Literatura académica sobre el tema "United Nations. Commision on Human Rights. Session 2002)"

The fifty-eighth session of the United Nations Commission on Human Rights opened with the United States in an observer seat for the first time ever. The Commission ultimately adopted ninety-two resolutions and eighteen decisions, thirty-nine of which were adopted by roll-call vote. Subsequently, at its July 2002 session, the Economic and Social Council (ECOSOC, the parent body of the Commission) approved nearly all of the Commission's decisions by similar votes. The United States was also reelected to the Commission for its fiftyninth session during a separate ECOSOC meeting.The debate during the Commission's deliberations was more chaotic and fractious than in prior years, reflecting the membership of an increased number of repressive governments that sought to block international scrutiny of their human rights practices.

In October 2000 an informal working group of the United Nations Commission on Human Rights met to discuss the latest drafts of an Optional Protocol to the 1984 United Nations Convention against Torture. The Working Group itself met for its 9th session in February 2001 and its 10th session was held in January 2002.2 The primary purpose of this Optional Protocol is to create a new international mechanism that will have a preventive role and which would operate by conducting visits to states and to places of detention within states and, in the light of such visits, enter into a ‘dialogue’ with the state concerned in order to help them ensure that torture does not occur. The origins of this initiative lie in a proposal formally tabled in the early 1980s during the negotiations that led up to the adoption of the UNCAT itself but at that time it was clear that so radical a move as the establishment of an international body with an automatic right of entry into any place of detention would be unacceptable within the broader international community.3 However, the idea was taken up on a regional level within Europe and in 1987 the Council of Europe adopted the European Convention for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment which established the European Committee of the same name (known as the CPT), very much by way of an example to the rest of the world, or so it was thought.4

At the conclusion of its 29th session in 2002, the United Nations (UN) Committee on Economic, Social and Cultural Rights (hereinafter the Committee) identified a human right to access water uniquely straddling two provisions of the International Covenant on Economic, Social and Cultural Rights (the Covenant).1 General Comment No. 15 novelly defined a universal entitlement to sufficient, safe, acceptable, physically accessible and affordable water for personal and domestic use.2 This article critiques that instrument for the phraseology employed, the substantive omissions and the reasoning of the Committee. The article also evaluates the broader implications of a human right to access water within a liberalised market context. Paragraph 1 questions the legal basis identified by the Committee and considers the existence of a right to access water under contemporary international law. Paragraph 2 assesses the policy justifications which prompted a human rights orientation to the global challenges confronting water resources including the treatment of water services under international economic law. Most notable among the several omissions from General Comment No. 15 is the increasingly prominent role and responsibilities of the private sector as outlined in paragraph 3. Paragraph 4 sceptically examines the prospects for implementing a human rights approach to water resources in light of applicable economic and environmental principles. Finally, it is argued that unreflective resort to the General Comment template for addressing individual interests will render such instruments outdated or unhelpful as normative guides and several solutions are offered in paragraph 5.

Since September 11, Muslims in Australia have experienced a heightened level of religiously and racially motivated vilification (Human Rights and Equal Opportunity Commission). These fears were poignantly expressed in a letter to the Editor of The West Australian newspaper from a Muslim woman shortly after the London terror attacks: All I want to say is that for those out there who might have kamikaze ideas of doing such an act here in Australia, please think of others (us) in your own community. The ones who will get hurt are your own, especially we the women who are an obvious target in the public and have to succumb to verbal abuse most of the time. Dealing with abuse and hatred from some due to 9/11 and Bali is not something I want to go through again. (21) The atmosfear of terror finds many expressions among the Muslim communities in Australia: the fear of backlash from some sectors of the wider community; the fear of subversion of Islamic identity in meeting the requirements of a politically defined “moderate” Islam; the fear of being identified as a potential terrorist or “person of interest” and the fear of potentially losing the rights bestowed on all other citizens. This fear or fears are grounded in the political and the media response to terrorism that perpetuates a popular belief that Muslims, as a culturally and religiously incompatible “other”, pose a threat to the Australian collective identity and, ostensibly, to Australia’s security. At the time of publication, for example, there was mob violence involving 5,000 young people converging on Sydney’s Cronulla beach draped in Australian flags singing Waltzing Matilda and Advance Australia Fair as well as chanting “kill the Lebs”, “no more Lebs” (Lebanese). The mob was itself brought together by a series of SMS messages, appealing to participants to “help support Leb and Wog bashing day” and to “show solidarity” against a government-identified “threat to Aussie identity” (The West Australian). Since September 11 and the ensuing war on terror, a new discourse of terrorism has emerged as a way of expressing how the world has changed and defining a state of constant alert (Altheide). “The war on terror” refers as much to a perpetual state of alertness as it does to a range of strategic operations, border control policies, internal security measures and public awareness campaigns such as “be alert, not alarmed”. According to a poll published in The Sydney Morning Herald in April 2004, 68 per cent of Australians believed that Australia was at threat of an imminent terrorist attack (Michaelsen). In a major survey in Australia immediately after the September 11 attacks Dunn & Mahtani found that more than any other cultural or ethnic group, Muslims and people from the Middle East were thought to be unable to fit into Australia. Two thirds of those surveyed believed that humanity could be sorted into natural categories of race, with the majority feeling that Australia was weakened by people of different ethnic origins. Fifty-four per cent of those surveyed, mainly women, said they would be concerned if a relative of theirs married a Muslim. The majority of the Muslim population, not surprisingly, has gone into a “siege mentality” (Hanna). The atmosfear of terror in the Western world is a product of the media and political construction of the West as perpetually at threat of a terrorist attack from a foreign, alien, politically defined “other”, where “insecurity…is the new normal” (Massumi 31). Framed in a rhetoric that portrays it as a battle for the Western values of democracy and freedom, the “war on terror” becomes not just an event in space and time