deaths were averted, they were mainly in the high-income countries rather than in countries that failed to reach the vaccine coverage threshold for preventing the emergence of new variants.[27] There were more than 250,000 COVID-related deaths in African countries.[28] Though this figure is significantly lower than reported COVID-19 deaths in North America (1.6 million), the report and other studies confirm that many of the deaths in Africa could have been prevented if the vaccines had been widely distributed in the region. [29] Still at the macro level, whereas 78 percent of individuals in high-income countries were vaccinated by February 15, 2022, only 11 percent of persons in low-income countries were vaccinated by the same date.[30] By February 15, 2022, high-income countries like Lithuania and Gibraltar (a UK territory) had more than 300 percent of doses required for vaccinating their population, while low-income countries in Africa had only managed to secure about 10 percent of the necessary vaccine doses for their people. Burundi had vaccinated less than 1 percent of its population by December 2022. The disparity between countries of similar income levels was also evident. For example, among 75 low- and middle-income countries, only about 14 countries reported vaccinating at least 50 percent of their population. And, while high-income countries like Qatar had secured more than 105 percent of doses for their people, other high-income countries like Liechtenstein had only managed about 67 percent vaccination coverage by December 2022.[31] Within countries, vaccination coverage gaps were also evident between urban and rural areas, with the former having higher vaccination coverage than the latter.[32] There were many tangible solidaristic efforts to cooperate or reach out through schemes like the COVID-19 Vaccines Global Access (COVAX), African Vaccine Acquisition Trust (AVAT) and Technology Access Pool (C-TAP). Notably, the schemes were testaments of the global recognition to lift others as we rise and not leave anyone behind. Both high-income and low- and middle-income countries supported the programs as an expression of solidarity. Indeed, many low- and middle-income countries secured about 800 million doses through these schemes by the end of December 2021. Nonetheless, this was still far below these countries’ two-billion-dose target by the same date. The wealthier countries’ rhetoric of support did not lead to delivery of enough vaccines. The support by high-income countries seems disingenuous. While high-income countries at first allocated vaccines carefully and faced shortages, they had plentiful supplies before many countries had enough for their most vulnerable people. Thus, these schemes did very little to ensure the well-being of people in low- and middle-income countries that relied on them. These schemes had many shortcomings. For example, COVAX relied on donations and philanthropy to meet its delivery targets. In addition, despite their support for these schemes, many high-income countries hardly relied on them for their COVID-19 vaccine procurement. Instead, these high-income countries made their own private arrangements. In fact, high-income countries relied on multilateral agreements and direct purchases to secure about 91 percent of their vaccines.[33] These solidaristic underfunded schemes had to compete to procure vaccines with the more highly resourced countries. Arguably, many factors were responsible for the uneven distribution of COVID-19 vaccines. For example, vaccine production sites facilitated vaccine nationalism whereby countries prioritized their needs and enabled host states like the UK to stockpile vaccines quickly. Regions without production hubs, like many places in Africa, experienced supply insecurity.[34] The J & J-Aspen Pharmacare deal under which a South African facility would produce the J&J COVID vaccine did not improve the local supply.[35] Companies sold vaccines at higher than the cost of production despite pledges by many companies to sell COVID-19 vaccines at production cost. AstraZeneca was the only company reported to have initially sold vaccines at cost until it replaced this with tiered pricing in late 2021.[36] Moderna estimated a $19 billion net profit from COVID-19 vaccine sales by the end of 2021. Pricing practices undermined solidaristic schemes designed to help low-income countries access the doses required for their populations.