Academic literature on the topic 'Canada. 1980 September 26. 2007 September 21'

The cardiac surgery is the youngest surgical specialty that has emerged in the early period of the 20th century. Surprisingly, however, it is also the first surgical specialty that seems to be the first to disappear in a way or another in the second half of the 21st century. Even if the optimists consider this will never happen, it is expected that cardiac surgery will suffer a radical metamorphosis, which makes the realists say that this field of surgery will actually disappear.Before the beginning of the 20th century, the surgeons around the world have been convinced that human heart is untouchable. Remarkable surgeons of the 19th century like Theodor Billroth – the founder of the Viennese school of surgery- said in 1863 that “ Any surgeon that dares to perform surgery on the heart will fail and will lose the appreciation of his colleagues” [1]. This statement reveals the general opinion of that time, that the human heart is the center of the soul, of life itself and therefore it should never be touched. Considering this, Sharman stated in 1902 in „The American Journal of Medical Association” : “even though the heart lies at a few centimeters beneath the skin, it took 2400 years for surgery to reach this distance” [2].Ironically, the same year that English surgeon Stephan Paget stated that “probably the human heart is boundary that nature set for any kind of surgery -1896- was also the year when Ludwig Rehn, a German surgeon from Frankfurt, managed to successfully repair a right ventricular wound, signing the birth certificate of the cardiac surgery [3]. Since then the myth that the human heart can’t be touched by surgeons vanished and the sacred center of the heart has been opened…Two distinct periods of cardiac surgery can be identified over the next 100 years. The first period is the so called “surgery on a closed heart”, before the invention of extracorporeal circulation. In this heroic period, the first interventions that involved the pericardium were performed.In the first years of the 20th century, Alexis Carell imagined the experimental basis of cardio-vascular surgery. He invented the vascular sutures, demonstrated the possibility of organ transplantation and imagined coronary surgery. As recognition of his fundamental work he received the Nobel prize for medicine and physiology in 1912. Although he never performed surgery on humans, Alexis Carell remains to this day the first surgeon in history that was awarded with this prestigious prize [4].Surgery of the pericardium started in 1920 with Ludwig Rehn and Ferdinand Sauerbruch [5]. The first surgical approach of the aortic valve was realized by Theodor Tyffier in Paris in 1912 [6]. He succeeded to enlarge an aortic stenosis through a purse on the anterior wall of the aorta. In 1923, in Boston, USA, Elliot Cuttler realized the first instrumental mitral valve valvulotomy on a 12 year old girl [7]. Using a specially modified forceps, and the apex of the left ventricle as the initial approach, he managed to successfully open the mitral valve commissures and then to close the incision on the left ventricle. The first digital mitral valve commissurotomy through the left appendage was performed in 1925 by Sir Henry Soutar[8]. Catastrophic results ( 90% mortality) lead surgeons to abandon this procedure for the next 25 years. In 1948, Charles P. Bailey (Philadelphia), Dwight E. Harken (Boston) and Russell Brock (London) realized the first successful mitral valve commissurotomy [9,10].The first ligature of patent arterial duct was performed by Robert Edward Gross. This procedure took place at Harvard Medical School and Children’s Hospital from Boston, Massachusetts, in 1938 [11].Palliative treatment of the Fallot tetralogy started with the first systemic-pulmonary shunt,realized by Alfred Blalock in 1944 at John Hopkins Hospital [12]. The idea of subclavio-pulmonaryanastomosis was born with the contribution of Hellen Taussig, founder of pediatric cardiology.Treatment of aortic coarctation was independently realized by Edward Gross and Clarance Crafoord in 1945. Both surgeons managed to excised the diseased segment of the aorta and then performed an end to end anastomosis of the aorta [13].Sir Thomas Holmes-Sellors in 1947 and Russel Brock in 1948 realized the first pulmonary valvevalvulotomy [10].In our country, professor Nicolae Hortolomei was the first to perform surgery on the heart atColtea Hospital. He legated a patent arterial duct, excised an aortic coarctation and successfullyrealized in 1953 a digitally mitral valve commissurotomy [14].The second period of cardiac surgery began with the developing of the extracorporeal circulation.This technology allowed stopping the heart and keeping the patient alive, using a device thatmanage to circulate and oxygenate the blood. This ensemble composed of a pomp and anoxygenator was called “the extracorporeal circulation machine” and made possible the future development of “open cardiac surgery”.In 1946 Wilfred G. Bigelow (Toronto, Canada ), demonstrated the role of hypothermia inincreasing the tissue resistance to hypoxemia. This concept is fundamental in the development of extracorporeal circulation [15]. The first procedure on an open heart was realized by John Lewis from University of Minnesota, Mineapolis USA, on 2 september 1952. He used profund hypotermia and occlusion of the caval veins, without using extracorporeal circulation. Using this technique he closed an interatrial septal defect in a 6 year old boy. Time was his biggest limitation, because the heart could not be stoped for more than 8-10 minutes.On 6 may 1953, John H. Gibbon realised the first open heart surgery using an extracorporealcirculation machine [16]. He succesfully closed and interatrial septal deffect on an 18 years old girl.Unfortunatly he lost the following 4 patients, and he decided to abandon this king of surgery after20 years of research.A year later, on the 26th of March 1954 at „University of Minesotta” from Mineapolis USA, C.Walton Lillehei closed an inteventricluar septal defect on a child using the so called “crossedcirculation technique”. In this procedure, he connected the patient’s circulaton to his fathercirculation, trying to repoduce the fetal circulation [17]. Using this technique he operated 45patients, being the first surgeon that closed ventricular septal defects, corrected the commonatrioventricular canal and treated the Fallot tetralogy. Finding a compatible match for the “cross circulation” was the biggest limit of this technique. This method was untill the developement of liver and renal transplant, the only kind of surgery that could reach 200% mortality rate and was abandoned later due to ethical considerations.Starting from 1955, John Kirkling (Mayo Clinic), used the extracorporeal circulation machine(pomp - oxigenator) [18]. He used the Mayo-Gibbon-IBM type, and this technology began to beused all over the world.In Romania, the first surgical procedure on the heart using an extracorporeal circulation machinewas realized in 1961 at Fundeni Hospital (Bucharest). A remarkable team composed of professor Voinea Marinescu and professor Dan Setlacec, closed an atrial septal defect on an 18 years old boy.The extracorporeal machine was handled by Marian Ionescu, and the anesthesia was managed by professor George Litarczek. The patient is still living.Surgery of the cardiac valves started in 1960 when Albert Starr realized the first mitral valvereplacement [19].Without a doubt coronary artery bypass grafting is the most widly spread type of cardiac surgery.Initially introduced by Michael DeBakey and later perfected by Renee Favaloro in 1960, thisprocedure remains one of the most frequent and best studied type of surgery in medicine [20].A crucial moment in the history of cardiac surgery is represented by the first cardiac transplanton human performed by Christian Barnard in 1967[21]. This achievement consecrate cardiacsurgery as a high performace field and made the cardiac surgen a public figure. In this moment, thelove story between cardiac surgery and media started. Most probably the majority of active cardiac surgeons of this generation owe Christiaan Barnard their option for choosing this field and this medical specialty her huge succes.It is considered that the maximum moment of cardiac surgery is the year 1986 when worldwide over 2000 procedures on the open heart were performed daily.But new discoveries started to appear in the cardiovascular field. In the 70s percutaneous procedures were invented. Andreas Gruntzig realized in 1977 the first coronary angioplasty and coronary stents were implanted in 1986 by Puel and Sigwart. Development on interventional cardiology was exponential and nowadays at the European Association of Cardiothoracic Surgery simposium about the future of cardiac surgery, 90% of the cardiac surgeons stated that they would prefer the coronary stent over coronar artery bypass grafting surgery if they would have to choose as patients.Starting with 2003 when was realised the first transcatheter aortic valve implantation (TAVI), the exclusive field of cardiac valve surgery is partialy claimed by interventional cardiology [23].The field of aortic anevrisms and acute dissections falls from cardiac surgery also to interventional cardiology after the developement of endoaortic stent grafts [24,25].As a consequence the number of coronary artery bypass grating procedures falls 28% between 1997 and 2004 in the USA. Meanwhile coronary percutaneos procedures rises with 121% [24,28]. Also it is possible that for the first time in history, the number of cardiac surgeons will decrease untill 2020 [24.28].But cardiac surgery extends in to new fields in order to survive. For exemple, one of the future aspect is the treatment of cardiac insuffiency. It is estimated that over 5 milion americans have cardiac insuffiency [26] and cardiac transplantation is the solution for these patients. Unfortunately, the number of donors falls, and this is no longer an effective solution. Multiple devices are designed in order to help the heart, ranging from univentricular asist devices to artificial hearts. This devices can act as a bridge to cardiac transplantation or they can be the solution for patients that are not eligible for cardiac transplantation.Surgical treatment of atrial fibrilation remains a solid options for patients with this disease which have a high risk of emboly or progression to cardiac insufficiency [27].The field of corection of congenital cardiac malformations lessens because of early diagnostic and possibility to end the pregnancy. But there are surgical treatments for children that are born with complex congenital heart malformations with optimal results.The development of minimally invasive techniques, robotics and hybrid ones represents the response of cardiac surgery to interventional cardiology.Apparently, cardiac surgery and interventional cardiology are merging. More and more patients are heald in hybrind operating rooms, using hybrid techniques. The concept of “heart teams” emerges- a team made of cardiologists, cardiac surgeons and cardiac anesthesiologists. Probably, in the future will exist only a cardiologist-cardiac surgeon or a cardiac surgeon-cardiologist, either way a specialist in cardiovascular medicine.The conclusion isn’t pessimistic. As long as there will be patients, doctors will be needed. It remains to be seen if they will be surgeons, interventional cardiologists or just cardiologists.Certainly, general anesthesia, opeaning the mediastinum through median sternotomy using an electic saw and circulating the patients blood through the extracorporeal circulation machine, not to mention stopping the heart, isn’t the future.But introducing needls in arteries, wires in the aorta and pen sprins into the coronary isn’t also the future.Without a doubt, the future belongs to physicians that will cure cardiovascular disease with pills or even better just with advices...

“I suppose in reality not a leaf goes yellow in autumn without ceasing to care about its sap and making the parent tree very uncomfortable by long growling and grumbling - but surely nature might find some less irritating way of carrying on business if she would give her mind to it. Why should the generations overlap one another at all? Samuel Butler, The Way of All Flesh1 Millenials or Generation Y physicians (born 1977/1980-1995) today form the majority of medical personnel, from medical students and residents in their early twenties and thirties to young attending physicians hitting forty; practicing side-by-side with Generation X (1965-1976/1980) in their late thirties to early fifties; Baby Boomers (1946-1964) in their mid-fifties, sixties and early seventies; and the last of the Silent Generation or Traditionalists (1925-1945) in their mid-seventies, eighties and nineties.2,3 Among 734 Fellows of the Philippine Society of Otolaryngology – Head and Neck Surgery alone, there are currently 18 Traditionalists, 192 Boomers, 360 Generation X, and 164 Millenials. Assuming the 862 board-certified Diplomates waiting to become full-fledged Fellows and 182 Residents-in-Training are also Millenials, there are a total of 1,208 Millenials in the field of Otolaryngology Head and Neck Surgery in the Philippines. With four distinct generations simultaneously in the workforce, it is not unusual to hear older physicians gripe about “these Millenials,” and how different they are from previous generations. The so-called generation gap has been used to characterize inter-generational relations, wherein the preceding generation historically puts down the younger, and the succeeding generation usually complains about the older one. I posit that central to this conflict is a clash between tradition -- the way things should be done (as perceived by the older generation) -- and disruption, the way things can be done differently (from the perspective of the younger generation). In particular (meaning no offense to the “in-between” Generation X, and at risk of being overly simplistic), this is highlighted by the supposed looming showdown between Baby Boomers who are not yet ready to leave and Millenials who can hardly wait to take over.4 Tradition, a “statement, belief or practice handed down from generation to generation” comes from the Old French tradicion “transmission, presentation, handing over” and directly from the Latin traditionem “delivery, surrender, a handing down, a giving up,” from tradere “deliver, hand over,” derived from trans – “over” + dare “to give.”5 Although older generations may like to think they uphold tradition (giving them the right and duty to pass it on to succeeding ones), a large part of what defines each generation in the first place is their departure from the statements, beliefs or practices of their predecessors. Such a transition may have been gradual or sudden, and more pronounced in some generations than in others. Our post-war Boomer generation grew up in a world where face-to-face communication was supplemented by the written (handwritten, typewritten, typeset or telegraphed) and spoken (rotary-dial telephone) word. In medicine and medical education, history and physical examination were taught through lectures (with overhead and opaque projectors, slides on carousels and filmstrips) and live demonstrations on patients and on one another. The advent of word processing and advances in telecommunications and technology that became available to Generation X (who in the Philippines include “martial law babies” oblivious to our “wonder years” of the sixties) gradually changed the landscape of medical education and practice, but it would take the digital and internet revolution to finally, drastically change the world-- and Millenials were the primary beneficiaries of this change. Disruption, from the Latin disruptionem “a breaking asunder,” which comes from disrumpere “break apart, split, shatter, break to pieces,” from dis- “apart” + rumpere “to break”6 perhaps best describes the Baby Boomer generation’s experience of the technological revolution that Millenials grew up with. Suddenly, everything could be had in a split-second and the world was connected in real time. No longer did one have to master penmanship, typing and speed-reading, and homes no longer displayed dictionaries and encyclopedias. Even the library card catalogue and periodicals index became obsolete, as most anything became instantly available and accessible – including information, fast food and relationships. Millenials grew up with this transition, and readily mastered the rapidly changing technology. The locus of socialization was no longer face-to-face interaction within the family, but the worldwide web and social media. In medical education, lectures gave way to podcasts and webinars; heavy textbooks gave way to electronic references; and even dissection gave way to 3D virtual human anatomy. The Millenials’ expertise in, and dependence on, technology can both be their boon and bane – as I often note when residents and students automatically search their peripheral brains (a.k.a. mobile devices) to answer a ward round question. But they are also as quick to intuitively master the diagnostic and therapeutic tools that did not exist when their older colleagues were in residency.7 The early access that Millenials and Generation X had to computer resources in childhood certainly laid “a critical foundation for use of these systems later in life,” compared to Baby Boomers and Traditionalists whose “lack of early experience may limit their enthusiasm” for such tools.3 As Cole puts it, “Baby Boomers don't react well to a 20-something coming in and disrupting the way things have ‘always been’ while Millennials don't react well when they're told to shoot for the moon and ‘do big things,’ and then when they walk in the door with new ideas ready to disrupt age-old models, get told to know their place.”8 Thus, older generations of physicians may question how the stock knowledge and clinical eye of Millenials can compare to theirs, who learned medicine without these tools, and wonder how Millenials would fare in conflict and catastrophic situations when technology fails, or in low- and middle-income rural settings where technology is scarce. Conversely, Millenials wonder why Boomers insist on their old ways and just don’t get it! Perhaps we can learn from Mohr et al.3 about bridging generational issues in medical and surgical education—for instance, between the Socratic Method whereby Boomers may appear to intimidate learners9 versus the Millenial expectation that presentation of information be tailored to their needs, individually or via available technology.10 It could be helpful for Millenials who are “outcomes-oriented and value doing more than knowing”11 “to realize that Traditionalists and Boomers ‘know how to do’ and are ready and able to teach.”3 On the other hand, “when instructing Boomers in new technology or information,” the Millenial teacher “should recognize that this role reversal is uncomfortable to older generations” and “mitigate discomfort … by focus(ing) on the relevance of the information and creat(ing) an environment in which it is ‘safe’ to ask questions and challenge the teacher.”3 Indeed, if inter-generational differences could be surmounted, there is much that Boomers can learn from Millenials, and vice versa. If as Cole observes, “this great debate is hauntingly similar to a parent/child argument,”8 it is because Boomers and Millennials are “also each other’s children and parents, bound together in an intricate web of love, support, anxiety, resentment, and interdependence.”4 Perhaps by involving Generation X in bridging the great divide, and fostering an environment that allows for inter-generational differences in teaching and learning styles, non-disruptive disruption of tradition can take place. Each generation must have the humility (as opposed to intellectual arrogance) to accept that they can learn from other generations – younger or older—for truly meaningful medical progress to take place. We cannot do otherwise, for Generation Z (born after 1995, and about to enter Medical School) is already poised to join the fray. References Butler S. The Way of All Flesh. New York: Dover Publications, 2004. 