but a metonym for a new world order, drawing on distinctions between “us” and “them” and “the West” and “others” (Osuri and Banerjee) and motivating collective identity based on a construction of “us” as victims and “them” as the objects of fear, concern and suspicion. The political response to the war on terror has inculcated an atmosfear of terror where Australian Muslims are identified as the objects of this fear. The fear of terrorism is being modulated through government and the popular media to perpetuate a state of anxiety that finds expression in the heightened levels of concern and suspicion over a perceived threat. In the case of the war on terror, this threat is typically denoted as radical Islam and, by inference, Australian Muslims. In his exposition of political fear, Corey Robin notes that a central element of political fear is that it is often not read as such – rendering it alien to analysis, critical debate and understanding. Nowhere is this more salient than in the rhetoric on the war on terror characterised by the familiar invocation of terms like democracy and freedom to make distinctions between “the West and the rest” and to legitimise references to civilised and uncivilised worlds. In his speech delivered at the United Nations Security Council Ministerial Session on Terrorism on 20 January 2003, Colin Powell invoked the rhetoric of a clash of civilisations and urged, “we must rid the civilised world of this cancer … We must rise to the challenge with actions that will ride the globe of terrorism and create a world in which all God’s children can live without fear”. It is this construction of the war on terror as a global battle between “the West and the rest” that enables and facilitates the affective response to political fear – a reaffirmation of identity and membership of a collective. As Robin states: Understanding the objects of our fear as less than political allows us to treat them as intractable foes. Nothing can be done to accommodate them: they can only be killed or contained. Understanding the objects of our fear as not political also renews us as a collective. Afraid, we are like the audience in a crowded theatre confronting a man falsely shouting fire: united, not because we share similar beliefs of aspiration but because we are equally threatened. (6) This response has found expression in the perception of Muslims as an alien, culturally incompatible and utterly threatening other, creating a state of social tension where the public’s anxiety has been and continues to be directed at Australian Muslims who visibly represent the objects of the fear of terror. The Australian Government’s response to the war on terror exemplifies what Brian Massumi terms “affective modulation” whereby the human response to the fear of terror, that of a reinforcement and renewal of collective identity, has been modulated and transformed from an affective response to an affective state of anxiety – what the authors term the atmosfear of terror. Affect for Massumi can be inscribed in the flesh as “traces of experience” – an accumulation of affects. It is in this way that Massumi views affect as “autonomous” (Megan Watkins also makes this argument, and has further translated Massumi's notions into the idea of pedagogic affect/effect). In the Australian context, after more than four years of collected traces of experiences of images of threat, responses to terrorism have become almost reflexive – even automated. Affective modulation in the Australian context relies on the regenerative capacity of fear, in Massumi’s terms its “ontogenetic powers” (45) to create an ever-present threat and maintain fear as a way of life. The introduction of a range of counter-terrorism strategies, internal-security measures, legislative amendments and policies, often without public consultation and timed to coincide with “new” terror alerts is testimony to the affective machinations of the Australian government in its response to the war on terror. Virilio and Lotringer called “pure war” the psychological state that happens when people know that they live in a world where the potential for sudden and absolute destruction exists. It is not the capacity for destruction so much as the continual threat of sudden destruction that creates this psychology. Keith Spence has stated that in times of crisis the reasoned negotiation of risk is marginalised. The counter-terrorism legislation introduced in response to the war on terror is, arguably, the most drastic anti-libertarian measures Australia has witnessed and constitutes a disproportionate response to Australia’s overall risk profile (Michaelsen). Some of these measures would once have seemed an unthinkable assault on civil liberties and unreasonably authoritarian. Yet in the war on terror, notes Jessica Stern, framed as a global war of good versus evil, policies and strategies that once seemed impossible suddenly become constructed as rationale, if not prudent. Since September 11, the Australian government has progressively introduced a range of counter-terrorism measures including over 30 legislative amendments and, more recently, increased powers for the police to detain persons of interest suspected of sedition. In the wake of the London bombings, the Prime Minister called a summit with Muslim representatives from around the nation. In the two hours that they met, the summit developed a Statement of Principles committing members of Muslim communities to combat radicalisation and pursue “moderate” Islam. As an affective machination, the summit presents as a useful political tool for modulating the existing anxieties in the Australian populace. The very need for a summit of this nature and for the development of a Statement of Principles (later endorsed by the Council of Australian Governments or COAG) sends a lucid message to the Australian public. Not only are Australian Muslims responsible for terrorism but they also have the capacity to prevent or minimise the threat of an attack in Australia. Already the focus of at least a decade of negative stereotyping in the popular Australia media (Brasted), Australian Muslims all too quickly and easily became agents in the Government’s affective tactics. The policy response to the war on terror has given little consideration to the social implications of sustaining a fear of terrorism, placing much emphasis on security- focused counter-terrorism measures rather than education and dialogue. What governments and communities need to address is the affective aspects of the atmosfear of terror. Policy makers can begin by becoming self-reflexive and developing an understanding of the real impact of fear and the affective modulation of this fear. Communities can start by developing an understanding of how policy induced fear is affecting them. To begin this process of reflection, governments and communities need to recognise fear of terrorism as a political tool. Psychological explanations for fear or trauma are important, especially if we are to plan policy responses to them. However, if we are to fight against policy-induced fear, we need to better understand and recognise affective modulation as a process that is not reducible to individual psychology. Viewed from the perspective of affect, the atmosfear of terror reveals an attempt to modulate public anxiety and sustain a sense of Australia as perpetually at threat from a culturally incompatible and irreconcilable “other”. References Altheide, David. L. “Consuming Terrorism.” Symbolic Interaction 27.3 (2004): 289–308. Brasted, Howard, V. “Contested Representations in Historical Perspective: Images of Islam and the Australian Press 