[37] The unwillingness of Western pharmaceutical companies like Johnson and Johnson, Pfizer-BioNTech, and Moderna to temporarily relinquish intellectual property rights or transfer technology that would have eased vaccine production in low-income countries that lacked production capabilities even when taxpayers’ money or public funding accelerated about 97 percent of vaccine discovery is another example of acting without solidarity. South Africa and India proposed the transfer of essential technological information about COVID-19 vaccines to them to increase local production.[38] The EU, UK, and Germany, which host many of these pharmaceutical companies, opposed the technology transfers.[39] Corporations protected their intellectual property and technology for profits. There were many other factors, like vaccine hoarding. Although the solidaristic rhetoric suggested a global community united to help distribute the vaccine, COVID-19 vaccine distribution demonstrates that individuals, institutions, regions, or states will prioritize their needs and interests. This leads to the question, “What sort of behaviors can reasonably be expected of individuals in difficult situations? In what ways can solidarity be re-imagined to accommodate such behaviors? Ought solidarity be re-imagined to accommodate such actions? III. COVID-19 Vaccine Disparity: Lessons For Solidarity Literature COVID-19 vaccine distribution disparity has been described as inequitable and immoral.[40] One justification for the negative depiction is that it is irresponsible of individual states or nations to prioritize their own needs over the global good, especially when realizing the global interest is necessary for ensuring individual good. Although such contributions to the ethical discourse on COVID-19 vaccine disparity are essential, they could also distract attention from vital conversations concerning how and why current solidarity conceptions can better reflect core human dispositions. To clarify, the contestation is not that solidaristic acts of reaching out to others are morally unrealistic or non-realizable. There are historical examples of solidarity, particularly to end a common affliction or marginalization. An example is the LGBT support of HIV/AIDS-infected persons based on their shared identities to confront and end the stigma, apathy, and homophobia that accompanied the early years of the crisis.[41] Equally, during the apartheid years in South Africa, Black students formed solidarity groups as a crucial racial response to racism and oppression by the predominantly White government.[42] Additionally, the World Health Organization’s (WHO) director, Tedros Ghebreyesus cited solidarity and its rhetoric as the reason for the resilience of societies that safely and efficiently implemented restrictive policies that limited COVID-19 transmission. To improve its relevance to emergencies, solidarity ought to be reconceptualized considering COVID-19 vaccine distribution. As demonstrated by the COVID-19 vaccine distribution disparity, individuals find it difficult to help others in emergencies and share resources given their internal pressing needs. Moreover, humans have a natural tendency to take care of those with whom they identify. That may be by country or region, race, ethnicity, socioeconomic status, type of employment, or other grouping. By extension, the morality that arises from the tendency towards “the tribe” is sometimes loyalty to one’s broader group. Evidence from human evolutionary history, political science, and psychology yields the claim that “tribal [morality] is a natural and nearly ineradicable feature of human cognition, and that no group—not even one’s own—is immune.”[43] Tribal morality influences mantras like America First, South Africans Above Others, or (arguably) Brexit. These conflict with solidarity. As another global example, climate change concerns are not a priority of carbon’s worst emitters like the US, China, and Russia. In fact, in 2017, the US pulled out of the Paris Agreement, a tangible effort to rectify the climate crisis.