315 pages. The Center for Generational Kinetics. How to determine generational birth years. November 28, 2016 ©2016 [cited 2017 Nov 2.] Available from: http://genhq.com/generational_birth_years/ Mohr NM, Moreno-Walton L, Mills AM, Brunett PH, Promes SB. Generational Influences in Academic Emergency Medicine: Teaching and Learning, Mentoring, and Technology (Part I). Acad Emerg Med. 2011 Feb;18(2):190-199. DOI: 10.1111/j.1553-2712.2010.00985.x PMID: 21314779 PMCID: PMC3076332 Taylor P, Pew Research Center. The Next America: Boomers, Millenials, and the Looming Generational Showdown. New York: PublicAffairs, 2016. 384 pages. Harper D. Online Etymology Dictionary © 2001-2017 [Cited 2017 November 2.] Available from: https://www.etymonline.com/word/tradition Harper D. Online Etymology Dictionary © 2001-2017 [Cited 2017 November 2.] Available from: https://www.etymonline.com/word/disruption Sopher M. How Millenial Doctors Will Shape the Future of Health Care. Blog on the Internet, Baltimore: Rendia, 2016 October 26. [Cited 2017 November 2.] Available from: https://blog.rendia.com/millennials/ Cole N. The Real Reason Baby Boomers and Millenials Don’t See Eye to Eye (Written by a Millenial). Southeast Asia. 2017 Jan 20 [Cited 2017 November 2] Available from: https://www.inc.com/nicolas-cole/the-real-reason-baby-boomers-and-millennials-dont-see-eye-to-eye-written-by-a-mi.html Seabrook M. Intimidation in medical education: students' and teachers' perspectives. Studies Higher Educ. 2004;29(1):59–74. http://dx.doi.org/10.1080/1234567032000164877 Feiertag J, Berge ZL. Training generation N: How educators should approach the Net Generation. Education and Training. 2008 September;50(6):457–64. DOI: 10.1108/00400910810901782 Mangold K. Educating a new generation: teaching baby boomer faculty about millennial students. Nurse Educ. 2007 Jan-Feb;32(1):21-23. PMID: 17220763

Inculturation emerged as a result of paradigm shifts in the missionary outlook of the Church necessitated by a heightened sense of culture, especially the plurality of cultures. This outlook saw culture as a tool for the transmission of the Gospel message to different frontiers. In view of this, dialogue with culture has passed from being an exception to the rule to becoming normative. Inculturation is a complex process, which must be undertaken gradually and critically. Overall, it aims to incarnate the Gospel in every culture by maintaining a healthy balance between tradition and progress. In this paper, the method of inculturation that is highlighted is the one developed by Charles Kraft and Anscar Chupungco known as “dynamic equivalence,” which seeks to build a “communicational bridge” between the Gospel message and human experience. This paper, therefore, embarks upon the discussion of faith-culture dialogue, keeping in mind Church’s efforts to proclaim the message of the Gospel: first, by first tracing the historical development of Inculturation, highlighting the Church’s disposition towards faith culture dialogue; second, by discussing the nature and dynamics of inculturation, focusing on its essential characteristics; and lastly, delineating the process of inculturation, which underscores dynamic equivalence as method. References Acevedo, Marcelo S.J., Inculturation and the Challenge of Modernity. Rome: Pontifical Gregorian University, 1982. Alberigo, Giuseppe “The Announcement of the Council: From Security of the Fortress to the Lure of Quest,” in History of Vatican II, 1 Announcing and Preparing Vatican II: Toward a New Era in Catholicism, ed. Giuseppe Alberigo and Joseph A. Komonchak. Maryknoll, NY: Orbis. 1-54. Aleaz, K.P. “The Theology of Inculturation Re-Examined,” Asia Journal of Theology 25, 2 (2011):232. Amalorpavadass, D.S. “Indian Culture. Integrating Cultural Elements into Spirituality” in Indian Christian Spirituality ed. By D.S. Amalorpvadass, Bangalore: NBCLC, 1982, 100. Arbuckle, Gerard A. “Christianity, Identity, and Cultures: A Case Study” The Australasian Catholic Report (January, 2013): 41-43. Arbuckle, Gerard Earthing the Gospel: An Inculturation Handbook for the Pastoral Worker. Maryknoll, New York: Orbis Books, 1990. Arevalo, Catalino “Inculturation in the Church: The Asian Context,” Landas 25 (2011): 83-134. Arrupe, P. 1978, “Letter to the Whole Society on Inculturation” Aixala (ed.) 3, 172-181. Barnes, Michael SJ, Theology and the Dialogue of Religions. Cambridge: Cambridge Unviersity Press, 2002. Bevans, Stephen SVD. “Revisiting Mission as Vatican II: Theology and Practice for Today’s Mission Church” Theological Studies 74 (2013): 26. Chupungco, Anscar. “Two Methods of Liturgical Inculturation: Creative Assimilation and Dynamic Equivalence” in Liturgy for the Filipino Church: A Collection of Talks of Anscar J. Chupungco, OSB given at the National Meeting of Diocesan Directors of Liturgy (1986-2004), ed. Josefina M. Manabat, SLD. Mendiola. Manila: San Beda College, Graduate School of Liturgy, 2004. 18-33. Chupungco, Anscar Liturgies of the Future: the Process and Methods of Inculturation. Collegeville Minnesota: A Pueblo Book, 1989. Chupungco, Anscar. “Liturgy and Inculturation,” East Asian Pastoral Review 18 (1981): 264. Costa R.O. (ed.) One Faith, Many Cultures: Inculturation, Indigenization, and Contextualization. Maryknoll: NY Orbis, 1988. Chupungco, Anscar in “Liturgy and Inculturation,” East Asian Pastoral Review 18 (1981): 264. De la Rosa, Rolando V. Beginnings of the Filipino Dominicans: History of the Filipinization of the Religious Orders in the Philippines, Revised Edition. Manila: UST Publishing House, 1990. De Mesa, Jose M. Why Theology is Never Far from Home. Manila: De La Salle University Press, Inc., 2003. Eilers, Franz-Josef. Communicating Between Cultures: An Introduction to Intercultural Communication. Fourth Updated Edition. Manila: Logos, Divine Word Publication, 2012. Federation of Asian Bishops’ Conferences, Resource Manual for Catholics in Asia: Dialogue. Thailand: FABC-OEIA, 2001. Follo, Francesco “Inculturation and Interculturality in John Paul II and Benedict XVI.” Retrieved 5 February 2014 from http://www.oasiscenter.eu/articles/interreligious-dialogue/2010/03/29/inculturation-and-interculturality-in-john-paul-ii-and-benedict-xvi quoting Ratzinger’s speech during the 25th anniversary of the John Paul II Institute for Studies on Marriage and Family, 11 May 2006. Genero, Bartolome. ed. Inculturazione della fede: Sagi Interdisciplinarii. Naple: Edizioni ehoniane, 1981. Gorski, John F. M.M., “Christology, Inculturation, and Their Missiological Implications: A Latin American Perspective,” International Bulletin of Missionary Research 28, 2 (2004): 61, Javier, Edgar G. SVD, Dialogue: Our Mission Today. Quezon City: Claretian Publication and ICLA Publications, 2006. Jeremiah, Anderson “Inculturation: A Sub-Altern Critique of K.P. Aleaz’ ‘Indian Christian Vedanta,’ The Asia Journal of Theology 21, 2. (October 2007): 398-411. Kraft, Charles H. Christianity in Culture: A Study in Biblical Theologizing in Cross-Cultural Perspective. New York: Orbis Books, 1980. Kroeger, James, H., “The Faith-Culture Dialogue in Asia: Ten FABC Insights on Inculturation,” oletin Eclesiastico de Filipinas 85, 870 (2009): 7-28. Masson, Joseph ‘L Église ouverte ser le monde’in NRT, 84 (1962) 1038. Mercado, Leonardo N. Inculturation and Filipino Theology, Asia Pacific Missiological Series 2. Manila: Divine Word Publication, 1992. Mercado, Leonardo N. Elements of Filipino Theology. Tacloban City, Philippines: Divine Word University, 1975. Mitchell, Nathan “Culture, Inculturation, and Sacrosanctum Concilium,” Worship 77, 2 (March 2003): 171-181. Pietrzak, Daniel Interculturality and Internationality: A Utopia or a Constructive Tension for a Franciscan Missiology? Retrieved September 9, 2014 from http://www2.ofmconv.pcn.net/docs/en/general/miscon06_india/Interculturality%20and%20Internationality%20%20a%20utopia%20or%20a%20constructive%20tension%20for%20a%20Franciscan%20Missiology.pdf Radcliffe, Timothy. “Inculturation,” Review for Religious (Sept – Oct 1994): 646-657. Schreiter, Robert. “The Legacy of St. Francis Xavier: Inculturation of the Gospel Then and Now” East Asian Pastoral Review 44 (2007): 17-31. Schreiter, Robert J. Constructing Local Theologies. Maryknoll, New York: Orbis Books, 1993. Shorter, Aylward Toward a Theology of Inculturation. Eugene, Oregon: Wipf and Stock Publishers, 1999. Stanley, Brian. “Inculturation: Historical Background, Theological Foundations and Contemporary Questions,” Transformation 24, 1 (January 2007): 21-27. Timoner, Gerard F. “Intercultural Theology as a Way of Doing Theology” in Philippiniana Sacra XLI, 121 (January-April, 2006): 75-46. Timoner, Gerard. “Theology of Inculturation: A Critical Appraisal,” Philippiniana Sacra XL no. 119 (2005): 322-325. Ustorf, Werner “The Cultural Origins of Intercultural Theology” Mission Studies 25 (2008): 229-251. Wijsen, Frans “Intercultural Theology” Exchange 30, 3 (2001): 222-230.

In this paper, we propose a new method for domain adaptation in Statistical Machine Translation for low-resource domains in English-Vietnamese language. Specifically, our method only uses monolingual data to adapt the translation phrase-table, our system brings improvements over the SMT baseline system. We propose two steps to improve the quality of SMT system: (i) classify phrases on the target side of the translation phrase-table use the probability classifier model, and (ii) adapt to the phrase-table translation by recomputing the direct translation probability of phrases. Our experiments are conducted with translation direction from English to Vietnamese on two very different domains that are legal domain (out-of-domain) and general domain (in-of-domain). The English-Vietnamese parallel corpus is provided by the IWSLT 2015 organizers and the experimental results showed that our method significantly outperformed the baseline system. Our system improved on the quality of machine translation in the legal domain up to 0.9 BLEU scores over the baseline system,… Keywords: Machine Translation, Statistical Machine Translation, Domain Adaptation References [1] Philipp Koehn, Franz Josef Och, Daniel Marcu, Statistical phrase-based translation, In Proceedings of HLT-NAACL, Edmonton, Canada, 2003, 127-133. [2] Yonghui Wu, Mike Schuster, Zhifeng Chen, Quoc V. Le, Mohammad Norouzi, Wolfgang Macherey, Maxim Krikun, Yuan Cao, Qin Gao, Klaus Macherey, Jeff Klingner, Apurva Shah, Melvin Johnson, Xiaobing Liu, Łukasz Kaiser, Stephan Gouws, Yoshikiyo Kato, Taku Kudo, Hideto Kazawa, Keith Stevens, George Kurian, Nishant Patil, Wei Wang, Cliff Young, Jason Smith, Jason Riesa, Alex Rudnick, Oriol Vinyals, Greg Corrado, Macduff Hughes and Jeffrey Dean, Google’s neural machine translation system: Bridging the gap between human and machine translation, CoRR, abs/1609.08144, 2016. [3] Luisa Bentivogli, Arianna Bisazza, Mauro Cettolo and Marcello Federico, Neural versus phrase-based machine translation quality: A case study, 2016. [4] Barry Haddow, Philipp Koehn, Analysing the effect of out-of-domain data on smt systems, In Proceedings of the Seventh Workshop on Statistical Machine Translation, 2012, 422-432. [5] Boxing Chen, Roland Kuhn and George Foster, Vector space model for adaptation in statistical machine translation, Proceedings of the 51st Annual Meeting of the Association for Computational Linguistics, 2013, pp. 1285-1293. [6] Daniel Dahlmeier, Hwee Tou Ng, Siew Mei Wu4, Building a large annotated corpus of learner english: The nus corpus of learner english, In Proceedings of the NAACL Workshop on Innovative Use of NLP for Building Educational Appli-cations, 2013. [7] Eva Hasler, Phil Blunsom, Philipp Koehn and Barry Haddow, Dynamic topic adaptation for phrase-based mt, In Proceedings of the 14th Conference of the European Chapter of The Association for Computational Linguistics, 2014, pp. 328-337. [8] George Foster, Roland Kuhn, Mixture-model adaptation for smt, Proceedings of the Second Workshop on Statistical Machine Translation, Prague, Association for Computational Linguistics, 2007, pp. 128-135. [9] George Foster, Boxing Chen, Roland Kuhn, Simulating discriminative training for linear mixture adaptation in statistical machine translation, Proceedings of the MT Summit, 2013. [10] Hoang Cuong, Khalil Sima’an, and Ivan Titov, Adapting to all domains at once: Rewarding domain invariance in smt, Proceedings of the Transactions of the Association for Computational Linguistics (TACL), 2016. [11] Ryo Masumura, Taichi Asam, Takanobu Oba, Hirokazu Masataki, Sumitaka Sakauchi, and Akinori Ito, Hierarchical latent words language models for robust modeling to out-of domain tasks, Proceedings of the 2015 Conference on Empirical Methods in Natural Language Processing, 2015, pp. 1896-1901. [12] Chenhui Chu, Raj Dabre, and Sadao Kurohashi. An empirical comparison of simple domain adaptation methods for neural machine translation, 2017. [13] Markus Freitag, Yaser Al-Onaizan, Fast domain adaptation for neural machine translation, 2016. [14] Jia Xu, Yonggang Deng, Yuqing Gao and Hermann Ney, Domain dependent statistical machine translation, In Proceedings of the MT Summit XI, 2007, pp. 515-520. [15] Hua Wu, Haifeng Wang Chengqing Zong, Domain adaptation for statistical machine translation with domain dictionary and monolingual corpora, In Proceedings of the 22nd International Conference on Computational Linguistics (Coling 2008), Manchester, UK, 2008, pp. 993-1000. [16] Adam Berger, Stephen Della Pietra, and Vincent Della Pietra, A maximum entropy approach to natural language processing, Computational Linguistics, 22, 1996. [17] 18Santanu Pal, Sudip Naskar, Josef Van Genabith, Uds-sant, English-German hybrid machine translation system, In Proceedings of the Tenth Workshop on Statistical Machine Translation, Lisbon, Portugal, September, Association for Computational Linguistics, 2015, pp. 152-157. [18] Louis Onrust, Antal van den Bosch, Hugo Van hamme, Improving cross-domain n-gram language modelling with skipgrams, Proceedings of the 54th Annual Meeting of the Association for Computational Linguistics, Berlin, Germany, 2016, pp. 137-142. [19] Mark Aronoff, Kirsten Fudeman, What is morphology, V 8. john wiley and sons, 2011. [20] Laurence C. Thompson, The problem of the word in vietnamese, In journal of the International Linguistic Association 19(1) (1963) 39-52. https:// doi.org/1080/00437956.1963.11659787. [21] Binh N. Ngo, The Vietnamese language learning framework, Journal of Southeast Asian Language Teaching 10 (2001) 1-24. [22] Le Hong Phuong, Nguyen Thi Minh Huyen, Azim Roussanaly, Ho Tuong Vinh, A hybrid approach to word segmentation of vietnamese texts, 2008. [23] Philipp Koehn, Hieu Hoang, Alexandra Birch, Chris Callison-Burch, Marcello Federico, Nicola Bertoldi, Brooke Cowan, Wade Shen, Christine Moran, Richard Zens, Chris Dyer, Ondřej Bojar, Alexandra Constantin, Evan Herbst, Moses: Open source toolkit for statistical machine translation, In ACL-2007: Proceedings of demo and poster sessions, Prague, Czech Republic, 2007, pp.177-180. [24] Franz Josef Och, Minimum error rate training in statistical machine translation, In Proceedings of ACL, 2003, pp.160-167. [25] Andreas Stolcke, Srilm - an extensible language modeling toolkit, in proceedings of international conference on spoken language processing, 2002. [26] Papineni, Kishore, Salim Roukos, Todd Ward, WeiJing Zhu, Bleu: A method for automatic evaluation of machine translation, ACL, 2002. [27] G. Klein, Y. Kim, Y. Deng, J. Senellart, A.M. Rush, OpenNMT: Open-Source Toolkit for Neural Machine Translation. ArXiv e-prints. [28] Pratyush Banerjee, Jinhua Du, Baoli Li, Sudip Kr. Naskar, Andy Way and Josef van Genabith, Combining multi-domain statistical machine translation models using automatic classifiers, In Proceedings of AMTA 2010., 2010.