1950-2000”. In A. Saeed & S. Akbarzadeh, Muslim Communities in Australia. Sydney: U of NSW P, 2001. Dunn, K.M., and M. Mahtani. “Media Representations of Ethnic Minorities.” Progress in Planning 55.3 (2001): 63–72. Dunn, K.M. “The Cultural Geographies of Citizenship in Australia.” Geography Bulletin 33.1 (2001): 4–8. “Genesis of Cronulla’s Ugly Sunday Began Years Ago.” The West Australian 2005: 11. Green, Lelia. “Did the World Really Change on 9/11?” Australian Journal of Communication 29.2 (2002): 1–14. Hanna, D. 2003. “Siege Mentality: Current Australian Response.” Salam July-Aug. (2003): 12–4. Human Rights and Equal Opportunity Commission. Ismaa – Listen: National Consultations on Eliminating Prejudice against Arab and Muslim Australians. Sydney: Human Rights and Equal Opportunity Commission, 2004. Kerbaj, Richard. “Clerics Still Preaching Hatred of West.” The Australian 3 Nov. 2005. Kinnvall, Catarina. “Globalization and Religious Nationalism: Self, Identity, and the Search for Ontological Security.” Political Psychology 25.5 (2004): 741. “Letters to the Editor.” The West Australian 25 July 2005: 21. Massumi, Brian. “Fear (The Spectrum Said).” Positions 13.1 (2005): 31–48. Massumi, Brian. “The Autonomy of Affect.” In P. Patton, ed., Deleuze: A Critical Reader. Cambridge, Mass.: Blackwell, 1996. “Meeting with Islamic Community Leaders, Statement of Principles.” 23 Aug. 2005. http://www.pm.gov.au/news/media_releases/media_Release1524.html> Michaelsen, Christopher. “Antiterrorism Legislation in Australia: A Proportionate Response to the Terrorist Threat?” Studies in Conflict and Terrorism 28.4 (2005): 321–40. Osuri, Goldie, and Subhabrata Bobby Banerjee. “White Diasporas: Media Representations of September 11 and the Unbearable Whiteness of Being in Australia.” Social Semiotics 14.2 (2004): 151–71. Powell, Colin. “Ridding the World of Global Terrorism: No Countries or Citizens are Safe.” Vital Speeches of the Day 69.8 (2003): 230–3. Robin, Corey. Fear: The History of a Political Idea. New York: Oxford UP, 2004. Spence, Keith. “World Risk Society and War against Terror.” Political Studies 53.2 (2005): 284–304. Stern, Jessica. “Fearing Evil.” Social Research 71.4 (2004): 1111–7. “Terrorism Chronology.” Parliament of Australia Parliamentary Library. http://www.aph.gov.au/library/intguide/law/terrorism.htm> Tomkins, Silvan. Affect, Imagery and Consciousness. New York: Springer Publishing, 1962. Virilio, Paul, and Sylvere Lotringer. Pure War. New York: Semio-text(e), 1997. Watkins, Megan. “Pedagogic Affect/Effect: Teaching Writing in the Primary Years of School.” Presented at Redesigning Pedagogy: Research, Policy, Practice Conference. Singapore: National Institute of Education, 31 May 2005. Citation reference for this article MLA Style Aly, Anne, and Mark Balnaves. "The Atmosfear of Terror: Affective Modulation and the War on Terror." M/C Journal 8.6 (2005). echo date('d M. Y'); ?> <http://journal.media-culture.org.au/0512/04-alybalnaves.php>. APA Style Aly, A., and M. Balnaves. (Dec. 2005) "The Atmosfear of Terror: Affective Modulation and the War on Terror," M/C Journal, 8(6). Retrieved echo date('d M. Y'); ?> from <http://journal.media-culture.org.au/0512/04-alybalnaves.php>.

Introduction The scientific validity of climate change claims, how to intervene (if at all) in environmental, economic, political and social consequences of climate change, and the adaptation and mitigation needed with any given climate change scenario, are contested areas of public, policy and academic discourses. For marginalised populations, the climate discourses around adaptation, mitigation, vulnerability and resilience are of particular importance. This paper considers the silence around disabled people in these discourses. Marci Roth of the Spinal Cord Injury Association testified before Congress in regards to the Katrina disaster: [On August 29] Susan Daniels called me to enlist my help because her sister in-law, a quadriplegic woman in New Orleans, had been unsuccessfully trying to evacuate to the Superdome for two days. […] It was clear that this woman, Benilda Caixetta, was not being evacuated. I stayed on the phone with Benilda, for the most part of the day. […] She kept telling me she’d been calling for a ride to the Superdome since Saturday; but, despite promises, no one came. The very same paratransit system that people can’t rely on in good weather is what was being relied on in the evacuation. […] I was on the phone with Benilda when she told me, with panic in her voice “the water is rushing in.” And then her phone went dead. We learned five days later that she had been found in her apartment dead, floating next to her wheelchair. […] Benilda did not have to drown. (National Council on Disability, emphasis added) According to the Intergovernmental Panel on Climate Change (IPCC), adaptation is the “Adjustment in natural or human systems in response to actual or expected climatic stimuli or their effects, which moderates harm or exploits beneficial opportunities” (IPCC, Climate Change 2007). Adaptations can be anticipatory or reactive, and depending on their degree of spontaneity they can be autonomous or planned (IPCC, Fourth Assessment Report). Adaptations can be private or public (IPCC, Fourth Assessment Report), technological, behavioural, managerial and structural (National Research Council of Canada). Adaptation, in the context of human dimensions of global change, usually refers to a process, action or outcome in a system (household, community, group, sector, region, country) in order for that system to better cope with, manage or adjust to some changing condition, stress, hazard, risk or opportunity (Smit and Wandel). Adaptation can encompass national or regional strategies as well as practical steps taken at the community level or by individuals. According to Smit et al, a framework for systematically defining adaptations is based on three questions: (i) adaptation to what; (ii) who or what adapts; and (iii) how does adaptation occur? These are essential questions that have to be looked at from many angles including cultural and anthropological lenses as well as lenses of marginalised and highly vulnerable populations. Mitigation (to reduce or prevent changes in the climate system), vulnerability (the degree to which a system is susceptible to, and unable to cope with, the adverse effects of climate change), and resilience (the amount of change a system can undergo without changing state), are other important concepts within the climate change discourse. Non-climate stresses can increase vulnerability to climate change by reducing resilience and can also reduce adaptive capacity because of resource deployment to competing needs. Extending this to the context of disabled people, ableism (sentiment to expect certain abilities within humans) (Wolbring, “Is there an end to out-able?”) and disablism (the unwillingness to accommodate different needs) (Miller, Parker and Gillinson) are two concepts that will thus play themselves out in climate discourses. The “Summary for Policymakers” of the IPCC 2007 report, Climate Change 2007: Impacts, Adaptation and Vulnerability, states: “Poor communities can be especially vulnerable, in particular those concentrated in high-risk areas. They tend to have more limited adaptive capacities, and are more dependent on climate-sensitive resources such as local water and food supplies.” From this quote one can conclude that disabled people are particularly impacted, as the majority of disabled people live in poverty (Elwan). For instance, CARE International, a humanitarian organisation fighting global poverty, the UN Office for the