[44] Droughts experienced by indigenous people in Turkana, the melting ice experienced by the Inuit, the burning bush experienced by the aboriginal Australians, and the rise in ocean levels that remain a constant threat to the Guna are examples of the harm of the changing climate. In the case of climate action, it appears that governments prioritize their self-interests or the interests of their people, over cooperation with governments of places negatively impacted. In the instance of COVID-19 vaccine distribution disparity, loyalty to the group was evident as states and countries kept vaccines for their own residents. Solidarity has a focus on shared interests and purpose, but in its current conceptions it ignores human nature’s loyalty to groups. In emergencies that involve scarcity, solidarity needs to be redefined to address the impulse to keep vaccines for one’s own country’s population and the choice to sell vaccines to the highest bidder. For solidarity to be normatively relevant in difficult and emergency circumstances, solidarity scholars ought to leverage the knowledge of human natural tendency to prioritize one’s own group to rethink this concept. IV. Rethinking Solidarity For Challenging Circumstances In the globalized world, exhibiting solidarity with one another remains intrinsically valuable. It makes the world better off. But the challenge remains ensuring that individuals can exhibit solidarity in ways that align with their natural instincts. Rather than helping those seen as other, or behaving altruistically without solidarity, people, governments, and organizations should engage in solidarity to help others and themselves as part of the global community. A rational self-interest approach to solidarity is similar, while altruism is distinguishable. Solidarity can be expanded to apply when the human race as a whole is threatened and common interests prevail, sometimes called nonexclusive solidarity.[45] That is distinguished from altruism as solidarity involves seeing each other as having shared interests and goals – the success of others would lead to the success of all. For example, cleaner air or limiting the drivers of human-made climate change would benefit all. Warning the public, implementing social distancing and masking, and restricting travel are examples of global goals that required solidaristic actions to benefit the human race.[46] Arguably, this conception of solidarity could apply to a scarce resource, like the COVID-19 vaccine. Notably, the solidarity rhetoric that this gives rise to is that COVID-19 vaccine equitable distribution is a fight for the human race. Solidarity has been applied to scarcity and used to overcome deprivation due to scarcity. In the case AIDS/HIV, there were many arguments and then programs to reduce drug prices and to allocate and condoms to countries where the epidemic was more pronounced and continuing to infect people. Similarly, a solidarity-inspired effort led to treatments for resistant tuberculosis.[47] Summarily, I suggest that we cannot tackle global health problems without exhibiting solidarity with one another. Humans can exhibit solidarity in ways that align with their natural instincts. To do this, nonexclusive solidarity described in this section, is required. Although the nonexclusive solidarity recognizes difference, it avoids the “logic of competition that makes difference toxic.”[48] Without necessarily requiring every country's leaders to prioritize global citizens equally, the nonexclusive solidarity at least, prohibits forms of competition that undermine initiatives like COVAX from securing the required vaccines to reach the vaccine coverage target. CONCLUSION COVID-19 vaccine distribution disparity does not create a new problem. Instead, it reveals an existing concern. This is the disconnect between dominant human psychological makeup and the sort of solidarity expounded in current literature or solidaristic actions. Notably, it reveals a failure of current solidarity conceptions to reflect the natural human tendency to prioritize the interests of one’s own group. As such, the disparity requires rethinking or reconceptualization of solidarity in ways that align with the dominant human tendency. As conceptualized currently, solidarity enjoins a form of morality that many found very difficult to adhere to during the COVID-19 pandemic. Notably, they perceived solidarity as a call to help strangers. Humans are linked by something that is far more important than a relationship between strangers. The unbreakable bond among humans that this idea gives rise to would necessitate genuine concern for each other’s well-being since we are implicated in