Photo by Hédi Benyounes on Unsplash ABSTRACT The current incarceration facilities for the growing number of women are depriving expecting mothers of adequate care crucial for the child’s mental and physical development. Programs need to be established to counteract this. INTRODUCTION Currently, Diana Sanchez was eight months pregnant when she was arrested for identity theft and put in a prison cell in Denver. At five a.m., two weeks after being incarcerated, she announced to a deputy outside her cell that she was going into labor. Footage from a camera in her cell shows her pacing anxiously or writhing in her bed for the five hours preceding the arrival of her son. She banged on the door and begged for help. All she received was an absorbent pad. She gave birth alone in her prison cell on July 31, 2015, around 10:45 am. At 11:00 am, a prison nurse walked in to cut the umbilical cord and take Sanchez’s newborn baby without offering postnatal care. Sanchez was later sent to a hospital, and her baby was separated from her until she was put on probation. In 2018, on behalf of her three-year-old son, Sanchez sued Denver Health and Denver Sheriff Department and won a $480,000 settlement.[1] Though many more men are incarcerated than women, the rate of growth of female incarceration has exceeded that of male incarceration for decades. One study estimated that 231,000 women are currently incarcerated in the US,[2] 80 percent of whom are mothers, and 150,000 pregnant.[3] Another recent study of 1,396 incarcerated pregnant women found that 92 percent had live births, 6.5 percent had stillbirths or miscarriages, and 4 percent terminated the pregnancy. The authors found that there is no system of reporting pregnancy outcomes in US prisons. There is a noteworthy ethical lapse in mental, emotional, and medical care that threatens the well-being of pregnant women in prison. According to Carolyn Sufrin, “Pregnant incarcerated people are one of the most marginalized and forgotten groups in our country… and women who don't get counted don't count.” [4] Poor documentation, visibility, and transparency contribute to the systemic abuse of incarcerated women. Studies document women giving birth alone in cells and shackles in solitary confinement. Their complaints regarding contractions, bleeding, and other pains of labor are often ignored.[5] l. Prenatal Care in American Prisons Diana Sanchez was not offered any prenatal care after she was incarcerated. And neither she nor her son received appropriate postnatal care.[6] Sanchez was on medication for opioid withdrawal while pregnant, which could have been detrimental to her baby’s health.[7] There is an unacceptable absence of pre- and postnatal care in most US prisons. A lack of regulation makes the availability of perinatal care unpredictable and unreliable. Several studies confirmed that there is not a standard for prenatal care for women incarcerated during pregnancy. [8] Knowledge of the appropriate mental and physical care pregnant women require, addiction support, and support for maternal-infant bonding all exists outside the prison system and ought to be used as a benchmark. At the very least, pregnant women, birthing women, and new mothers should not be placed in solitary confinement or shackled.[9] In the prenatal arena, depriving an individual of adequate healthcare is not appropriate and could be cruel and unusual. Only 18 percent of funding in prisons goes to health care for the prisoners. That is roughly $5.7 thousand per prisoner, according to an NIH study done in 2015.[10] There should be an adequate amount of funding for the health needs of incarcerated pregnant women. By depriving pregnant women of healthcare, the prisons are depriving the fetus of adequate care. ll. Respect for Autonomy During Incarceration Women maintain healthcare autonomy even when incarcerated. The purpose of a prison sentence is retribution for crimes and rehabilitation to prevent reoffending.[11] The separation of a mother and newborn causes significant developmental and psychological harm to the child and the parent. Parent-child separation does not serve the purpose of retribution or rehabilitation and is authorized only due to prisons’ limited space and resources that make it difficult to accommodate children, as well as a state interest in children’s best interests or the custody rights of the other parent. When it is possible to keep a family together, prisons should make every effort to do so for the health of the mother-child relationship. Incarcerated people may become a burden to family or society due to prison medical neglect. For example, diabetes and hypertension, which can occur during pregnancy, can worsen without treatment. The inability to access the care they would otherwise want and need endangers women and poses a burden to the healthcare system after incarceration, Depersonalizing individuals convicted of crimes must be placed in the context of historical eugenics practices. State-sanctioned sterilization and efforts to prevent women from reproducing were widespread during the early 20th century.[12] Cases of coerced and nonconsensual sterilization of incarcerated women and men evidence the history of eugenics.[13]Abortions are offered to some incarcerated women.[14] However, many incarcerated women are denied the right to see healthcare providers to thoroughly discuss abortion or other options.[15] Although the abortions are consensual, the quality of consent is questionable. lll. Prison Nursery Programs, “I need something to live for…” Indiana Women’s Prison (IWP), a max security female prison, has a program called Wee Ones that enables women convicted of nonviolent crimes to spend 30 months bonding with their newborn child. It is one of eight programs in the country that allows pregnant mothers to spend the last few months of their sentence with their children. It is a voluntary program that allows pregnant offenders a private room in a housing unit. It offers parent education, resources that are accessible after release, and career education. The program application process and the rules to which women must adhere to remain in the program are stringent. The programs generally have a zero-tolerance policy. Even simply sleeping in the same bed as the child or arguing with other mothers can result in termination from the program. Kara, a pregnant woman incarcerated for drug possession, had a history of abuse in her family and tended to act out in anger against her peers in the program. She was learning how to have healthy reactions to anger when handling her child, but her temper ultimately led to her removal from the program. Her son was placed in foster care, and Kara returned to the regular cells. In an interview before her transfer, she told the camera that Charlie gave her a purpose. With tears in her eyes, she said, “Charlie was my way of life here [...] I need something to live for [,] and I screwed up.”[16] Pregnancy in prison can be a way to improve quality of life for some women. Studies demonstrate that nursery programs improve mental health of the incarcerated women.[17] The secure attachment of the infant to its primary caregiver promotes healthy development in the child and a bonded relationship with the mother.[18] The close bond between mother and child in prisons has been shown to decrease recidivism and to reduce the burden on the foster care system.[19] Women who do not qualify for these programs, or are incarcerated in prisons without them, are separated from their newborn babies and their other children. The disconnect can lead to the child rejecting the incarcerated mother once she is released.[20] Programs like Wee Ones honor women’s autonomy while they are incarcerated. During interviews, the women expressed that although raising a child in that environment is difficult, it was better than not being with their children. While rocking a baby in her lap, one inmate expressed her frustrations with Wee Ones but then paused to express gratitude and said, “After all, it’s prison. And prison ain’t supposed to be nice.”[21] The ethical issue of autonomy reflects a more difficult dilemma in the prison landscape. lV. Counter Arguments: Do the Nursery Programs Work for the Children and the Women Typically, newborns are taken from their incarcerated mothers within two to three days of birth and sent to live with a relative or placed in foster care. Many women are never reunited with their babies. There is much debate over whether the programs are beneficial to the children. One ethical issue is whether children, as innocents, are being punished either by being in the prison system or by being separated from their mothers. Skeptics, like James Dwyer, have argued against keeping innocent babies in the custody of incarcerated mothers asserting that there is little evidence demonstrating that the programs rehabilitate the women.[22] Dwyer commented on the “reckless” hopefulness the programs provide: "It might, in fact, be the babies distract them from rehabilitation they should be doing instead. […] They're so focused on childcare and have this euphoria — they think they'll be just fine when they get out of prison and they're not. We just don't know."[23] One study showed that 58 percent of incarcerated women are arrested again after release, 38 percent are reconvicted, and 30 percent return to prison within three years.[24] Dwyer uses this data to argue that the programs are not worthwhile. However, the data is not limited to the special population that had the prison nursery experience. The data applies to all incarcerated women limiting its applicability. More importantly, there is compelling evidence to support prison nursery programs.[25] The programs do decrease recidivism[26] and prison misconduct,[27] and they allow women to create stronger bonds with their children.[28] Bev Little argues that allowing mothers to bond with their babies only delays the inevitable separation and will cause trauma and have other ill effects on the baby. [29] But others feel that stronger maternal-fetal attachment is best for both parties. There is evidence that the bond, once formed, is long-lasting. Later in life, there is less drug addiction among children who stayed in the nursery rather than being separated from their mothers.[30] Another counterargument is that the policies in prison nurseries are not as useful for motherhood outside of the facility; thus, an issue with recidivism occurs because the women are less prepared for motherhood upon release from prison. Prison nursery programs establish methods and procedures for successful motherhood that are unique to operation within correctional environments. Yet, fortunately, parenting classes offered by prisons and jails emphasize sacrifice, self-restraint, and dedicated attention to the baby. These classes aptly apply to motherhood outside of prison.[31] One incarcerated mother experiencing addiction, Kima, was described as ambivalent toward her pregnancy. “It’s something about knowing but not knowing that makes me not accountable or makes me think I’m not accountable,” Kima shared.[32] After the nurse confirmed her pregnancy, she acknowledged fear and knew she would be held accountable to the baby. The occurrence of pregnancy ambivalence is common.[33] A study of a population of prisoners from Rhode Island found that 41 percent of the women expressed ambivalent attitudes about pregnancy. 70 of the women from a population in San Francisco expressed ambivalent or negative attitudes towards pregnancy.[34] But the ambivalence of some women toward pregnancy is not a reason to prevent women who feel differently from reaping the full benefits of programs that support them during pregnancy. Another counterargument is that prison is becoming a comfort that women might seek if they are homeless or housing insecure. For example, Evelyn was released from a San Francisco jail after being arrested for using cocaine. She was 26 weeks pregnant and had a four-year-old son in the custody of her aunt. Following her release, she was homeless and using drugs in the streets. She felt that her only hope of keeping her baby safe was to go back to jail. Like Kima, she had been in and out of jail from a young age. She grew accustomed to and dependent on the care provided there. While incarceration can provide a home and a nursery, there is no ethical reason to argue for making prison less comfortable by separating babies and children from incarcerated women. Instead, these facts suggest we are not doing enough for women outside prisons either. CONCLUSION Many experts stress the dearth of research and information on these women and their babies. There is no empirical data to show how big the problem is, but there is evidence that programs providing nursery care for the children of incarcerated women have many benefits. Because the research is not largescale enough, many pregnant women in the prison system are ignored. Many women give birth in unacceptable conditions, and their children are taken from them the moment the umbilical cord is cut. While the US incarcerates too many women, a movement to expand prison nurseries could help new mothers bond with their children. Strong educational programs could aid in lowering the rates of recidivism by providing therapeutic resources for mothers.[35] There is a growing problem of mass incarceration in the US as many women are placed in correctional facilities. Most of these women are convicted of possession or use of illegal substances.[36] Many women come from disadvantaged backgrounds, poverty, and have experienced addiction. Depriving an expectant mother of adequate care is cruel and irresponsible both to the mother and her innocent child. The criminal justice system is harming children both mentally and physically. Reform of the system is needed to provide the basic care those children need. Programs like IWP’s Wee Ones are necessary for physical, psychological, and social development. A program that offers a place for mothers to raise their babies in the community of other mothers would incentivize and facilitate healthy parental habits. Further programs for mothers who are released from prison would give them valuable resources to keep them from returning and encourage healthy relationships between the mother and the baby. - [1] Li, D. K. Video allegedly shows woman giving birth in Denver jail cell alone, with no assistance. Denver: NBC News, 2019. [2] Kajstura, Aleks. “Women's Mass Incarceration: The Whole Pie 2019.” Prison Policy Initiative, 29 Oct. 2019, https://www.prisonpolicy.org/reports/pie2019women.html. (“Including those in prisons, jails, and other correctional facilities.”) [3] Swavola, E, K Riley and R Subramanian. "Overlooked: Women and Jails in an Era of Reform." Vera Institute of Justice August 2016. [4] Sufrin, C. Pregnant Behind Bars: What We Do and Don't Know About Pregnancy and Incarceration Allison Chang. 21 March 2019. Transcript. [5] Sufrin, C., 2019. (Suffrin expressed that she had seen such practices firsthand working as an OB/GYN for incarcerated women.) [6] Padilla, M. “Woman Gave Birth in Denver Jail Cell Alone, Lawsuit Says,” New York Times, Sep. 1, 2019. [7] Li, D. “Video allegedly shows woman giving birth in Denver jail cell alone, with no assistance,” NBC U.S. News, Apr. 29. 2019. [8] Knittel, A. and C. Sufrin. "Maternal Health Equity and Justice for Pregnant Women Who Experience Incarceration." JAMA Network Open 3.8 (2020). A study in Ontario, Canada, coincided with a study done in Australia. [9] Sufrin, C., et al. "Pregnancy Outcomes in US Prisons, 2016–2017." p. 803-804. [10] Sridhar, S., R. Cornish and S. Fazel. "The Costs of Healthcare in Prison and Custody: Systematic Review of Current Estimates and Proposed Guidelines for Future Reporting." Frontiers in Psychiatry 9.716 (2018). [11] Kifer, M., Hemmens, C., Stohr, M. K. “The Goals of Corrections: Perspectives from the Line” Criminal Justice Review. 1 May 2003 [12] Perry, D. M. "Our Long, Troubling History of Sterilizing the Incarcerated." The Marshall Project: Sterilization of Women in Prison 26 July 2017. [13] Rachel Roth & Sara L. Ainsworth, If They Hand You a Paper, You Sign It: A Call to End the Sterilization of Women in Prison, 26 Hastings WOMEN's L.J. 7 (2015); See Skinner v. Oklahoma ex rel. Williamson, 316 U.S. 535 (1942) (procreation considered a fundamental right; fact pattern of male sterilization in prison based on type of crime.) [14] Sufrin, C., M. D. Creinin, J. C. Chang. “Incarcerated Women and Abortion Provision: A Survey of Correctional Health Providers.” Perspectives on Sexual and Reproductive Health. p. 6-11. 23 March 2009. [15] Kasdan, D. “Abortion Access for Incarcerated Women: Are Correctional Health Practices in Conflict with Constitutional Standards?” Guttmacher Institute. 26 March 2009. [16] Born Behind Bars. Season 1, Episode 5, “They Can Take Your Baby Away,” produced by Luke Ellis, Francis Gasparini, & Jen Wise, aired on 15 Nov. 2017 A&E Networks [17] Bick, J., & Dozier, M. (2008). Helping Foster Parents Change: The Role of Parental State of Mind. In H. Steele & M. Steele (Eds.), Clinical applications of the Adult Attachment Interview (pp. 452–470). New York: Guilford Press. [18]Sroufe, L. A., B. Egeland, E. A. Carlson, W. A. Collins. (2005). The Development of the Person: The Minnesota Study of Risk and Adaptation from Birth to Adulthood. New York: Guilford Press. [19] Goshin, L. S., & Byrne, M. W. “Converging Streams of Opportunity for Prison Nursery Programs in the United States.” Journal of Offender Rehabilitation. 15 Apr 2009. [20] Babies Behind Bars. Dirs. W. Serrill and S. O'Brien. 2015. Another IWP pregnant woman is Taylor. At the time of the show, she was pregnant and expecting twins. In interviews throughout the episode, she expressed how her pregnancies in prison had put her in a better mood and felt beneficial to her. She had tried to sign up for the nursery program for her previous pregnancy, but her sentence was too long to get it. Her child was sent to live with a caregiver, and when Taylor was on probation, Taylor’s daughter didn’t want to be around Taylor. Taylor was so distraught that she messed up and went back, this time, pregnant with twins. After she was reincarcerated, she was able to be accepted into Wee Ones. She expressed to the camera man that the program might help her feel more like a mother so that when she gets out, she will have someone to care for. Taylor, Kara, and many other women depend on their children or their pregnancy for a purpose while behind bars. They relied on their babies to be a boon for them. [21] Babies Behind Bars. Dirs. W. Serrill and S. O'Brien. 2015. [22] Corley, C. "Programs Help Incarcerated Moms Bond with Their Babies in Prison." Criminal Justice Collaborative (2018). [23] Corley, C. "Programs Help Incarcerated Moms Bond with Their Babies in Prison." Criminal Justice Collaborative (2018). [24] Owen, B. & Crow, J. “Recidivism among Female Prisoners: Secondary Analysis of the 1994 BJS Recidivism Data Set” Department of Criminology California State University (2006) p. 28 [25] Prison Nursery Programs: Literature Review and Fact Sheet for CT. Diamond Research Consulting, 2012, www.cga.ct.gov/2013/JUDdata/tmy/2013HB-06642-R000401-Sarah Diamond - Director, Diamond Research Consulting-TMY.PDF. [26] New York Department of Correction Services (NYDOCS). (1993). Profile of Participants: The Bedford and Taconic Nursery Program in 1992. Albany, NY. Department of Correction Services.Rowland, M., & Watts, A. (2007). Washington State’s effort to the generational impact on crime. Corrections Today. Retrieved September 12, 2007, from http://www. aca.org/publications/pdf/Rowland_Watts_Aug07.pdf. [27] Carlson, J. R. (2001). Prison nursery 2000: A five-year review of the prison nursery at the Nebraska Correctional Center for Women. Journal of Offender Rehabilitation, 33, 75–97. [28] Carlson, J.R. [29] Little, B. "What Happens When a Woman Gives Birth Behind Bars?" A+E Networks, 29 October 2019. <https://www.aetv.com/real-crime/what-happens-when-a-woman-gives-birth-in-jail-or-prison>. [30] Margolies, J. K., & Kraft-Stolar, T. When “Free” Means Losing Your Mother: The Collision of Child Welfare and the Incarceration of Women in New York State 1, 9 (Correctional Association of N.Y. Women in Prison Project 2006) [31] Sufrin, C. Jailcare: Finding the Safety Net for Women Behind Bars. Berkeley: University of California Press, 2017. [32] Sufrin, C. Jailcare: p. 155. [33] Peart, M. S. & Knittel, A. K. “Contraception need and available services among incarcerated women in the United States: a systematic review.” Contraception and Reproductive Medicine. 17 March 2020 [34] LaRochelle, F., C. Castro, J. Goldenson, J. P. Tulsky, D.L. Cohan, P. D. Blumenthal, et al. “Contraceptive use and barriers to access among newly arrested women.” J Correct Health Care. (2012) p. 111–119. [35] Goshin, L., & Byrne, M. (2009). “Converging streams of opportunity for prison nursery programs in the United States.” Journal of Offender Rehabilitation. 2009. p.271–295. [36] Elizabeth Swavola, Kristine Riley, Ram Subramanian. Overlooked: Women and Jails in an Era of Reform. New York: Vera Institute of Justice, 2016.