Coordination of Humanitarian Affairs, and Maplecroft, a company that specialises in the calculation, analysis and visualisation of global risks, conclude: “The degree of vulnerability is determined by underlying natural, human, social, physical and financial factors and is a major reason why poor people—especially those in marginalised social groups like women, children, the elderly and people with disabilities—are most affected by disasters” (CARE International). The purpose of this paper is to expose the reader to (a) how disabled people are situated in the culture of the climate, adaptation, mitigation and resilience discourse; (b) how one would answer the three questions, (i) adaptation to what, (ii) who or what adapts, and (iii) how does adaptation occur (Smit et al), using a disabled people lens; and (c) what that reality of the involvement of disabled people within the climate change discourse might herald for other groups in the future. The paper contends that there is a pressing need for the climate discourse to be more inclusive and to develop a new social contract to modify existing dynamics of ableism and disablism so as to avoid the uneven distribution of evident burdens already linked to climate change. A Culture of Neglect: The Situation of Disabled People As climates changes, environmental events that are classified as natural disasters are expected to be more frequent. In the face of recent disaster responses, how effective have these efforts been as they relate to the needs and challenges faced by disabled people? Almost immediately after Hurricane Katrina devastated the Gulf Coast, the National Council on Disability (NCD) in the United States estimated that 155,000 people with disabilities lived in the three cities hardest hit by the hurricane (about 25 per cent of the cities’ populations). The NCD urged emergency managers and government officials to recognise that the need for basic necessities by hurricane survivors with disabilities was “compounded by chronic health conditions and functional impairments … [which include] people who are blind, people who are deaf, people who use wheelchairs, canes, walkers, crutches, people with service animals, and people with mental health needs.” The NCD estimated that a disproportionate number of fatalities were people with disabilities. They cited one statistic from the American Association of Retired Persons (AARP): “73 per cent of Hurricane Katrina-related deaths in New Orleans area were among persons age 60 and over, although they comprised only 15 per cent of the population in New Orleans.” As the NCD stated, “most of those individuals had medical conditions and functional or sensory disabilities that made them more vulnerable. Many more people with disabilities under the age of 60 died or were otherwise impacted by the hurricanes.” As these numbers are very likely linked to the impaired status of the elderly, it seems reasonable to assume similar numbers for non-elderly disabled people. Hurricane Katrina is but one example of how disabled people are neglected in a disaster (Hemingway and Priestley; Fjord and Manderson). Disabled people were also disproportionately impacted in other disasters, such as the 1995 Great Hanshin Earthquake in Japan (Nakamura) or the 2003 heatwave in France, where 63 per cent of heat-related deaths occurred in institutions, with a quarter of these in nursing homes (Holstein et al.). A review of 18 US heatwave response plans revealed that although people with mental or chronic illnesses and the homeless constitute a significant proportion of the victims in recent heatwaves, only one plan emphasised outreach to disabled persons, and only two addressed the shelter and water needs of the homeless (Ebi and Meehl; Bernhard and McGeehin). Presence of Disabled People in Climate Discourse Although climate change will disproportionately impact disabled people, despite the less than stellar record of disaster adaptation and mitigation efforts towards disabled people, and despite the fact that other social groups (such as women, children, ‘the poor’, indigenous people, farmers and displaced people) are mentioned in climate-related reports such as the IPCC reports and the Human Development Report 2007/2008, the same reports do not mention disabled people. Even worse, the majority of the material generated by, and physically set up for, discourses on climate, is inaccessible for many disabled people (Australian Human Rights Commission). For instance, the IPCC report, Climate Change 2007: Impacts, Adaptation and Vulnerability, contains Box 8.2: Gender and natural disasters, makes the following points: (a) “men and women are affected differently in all phases of a disaster, from exposure to risk and risk perception; to preparedness behaviour, warning communication and response; physical, psychological, social and economic impacts; emergency response; and ultimately to recovery and reconstruction”; (b) “natural disasters have been shown to result in increased domestic violence against, and post-traumatic stress disorders in, women”; and (c) “women make an important contribution to disaster reduction, often informally through participating in disaster management and acting as agents of social change. Their resilience and their networks are critical in household and community recovery.” The content of Box 8.2 acknowledges the existence of different perspectives and contributions to the climate discourse, and that it is beneficial to explore these differences. It seems reasonable to assume that differences in perspectives, contributions and impact may well also exist between people with and without disabilities, and that it may be likewise beneficial to explore these differences. Disabled people are differently affected in all phases of a disaster, from exposure to risk and risk perception; to preparedness behaviour, warning communication and response; physical, psychological, social and economic impacts; emergency response; and ultimately to recovery and reconstruction. Disabled people could also make an important contribution to disaster reduction, often informally through participating in disaster management and acting as agents of social change. Their resilience and their networks are critical in household and community recovery, important as distributors of relief efforts and in reconstruction design. The Bonn Declaration from the 2007 international conference, Disasters are always Inclusive: Persons with Disabilities in Humanitarian Emergency Situations, highlighted many problems disabled people are facing and gives recommendations for inclusive disaster preparedness planning, for inclusive response in acute emergency situations and immediate rehabilitation measures, and for inclusive post-disaster reconstruction and development measures. Many workshops were initiated by disabled people groups, such as Rehabilitation International. However, the disabled people disaster adaptation and mitigation discourse is not mainstreamed. Advocacy by people with disability for accessible transport and universal or “life-cycle” housing (among other things) shows how they can contribute significantly to more effective social systems and public facilities. These benefit everyone and help to shift public expectations towards accessible and flexible amenities and services—for example, emergency response and evacuation procedures are much easier for all if such facilities are universally accessible. Most suggestions by disabled people for a more integrative, accessible physical environment and societal attitude benefit everyone, and gain special importance with the ever-increasing proportion of elderly people