one another's lives. The exact ways a conception of solidarity that applies to the global community can inform guidelines and policies in emergencies and difficult situations when individuals are expected to be solidaristic is a recommended task for future studies. - [1] Ingmar Persson & Julian Savulescu 2019. The Duty to be Morally Enhanced. Topoi, 38, 7-14. [2] M. Inouye 2023. On Solidarity, Cambridge, MA, Boston Review. [3] Barbara Prainsack & Alena Buyx 2011. Solidarity. Reflections on an Emerging Concept in Bioethics. Summary. [4] Oxford Languages (“unity or agreement of feeling or action, especially among individuals with a common interest; mutual support within a group.”) [5] Mikolaj Glinski. 2015. The Solidarity Movement: Anti-Communist, Or Most Communist Thing Ever? The Solidarity Movement: Anti-Communist, Or Most Communist Thing Ever?. https://culture.pl/en/article/the-solidarity-movement-anti-communist-or-most-communist-thing-ever. [6] Carola Frege, Edmund Heery & Lowell Turner 2004. 137The New Solidarity? Trade Union Coalition-Building in Five Countries. In: FREGE, C. & KELLY, J. (eds.) Varieties of Unionism: Strategies for Union Revitalization in a Globalizing Economy. Oxford University Press. [7] Barbara Prainsack & Alena Buyx 2011. Solidarity. Reflections on an Emerging Concept in Bioethics. Summary. [8] Prainsack & Buyx, 2017. [9] Angus Dawson & Bruce Jennings 2012. The Place of Solidarity in Public Health Ethics. Public Health Reviews, 34, 4. [10] Sally J. Scholz 2008. Political Solidarity, Penn State University Press. [11] Emanuele Bertusi. 2017. An analysis of Adam Smith's concept of self-interest: From Selfish behavior to social interest. Libera Universita Internazionale Degli Studi Sociali. [12] Sally J. Scholz 2008. Political Solidarity, Penn State University Press. [13] Marius R. Busemeyer & Dominik Lober 2020. Between Solidarity and Self-Interest: The Elderly and Support for Public Education Revisited. Journal of Social Policy, 49, 425-444. [14] Scholz, 2008. [15] Sara Ahmed 2004. The Cultural Politics of Emotion, New York, Routledge. [16] C. Ewuoso, T. Obengo & C. Atuire 2022. Solidarity, Afro-communitarianism, and COVID-19 vaccination. J Glob Health, 12, 03046. [17] J Mugumbate 2013. Exploring African philosophy: The value of ubuntu in social work. Afri J Soc W 3, 82-100. [18] Salewa Olawoye-Mann 2023. 55Beyond Coping: The Use of Ajo Culture among Nigerian Immigrants to Counter Racial Capitalism in North America. In: HOSSEIN, C. S., AUSTIN, S. D. W. & EDMONDS, K. (eds.) Beyond Racial Capitalism: Co-operatives in the African Diaspora. Oxford University Press. [19] Estrella Gualda 2022. Altruism, Solidarity and Responsibility from a Committed Sociology: Contributions to Society. The American Sociologist, 53, 29-43. [20] Ewuoso, Obengo & Atuire 2022. [21] T. Metz 2015. An African theory of social justice. In: BIOSEN, C. & MURRAY, M. (eds.) Distributive Justice Debates in Political and Social Thought: Perspectives on Finding a Fair Share. New York: Routledge. [22] Victoria Pilkington, Sarai Mirjam Keestra & Andrew Hill 2022. Global COVID-19 Vaccine Inequity: Failures in the First Year of Distribution and Potential Solutions for the Future. Frontiers in Public Health, 10. [23] M. Hafner, E. Yerushalmi, C. Fays, E. Dufresne & C. Van Stolk 2022. COVID-19 and the Cost of Vaccine Nationalism. Rand Health Q, 9, 1. [24] Mohsen Bayati, Rayehe Noroozi, Mohadeseh Ghanbari-Jahromi & Faride Sadat Jalali 2022. Inequality in the distribution of Covid-19 vaccine: a systematic review. International Journal for Equity in Health, 21, 122. [25] Graham Dutfield, Siva Thambisetty, Aisling Mcmahon, Luke Mcdonagh & Hyo Kang 2022. Addressing Vaccine Inequity During the COVID-19 Pandemic: The TRIPS Intellectual Property Waiver Proposal and Beyond. Cambridge Law Journal, 81. [26] Patrick King, Mercy Wendy Wanyana, Richard Migisha, Daniel Kadobera, Benon Kwesiga, Biribawa Claire, Michael Baganizi & Alfred Driwale. 