Photo by Christian Bowen on Unsplash ABSTRACT Assisted Reproductive Technology can be a beneficial tool for couples unable to reproduce independently; however, it has historically discriminated against the LGBTQ+ community members. Given the evolution and acceptance of LGBTQ rights in recent years, discrimination and barriers to access reproductive technology and health care should be readdressed as they still exist within this community. INTRODUCTION In recent years, the LGBTQ+ community has made great strides toward attaining equal rights. This fight dates back to 1970 when Michael Baker and McConnell applied for a marriage license in Minnesota.[1] After the county courthouse denied the couple's request, they appealed to the Minnesota Supreme Court. Baker and McConnell’s dispute reached the US Supreme Court. Baker v. Nelson[2] was the first time a same-sex couple attempted to pursue marriage through higher courts in the US.[3] Because the couple lost the case, Baker changed his name to a gender-neutral one, and McConnell adopted Baker, allowing Baker and McConnell to have legal protections like the ability to receive certain inheritances. Baker and McConnell received a marriage license from an unsuspecting clerk from Blue Earth County, where they wed on September 3, 1971.[4] BACKGROUND The Supreme Court’s decision left individual state legislatures the option to accommodate same-sex couples’ rights constitutionally. As a result, some states banned same-sex marriage, while others offered alternative options such as domestic partnerships. With many obstacles, such as the Defense of Marriage Act (DOMA) and President Bush’s efforts to limit marriage to heterosexual people, Massachusetts became the first state to legalize gay marriage in 2003.[5] Other states slowly followed. Finally, in 2015 the US Supreme Court made same-sex marriage legal in all 50 states in Obergefell v. Hodges,[6] marking an important milestone for the LGBTQ+ community’s fight toward marriage equality. The Obergefell v. Hodges decision emphasized that members of the homosexual community are “not to be condemned to live in loneliness, excluded from one of civilization's oldest institutions,” thus granting them the right to “equal dignity in the eyes of the law.”[7] This paper argues that in the aftermath of the wide acceptance of LGBTQ rights, discrimination and barriers to access reproductive technology and health care persist nationally. Procreation also faces discrimination. Research supports that children’s overall psychological and physical welfare with same-sex parents does not differ compared to children with heterosexual parents.[8] Some others worry about the children’s developmental health and argue that same-sex male couples’ inability to breastfeed their children may be harmful; however, such parents can obtain breast milk via surrogate donation.[9] Further concerns regarding confusion in gender identity in children raised by same-sex parents are not supported by research in the field indicating that there are “no negative developmental or psychological outcomes for a child, nor does it result in differing gender identity, gender role behavior or sexual partner preference compared to opposite-sex parents.”[10] ANALYSIS l. Desire to Procreate The American perception toward same-sex unions has evolved “from pathology to deviant lifestyle to identity.”[11] In 2001, only 35 percent of Americans favored same‐sex marriage, while 62 percent favored it in 2017.[12] The “Gay marriage generation”[13] has a positive attitude toward same-sex unions, arising from the “interaction among activists, celebrities, political and religious leaders, and ordinary people, who together reconfigured Americans’ social imagination of homosexuality in a way that made gay marriage seem normal, logical, and good.”[14] Same-sex couples’ right to build a biological family and ability to do so using modern reproductive technology is unclear. The data generated by the LGBTQ Family Building Survey revealed “dramatic differences in expectations around family building between LGBTQ millennials (aged 18-35) and older generations of LGBTQ people,”[15] which may be in part attributable to recent federal rulings in favor of same-sex couples. Three important results from this survey are that 63 percent of LGBTQ millennials are considering expanding their families throughout parenthood, 48 percent of LGBTQ millennials are actively planning to grow their families, compared to 55 percent of non-LGBTQ millennials; and 63 percent of those LGBTQ people interested in building a family expect to use assisted reproductive technology (ART), foster care, or adoption to become parents.[16] There are 15.9 million Americans who identify as LGBTQ+ (6.1 million of whom are 18 to 35 years old); thus, an estimated “3.8 million LGBTQ+ millennials are considering expanding their families in the coming years, and 2.9 million are actively planning to do so.”[17] Yet access and affordability to ART, especially in vitro fertilization (IVF) and surrogacy for same-sex couples, has not been consistent at a national level. The two primary problems accessing ART for the LGBTQ community are the lack of federal law and cost. A federal law that guaranteed coverage would address both problems. ll. ART for Same-Sex Couples All same-sex male (SSM) couples and same-sex female (SSF) couples must involve third parties, including surrogates or egg or sperm donors.[18] ART involves the legal status of “up to two women (surrogate and egg donor),” the intended parents, and the child for SSM couples.[19] While sometimes necessary for heterosexual couples using ART, an egg or sperm from someone other than the intended parents or a surrogate will always be necessary for the LGBTQ people seeking ART. ART, in particular IVF, is essential for infertile couples unable to conceive on their own. Unlike other industrialized countries (such as Canada, the United Kingdom, Sweden, Germany, and Australia), the US does not heavily oversee this multibillion-dollar industry.[20] The American Society for Reproductive Medicine does provide lengthy guidelines to fertility clinics and sperm banks; however, state lawmakers have been less active as they seem to avoid the controversy surrounding controversial topics like embryo creation and abortion.[21] As a result, states “do not regulate how many children may be conceived from one donor, what types of medical information or updates must be supplied by donors, what genetic tests may be performed on embryos, how many fertilized eggs may be placed in a woman or how old a donor can be.”[22] lll. A Flawed Definition of Infertility The WHO defines the medical definition of infertility as “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after twelve months or more of regular unprotected sexual intercourse.”[23] This antiquated definition must be updated to include social infertility to integrate same-sex couples’ rights.[24] In the US, single individuals and LGBTQ couples interested in building a family by biological means are considered “socially infertile.”[25] If insurance coverage is allotted only to those with physical infertility, then it is exclusive to the heterosexual community. Although some states, such as New York, discussed below, have directly addressed this inequality by extending the definition of infertility and coverage of infertility treatments to include all residents regardless of sexual orientation, this is not yet the norm everywhere else. The outdated definition of infertility is one of the main issues affecting same-sex couples’ access to ART, as medical insurance companies hold on to the formal definition of infertility to deny coverage. lV. Insurance Coverage for IVF Insurance coverage varies per state and relies on the flawed definition of infertility. As of August 2020, 19 states have passed laws requiring insurance coverage for infertility, 13 of which include IVF coverage, as seen in Figure 1. Also, most states do not offer IVF coverage to low-income people through Medicaid.[26] In states that mandate IVF insurance coverage, the utilization rate was “277% of the rate when there was no coverage,”[27] which supports the likelihood that in other states, the cost is a primary barrier to access. When insurance does not cover ART, ART is reserved for wealthy individuals. One cycle of ART could cost, on average, “between $10,000 and $15,000.”[28] In addition, multiple cycles are often required as one IVF cycle only has “about a 25% to 30%” live birth success rate.[29] Altogether, the total cost of successful childbirth was estimated from $44,000 to $211,940 in 1992.[30] On February 11, 2021, New York Governor Andrew M. Cuomo “directed the Department of Financial Services to ensure that insurers begin covering fertility services immediately for same-sex couples who wish to start a family.”[31] New York had recently passed an IVF insurance law that required “large group insurance policies and contracts that provide medical, major medical, or similar comprehensive-type coverage and are delivered or issued for delivery in New York to cover three cycles of IVF used in the treatment of infertility.”[32] But the law fell short for same-sex couples, which were still required to “pay 6 or 12 months of out-of-pocket expenses for fertility treatments such as testing and therapeutic donor insemination procedures before qualifying for coverage.”[33] Cuomo’s subsequent order made up for gaps in the law, which defined infertility as “the inability to conceive after a certain period of unprotected intercourse or donor insemination.”[34] Cuomo’s order and the law combine to make New York an example other states can follow to broaden access to ART. V. Surrogacy Access to surrogacy also presents its own set of problems, although not exclusive to the LGBTQ community. Among states, there are differences in how and when parental rights are established. States in dark green in Figure 2 allow pre-birth orders, while the states in light green allow post-birth parentage orders. Pre-birth orders “are obtained prior to the child’s birth, and they order that the intended parent(s) will be recognized as the child’s only legal parent(s) and will be placed on the child’s birth certificate,” while post-birth parentage orders have the same intent but are obtained after the child’s birth. [35] For instance, states can require genetic testing post-birth, possibly causing a delay in establishing parentage.[36] Although preventable through the execution of a health care power of attorney, a surrogate mother could be the legal, medical decision-maker for the baby before the intended parents are legally recognized. On February 15, 2021, gestational surrogacy – the most popular type of surrogacy in which the surrogate has no biological link to the baby – was legalized in New York,[37] but it remains illegal in some states such as Nebraska, Louisiana, and Michigan.[38] In addition, the costs of surrogacy are rising, and it can cost $100,000 in the US.[39] Medicaid does not cover surrogacy costs,[40] and some health insurance policies provide supplemental surrogacy insurance with premiums of approximately $10,000 and deductibles starting at $15,000.[41] Thus, “surrogacy is really only available to those gay and lesbian couples who are upper class,”[42] leaving non-affluent couples out of options to start a family through biological means. Vl. A Right to Equality and Procreation Some argue that same-sex couples should have the right to procreate (or reproductive rights). Based on arguments stemming from equal rights and non-discrimination, same-sex couples who need to use ART to procreate should have access to it. The need to merge social infertility into the currently incomplete definition of fertility could help same-sex couples achieve access through insurance coverage. The human right of equality and non-discrimination guarantees “equal and effective protection against discrimination on any ground.”[43] The United Nations later clarified that “sexual orientation is a concept which is undoubtedly covered” [44] by this protection. The right to procreate is not overtly mentioned in the US Constitution; however, the Equal Protection Clause states that “No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States… without due process of law.”[45] In fact, some states have abridged the reproductive privileges of some US citizens by upholding prohibitive and intricate mechanisms that deter same-sex couples from enjoying the privileges other citizens have. The Supreme Court acknowledged procreation as a “fundamental”[46] personal right, in Skinner v. Oklahoma, mandating that the reproductive rights of individuals be upheld as the right to procreate is “one of the basic civil rights of man”[47] because “procreation [is] fundamental to the very existence and survival of the race.”[48] In Eisenstadt v. Baird, the courts also supported that “the decision whether to bear or beget a child” fundamentally affects a person.[49] I argue that this protection extends to same-sex couples seeking to procreate. Finally, Obergefell v. Hodges held that the Due Process and Equal Protection clauses ensure same-sex couples the right to marriage, as marriage “safeguards children and families, draw[ing] meaning from related rights of childrearing, procreation, and education.”[50] By implicit or explicit means, these cases align with the freedom to procreate that should not be unequally applied to different social or economic groups. Yet, the cases do not apply to accessing expensive tools to procreate. As heterosexuals and the LGBTQ community face trouble accessing expensive ART for vastly different reasons, especially IVF and surrogacy, the equal rights or discrimination argument is not as helpful. For now, it is relevant to adoption cases where religious groups can discriminate.[51] The insurance coverage level may be the best approach. While the social norms adapt and become more inclusive, the elimination of the infertility requirement or changing the definition of infertility could work. Several arguments could address the insurance coverage deficit. Under one argument, a biological or physical inability to conceive exists in the homosexual couple trying to achieve a pregnancy. Depending on the wording or a social definition, a caselaw could be developed arguing the medical definition of infertility applies to the LGBTQ community as those trying to procreate are physically unable to conceive as a couple planning to become parents. One counterargument to that approach is that it can be offensive to label people infertile (or disabled) only because of their status as part of a homosexual couple.[52] CONCLUSION In the last 50 years, there has been a notable shift in the social acceptance of homosexuality.[53] Marriage equality has opened the door for further social and legal equality, as evidenced by the increased number of same-sex couples seeking parenthood “via co-parenting, fostering, adoption or surrogacy” – colloquially referred to as the ‘Gayby Boom’.[54] However, some prejudice and disdain toward LGBTQ+ parenting remain. Equitable access to ART for all people may be attainable as new technology drives costs down, legislators face societal pressure to require broader insurance coverage, and social norms become more inclusive. [1] Eckholm, E. (2015, May 17). The same-sex couple who got a marriage license in 1971. Retrieved April 08, 2021, from https://www.nytimes.com/2015/05/17/us/the-same-sex-couple-who-got-a-marriage-license-in-1971.html [2] Eckholm, E. [3] A brief history of civil rights in the United States: A timeline of the legalization of same-sex marriage in the U.S. (2021, January 27). Retrieved April 08, 2021, from https://guides.ll.georgetown.edu/c.php?g=592919&p=4182201 [4] Eckholm, E. [5] A brief history of civil rights in the United States: A timeline of the legalization of same-sex marriage in the U.S. (2021, January 27). Retrieved April 08, 2021, from https://guides.ll.georgetown.edu/c.php?g=592919&p=4182201 [6] A brief history of civil rights in the United States [7] A brief history of civil rights in the United States [8] Lee, J., & Bolzendahl, C. (2019). Acceptance and Rejection: Patterns of opinion on homosexuality in the United States and the world. Sociological Forum, 34(4), 1026-1031. doi:10.1111/socf.12562 [9] Lee, J., et al. [10] Lee, J., et al. [11] Lee, J., et al. [12] Lee, et al. [13] Lee, et al. [14] Lee, et al. [15] LGBTQ family building survey. (2020, July 02). Retrieved April 08, 2021, from https://www.familyequality.org/resources/lgbtq-family-building-survey/ [16] LGBTQ family building survey. (2020, July 02). Retrieved April 08, 2021, from https://www.familyequality.org/resources/lgbtq-family-building-survey/ [17] LGBTQ family building survey. (2020, July 02). Retrieved April 08, 2021, from https://www.familyequality.org/resources/lgbtq-family-building-survey/ [18] Mackenzie, S. C., Wickins-Drazilova, D., & Wickins, J. (2020). The ethics of fertility treatment for same-sex male couples: Considerations for a modern fertility clinic. European Journal of Obstetrics & Gynecology and Reproductive Biology, 244, 71-75. doi:10.1016/j.ejogrb.2019.11.011 [19] Mackenzie, et al. [20] Ollove, M. (2015, March 18). States not eager to regulate fertility industry. Retrieved April 08, 2021, from https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/3/18/states-not-eager-to-regulate-fertility-industry [21] Ollove, M. [22] Ollove, M. [23] World Health Organization. (2020, September 14). Infertility. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/infertility [24] Leondires, M. P. (2020, March 19). Fertility insurance Mandates & same-sex couples. Retrieved April 08, 2021, from https://www.gayparentstobe.com/gay-parenting-blog/fertility-insurance-mandates-same-sex-couples/ [25] Lo, W., & Campo-Engelstein, L. (2018). Expanding the Clinical Definition of Infertility to Include Socially Infertile Individuals and Couples. Reproductive Ethics II, 71–83. https://doi.org/10.1007/978-3-319-89429-4_6 [26] Mohapatra, S. (2015). Assisted Reproduction Inequality and Marriage Equality. Chicago-Kent Law Review, 92(1). Retrieved April 08, 2021, from https://scholarship.kentlaw.iit.edu/cgi/viewcontent.cgi?article=4146&context=cklawreview [27] Mohapatra, S. [28] Mohapatra, S. [29] Mohapatra, S. [30] Mohapatra, S. [31] Governor Cuomo announces new actions to expand access to FERTILITY coverage for same sex couples as part of 2021 Women's Agenda. (n.d.). [32] Health Insurers FAQs: IVF and Fertility Preservation Law Q&A Guidance. (n.d.). Retrieved April 08, 2021, from https://www.dfs.ny.gov/apps_and_licensing/health_insurers/ivf_fertility_preservation_law_qa_guidance [33] Governor Cuomo announces new actions to expand access to FERTILITY coverage for same sex couples as part of 2021 Women's Agenda. (n.d.). Retrieved April 08, 2021, from https://www.governor.ny.gov/news/governor-cuomo-announces-new-actions-expand-access-fertility-coverage-same-sex-couples-part#:~:text=February%2011%2C%202021-,Governor%20Cuomo%20Announces%20New%20Actions%20to%20Expand%20Access%20to%20Fertility,Part%20of%202021%20Women's%20Agenda&text=Cuomo%20today%20directed%20the%20Department,wish%20to%20start%20a%20family. [34] Leondires, M. P. [35] Assisted reproduction parentage proceedings information: Academy of Adoption and Assistive Reproduction Attorneys (AAAA). (2019, March 14). Retrieved April 08, 2021, from https://adoptionart.org/assisted-reproduction/parentage-proceedings/ [36] Assisted reproduction parentage proceedings information. [37] Governor Cuomo reminds surrogates and parents of their new Insurance rights and protections During Gestational Surrogacy. (n.d.). Retrieved April 08, 2021, from https://www.governor.ny.gov/news/governor-cuomo-reminds-surrogates-and-parents-their-new-insurance-rights-and-protections-during [38] U.S. Surrogacy Map: Surrogacy laws by state. (2020, December 23). Retrieved April 08, 2021, from https://www.creativefamilyconnections.com/us-surrogacy-law-map/ [39] Mohapatra, S. [40] Beitsch, R. (2017, June 29). As surrogacy surges, new parents seek legal protections. Retrieved April 08, 2021, from https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/06/29/as-surrogacy-surges-new-parents-seek-legal-protections#:~:text=Medicaid%20does%20not%20cover%20surrogacy,and%20intended%20parents%20at%20risk. [41] Where to find surrogacy insurance? (2017, November 02). Retrieved April 08, 2021, from https://surrogate.com/intended-parents/surrogacy-laws-and-legal-information/where-can-i-find-surrogacy-insurance/ [42] Mohapatra, S. [43] International covenant on civil and political rights. (n.d.). Retrieved April 08, 2021, from https://www.ohchr.org/en/professionalinterest/pages/ccpr.aspx [44] United Nations. (2003). Human rights in the administration of justice: a manual on human rights for judges, prosecutors and lawyers. [45] U.S. Const. amend. XIV, § 1. [46] Skinner v. Oklahoma, Https://caselaw.findlaw.com/us-supreme-court/316/535.html (June 1, 1942). [47] Skinner v. Oklahoma [48] Skinner v. Oklahoma [49] Eisenstadt v. Baird, Https://www.lexisnexis.com/community/casebrief/p/casebrief-eisenstadt-v-baird (March 22, 1972). [50] Obergefell v. Hodges [51] Higgins, T. (2021, June 17). Supreme Court sides with Catholic adoption agency that refuses to work with LGBT couples. CNBC. https://www.cnbc.com/2021/06/17/supreme-court-sides-with-catholic-adoption-agency-that-refuses-to-work-with-lgbt-couples.html. [52] Bowerman, M., May, A., & Rossman, S. (2017, April 24). Should the definition of infertility be more inclusive? USA Today. https://www.usatoday.com/story/news/nation-now/2017/04/22/same-sex-couples-covered-infertility-insurance/100644092/. [53] Mackenzie, et al. [54] Mackenzie, et al.