in society. The IPCC Fourth Assessment Report is intended to be a balanced assessment of current knowledge on climate change mitigation. However, none of the 2007 IPCC reports mention disabled people. Does that mean that disabled people are not impacted by, or impact, climate change? Does no knowledge of adaptation, mitigation and adaptation capacity from a disabled people lens exist, or does the knowledge not reach the IPCC, or does the IPCC judge this knowledge as irrelevant? This culture of neglect and unbalanced assessment of knowledge evident in the IPCC reports was recognised before for rise of a ‘global’ climate discourse. For instance, a 2001 Canadian government document asked that research agendas be developed with the involvement of, among others, disabled people (Health Canada). The 2009 Nairobi Declaration on Africa’s response to climate change (paragraph 36) also asks for the involvement of disabled people (African Ministerial Conference on the Environment). However, so far nothing has trickled up to the international bodies, like the IPCC, or leading conferences such as the United Nations Climate Change Conference Copenhagen 2009. Where Will It End? In his essay, “We do not need climate change apartheid in adaptation”, in the Human Development Report 2007/2008, Archbishop Desmond Tutu suggests that we are drifting into a situation of global adaptation apartheid—that adaptation becomes a euphemism for social injustice on a global scale (United Nations Development Programme). He uses the term “adaptation apartheid” to highlight the inequality of support for adaptation capacity between high and low income countries: “Inequality in capacity to adapt to climate change is emerging as a potential driver of wider disparities in wealth, security and opportunities for human development”. I submit that “adaptation apartheid” also exists in regard to disabled people, with the invisibility of disabled people in the climate discourse being just one facet. The unwillingness to accommodate, to help the “other,” is nothing new for disabled people. The ableism that favours species-typical bodily functioning (Wolbring, “Is there an end to out-able?”; Wolbring, “Why NBIC?”) and disablism (Miller, Parker, and Gillinson)—the lack of accommodation enthusiasm for the needs of people with ‘below’ species-typical body abilities and the unwillingness to adapt to the needs of “others”—is a form of “adaptation apartheid,” of accommodation apartheid, of adaptation disablism that has been battled by disabled people for a long time. In a 2009 online survey of 2000 British people, 38 per cent believed that most people in British society see disabled people as a “drain on resources” (Scope). A majority of human geneticist concluded in a survey in 1999 that disabled people will never be given the support they need (Nippert and Wolff). Adaptation disablism is visible in the literature and studies around other disasters. The 1988 British Medical Association discussion document, Selection of casualties for treatment after nuclear attack, stated “casualties whose injuries were likely to lead to a permanent disability would receive lower priority than those expected to fully recover” (Sunday Morning Herald). Famine is seen to lead to increased infanticide, increased competitiveness and decreased collaboration (Participants of the Nuclear Winter: The Anthropology of Human Survival Session). Ableism and disablism notions experienced by disabled people can now be extended to include those challenges expected to arise from the need to adapt to climate change. It is reasonable to expect that ableism will prevail, expecting people to cope with certain forms of climate change, and that disablism will be extended, with the ones less affected being unwilling to accommodate the ones more affected beyond a certain point. This ableism/disablism will not only play itself out between high and low income countries, as Desmond Tutu described, but also within high income countries, as not every need will be accommodated. The disaster experience of disabled people is just one example. And there might be climate change consequences that one can only mitigate through high tech bodily adaptations that will not be available to many of the ones who are so far accommodated in high income countries. Desmond Tutu submits that adaptation apartheid might work for the fortunate ones in the short term, but will be destructive for them in the long term (United Nations Development Programme). Disability studies scholar Erik Leipoldt proposed that the disability perspective of interdependence is a practical guide from the margins for making new choices that may lead to a just and sustainable world—a concept that reduces the distance between each other and our environment (Leipoldt). This perspective rejects ableism and disablism as it plays itself out today, including adaptation apartheid. Planned adaptation involves four basic steps: information development and awareness-raising; planning and design; implementation; and monitoring and evaluation (Smit et al). Disabled people have important knowledge to contribute to these four basic steps that goes far beyond their community. Their understanding and acceptance of, for example, the concept of interdependence, is just one major contribution. Including the concept of interdependence within the set of tools that inform the four basic steps of adaptation and other facets of climate discourse has the potential to lead to a decrease of adaptation apartheid, and to increase the utility of the climate discourse for the global community as a whole. References African Ministerial Conference on the Environment. Nairobi Declaration on the African Process for Combating Climate Change. 2009. 26 Aug. 2009 ‹ http://www.unep.org/roa/Amcen/Amcen_Events/3rd_ss/Docs/nairobi-Decration-2009.pdf ›. American Association of Retired Persons. We Can Do Better: Lessons Learned for Protecting Older Persons in Disasters. 2009. 26 Aug. 2009 ‹ http://assets.aarp.org/rgcenter/il/better.pdf ›. Australian Human Rights Commission. “Climate Change Secretariat Excludes People with Disabilities.” 2008. 26 Aug. 2009 ‹ http://www.hreoc.gov.au/about/media/media_releases/2008/95_08.html ›. Bernhard, S., and M. McGeehin. “Municipal Heatwave Response Plans.” American Journal of Public Health 94 (2004): 1520-21. CARE International, the UN Office for the Coordination of Humanitarian Affairs, and Maplecroft. Humanitarian Implications of Climate Change: Mapping Emerging Trends and Risk Hotspots for Humanitarian Actors. CARE International, 2008. 26 Aug. 2009 ‹ http://www.careclimatechange.org/files/reports/Human_Implications_PolicyBrief.pdf ›, ‹ http://www.careclimatechange.org/files/reports/CARE_Human_Implications.pdf ›. "Disasters Are Always Inclusive: Persons with Disabilities in Humanitarian Emergency Situations." Bonn Declaration from the International Conference: Disasters Are Always Inclusive: Persons with Disabilities in Humanitarian Emergency Situations. 2007. 26 Aug. 2009 ‹ http://www.disabilityfunders.org/webfm_send/6, http://www.disabilityfunders.org/emergency_preparedness ›, ‹ http://bezev.de/bezev/aktuelles/index.htm ›. Ebi, K., and G. Meehl. Heatwaves and Global Climate Change: The Heat Is On: Climate Change and Heatwaves in the Midwest. 2007. 26 Aug. 2009 ‹ www.pewclimate.org/docUploads/Regional-Impacts-Midwest.pdf ›. Elwan, A. Poverty and Disability: A Survey of the Literature. 