2023. Covid 19 vaccine uptake and coverage, Uganda 2021-2022. UNIPH Bulletin, 8. https://uniph.go.ug/covid-19-vaccine-uptake-and-coverage-uganda-2021-2022/#: [27] O. J. Watson, G. Barnsley, J. Toor, A. B. Hogan, P. Winskill & A. C. Ghani 2022. Global impact of the first year of COVID-19 vaccination: a mathematical modelling study. Lancet Infect Dis, 22, 1293-1302. [28] Arcgis January 21, 2024. African dashboard for tracking the COVID-19 in real-time. https://www.arcgis.com/apps/dashboards/b959be51c0014845ad44142bce1b68fe [29] Jai K. Das, Hsien Yao Chee, Sohail Lakhani, Maryam Hameed Khan, Muhammad Islam, Sajid Muhammad & Zulfiqar A. Bhutta 2023. COVID-19 Vaccines: How Efficient and Equitable Was the Initial Vaccination Process? Vaccines, 11, 11. O. J. Watson, G. Barnsley, J. Toor, A. B. Hogan, P. Winskill & A. C. Ghani 2022. Global impact of the first year of COVID-19 vaccination: a mathematical modelling study. Lancet Infect Dis, 22, 1293-1302. [30] Pilkington, Keestra & Hill 2022. [31] Kunyenje, et al. 2023. [32] Pilkington, Keestra & Hill 2022. [33] Jai K. Das, Hsien Yao Chee, Sohail Lakhani, Maryam Hameed Khan, Muhammad Islam, Sajid Muhammad & Zulfiqar A. Bhutta 2023. COVID-19 Vaccines: How Efficient and Equitable Was the Initial Vaccination Process? Vaccines, 11, 11. [34] Kunyenje, et al. 2023. [35] Lynsey Chutel. 2022. Africa's first COVID-19 vaccine factory hasn't received a single order. Africa's first COVID-19 vaccine factory hasn't received a single order. https://www.nytimes.com/2022/05/12/world/africa/south-africa-covid-vaccine-factory.html [36] Graham Dutfield, Siva Thambisetty, Aisling Mcmahon, Luke Mcdonagh & Hyo Kang 2022. Addressing Vaccine Inequity During the COVID-19 Pandemic: The TRIPS Intellectual Property Waiver Proposal and Beyond. Cambridge Law Journal, 81. [37] Dutfield, et al. [38] Hannah Balfour. June 17, 2022 2022. WTO waives intellectual property rights for COVID-19 vaccines. European Pharmaceutical Review https://www.europeanpharmaceuticalreview.com/news/172329/breaking-news-wto-waives-intellectual-property-rights-for-covid-19-vaccines/ [39] Government Uk. 2021. UK statements to the TRIPS Council: Item 15 waiver proposal for COVID-19. UK statements to the TRIPS Council: Item 15 waiver proposal for COVID-19 . https://www.gov.uk/government/news/uk-statement-to-the-trips-council-item-15 [40] Victoria Pilkington, Sarai Mirjam Keestra & Andrew Hill 2022. Global COVID-19 Vaccine Inequity: Failures in the First Year of Distribution and Potential Solutions for the Future. Frontiers in Public Health, 10. [41] Benjamin Klassen 2021. ‘Facing it Together’: Early Caregiving Responses to Vancouver's HIV/AIDS Epidemic. Gender & History, 33, 774-789. [42] Mabogo P. More 2009. Black solidarity: A philosophical defense. Theoria: J Soc and Pol Theory, 56, 20-43. [43] Cory J. Clark, Brittany S. Liu, Bo M. Winegard & Peter H. Ditto 2019. Tribalism Is Human Nature. Current Directions in Psychological Science, 28, 587-592. [44] Hai-Bin Zhang, Han-Cheng Dai, Hua-Xia Lai & Wen-Tao Wang 2017. U.S. withdrawal from the Paris Agreement: Reasons, impacts, and China's response. Advances in Climate Change Research, 8, 220-225. [45] Arto Laitinen & Anne Birgitta Pessi 2014. Solidarity: Theory and Practice. An Introduction. In: LAITINEN, A. & PESSI, A. B. (eds.) Solidarity: Theory and Practice. Lexington Books. [46] X. Li, W. Cui & F. Zhang 2020. Who Was the First Doctor to Report the COVID-19 Outbreak in Wuhan, China? J Nucl Med, 61, 782-783. [47] Atuire, C. A., & Hassoun, N. 2023. Rethinking solidarity towards equity in global health: African views. International journal for equity in health, 22(1), 52. https://doi.org/10.1186/s12939-023-01830-9 [48] Samo Tomšič 2022. No Such Thing as Society? On Competition, Solidarity, and Social Bond. differences, 33, 51-71.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-09-01T13:12:16Z No. of bitstreams: 1 Maurino Marques Nascimento Junior.pdf: 1599278 bytes, checksum: cea775b45a5fefccc276ed5d8d27437b (MD5)
Made available in DSpace on 2017-09-01T13:12:16Z (GMT). No. of bitstreams: 1 Maurino Marques Nascimento Junior.pdf: 1599278 bytes, checksum: cea775b45a5fefccc276ed5d8d27437b (MD5) Previous issue date: 2017-08-22
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
The gospel according to Luke, in the extended section of Jesus' ascent to Jerusalem (Lk 9:51–19:28), presents the conditions cited by Jesus for one to become his disciple. The purpose of this dissertation is to examine each of these conditions by focusing specifically on the text of Luke 14:25-33. To do so, an exegetical analysis of the text will be developed, which will serve as a basis for a subsequent theological analysis and consequent hermeneutic actualization. The theme is relevant, since discipleship has been and remains the essence of the Christian life in the sense of a godly life in community. The methodology applied in this work will be guided by a bibliographical research, which will be based on several authors, who have developed studies and research on the subject. The conditions put forward by Jesus, presented in the Lucan text, express the radicality and the necessity of a conscious decision on the position that will be adopted before them. From these factors will depend a genuine position as a disciple of Jesus Christ, who obeys and follows