Photo by Sean Pollock on Unsplash ABSTRACT Bioethics and Corporate Social Responsibility (CSR) were born out of similar concerns, such as the reaction to scandal and the restraint of irresponsible actions by individuals and organizations. However, these fields of knowledge are seldom explored together. This article attempts to explain the motives behind the gap between bioethics and CSR, while arguing that their shared agenda – combined with their contrasting principles and goals – suggests there is potential for fruitful dialogue that enables the actualization of bioethical agendas and provides a direction for CSR in health-related organizations. INTRODUCTION Bioethics and Corporate Social Responsibility (CSR) seem to be cut from the same cloth: the concern for human rights and the response to scandal. Both are tools for the governance of organizations, shaping how power flows and decisions are made. They have taken the shape of specialized committees, means of stakeholder inclusion at deliberative forums, compliance programs, and internal processes. It should be surprising, then, that these two fields of study and practice have developed separately, only recently re-approaching one another. There have been displays of this reconnection both in academic and corporate spaces, with bioethics surfacing as part of the discourse of CSR and compliance initiatives. However, this is still a relatively timid effort. Even though the bioethics-CSR divide presents mostly reasonable explanations for this difficult relationship between the disciplines, current proposals suggest there is much to be gained from a stronger relationship between them. This article explores the common history of bioethics and corporate social responsibility and identifies their common features and differences. It then explores the dispute of jurisdictions due to professional and academic “pedigree” and incompatibilities in the ideological and teleological spheres as possible causes for the divide. The discussion turns to paths for improving the reflexivity of both disciplines and, therefore, their openness to mutual contributions. I. Cut Out of the Same Cloth The earliest record of the word “bioethics” dates back to 1927 as a term that designates one’s ethical responsibility toward not only human beings but other lifeforms as well, such as animals and plants.[1] Based on Kantian ethics, the term was coined as a response to the great prestige science held at its time. It remained largely forgotten until the 1970s, when it resurfaced in the United States[2] as the body of knowledge that can be employed to ensure the responsible pursuit and application of science. The resurgence was prompted by a response to widespread irresponsible attitudes toward science and grounded in a pluralistic perspective of morality.[3] In the second half of the twentieth century, states and the international community assumed the duty to protect human rights, and bioethics became a venue for discussing rights.[4] There is both a semantic gap and a contextual gap between these two iterations, with some of them already being established. Corporate social responsibility is often attributed to the Berle-Dodd debate. The discussion was characterized by diverging views on the extent of the responsibility of managers.[5] It was later settled as positioning the company, especially the large firm, as an entity whose existence is fomented by the law due to its service to the community. The concept has evolved with time, departing from a largely philanthropic meaning to being ingrained in nearly every aspect of a company’s operations. This includes investments, entrepreneurship models, and its relationship to stakeholders, leading to an increasing operationalization and globalization of the concept.[6] At first sight, these two movements seem to stem from different contexts. Despite the difference, it is also possible to tell a joint history of bioethics and CSR, with their point of contact being a generalized concern with technological and social changes that surfaced in the sixties. The publishing of Silent Spring in 1962 by Rachel Carson exemplifies this growing concern over the sustainability of the ruling economic growth model of its time by commenting on the effects of large-scale agriculture and the use of pesticides in the population of bees, one of the most relevant pollinators of crops consumed by humans. The book influenced both the author responsible for the coining bioethics in the 1971[7] and early CSR literature.[8] By initiating a debate over the sustainability of economic models, the environmentalist discourse became a precursor to vigorous social movements for civil rights. Bioethics was part of the trend as it would be carried forward by movements such as feminism and the patients’ rights movement.[9] Bioethics would gradually move from a public discourse centered around the responsible use of science and technology to academic and government spaces.[10] This evolution led to an increasing emphasis on intellectual rigor and governance. The transformation would unravel the effort to take effective action against scandal and turn bioethical discourse into governance practices,[11] such as bioethics and research ethics committees. The publication of the Belmont Report[12] in the aftermath of the Tuskegee Syphilis Experiment, as well as the creation of committees such as the “God Committee,”[13] which aimed to develop and enforce criteria for allocating scarce dialysis machines, exemplify this shift. On the side of CSR, this period represents, at first, a stronger pact between businesses and society due to more stringent environmental and consumer regulations. But afterward, a joint trend emerged: on one side, the deregulation within the context of neoliberalism, and on the other, the operationalization of corporate social responsibility as a response to societal concerns.[14] The 1990s saw both opportunities and crises that derived from globalization. In the political arena, the end of the Cold War led to an impasse in the discourse concerning human rights,[15] which previously had been split between the defense of civil and political rights on one side and social rights on the other. But at the same time, agendas that were previously restricted territorially became institutionalized on a global scale.[16] Events such as the European Environment Agency (1990), ECO92 in Rio de Janeiro (1992), and the UN Global Compact (2000) are some examples of the globalization of CSR. This process of institutionalization would also mirror a crisis in CSR, given that its voluntarist core would be deemed lackluster due to the lack of corporate accountability. The business and human rights movement sought to produce new binding instruments – usually state-based – that could ensure that businesses would comply with their duties to respect human rights.[17] This rule-creation process has been called legalization: a shift from business standards to norms of varying degrees of obligation, precision, and delegation.[18] Bioethics has also experienced its own renewed identity in the developed world, perhaps because of its reconnection to public and global health. Global health has been the object of study for centuries under other labels (e.g., the use of tropical medicine to assist colonial expeditions) but it resurfaced in the political agenda recently after the pandemics of AIDS and respiratory diseases.[19] Bioethics has been accused from the inside of ignoring matters beyond the patient-provider relationship,[20] including those related to public health and/or governance. Meanwhile, scholars claimed the need to expand the discourse to global health.[21] In some countries, bioethics developed a tight relationship with public health, such as Brazil,[22] due to its connections to the sanitary reform movement. The United Kingdom has also followed a different path, prioritizing governance practices and the use of pre-established institutions in a more community-oriented approach.[23] The Universal Declaration on Bioethics and Rights followed this shift toward a social dimension of bioethics despite being subject to criticism due to its human rights-based approach in a field characterized by ethical pluralism.[24] This scenario suggests bioethics and CSR have developed out of similar concerns: the protection of human rights and concerns over responsible development – be it economic, scientific, or technological. However, the interaction between these two fields (as well as business and human rights) is fairly recent both in academic and business settings. There might be a divide between these fields and their practitioners. II. A Tale of Jurisdictions It can be argued that CSR and business and human rights did not face jurisdictional disputes. These fields owe much of their longevity to their roots in institutional economics, whose debates, such as the Berle-Dodd debate, were based on interdisciplinary dialogue and the abandonment of sectorial divisions and public-private dichotomies.[25] There was opposition to this approach to the role of companies in society that could have implications for CSR’s interdisciplinarity, such as the understanding that corporate activities should be restricted to profit maximization.[26] Yet, those were often oppositions to CSR or business and human rights themselves. The birth of bioethics in the USA can be traced back to jurisdictional disputes over the realm of medicine and life sciences.[27] The dispute unfolded between representatives of science and those of “society’s conscience,” whether through bioethics as a form of applied ethics or other areas of knowledge such as theology.[28] Amid the civil rights movements, outsiders would gain access to the social sphere of medicine, simultaneously bringing it to the public debate and emphasizing the decision-making process as the center of the medical practice.[29] This led to the emergence of the bioethicist as a professional whose background in philosophy, theology, or social sciences deemed the bioethicist qualified to speak on behalf of the social consciousness. In other locations this interaction would play out differently: whether as an investigation of philosophically implied issues, a communal effort with professional institutions to enhance decision-making capability, or a concern with access to healthcare.[30] In these situations, the emergence and regulation of bioethics would be way less rooted in disputes over jurisdictions. This contentious birth of bioethics would have several implications, most related to where the bioethicist belongs. After the civil rights movements subsided, bioethics moved from the public sphere into an ivory tower: intellectual, secular, and isolated. The scope of the bioethicist would be increasingly limited to the spaces of academia and hospitals, where it would be narrowed to the clinical environment.[31] This would become the comfort zone of professionals, much to the detriment of social concerns. This scenario was convenient to social groups that sought to affirm their protagonism in the public arena, with conservative and progressive movements alike questioning the legitimacy of bioethics in the political discourse.[32] Even within the walls of hospitals and clinics, bioethics would not be excused from criticism. Afterall, the work of bioethicists is often unregulated and lacks the same kind of accountability that doctors and lawyers have. Then, is there a role to be played by the bioethicist? This trend of isolation leads to a plausible explanation for why bioethics did not develop an extensive collaboration with corporate social responsibility nor with business and human rights. Despite stemming from similar agendas, bioethics’ orientation towards the private sphere resulted in a limited perspective on the broader implications of its decisions. This existential crisis of the discipline led to a re-evaluation of its nature and purpose. Its relevance has been reaffirmed due to the epistemic advantage of philosophy when engaging normative issues. Proper training enables the bioethicist to avoid falling into traps of subjectivism or moralism, which are unable to address the complexity of decision-making. It also prevents the naïve seduction of “scientifying” ethics.[33] This is the starting point of a multitude of roles that can be attributed to the bioethicists. There are three main responsibilities that fall under bioethics: (i) activism in biopolicy, through the engagement in the creation of laws, jurisprudence, and public policies; (ii) the exercise of bioethics expertise, be it through the specialized knowledge in philosophical thought, its ability to juggle multiple languages related to various disciplines related to bioethics, or its capacity to combat and avoid misinformation and epistemic distortion; (iii) and, intellectual exchange, by exercising awareness that it is necessary to work with specialists from different backgrounds to achieve its goals.[34] All of those suggest the need for bioethics to improve its dialogue with CSR and business and human rights. Both CSR and business and human rights have been the arena of political disputes over the role of regulations and corporations themselves, and the absence of strong stances by bioethicists risks deepening their exclusion from the public arena. Furthermore, CSR and business and human rights are at the forefront of contemporary issues, such as the limits to sustainable development and appropriate governance structures, which may lead to the acceptance of values and accomplishment of goals cherished by bioethics. However, a gap in identifying the role and nature of bioethics and CSR may also be an obstacle for bridging the chasm between bioethics and CSR. III. From Substance to Form: Philosophical Groundings of CSR and Bioethics As mentioned earlier, CSR is, to some extent, a byproduct of institutionalism. Institutional economics has a philosophical footprint in the pragmatic tradition[35], which has implications for the purpose of the movement and the typical course of the debate. The effectiveness of regulatory measures is often at the center of CSR and business and human rights debates: whatever the regulatory proposal may be, compliance, feasibility, and effectiveness are the kernel of the discussion. The axiological foundation is often the protection of human rights. But discussions over the prioritization of some human rights over others or the specific characteristics of the community to be protected are often neglected.[36] It is worth reinforcing that adopting human rights as an ethical standard presents problems to bioethics, given its grounding in the recognition of ethical pluralism. Pragmatism adopts an anti-essentialist view, arguing that concepts derive from their practical consequences instead of aprioristic elements.[37] Therefore, truth is transitory and context dependent. Pragmatism embraces a form of moral relativism and may find itself in an impasse in the context of political economy and policymaking due to its tendency to be stuck between the preservation of the status quo and the defense of a technocratic perspective, which sees technical and scientific progress as the solution to many of society’s issues.[38] These characteristics mean that bioethics has a complicated relationship with pragmatism. Indeed, there are connections between pragmatism and the bioethics discourse. Both can be traced back to American naturalism.[39] The early effort in bioethics to make it ecumenical, thus building on a common but transitory morality,[40] sounds pragmatic. Therefore, scholars suggest that bioethics should rely on pragmatism's perks and characteristics to develop solutions to new ethical challenges that emerge from scientific and technological progress. Nonetheless, ethical relativism is a problem for bioethics when it bleeds from a metaethical level into the subject matters themselves. After all, the whole point of bioethics is either descriptive, where it seeks to understand social values and conditions that pertain to its scope, or normative, where it investigates what should be done in matters related to medicine, life sciences, and social and technological change. It is a “knowledge of how to use knowledge.” Therefore, bioethics is a product of disillusionment regarding science and technology's capacity to produce exclusively good consequences. It was built around an opposition to ethical relativism—even though the field is aware of the particularity of its answers. This is true not only for the scholarly arena, where the objective is to produce ethically sound answers but also for bioethics governance, where relativism may induce decision paralysis or open the way to points of view disconnected from facts.[41] But there might be a point for more pragmatic bioethics. Bioethics has become an increasingly public enterprise which seeks political persuasion and impact in the regulatory sphere. When bioethics is seen as an enterprise, achieving social transformation is its main goal. In this sense, pragmatism can provide critical tools to identify idiosyncrasies in regulation that prove change is needed. An example of how this may play out is the abortion rights movement in the global south.[42] Despite barriers to accessing safe abortion, this movement came up with creative solutions and a public discourse focused on the consequences of its criminalization rather than its moral aspects. IV. Bridging the Divide: Connections Between Bioethics and CSR There have been attempts to bring bioethics and CSR closer to each other. Corporate responsibility can be a supplementary strategy for achieving the goals of bioethics. The International Bioethics Committee (IBC), an institution of the United Nations Educational, Scientific and Cultural Organization (UNESCO), highlights the concept that social responsibility regarding health falls under the provisions of the Universal Declaration on Bioethics and Human Rights (UDBHR). It is a means of achieving good health (complete physical, mental, and social well-being) through social development.[43] Thus, it plays out as a condition for actualizing the goals dear to bioethics and general ethical standards,[44] such as autonomy and awareness of the social consequences of an organization’s governance. On this same note, CSR is a complementary resource for healthcare organizations that already have embedded bioethics into their operations[45] as a way of looking at the social impact of their practices. And bioethics is also an asset of CSR. Bioethics can inform the necessary conditions for healthcare institutions achieving a positive social impact. When taken at face value, bioethics may offer guidelines for ethical and socially responsible behavior in the industry, instructing how these should play out in a particular context such as in research, and access to health.