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Photo ID 158378414 © Eduard Muzhevskyi | Dreamstime.com ABSTRACT There is a debate about the ethical implications of using human embryos in stem cell research, which can be influenced by cultural, moral, and social values. This paper argues for an adaptable framework to accommodate diverse cultural and religious perspectives. By using an adaptive ethics model, research protections can reflect various populations and foster growth in stem cell research possibilities. INTRODUCTION Stem cell research combines biology, medicine, and technology, promising to alter health care and the understanding of human development. Yet, ethical contention exists because of individuals’ perceptions of using human embryos based on their various cultural, moral, and social values. While these disagreements concerning policy, use, and general acceptance have prompted the development of an international ethics policy, such a uniform approach can overlook the nuanced ethical landscapes between cultures. With diverse viewpoints in public health, a single global policy, especially one reflecting Western ethics or the ethics prevalent in high-income countries, is impractical. This paper argues for a culturally sensitive, adaptable framework for the use of embryonic stem cells. Stem cell policy should accommodate varying ethical viewpoints and promote an effective global dialogue. With an extension of an ethics model that can adapt to various cultures, we recommend localized guidelines that reflect the moral views of the people those guidelines serve. BACKGROUND Stem cells, characterized by their unique ability to differentiate into various cell types, enable the repair or replacement of damaged tissues. Two primary types of stem cells are somatic stem cells (adult stem cells) and embryonic stem cells. Adult stem cells exist in developed tissues and maintain the body’s repair processes.[1] Embryonic stem cells (ESC) are remarkably pluripotent or versatile, making them valuable in research.[2] However, the use of ESCs has sparked ethics debates. Considering the potential of embryonic stem cells, research guidelines are essential. The International Society for Stem Cell Research (ISSCR) provides international stem cell research guidelines. They call for “public conversations touching on the scientific significance as well as the societal and ethical issues raised by ESC research.”[3] The ISSCR also publishes updates about culturing human embryos 14 days post fertilization, suggesting local policies and regulations should continue to evolve as ESC research develops.[4] Like the ISSCR, which calls for local law and policy to adapt to developing stem cell research given cultural acceptance, this paper highlights the importance of local social factors such as religion and culture. I. Global Cultural Perspective of Embryonic Stem Cells Views on ESCs vary throughout the world. Some countries readily embrace stem cell research and therapies, while others have stricter regulations due to ethical concerns surrounding embryonic stem cells and when an embryo becomes entitled to moral consideration. The philosophical issue of when the “someone” begins to be a human after fertilization, in the morally relevant sense,[5] impacts when an embryo becomes not just worthy of protection but morally entitled to it. The process of creating embryonic stem cell lines involves the destruction of the embryos for research.[6] Consequently, global engagement in ESC research depends on social-cultural acceptability. a. US and Rights-Based Cultures In the United States, attitudes toward stem cell therapies are diverse. The ethics and social approaches, which value individualism,[7] trigger debates regarding the destruction of human embryos, creating a complex regulatory environment. For example, the 1996 Dickey-Wicker Amendment prohibited federal funding for the creation of embryos for research and the destruction of embryos for “more than allowed for research on fetuses in utero.”[8] Following suit, in 2001, the Bush Administration heavily restricted stem cell lines for research. However, the Stem Cell Research Enhancement Act of 2005 was proposed to help develop ESC research but was ultimately vetoed.[9] Under the Obama administration, in 2009, an executive order lifted restrictions allowing for more development in this field.[10] The flux of research capacity and funding parallels the different cultural perceptions of human dignity of the embryo and how it is socially presented within the country’s research culture.[11] b. Ubuntu and Collective Cultures African bioethics differs from Western individualism because of the different traditions and values. African traditions, as described by individuals from South Africa and supported by some studies in other African countries, including Ghana and Kenya, follow the African moral philosophies of Ubuntu or Botho and Ukama, which “advocates for a form of wholeness that comes through one’s relationship and connectedness with other people in the society,”[12] making autonomy a socially collective concept. In this context, for the community to act autonomously, individuals would come together to decide what is best for the collective. Thus, stem cell research would require examining the value of the research to society as a whole and the use of the embryos as a collective societal resource. If society views the source as part of the collective whole, and opposes using stem cells, compromising the cultural values to pursue research may cause social detachment and stunt research growth.[13] Based on local culture and moral philosophy, the permissibility of stem cell research depends on how embryo, stem cell, and cell line therapies relate to the community as a whole. Ubuntu is the expression of humanness, with the person’s identity drawn from the “’I am because we are’” value.[14] The decision in a collectivistic culture becomes one born of cultural context, and individual decisions give deference to others in the society. Consent differs in cultures where thought and moral philosophy are based on a collective paradigm. So, applying Western bioethical concepts is unrealistic. For one, Africa is a diverse continent with many countries with different belief systems, access to health care, and reliance on traditional or Western medicines. Where traditional medicine is the primary treatment, the “’restrictive focus on biomedically-related bioethics’” [is] problematic in African contexts because it neglects bioethical issues raised by traditional systems.”[15] No single approach applies in all areas or contexts. Rather than evaluating the permissibility of ESC research according to Western concepts such as the four principles approach, different ethics approaches should prevail. Another consideration is the socio-economic standing of countries. In parts of South Africa, researchers have not focused heavily on contributing to the stem cell discourse, either because it is not considered health care or a health science priority or because resources are unavailable.[16] Each country’s priorities differ given different social, political, and economic factors. In South Africa, for instance, areas such as maternal mortality, non-communicable diseases, telemedicine, and the strength of health systems need improvement and require more focus[17] Stem cell research could benefit the population, but it also could divert resources from basic medical care. Researchers in South Africa adhere to the National Health Act and Medicines Control Act in South Africa and international guidelines; however, the Act is not strictly enforced, and there is no clear legislation for research conduct or ethical guidelines.[18] Some parts of Africa condemn stem cell research. For example, 98.2 percent of the Tunisian population is Muslim.