O evangelho segundo Lucas, na extensa seção da subida de Jesus a Jerusalém (Lc 9,51–19,28), apresenta as condições citadas por Jesus para que alguém se torne seu discípulo. O objetivo da presente dissertação é examinar cada uma dessas condições, focalizando especificamente o texto de Lc 14,25-33. Para tanto será desenvolvida uma análise exegética do texto que servirá de base para uma posterior análise teológica e uma consequente atualização hermenêutica. O tema é relevante, uma vez que o discipulado foi e continua sendo a essência da vida cristã, no sentido de uma vida piedosa em comunidade. A metodologia aplicada neste trabalho se orientará por uma pesquisa bibliográfica, que tomará por base diversos autores que desenvolveram estudos e pesquisas sobre o tema. As condições apresentadas por Jesus e narradas no texto lucano expressam a radicalidade e a necessidade de uma decisão consciente quanto ao posicionamento que, diante delas, se adotará. Delas dependerá o seguimento genuíno do discípulo de Jesus Cristo

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-09-29T12:34:58Z No. of bitstreams: 1 Victor da Silva Almeida Filho.pdf: 1453247 bytes, checksum: 440494c02418fcfa50c70b51c2a54830 (MD5)
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Pontifícia Universidade Católica de São Paulo - PUCSP
This study is an analysis of the account of Luke 7, 11-17 better known as the resurrection of the son of the widow of Naim. In a first moment the work deals with general questions of the Gospel according to Luke, presenting the structural analyzes of the narrative. So, the pericope of Naim assumes a literary function, serving to complete the answer to the messengers sent by John the Baptist (Lk 7, 18-23) about the identity of Jesus. To prove this, Luke employs the Greek verb σπλαγχνίζομαι, to be moved with compassion, to a widowed woman who was in a situation of vulnerability. We studied the rule for the use of this verb in the pericope as well as its semantic root and its two other occurrences in the Lucan Gospel. For the analysis and interpretation of Lk 7,11-17, analytical elements of contemporary biblical exegetical methodology were used. The research valorized the diachronic studies by making the interface with the synchronic studies and intertextual analyzes, aided by texts of the Magisterium of Pope Francis. The results achieved were a better understanding of the Lucan account, because in using the verb σπλαγχνίζομαι the author does so in a conscious and coherent way towards those who are in a situation of vulnerability and uses their own literary criteria and their particular narrative style
Este estudo é uma análise do relato de Lc 7,11-17, mais conhecido como a ressurreição do filho da viúva de Naim. Em um primeiro momento, o trabalho trata de questões gerais do Evangelho segundo Lucas, apresentando as análises estruturais da narrativa. A perícope de Naim assume uma função literária, completando a resposta aos mensageiros enviados por João Batista (Lc 7,18-23) sobre a identidade de Jesus. Para demosntrar isso, Lucas emprega o verbo grego σπλαγχνίζομαι, “ser movido de compaixão”, para uma mulher viúva que se encontrava em situação de vulnerabilidade. Foram estudados os critérios para o emprego deste verbo na perícope, bem como sua raiz semântica e suas duas outras ocorrências no Evangelho lucano. Para a análise e interpretação de Lc 7,11-17 foram utilizados elementos analíticos da metodologia exegética bíblica contemporânea. A pesquisa valorizou os estudos diacrônicos, fazendo a interface com os estudos sincrônicos e análises intertextuais, auxiliados por textos do Magistério. Os resultados alcançados foram uma melhor compreensão do relato lucano, pois, ao empregar o verbo σπλαγχνίζομαι, o autor o faz de modo consciente e coerente para com os que se encontram em situação de vulnerabilidade e se vale de critérios literários próprios e de seu particular estilo narrativo