[46] When considering the relevance of rewarding mechanisms,[47] bioethics can guide the establishment of certification measures to restore lost trust in the pharmaceutical sector.[48] Furthermore, recognizing that the choice is a more complex matter than the maximization of utility can offer a nuanced perspective on how organizations dealing with existentially relevant choices understand their stakeholders.[49] However, all of those proposals might come with the challenge of proving that something can be gained from its addition to self-regulatory practices[50] within the scope of a dominant rights-based approach to CSR and global and corporate law. It is evident that there is room for further collaboration between bioethics and CSR. Embedding either into the corporate governance practices of an organization tends to be connected to promoting the other.[51] While there are some incompatibilities, organizations should try to overcome them and take advantage of the synergies and similarities. CONCLUSION Despite their common interests and shared history, bioethics and corporate social responsibility have not produced a mature exchange. Jurisdictional issues and foundational incompatibilities have prevented a joint effort to establish a model of social responsibility that addresses issues particular to the healthcare sector. Both bioethics and CSR should acknowledge that they hold two different pieces of a cognitive competence necessary for that task: CSR offers experience on how to turn corporate ethical obligations operational, while bioethics provides access to the prevailing practical and philosophical problem-solving tools in healthcare that were born out of social movements. Reconciling bioethics and CSR calls for greater efforts to comprehend and incorporate the social knowledge developed by each field reflexively[52] while understanding their insights are relevant to achieving some common goals. - [1]. Fritz Jahr, “Bio-Ethik: Eine Umschau Über Die Ethischen Beziehungen Des Menschen Zu Tier Und Pflanze,” Kosmos - Handweiser Für Naturfreunde 24 (1927): 2–4. [2]. Van Rensselaer Potter, “Bioethics, the Science of Survival,” Perspectives in Biology and Medicine 14, no. 1 (1970): 127–53, https://doi.org/10.1353/pbm.1970.0015. [3]. Maximilian Schochow and Jonas Grygier, eds., “Tagungsbericht: 1927 – Die Geburt der Bioethik in Halle (Saale) durch den protestantischen Theologen Fritz Jahr (1895-1953),” Jahrbuch für Recht und Ethik / Annual Review of Law and Ethics 21 (June 11, 2014): 325–29, https://doi.org/10.3726/978-3-653-02807-2. [4] George J. Annas, American Bioethics: Crossing Human Rights and Health Law Boundaries (Oxford ; New York: Oxford University Press, 2005). [5] Philip L. Cochran, “The Evolution of Corporate Social Responsibility,” Business Horizons 50, no. 6 (November 2007): 449–54, https://doi.org/10.1016/j.bushor.2007.06.004. p. 449. [6] Mauricio Andrés Latapí Agudelo, Lára Jóhannsdóttir, and Brynhildur Davídsdóttir, “A Literature Review of the History and Evolution of Corporate Social Responsibility,” International Journal of Corporate Social Responsibility 4, no. 1 (December 2019): 23, https://doi.org/10.1186/s40991-018-0039-y. [7] Potter, “Bioethics, the Science of Survival.” p. 129. [8] Latapí Agudelo, Jóhannsdóttir, and Davídsdóttir, “A Literature Review of the History and Evolution of Corporate Social Responsibility.” p. 4. [9] Albert R. Jonsen, The Birth of Bioethics (New York: Oxford University Press, 2003). p. 368-371. [10] Jonsen. p. 372. [11] Jonathan Montgomery, “Bioethics as a Governance Practice,” Health Care Analysis 24, no. 1 (March 2016): 3–23, https://doi.org/10.1007/s10728-015-0310-2. [12]. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, “The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research” (Washington: Department of Health, Education, and Welfare, April 18, 1979), https://www.hhs.gov/ohrp/sites/default/files/the-belmont-report-508c_FINAL.pdf. [13] Shana Alexander, “They Decide Who Lives, Who Dies,” in LIFE, by Time Inc, 19th ed., vol. 53 (Nova Iorque: Time Inc, 1962), 102–25. [14]. Latapí Agudelo, Jóhannsdóttir, and Davídsdóttir, “A Literature Review of the History and Evolution of Corporate Social Responsibility.” [15]. Boaventura de Sousa Santos, “Por Uma Concepção Multicultural Dos Direitos Humanos,” Revista Crítica de Ciências Sociais, no. 48 (June 1997): 11–32. [16] Latapí Agudelo, Jóhannsdóttir, and Davídsdóttir, “A Literature Review of the History and Evolution of Corporate Social Responsibility.” [17]. Anita Ramasastry, “Corporate Social Responsibility Versus Business and Human Rights: Bridging the Gap Between Responsibility and Accountability,” Journal of Human Rights 14, no. 2 (April 3, 2015): 237–59, https://doi.org/10.1080/14754835.2015.1037953. [18]. Kenneth W Abbott et al., “The Concept of Legalization,” International Organization, Legalization and World Politics, 54, no. 3 (2000): 401–4019. [19]. Jens Holst, “Global Health – Emergence, Hegemonic Trends and Biomedical Reductionism,” Globalization and Health 16, no. 1 (December 2020): 42–52, https://doi.org/10.1186/s12992-020-00573-4. [20]. Albert R. Jonsen, “Social Responsibilities of Bioethics,” Journal of Urban Health: Bulletin of the New York Academy of Medicine 78, no. 1 (March 1, 2001): 21–28, https://doi.org/10.1093/jurban/78.1.21. [21]. Solomon R Benatar, Abdallah S Daar, and Peter A Singer, “Global Health Challenges: The Need for an Expanded Discourse on Bioethics,” PLoS Medicine 2, no. 7 (July 26, 2005): e143, https://doi.org/10.1371/journal.pmed.0020143. [22]. Márcio Fabri dos Anjos and José Eduardo de Siqueira, eds., Bioética No Brasil: Tendências e Perspectivas, 1st ed., Bio & Ética (São Paulo: Sociedade Brasileira de Bioética, 2007). [23]. Montgomery, “Bioethics as a Governance Practice.” p. 8-9. [24]. Aline Albuquerque S. de Oliveira, “A Declaração Universal Sobre Bioética e Direitos Humanos e a Análise de Sua Repercussão Teórica Na Comunidade Bioética,” Revista Redbioética/UNESCO 1, no. 1 (2010): 124–39. [25] John R. Commons, “Law and Economics,” The Yale Law Journal 34, no. 4 (February 1925): 371, https://doi.org/10.2307/788562; Robert L. Hale, “Bargaining, Duress, and Economic Liberty,” Columbia Law Review 43, no. 5 (July 1943): 603–28, https://doi.org/10.2307/1117229; Karl N. Llewellyn, “The Effect of Legal Institutions Upon Economics,” The American Economic Review 15, no. 4 (1925): 665–83; Carlos Portugal Gouvêa, Análise Dos Custos Da Desigualdade: Efeitos Institucionais Do Círculo Vicioso de Desigualdade e Corrupção, 1st ed. (São Paulo: Quartier Latin, 2021). p. 84-94. [26] Milton Friedman, “A Friedman Doctrine‐- The Social Responsibility of Business Is to Increase Its Profits,” The New York Times, September 13, 1970, sec. Archives, https://www.nytimes.com/1970/09/13/archives/a-friedman-doctrine-the-social-responsibility-of-business-is-to.html. [27] Montgomery, “Bioethics as a Governance Practice.” p. 8. [28] John Hyde Evans, The History and Future of Bioethics: A Sociological View, 1st ed. (New York: Oxford University Press, 2012). [29] David J. Rothman, Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making, 2nd pbk. ed, Social Institutions and Social Change (New York: Aldine de Gruyter, 2003). p. 3. [30] Volnei Garrafa, Thiago Rocha Da Cunha, and Camilo Manchola, “Access to Healthcare: A Central Question within Brazilian Bioethics,” Cambridge Quarterly of Healthcare Ethics 27, no. 3 (July 2018): 431–39, https://doi.org/10.1017/S0963180117000810. [31] Jonsen, “Social Responsibilities of Bioethics.” [32] Evans, The History and Future of Bioethics. p. 75-79, 94-96. [33] Julian Savulescu, “Bioethics: Why Philosophy Is Essential for Progress,” Journal of Medical Ethics 41, no. 1 (January 2015): 28–33, https://doi.org/10.1136/medethics-2014-102284. [34] Silvia Camporesi and Giulia Cavaliere, “Can Bioethics Be an Honest Way of Making a Living? A Reflection on Normativity, Governance and Expertise,” Journal of Medical Ethics 47, no. 3 (March 2021): 159–63, https://doi.org/10.1136/medethics-2019-105954; Jackie Leach Scully, “The Responsibilities of the Engaged Bioethicist: Scholar, Advocate, Activist,” Bioethics 33, no. 8 (October 2019): 872–80, https://doi.org/10.1111/bioe.12659. [35] Philip Mirowski, “The Philosophical Bases of Institutionalist Economics,” Journal of Economic Issues, Evolutionary Economics I: Foundations of Institutional Thought, 21, no. 3 (September 1987): 1001–38. [36] David Kennedy, “The International Human Rights Movement: Part of the Problem?,” Harvard Human Rights Journal 15 (2002): 101–25. [37] Richard Rorty, “Pragmatism, Relativism, and Irrationalism,” Proceedings and Addresses of the American Philosophical Association 53, no. 6 (August 1980): 717+719-738. [38]. Mirowski, “The Philosophical Bases of Institutionalist Economics.” [39]. Glenn McGee, ed., Pragmatic Bioethics, 2nd ed, Basic Bioethics (Cambridge, Mass: MIT Press, 2003). [40]. Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 7th ed (New York: Oxford University Press, 2013). [41]. Montgomery, “Bioethics as a Governance Practice.” [42]. Debora Diniz and Giselle Carino, “What Can Be Learned from the Global South on Abortion and How We Can Learn?,” Developing World Bioethics 23, no. 1 (March 2023): 3–4, https://doi.org/10.1111/dewb.12385. [43]. International Bioethics Committee, On Social Responsibility and Health Report (Paris: Unesco, 2010). [44]. Cristina Brandão et al., “Social Responsibility: A New Paradigm of Hospital Governance?,” Health Care Analysis 21, no. 4 (December 2013): 390–402, https://doi.org/10.1007/s10728-012-0206-3. [45] Intissar Haddiya, Taha Janfi, and Mohamed Guedira, “Application of the Concepts of Social Responsibility, Sustainability, and Ethics to Healthcare Organizations,” Risk Management and Healthcare Policy Volume 13 (August 2020): 1029–33, https://doi.org/10.2147/RMHP.S258984. [46]The Biopharmaceutical Bioethics Working Group et al., “Considerations for Applying Bioethics Norms to a Biopharmaceutical Industry Setting,” BMC Medical Ethics 22, no. 1 (December 2021): 31–41, https://doi.org/10.1186/s12910-021-00600-y. [47] Anne Van Aaken and Betül Simsek, “Rewarding in International Law,” American Journal of International Law 115, no. 2 (April 2021): 195–241, https://doi.org/10.1017/ajil.2021.2. [48] Jennifer E. Miller, “Bioethical Accreditation or Rating Needed to Restore Trust in Pharma,” Nature Medicine 19, no. 3 (March 2013): 261–261, https://doi.org/10.1038/nm0313-261. [49] John Hardwig, “The Stockholder – A Lesson for Business Ethics from Bioethics?,” Journal of Business Ethics 91, no. 3 (February 2010): 329–41, https://doi.org/10.1007/s10551-009-0086-0. [50] Stefan van Uden, “Taking up Bioethical Responsibility?: The Role of Global Bioethics in the Social Responsibility of Pharmaceutical Corporations Operating in Developing Countries” (Mestrado, Coimbra, Coimbra University, 2012). [51] María Peana Chivite and Sara Gallardo, “La bioética en la empresa: el caso particular de la Responsabilidad Social Corporativa,” Revista Internacional de Organizaciones, no. 13 (January 12, 2015): 55–81, https://doi.org/10.17345/rio13.55-81. [52] Teubner argues that social spheres tend to develop solutions autonomously, but one sphere interfering in the way other spheres govern themselves tends to result in ineffective regulation and demobilization of their autonomous rule-making capabilities. These spheres should develop “reflexion mechanisms” that enable the exchange of their social knowledge and provide effective, non-damaging solutions to social issues. See Gunther Teubner, “Substantive and Reflexive Elements in Modern Law,” Law & Society Review 17, no. 2 (1983): 239–85, https://doi.org/10.2307/3053348.

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. 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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. 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[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. 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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. 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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.

In PilsenTwenty-six Station Road,She climbed to the third floorUp stairs which were all that was leftOf the whole house,She opened her doorFull on to the sky,Stood gaping over the edge.For this was the placeThe world ended.Thenshe locked up carefullylest someone stealSiriusor Aldebaranfrom her kitchen,went back downstairsand settled herselfto waitfor the house to rise againand for her husband to rise from the ashesand for her children’s hands and feet to be stuck back in placeIn the morning they found herstill as stone, sparrows pecking her hands.Five Minutes after the Air Raidby Miroslav Holub(Calder 287) Holding Still Detonation. Affect. During the Second World War, London and other European cities were subjected to the terrors of aerial bombardment, rendered through nightmarish anticipations of the bomber (Gollin 7) and the material storm of the real air-raid. The fall of bombs plagued cities and their citizens with the terrible rain of explosives and incendiary weapons. A volatile landscape was formed as the urban environment was ‘unmade’ and urged into violent motion. Flying projectiles of shrapnel, debris and people; avalanches of collapsing factories and houses; the inhale and exhale of compressed air and firestorms; the scream of the explosion. All these composed an incredibly fluid urban traumatic, as atmospheres fell over the cities that was thick with smoke, dust, and ventilated only by terror (see for instance Sebald 10 and Mendieta’s 3 recent commentary). Vast craters were imprinted onto the charred morphologies of London and Berlin as well as Coventry, Hamburg and Dresden. Just as the punctuations of the bombing saw the psychic as well as the material give way, writers portraying Britain as an ‘volcano island’ (Spaight 5) witnessed eruptive projections – the volleys of the material air-war; the emotional signature of charged and bitter reprisals; pain, anguish and vengeance - counter-strikes of affect. In the midst of all of this molten violence and emotion it seems impossible that a simultaneous sense of quiescence could be at all possible. More than mere physical fixity or geographical stasis, a rather different sort of experience could take place. Preceding, during and following the excessive mobilisation of an air raid, ‘stillness’ was often used to describe certain plateuing stretches of time-space which were slowed and even stopped (Anderson 740). Between the eruptions appeared hollows of calm and even boredom. People’s nervous flinching under the reverberation of high-explosive blasts formed part of what Jordan Crandall might call a ‘bodily-inclination’ position. Slackened and taut feelings condensed around people listening out for the oncoming bomber. People found that they prepared for the dreadful wail of the siren, or relaxed in the aftermath of the attack. In these instances, states of tension and apprehension as well as calm and relief formed though stillness. The peculiar experiences of ‘stillness’ articulated in these events open out, I suggest, distinctive ways-of-being which undo our assumptions of perpetually fluid subjectivities and the primacy of the ‘body in motion’ even within the context of unparalleled movement and uncertainty (see Harrison 423 and also Rose and Wylie 477 for theoretical critique). The sorts of “musics of stillness and silence able to be discovered in a world of movement” (Thrift, Still 50), add to our understandings of the material geographies of war and terror (see for instance Graham 63; Gregory and Pred 3), whilst they gesture towards complex material-affective experiences of bodies and spaces. Stillness in this sense, denotes apprehending and anticipating spaces and events in ways that sees the body enveloped within the movement of the environment around it; bobbing along intensities that course their way through it; positioned towards pasts and futures that make themselves felt, and becoming capable of intense forms of experience and thought. These examples illustrate not a shutting down of the body to an inwardly focused position – albeit composed by complex relations and connections – but bodies finely attuned to their exteriors (see Bissell, Animating 277 and Conradson 33). In this paper I draw from a range of oral and written testimony archived at the Imperial War Museum and the Mass Observation wartime regular reports. Edited publications from these collections were also consulted. Detailing the experience of aerial bombing during the Blitz, particularly on London between September 1940 to May 1941, forms part of a wider project concerning the calculative and affective dimensions of the aeroplane’s relationship with the human body, especially through the spaces it has worked to construct (infrastructures such as airports) and destroy. While appearing extraordinary, the examples I use are actually fairly typical of the patternings of experience and the depth and clarity with which they are told. They could be taken to be representative of the population as a whole or coincidentally similar testimonials. Either way, they are couched within a specific cultural historical context of urgency, threat and unparalleled violence.Anticipations The complex material geographies of an air raid reveal the ecological interdependencies of populations and their often urban environments and metabolisms (Coward 419; Davis 3; Graham 63; Gregory The Colonial 19; Hewitt Place 257). Aerial warfare was an address of populations conceived at the register of their bio-rhythmical and metabolic relationship to their milieu (Adey). The Blitz and the subsequent Allied bombing campaign constituted Churchill’s ‘great experiment’ for governments attempting to assess the damage an air raid could inflict upon a population’s nerves and morale (Brittain 77; Gregory In Another 88). An anxious and uncertain landscape constructed before the war, perpetuated by public officials, commentators and members of parliament, saw background affects (Ngai 5) of urgency creating an atmosphere that pressurised and squeezed the population to prepare for the ‘gathering storm’. Attacks upon the atmosphere itself had been readily predicted in the form of threatening gas attacks ready to poison the medium upon which human and animal life depended (Haldane 111; Sloterdijk 41-57). One of the most talked of moments of the Blitz is not necessarily the action but the times of stillness that preceded it. Before and in-between an air raid stillness appears to describe a state rendered somewhere between the lulls and silences of the action and the warnings and the anticipatory feelings of what might happen. In the awaiting bodies, the materialites of silence could be felt as a kind-of-sound and as an atmospheric sense of imminence. At the onset