[19] Tunisia does not permit stem cell research because of moral conflict with a Fatwa. Religion heavily saturates the regulation and direction of research.[20] Stem cell use became permissible for reproductive purposes only recently, with tight restrictions preventing cells from being used in any research other than procedures concerning ART/IVF. Their use is conditioned on consent, and available only to married couples.[21] The community's receptiveness to stem cell research depends on including communitarian African ethics. c. Asia Some Asian countries also have a collective model of ethics and decision making.[22] In China, the ethics model promotes a sincere respect for life or human dignity,[23] based on protective medicine. This model, influenced by Traditional Chinese Medicine (TCM), [24] recognizes Qi as the vital energy delivered via the meridians of the body; it connects illness to body systems, the body’s entire constitution, and the universe for a holistic bond of nature, health, and quality of life.[25] Following a protective ethics model, and traditional customs of wholeness, investment in stem cell research is heavily desired for its applications in regenerative therapies, disease modeling, and protective medicines. In a survey of medical students and healthcare practitioners, 30.8 percent considered stem cell research morally unacceptable while 63.5 percent accepted medical research using human embryonic stem cells. Of these individuals, 89.9 percent supported increased funding for stem cell research.[26] The scientific community might not reflect the overall population. From 1997 to 2019, China spent a total of $576 million (USD) on stem cell research at 8,050 stem cell programs, increased published presence from 0.6 percent to 14.01 percent of total global stem cell publications as of 2014, and made significant strides in cell-based therapies for various medical conditions.[27] However, while China has made substantial investments in stem cell research and achieved notable progress in clinical applications, concerns linger regarding ethical oversight and transparency.[28] For example, the China Biosecurity Law, promoted by the National Health Commission and China Hospital Association, attempted to mitigate risks by introducing an institutional review board (IRB) in the regulatory bodies. 5800 IRBs registered with the Chinese Clinical Trial Registry since 2021.[29] However, issues still need to be addressed in implementing effective IRB review and approval procedures. The substantial government funding and focus on scientific advancement have sometimes overshadowed considerations of regional cultures, ethnic minorities, and individual perspectives, particularly evident during the one-child policy era. As government policy adapts to promote public stability, such as the change from the one-child to the two-child policy,[30] research ethics should also adapt to ensure respect for the values of its represented peoples. Japan is also relatively supportive of stem cell research and therapies. Japan has a more transparent regulatory framework, allowing for faster approval of regenerative medicine products, which has led to several advanced clinical trials and therapies.[31] South Korea is also actively engaged in stem cell research and has a history of breakthroughs in cloning and embryonic stem cells.[32] However, the field is controversial, and there are issues of scientific integrity. For example, the Korean FDA fast-tracked products for approval,[33] and in another instance, the oocyte source was unclear and possibly violated ethical standards.[34] Trust is important in research, as it builds collaborative foundations between colleagues, trial participant comfort, open-mindedness for complicated and sensitive discussions, and supports regulatory procedures for stakeholders. There is a need to respect the culture’s interest, engagement, and for research and clinical trials to be transparent and have ethical oversight to promote global research discourse and trust. d. Middle East Countries in the Middle East have varying degrees of acceptance of or restrictions to policies related to using embryonic stem cells due to cultural and religious influences. Saudi Arabia has made significant contributions to stem cell research, and conducts research based on international guidelines for ethical conduct and under strict adherence to guidelines in accordance with Islamic principles. Specifically, the Saudi government and people require ESC research to adhere to Sharia law. In addition to umbilical and placental stem cells,[35] Saudi Arabia permits the use of embryonic stem cells as long as they come from miscarriages, therapeutic abortions permissible by Sharia law, or are left over from in vitro fertilization and donated to research.[36] Laws and ethical guidelines for stem cell research allow the development of research institutions such as the King Abdullah International Medical Research Center, which has a cord blood bank and a stem cell registry with nearly 10,000 donors.[37] Such volume and acceptance are due to the ethical ‘permissibility’ of the donor sources, which do not conflict with religious pillars. However, some researchers err on the side of caution, choosing not to use embryos or fetal tissue as they feel it is unethical to do so.[38] Jordan has a positive research ethics culture.[39] However, there is a significant issue of lack of trust in researchers, with 45.23 percent (38.66 percent agreeing and 6.57 percent strongly agreeing) of Jordanians holding a low level of trust in researchers, compared to 81.34 percent of Jordanians agreeing that they feel safe to participate in a research trial.[40] Safety testifies to the feeling of confidence that adequate measures are in place to protect participants from harm, whereas trust in researchers could represent the confidence in researchers to act in the participants’ best interests, adhere to ethical guidelines, provide accurate information, and respect participants’ rights and dignity. One method to improve trust would be to address communication issues relevant to ESC. Legislation surrounding stem cell research has adopted specific language, especially concerning clarification “between ‘stem cells’ and ‘embryonic stem cells’” in translation.[41] Furthermore, legislation “mandates the creation of a national committee… laying out specific regulations for stem-cell banking in accordance with international standards.”[42] This broad regulation opens the door for future global engagement and maintains transparency. However, these regulations may also constrain the influence of research direction, pace, and accessibility of research outcomes. e. Europe In the European Union (EU), ethics is also principle-based, but the principles of autonomy, dignity, integrity, and vulnerability are interconnected.[43] As such, the opportunity for cohesion and concessions between individuals’ thoughts and ideals allows for a more adaptable ethics model due to the flexible principles that relate to the human experience The EU has put forth a framework in its Convention for the Protection of Human Rights and Dignity of the Human Being allowing member states to take different approaches. Each European state applies these principles to its specific conventions, leading to or reflecting different acceptance levels of stem cell research. [44] For example, in Germany, Lebenzusammenhang, or the coherence of life, references integrity in the unity of human culture. Namely, the personal sphere “should not be subject to external intervention.”[45] Stem cell interventions could affect this concept of bodily completeness, leading to heavy restrictions. Under the Grundgesetz, human dignity and the right to life with physical integrity are paramount.