of the first air-raids sound became a signifier of what was on the way (MO 408). Waiting – as both practice and sensation – imparted considerable inertia that went back and forth through time (Jeffrey 956; Massumi, Parables 3). For Geographer Kenneth Hewitt, sound “told of the coming raiders, the nearness of bombs, the plight of loved ones” (When the 16). The enormous social survey of Mass Observation concluded that “fear seems to be linked above all with noise” (original emphasis). As one report found, “It is the siren or the whistle or the explosion or the drone – these are the things that terrify. Fear seems to come to us most of all through our sense of hearing” (MO 378). Yet the power of the siren came not only from its capacity to propagate sound and to alert, but the warning held in its voice of ‘keeping silent’. “Prefacing in a dire prolepsis the post-apocalyptic event before the event”, as Bishop and Phillips (97) put it, the stillness of silence was incredibly virtual in its affects, disclosing - in its lack of life – the lives that would be later taken. Devastation was expected and rehearsed by civilians. Stillness formed a space and body ready to spring into movement – an ‘imminent mobility’ as John Armitage (204) has described it. Perched on the edge of devastation, space-times were felt through a sense of impending doom. Fatalistic yet composed expectations of a bomb heading straight down pervaded the thoughts and feelings of shelter dwellers (MO 253; MO 217). Waves of sound disrupted fragile tempers as they passed through the waiting bodies in the physical language of tensed muscles and gritted teeth (Gaskin 36). Silence helped form bodies inclined-to-attention, particularly sensitive to aural disturbances and vibrations from all around. Walls, floors and objects carried an urban bass-line of warning (Goodman). Stillness was forged through a body readied in advance of the violence these materialities signified. A calm and composed body was not necessarily an immobile body. Civilians who had prepared for the attacks were ready to snap into action - to dutifully wear their gas-mask or escape to shelter. ‘Backgrounds of expectation’ (Thrift, Still 36) were forged through non-too-subtle procedural and sequential movements which opened-out new modes of thinking and feeling. Folding one’s clothes and placing them on the dresser in-readiness; pillows and sheets prepared for a spell in the shelter, these were some of many orderly examples (IWM 14595). In the event of a gas attack air raid precautions instructions advised how to put on a gas mask (ARPD 90-92),i) Hold the breath. ii) Remove headgear and place between the knees. iii) Lift the flap of the haversack [ …] iv) Bring the face-piece towards the face’[…](v) Breathe out and continue to breathe in a normal manner The rational technologies of drill, dressage and operational research enabled poise in the face of an eventual air-raid. Through this ‘logistical-life’ (Reid 17), thought was directed towards simple tasks by minutely described instructions. Stilled LifeThe end of stillness was usually marked by a reactionary ‘flinch’, ‘start’ or ‘jump’. Such reactionary ‘urgent analogs’ (Ngai 94; Tomkins 96) often occurred as a response to sounds and movements that merely broke the tension rather than accurately mimicking an air raid. These atmospheres were brittle and easily disrupted. Cars back-firing and changing gear were often complained about (MO 371), just as bringing people out of the quiescence of sleep was a common effect of air-raids (Kraftl and Horton 509). Disorientation was usually fostered in this process while people found it very difficult to carry out the most simple of tasks. Putting one’s clothes on or even making their way out of the bedroom door became enormously problematic. Sirens awoke a ‘conditioned reflex’ to take cover (MO 364). Long periods of sleep deprivation brought on considerable fatigue and anxiety. ‘Sleep we Must’ wrote journalist Ritchie Calder (252) noticing the invigorating powers of sleep for both urban morale and the bare existence of survival. For other more traumatized members of the population, psychological studies found that the sustained concentration of shelling caused what was named ‘apathy-retreat’ (Harrisson, Living 65). This extreme form of acquiescence saw especially susceptible and vulnerable civilians suffer an overwhelming urge to sleep and to be cared-for ‘as if chronically ill’ (Janis 90). A class and racial politics of quiescent affect was enacted as several members of the population were believed far more liable to ‘give way’ to defeat and dangerous emotions (Brittain 77; Committee of Imperial Defence).In other cases it was only once an air-raid had started that sleep could be found (MO 253). The boredom of waiting could gather in its intensity deforming bodies with “the doom of depression” (Anderson 749). The stopped time-spaces in advance of a raid could be soaked with so much tension that the commencement of sirens, vibrations and explosions would allow a person overwhelming relief (MO 253). Quoting from a boy recalling his experiences in Hannover during 1943, Hewitt illustrates:I lie in bed. I am afraid. I strain my ears to hear something but still all is quiet. I hardly dare breathe, as if something horrible is knocking at the door, at the windows. Is it the beating of my heart? ... Suddenly there seems relief, the sirens howl into the night ... (Heimatbund Niedersachsen 1953: 185). (Cited in Hewitt, When 16)Once a state of still was lost getting it back required some effort (Bissell, Comfortable 1697). Cautious of preventing mass panic and public hysteria by allowing the body to erupt outwards into dangerous vectors of mobility, the British government’s schooling in the theories of panicology (Orr 12) and contagious affect (Le Bon 17; Tarde 278; Thrift, Intensities 57; Trotter 140), made air raid precautions (ARP) officers, police and civil defence teams enforce ‘stay put’ and ‘hold firm’ orders to protect the population (Jones et al, Civilian Morale 463, Public Panic 63-64; Thomas 16). Such orders were meant to shield against precisely the kinds of volatile bodies they were trying to compel with their own bombing strategies. Reactions to the Blitz were moralised and racialised. Becoming stilled required self-conscious work by a public anxious not to be seen to ‘panic’. This took the form of self-disciplination. People exhausted considerable energy to ‘settle’ themselves down. It required ‘holding’ themselves still and ‘together’ in order to accomplish this state, and to avoid going the same way as the buildings falling apart around them, as some people observed (MO 408). In Britain a cup of tea was often made as a spontaneous response in the event of the conclusion of a raid (Brown 686). As well as destroying bombing created spaces too – making space for stillness (Conradson 33). Many people found that they could recall their experiences in vivid detail, allocating a significant proportion of their memories to the recollection of the self and an awareness of their surroundings (IWM 19103). In this mode of stillness, contemplation did not turn-inwards but unfolded out towards the environment. The material processual movement of the shell-blast literally evacuated all sound and materials from its centre to leave a vacuum of negative pressure. Diaries and oral testimonies stretch out these millisecond events into discernable times and spaces of sensation, thought and the experience of experience (Massumi, Parables 2). Extraordinarily, survivors mention serene feelings of quiet within the eye of the blast (see Mortimer 239); they had, literally, ‘no time to be frightened’ (Crighton-Miller 6150). A shell explosion could create such intensities of stillness that a sudden and distinctive lessening of the person and world are expressed, constituting ‘stilling-slowing diminishments’ (Anderson 744). As if the blast-vacuum had sucked all the animation from their agency, recollections convey passivity and, paradoxically, a much more heightened and contemplative sense of the moment (Bourke 121; Thrift, Still 41). More lucid accounts describe a multitude of thoughts and an attention to minute detail. Alternatively, the enormous peaking of a waking blast subdued all later activities to relative obsolescence. The hurricane of sounds and air appear to overload into the flatness of an extended and calmed instantaneous present.Then the whistling stopped, then a terrific thump as it hit the ground, and everything seem to expand, then contract with deliberation and stillness seemed to be all around. (As recollected by Bill and Vi Reagan in Gaskin 17)On the other hand, as Schivelbusch (7) shows us in his exploration of defeat, the cessation of war could be met with an outburst of feeling. In these micro-moments a close encounter with death was often experienced with elation, a feeling of peace and well-being drawn through a much more heightened sense of the now (MO 253). These are not pre-formed or contemplative techniques of attunement as Thrift has tracked, but are the consequence of significant trauma and the primal reaction to extreme danger.TracesSusan Griffin’s haunting A Chorus of Stones documents what she describes as a private life of war (1). For Griffin, and as shown in these brief examples, stillness and being-stilled describe a series of diverse experiences endured during aerial bombing. Yet, as Griffin narrates, these are not-so private lives. A common representation of air war can be found in Henry Moore’s tube shelter sketches which convey sleeping tube-dwellers harboured in the London underground during the Blitz. The bodies are represented as much more than individuals being connected by Moore’s wave-like shapes into the turbulent aggregation of a choppy ocean. What we see in Moore’s portrayal and the examples discussed already are experiences with definite relations to both inner and outer worlds. They refer to more-than individuals who bear intimate relations to their outsides and the atmospheric and material environments enveloping and searing through them. Stillness was an unlikely state composed through these circulations just as it was formed as a means of address. It was required in order to apprehend sounds and possible events through techniques of listening or waiting. Alternatively being stilled could refer to pauses between air-strikes and the corresponding breaks of tension in the aftermath of a raid. Stillness was composed through a series of distributed yet interconnecting bodies, feelings, materials and atmospheres oriented towards the future and the past. The ruins of bombed-out building forms stand as traces even today. Just as Massumi (Sensing 16) describes in the context of architecture, the now static remainder of the explosion “envelops in its stillness a deformational field of which it stands as the trace”. The ruined forms left after the attack stand as a “monument” of the passing of the raid to be what it once was – house, factory, shop, restaurant, library - and to become something else. The experience of those ‘from below’ (Hewitt 2) suffering contemporary forms of air-warfare share many parallels with those of the Blitz. Air power continues to target, apparently more precisely, the affective tones of the body. Accessed by kinetic and non-kinetic forces, the signs of air-war are generated by the shelling of Kosovo, ‘shock and awe’ in Iraq, air-strikes in Afghanistan and by the simulated air-raids of IDF aircraft producing sonic-booms over sleeping Palestinian civilians, now becoming far more real as I write in the final days of 2008. Achieving stillness in the wake of aerial trauma remains, even now, a way to survive the (private) life of air war. AcknowledgementsI’d like to thank the editors and particularly the referees for such a close reading of the article; time did not permit the attention their suggestions demanded. Grateful acknowledgement is also made to the AHRC whose funding allowed me to research and write this paper. ReferencesAdey, Peter. Aerial Geographies: Mobilities, Bodies and Subjects. Oxford: Wiley-Blackwell, 2010 (forthcoming). 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Swine semantics erupted into a linguistic battle between the two U.S. presidential candidates in the 2008 campaign over a lesser-known colloquialism “lipstick on a pig” reference in a speech by then Democratic presidential candidate, Barack Obama. This resulted in the Republicans sparring with the Democrats over the identification of the “swine” in question, claiming “sexism” and demanding an apology on behalf of then Governor Sarah Palin, the first female Republican vice presidential candidate. The Republican Party, fearful of being criticised for its own sexist and racist views (Kuhn par. 1), seized the opportunity to attack the Democrats with a proactive media campaign that made the lipstick comment a lead story in the media during a critical time less than two months before the election, derailing more serious campaign issues and focusing attention on Palin, who had just made her national political debut and whose level of experience was widely debated. Leskovec, Backstrom, and Kleinberg conducted a meme-tracking study for analysing news-cycle phrases in approximately 90 million stories from 1.6 million online sites spanning mainstream news to blogs during the final three months of the U.S. presidential election (1). They discovered that “lipstick on a pig” was “stickier” than other phrases and received “unexpectedly high popularity” (4). A simple Google search of “lipstick on a pig” resulted in 244,000 results, with more than half originating in 2008. Obama’s “Lipstick on a Pig” Reference During the final rounds of the 2008 U.S. presidential campaign, Democratic presidential candidate Barack Obama’s words at a widely televised campaign stop in Lebanon, Virginia, on 9 September, sparked a linguistic debate between the two major American political parties 56 days before Election Day. Obama attempted to debunk McCain’s strategy about change in the following statement:John McCain says he’s about change, too. [...] And so I guess his whole angle is, watch out, George Bush. Except for economic policy, healthcare policy, tax policy, education policy, foreign policy, and Karl Rove-style politics [...] That’s not change. That’s just calling some—the same thing, something different. But you know [...] you can put [...] lipstick on a pig. It’s still a pig (“Obama’s Take”).A reporter from The New York Times commented that it was clear to the audience that Obama’s “lipstick” phrase was a direct reference to McCain’s policies (Zeleny par. 5). Known as a well-educated, articulate speaker, perhaps one considered too professorial for mainstream America, Obama attempted to inject more folksy language and humour into his dialogue with the public. However, the Republicans interpreted the metaphor quite differently. Republicans Claim “Sexism” from a “Male Chauvinist Pig” The Republican contender John McCain and his entourage immediately took offence, claiming that the “pig” in question was a sexist comment referring to Palin, who was introduced on 29 August as the first female vice presidential candidate on the Republican ticket (“VP Pick”). A Republican National Committee spokeswoman quickly told the media, “Sarah Palin’s maverick record of reform doesn’t need any ‘dressing up,’ but the Obama campaign’s condescending commentary deserves some dressing down” (Chozick par. 8). McCain’s camp formed the Palin Truth Squad with 54 Republican women, primarily lawyers and politicians, on the same day as the metaphor was used, to counter negative media and Internet commentary about Palin (Harper A13). Almost immediately after Obama’s “lipstick” comment, McCain’s camp conducted a conference call with journalists and former Massachusetts Governor Jane Swift, a Republican and chair of the Palin Truth Squad, who stated the lipstick comment referred to Palin, “the only one of the four—the presidential and vice presidential candidates—who wears lipstick” (Kornblut and Shear par. 12). Another member of the Squad, Thelma Drake, then a Republican Representative from Virginia, said that “it’s hard for Barack Obama to paint himself as the agent of change if he harbors the same mindset that Palin and millions of women just like her, have been fighting against their whole lives” (Applegate par. 8). Swift and others also claimed Obama was referring to Palin since she had herself used a lipstick metaphor during her Republican National Convention speech, 3 Sepember: “I love those hockey moms. You know, they say the difference between a hockey mom and a pit bull? Lipstick” (“Palin’s Speech” par. 26). The Republicans also created an anti-Obama Web ad with the theme, “Ready to Lead? No. Ready to Smear? Yes,“ (Weisman and Slevin A01) with a compilation of video clips of Palin’s “lipstick” joke, followed by the latter part of Obama's “lipstick” speech, and CBS News anchorwoman, Katie Couric, talking about “sexism” in politics, that latter of which referred to an older clip referring to Hillary Clinton’s campaign for the White House. Both clips on Obama and Couric were taken out of context. CBS retaliated and released a statement that the network “does not endorse any candidate” and that “any use of CBS personnel in political advertising that suggests the contrary is misleading” (Silva par. 8). YouTube pulled the Republican Web ads stating that the cause was “due to a copyright claim” (Silva par. 7). Another porcine phrase became linked to Obama—“male chauvinist pig”—an expression that evolved as an outgrowth of the feminist movement in the 1960s and first appeared with the third word, “pig,” in the media in 1970 (Mansbridge and Flaster 261). BlogHer, a blog for women, posted “Liberal Chauvinist Pigs,” on the same day as Obama's speech, asking: “Does the expression male chauvinist pig come to mind?” (Leary par. 5) Other conservative blogs also reflected on this question, painting Obama as a male chauvinist pig, and chastising both the liberal media and the Democrats for questioning Palin’s credentials as a viable vice presidential candidate. Obama “Sexist Pig Gear” protest tee-shirts, buttons, and bumper stickers were sold online by Zazzle.com. Democratic Response to “Controversy” During a campaign stop in Norfolk, Virginia, the day after his “lipstick” comment, Obama called the Republican backlash the “latest made-up controversy by the John McCain campaign” and appealed for a return to more serious topics with “enough” of “foolish diversions” (“Obama Hits”). He stated that the Republicans “seize on an innocent remark, try to take it out of context, throw up an outrageous ad, because they know it’s catnip for the news media” (“Obama Hits”). Obama also referred to the situation as the “silly season of politics” in media interviews (James par. 8). Obama’s spokespeople rallied claiming that McCain played the “gender card about the use of a common analogy” (Kornblut and Shear par. 6). An Obama campaign spokesman distributed to the media copies of articles from a Chicago Tribune story in 2007 in which McCain applied the lipstick analogy about the healthcare strategy of Hillary Clinton, a previous female Democratic presidential contender (Chozick 11). Another Obama spokeswoman said that the porcine expression “was older than my grandfather’s grandfather,” (Zimmer par. 1) which also inspired the media and linguists to further investigate this claim. Evolution of “Lipstick on a Pig” This particular colloquial use of a “pig” evolved from a long history of porcine expressions in American politics. American political discourse has been rich with cultural references to porcine idioms with negative connotations. Pork barrels were common 19th-century household items used to store salt pork, and some plantation owners doled out the large barrels as rewards to slaves who then had to compete with each other to grab a portion (Maxey 693). In post-Civil War America, “pork barrel” became a political term for legislative bills “loaded with special projects for Members of Congress to distribute to their constituents back home as an act of largesse, courtesy of the federal taxpayer” (“Pork Barrel Legislation”). Today, “pork barrel” is widely used in the U.S., Australia, New Zealand, the United Kingdom, and other countries (“Definition Pork Barrel”) to refer to “government projects or appropriations yielding rich patronage benefits” (“Pork Barrel”). Conservative radio personality Rush Limbaugh coined the term, “porkulus,” as another expression for “pork barrel” by merging the words “pork and “stimulus,” while discussing President Obama’s economic stimulus package in January 2009 (Kuntz par. 1). Ben Zimmer, an American lexicologist, explained that “many porcine proverbs describe vain attempts at converting something from ugly to pretty, or from useless to useful” (par. 2). Zimmer and other writers investigated the heritage of “lipstick on a pig” over the past 500 years from “you can't make a silk purse from a sow’s ear,” “a hog in armour is still a hog,” and “a hog in a silk waistcoat is still a hog.” Zimmer connected the dots between the words “lipstick,” a 19th-century invention, and “pig” to a Los Angeles Times editor in 1926 who wrote: “Most of us know as much of history as a pig does of lipsticks” (par. 3). American Politicians Who Have Smeared “Lipstick on a Pig” Which American politicians had used “lipstick on a pig” before Obama? Both Democrats and Republicans have coloured their speech with this colloquialism to refer to specific issues, not specific people. In 2008, Elizabeth Edwards, wife of presidential hopeful John Edwards, used the porcine expression about McCain’s healthcare proposals at a Democratic campaign event and House Minority Leader John Boehner, a Republican, about weak Republican fundraising efforts during the same month (Covington and Curry par. 7-8). McCain ironically used the term twice to criticise Hillary Clinton’s healthcare proposals as “lipstick on a pig,” while they were both campaigning in 2007 (Covington and Curry par. 6). His statement received limited attention at the time. During a telephone interview in 2007, Obama also had used the pig analogy when referring to an “impossible assignment” George W. Bush gave to General Petraeus, who was then serving as the Multinational Forces Iraq Commander (Tapper par. 15). In 2004, Republican Vice President Richard Cheney applied a regional slant: “As we like to say in Wyoming, you can put all the lipstick you want on a pig, but at the end of the day it's still a pig,” about the national defence record of John Kerry, then a Democratic presidential nominee (Covington and Curry par. 4). A few months earlier that year, John Edwards, Democratic vice presidential candidate, scolded the Bush administration for putting “lipstick on a pig” on “lackluster job-creation numbers” (Covington and Curry par. 3). Representative Charles Rangel, a Democrat, identified the “pig” as a tax bill the same year (Siegel par. 15-16). In 1992, the late Governor of Texas, Ann Richards, a Democrat, who was known for colourful phrases, gave the pig a name when she said: “You can put lipstick on a hog and call it Monique, but it is still a pig,” referring to the Republican administration for deploying warships to protect oil tankers in the Middle East, effectively subsidizing foreign oil (Zimmer par. 4). A year earlier, when she introduced her first budget for Texas, she said: “This is not another one of those deals where you put lipstick on a hog and call it a princess” (Zimmer par. 4). The earliest reputed recorded use of an American politician using the phrase was Texas Democrat Jim Hightower, who applied it to depict the reorganisation of Ronald Reagan's Cabinet in 1986 (Macintyre 16). Time magazine reporters (Covington and Curry par. 2) and Zimmer (par. 3) claimed that a San Francisco radio personality, Ron Lyons, was one of the earliest quoted in print with “lipstick on a pig” about renovation plans for a local park in November 1985 in the Washington Post. Author of the Double-Tongued Dictionary, Grant Barrett, uncovered a 1980 article from a small Washington state newspaper as the earliest written record with an article that stated: “You can clean up a pig, put a ribbon on it’s [sic] tail, spray it with perfume, but it is still a pig” (Guzman par. 7). A book on communication also adopted the pig metaphor in its title in 2006, Lipstick on a Pig: Winning in the No-Spin Era by Someone Who Knows the Game, by Torie Clarke, who previously served as Assistant Secretary of Defense for Public Affairs under Donald Rumsfield during the early years of the G.W. Bush Administration. Media Commentary According to The New York Times (Leibovich and Barrett), “lipstick on a pig” was one of the most popular political buzzwords and phrases of 2008, along with others directly referring to Palin, “Caribou Barbie” and “Hockey Mom,” as well as “Maverick,” a popular term used by both McCain and Palin. Many journalists played on the metaphor to express disdain for negative political campaigns. A Wall Street Journal article asked: “What's the difference between a more hopeful kind of politics and old-fashioned attacks? Lipstick” (Chozick par. 1). International media also covered the Obama-McCain lipstick wars. The Economist, for example, wrote that the “descent of American politics into pig wrestling has dismayed America’s best friends abroad” (“Endless Culture War” par. 6). Bloggers claimed that Obama’s “lipstick” speech was influenced by copy and imagery from two leading American cartoonists. The Free Republic, self-acclaimed to be “the premier online gathering place for independent, grass-roots conservatism” (Freerepublic.com), claimed that Obama plagiarized almost verbatim the language leading into the “pig” comment from a Tom Toles cartoon that ran in the Washington Post on 5 Sepember (see fig. 1).Fig. 1. Toles, Tom. Cartoon. Washington Post. 5 Sep. 2008. 30 July 2010 Another cartoon by R. J. Matson appeared in the St. Louis Post Dispatch (see fig. 2) four days before Obama’s speech that depicted Palin not just as a pig wearing lipstick, but as one using pork barrel funding. The cartoon’s caption provides an interpretation of Palin's lipstick analogy: “Question: What’s the Difference Between a Hockey Mom Reformer and a Business-As-Usual Pork Barrel-Spending Politician? Answer: Lipstick.” Newsbusters.org blogger stated: “It’s not too far-fetched to say Team Obama is cribbing his stump speech laugh lines from the liberal funnies” (Shepherd par. 3). Fig 2. Matson, R. J. Cartoon. St. Louis Post Dispatch. 5 Sep. 2008. 30 July 2010 . A porcine American character known for heavy makeup and a starring role as one of the Muppets created by puppeteer Jim Henson in the 1970s, Miss Piggy still remains an American icon. She commented on the situation during an interview on the set of “Today,” an American television program. When the interviewer asked, “Were you surprised by all the hubbub this election season over your lipstick practices?,” Miss Piggy’s response was “Moi will not dignify that with a response” (Raphael par. 6-7). Concluding Comments The 2008 U.S. presidential election presented new players in the arena: the first African-American in a leading party and the first female Republican. During a major election, words used by candidates are widely scrutinised and, in this case, the “lipstick on a pig” phrase was misconstrued by the opposing party, known for conservative values, that latched onto the opportunity to level a charge of sexism against the more liberal party. Vocabulary about gender, like language about race, can become a “minefield” (Givhan M01). With today’s 24/7 news cycle and the blogosphere, the perceived significance of a political comment, whether innocent or not, is magnified through repeated analysis and commentary. The meme-tracking study by Leskovec, Backstrom, and Kleinberg observed that 2.5 hours was the typical time lag between stories originating in mainstream media and reaching the blogosphere (8); whereas only 3.5 percent of the stories began in blogs and later permeated into traditional media (9). An English author of the history of clichés and language, Julia Cresswell, stated that the “lipstick” term “seems to be another candidate for clichéhood” (61). Although usage of clichés can prove to cause complications as in the case of Obama’s lipstick reference, Obama was able to diffuse the Republican backlash quickly and make a plea to return to serious issues affecting voters. David Greenberg analysed Obama’s presidential win and explained: And although other factors, especially the tanking economy, obviously contributed more directly to his November victory, it would be a mistake to overlook the importance of his skill at mastering the politics of negative attacks. When Obama went negative against others, he carefully singled out aspects of his opponents’ characters that, he argued, American politics itself had to transcend; he associated his foes with the worst of the old politics and himself with the best of the new. When others fired at him, in contrast, he was almost always able to turn the criticisms back upon them—through feigned outrage, among other tactics—as perpetuating those selfsame blights on our politics (70). References Applegate, Aaron. “Rep. Drake Criticizes Obama for ‘Lipstick on a Pig’ Remark.” Virginia Pilot 10 Sep. 2008. 28 Jul. 2010. Chozick, Amy. “Obama Puts Different Twist on Lipstick.” Wall Street Journal 9 Sep. 2008. 30 Jul. 2010. Covington, Marti, and Maya Curry. “A Brief History of: ‘Putting Lipstick on a Pig.’” Time 11 Sep. 2008. 17 May 2010. Cresswell, Julia. “Let’s Hear it for the Cliché.” British Journalism Review 19.57 (2008): 57-61. “Endless Culture War.” The Economist 4 Oct. 2008: ABI/INFORM Global, ProQuest. 30 Jul. 2010. “Definition Pork Barrel.” Webster’s Online Dictionary. 30 Jul. 2010. freerepublic.com. “Welcome to Free Republic.” Free Republic 2009. 30 Jul. 2010. Givhan, Robin. “On the Subject of Race, Words Get in the Way.” Washington Post 20 Jan. 2008: M01. Greenberg, David. “Accentuating the Negative.” Dissent 56.2 (2009): 70-75. Guzman, Monica. “‘Lipstick on a Pig’ Finds Origin in Tiny State Newspaper.” Seattlepi.com 10 Sep. 2008. 17 May 2010. Harper, Jennifer. “Obama Comment Offends GOP Women; ‘Palin Truth Squad’ Sent Out to Counter ‘Lipstick on a Pig’ Remark.” Washington Times 10 Sep. 2008: A13. Huston, Warner Todd. “Did Obama Steal His Lip Stick on a Pig From a Political Cartoon?” Newsbusters.org 10 Sep. 2008. 15 Jul. 2010 . James, Frank. “Barack Obama on David Letterman.” Chicago Tribune 11 Sep. 2008. 15 Jul. 2010 http://www.swamppolitics.com/news/politics/blog/2008/09/barack_obama_on_david_letterma.html>. Kornblut, Anne E., and Michael D. Shear. “McCain Camp Sees an Insult in a Saying.” Washington Post 10 Sep. 2008. 30 Jul. 2010 AR2008090903531.html>. Kuhn, David P. “GOP Fears Charges of Racism, Sexism.” Politico.com 23 Feb. 2008. 4 Oct. 2010. Kuntz, Tom. “Porkulus.” NYTimes.com 8 Feb. 2009. 30 Jul. 2010. Leary, Anne. “Liberal Chauvinist Pigs.” BlogHer 9 Sep. 2008. 2 Oct. 2010. Leibovich, Mark, and Grant Barrett. “The Buzzwords of 2008.” New York Times 21 Dec. 2008. 29 Jul. 2010 http://www.nytimes.com/ref/weekinreview/buzzwords2008.html>. Leskovec, Jure, Lars Backstrom, and Jon Kleinberg. “Meme-tracking and the Dynamics of the News Cycle.” ACM SIGKDD International Conference on Knowledge Discovery and Data Mining, Paris, 28 Jun. 2009. 30 Jul. 2010 . Macintyre, Ben. “US Politics is Littered with Dawgs, Crawdaddys and Pigs in Lipstick.” The Times [London] 27 Sep. 2008: 16. Mansbridge, Jane, and Katherine Flaster. “Male Chauvinist, Feminist, Sexist, and Sexual Harassment: Different Trajectories in Feminist Linguistic Innovation.” American Speech 80.3 (Fall 2005): 256-279. Maxey, Chester Collins. “A Little History of Pork.” National Municipal Review, Volume VIII. Concord: Rumford Press, 1919. Google Books. 30 Jul. 2010. “Obama Hits Back Against McCain Campaign.” MSNBC 10 Sep. 2008. Televised Speech. 18 May 2010. “Obama’s Take on McCain's Version of Change.” CNN 9 Sep. 2009. YouTube.com. 17 May 2010. “Palin’s Speech at the Republican National Convention.” New York Times 3 Sep. 2008. 17 May 2010. “Pork Barrel.” Merriam-Webster Online Dictionary 2010. 30 Jul. 2010. “Pork Barrel Legislation.” C-SPAN Congressional Glossary. c-span.org. 17 May 2010. Raphael, Rina. “Miss Piggy: Obama Should Make Poodle First Pet” Today 13 Nov. 2008. MSNBC.com. 29 Jul. 2010. Shepherd, Ken. “Palin Shown As Lipsticked Pig in Cartoon Days Before Obama Remark.” NewsBusters.org 11 Sep. 2008. 30 Jul. 2010 . Siegel, Robert. “Putting Lipstick on a Pig.” National Public Radio 10 Sep. 2008. 16 Jul. 2010. Silva, Mark. “Katie Couric's 'Lipstick' Rescue: CBS.” Chicago Tribune 11 Sep. 2008. 30 Jul. 2010. Tapper, Jack. “A Piggish Debate: Power, Pop, and Probings from ABC News Senior White House Correspondent Jake Tapper.” ABC News 9 Sep. 2008. 29 Jul. 2010. “VP Pick Palin Makes Appeal to Women Voters.” NBC News, msnbc.com, and Associated Press 28 Aug. 2008. 30 Jul. 2010. Weisman, Jonathan, and Peter Slevin. “McCain Camp Hits Obama on More Than One Front.” Washington Post 11 Sep. 2008: A04. Zeleny, Jeff. “Feeling a Challenge, Obama Sharpens His Silver Tongue.” New York Times 10 Sep. 2008. 27 Jul. 2010. Zimmer, Ben. “Who First Put ‘Lipstick on a Pig’?” The Slate 10 Sep. 2008. 17 May 2010.

<em>Abstract.</em>—The Hudson River Estuary (defined here as the Hudson River drainage and New York Harbor) is home to a large and diverse ichthyofauna. Estimates of species richness reflect both their geographic boundaries and time periods. The most complete estimate is for the Hudson River drainage north of the southern tip of Manhattan, where, as of 2005, 212 fish species have been recorded. This includes 11 new forms not reported in the most recently published tally (1990). We categorize the fishes of the Hudson River drainage as derived from 12 zoogeographic or anthropogenic sources (including species for which we make no judgment [<em>n </em>= 26]), the largest contributions from which include temperate marine strays (<em>n </em>= 65), introduced species (<em>n </em>= 28), and freshwater species that survived Pleistocene glaciations in Atlantic coastal refugia (<em>n </em>= 21). Additional species appear to have invaded from the Mississippi refugia, some naturally (<em>n </em>= 11) and some later, via canals (<em>n </em>= 11). Only ten diadromous fishes occur in the estuary, but many of these are, or have been, commercially and recreationally important (e.g., Atlantic sturgeon <em>Acipenser oxyrinchus</em>, American shad <em>Alosa sapidissima</em>, and striped bass <em>Morone saxatilis</em>). Extremely high seasonal temperature changes in the main-channel Hudson River foster a seasonally dynamic ichthyofauna with relatively few species occurring year round. However, the small number of resident estuarine fishes (<em>n </em>= 8) often occur in high abundances. Species richness peaks between June and September and reaches a minimum in winter. Long-term data indicate that although species richness has increased with the additions of new species, diversity is decreasing because of the decrease in population size of certain species, especially native cyprinids. The Hudson estuary hosts a population of one federally endangered species, shortnose sturgeon <em>Acipenser brevirostrum</em>, which is flourishing. Only one species, the anadromous rainbow smelt <em>Osmerus mordax </em>appears to have become extirpated in the Hudson Estuary.

<em>Abstract.</em>—The Hudson River Estuary (defined here as the Hudson River drainage and New York Harbor) is home to a large and diverse ichthyofauna. Estimates of species richness reflect both their geographic boundaries and time periods. The most complete estimate is for the Hudson River drainage north of the southern tip of Manhattan, where, as of 2005, 212 fish species have been recorded. This includes 11 new forms not reported in the most recently published tally (1990). We categorize the fishes of the Hudson River drainage as derived from 12 zoogeographic or anthropogenic sources (including species for which we make no judgment [<em>n </em>= 26]), the largest contributions from which include temperate marine strays (<em>n </em>= 65), introduced species (<em>n </em>= 28), and freshwater species that survived Pleistocene glaciations in Atlantic coastal refugia (<em>n </em>= 21). Additional species appear to have invaded from the Mississippi refugia, some naturally (<em>n </em>= 11) and some later, via canals (<em>n </em>= 11). Only ten diadromous fishes occur in the estuary, but many of these are, or have been, commercially and recreationally important (e.g., Atlantic sturgeon <em>Acipenser oxyrinchus</em>, American shad <em>Alosa sapidissima</em>, and striped bass <em>Morone saxatilis</em>). Extremely high seasonal temperature changes in the main-channel Hudson River foster a seasonally dynamic ichthyofauna with relatively few species occurring year round. However, the small number of resident estuarine fishes (<em>n </em>= 8) often occur in high abundances. Species richness peaks between June and September and reaches a minimum in winter. Long-term data indicate that although species richness has increased with the additions of new species, diversity is decreasing because of the decrease in population size of certain species, especially native cyprinids. The Hudson estuary hosts a population of one federally endangered species, shortnose sturgeon <em>Acipenser brevirostrum</em>, which is flourishing. Only one species, the anadromous rainbow smelt <em>Osmerus mordax </em>appears to have become extirpated in the Hudson Estuary.