[46] The Embryo Protection Act of 1991 made producing cell lines illegal. Cell lines can be imported if approved by the Central Ethics Commission for Stem Cell Research only if they were derived before May 2007.[47] Stem cell research respects the integrity of life for the embryo with heavy specifications and intense oversight. This is vastly different in Finland, where the regulatory bodies find research more permissible in IVF excess, but only up to 14 days after fertilization.[48] Spain’s approach differs still, with a comprehensive regulatory framework.[49] Thus, research regulation can be culture-specific due to variations in applied principles. Diverse cultures call for various approaches to ethical permissibility.[50] Only an adaptive-deliberative model can address the cultural constructions of self and achieve positive, culturally sensitive stem cell research practices.[51] II. Religious Perspectives on ESC Embryonic stem cell sources are the main consideration within religious contexts. While individuals may not regard their own religious texts as authoritative or factual, religion can shape their foundations or perspectives. The Qur'an states: “And indeed We created man from a quintessence of clay. Then We placed within him a small quantity of nutfa (sperm to fertilize) in a safe place. Then We have fashioned the nutfa into an ‘alaqa (clinging clot or cell cluster), then We developed the ‘alaqa into mudgha (a lump of flesh), and We made mudgha into bones, and clothed the bones with flesh, then We brought it into being as a new creation. So Blessed is Allah, the Best of Creators.”[52] Many scholars of Islam estimate the time of soul installment, marked by the angel breathing in the soul to bring the individual into creation, as 120 days from conception.[53] Personhood begins at this point, and the value of life would prohibit research or experimentation that could harm the individual. If the fetus is more than 120 days old, the time ensoulment is interpreted to occur according to Islamic law, abortion is no longer permissible.[54] There are a few opposing opinions about early embryos in Islamic traditions. According to some Islamic theologians, there is no ensoulment of the early embryo, which is the source of stem cells for ESC research.[55] In Buddhism, the stance on stem cell research is not settled. The main tenets, the prohibition against harming or destroying others (ahimsa) and the pursuit of knowledge (prajña) and compassion (karuna), leave Buddhist scholars and communities divided.[56] Some scholars argue stem cell research is in accordance with the Buddhist tenet of seeking knowledge and ending human suffering. Others feel it violates the principle of not harming others. Finding the balance between these two points relies on the karmic burden of Buddhist morality. In trying to prevent ahimsa towards the embryo, Buddhist scholars suggest that to comply with Buddhist tenets, research cannot be done as the embryo has personhood at the moment of conception and would reincarnate immediately, harming the individual's ability to build their karmic burden.[57] On the other hand, the Bodhisattvas, those considered to be on the path to enlightenment or Nirvana, have given organs and flesh to others to help alleviate grieving and to benefit all.[58] Acceptance varies on applied beliefs and interpretations. Catholicism does not support embryonic stem cell research, as it entails creation or destruction of human embryos. This destruction conflicts with the belief in the sanctity of life. For example, in the Old Testament, Genesis describes humanity as being created in God’s image and multiplying on the Earth, referencing the sacred rights to human conception and the purpose of development and life. In the Ten Commandments, the tenet that one should not kill has numerous interpretations where killing could mean murder or shedding of the sanctity of life, demonstrating the high value of human personhood. In other books, the theological conception of when life begins is interpreted as in utero,[59] highlighting the inviolability of life and its formation in vivo to make a religious point for accepting such research as relatively limited, if at all.[60] The Vatican has released ethical directives to help apply a theological basis to modern-day conflicts. The Magisterium of the Church states that “unless there is a moral certainty of not causing harm,” experimentation on fetuses, fertilized cells, stem cells, or embryos constitutes a crime.[61] Such procedures would not respect the human person who exists at these stages, according to Catholicism. Damages to the embryo are considered gravely immoral and illicit.[62] Although the Catholic Church officially opposes abortion, surveys demonstrate that many Catholic people hold pro-choice views, whether due to the context of conception, stage of pregnancy, threat to the mother’s life, or for other reasons, demonstrating that practicing members can also accept some but not all tenets.[63] Some major Jewish denominations, such as the Reform, Conservative, and Reconstructionist movements, are open to supporting ESC use or research as long as it is for saving a life.[64] Within Judaism, the Talmud, or study, gives personhood to the child at birth and emphasizes that life does not begin at conception:[65] “If she is found pregnant, until the fortieth day it is mere fluid,”[66] Whereas most religions prioritize the status of human embryos, the Halakah (Jewish religious law) states that to save one life, most other religious laws can be ignored because it is in pursuit of preservation.[67] Stem cell research is accepted due to application of these religious laws. We recognize that all religions contain subsets and sects. The variety of environmental and cultural differences within religious groups requires further analysis to respect the flexibility of religious thoughts and practices. We make no presumptions that all cultures require notions of autonomy or morality as under the common morality theory, which asserts a set of universal moral norms that all individuals share provides moral reasoning and guides ethical decisions.[68] We only wish to show that the interaction with morality varies between cultures and countries. III. A Flexible Ethical Approach The plurality of different moral approaches described above demonstrates that there can be no universally acceptable uniform law for ESC on a global scale. Instead of developing one standard, flexible ethical applications must be continued. We recommend local guidelines that incorporate important cultural and ethical priorities. While the Declaration of Helsinki is more relevant to people in clinical trials receiving ESC products, in keeping with the tradition of protections for research subjects, consent of the donor is an ethical requirement for ESC donation in many jurisdictions including the US, Canada, and Europe.[69] The Declaration of Helsinki provides a reference point for regulatory standards and could potentially be used as a universal baseline for obtaining consent prior to gamete or embryo donation. For instance, in Columbia University’s egg donor program for stem cell research, donors followed standard screening protocols and “underwent counseling sessions that included information as to the purpose of oocyte donation for research, what the oocytes would be used for, the risks and benefits of donation, and process of oocyte stimulation” to ensure transparency for consent.[70] The program helped advance stem cell research and provided clear and safe research methods with paid participants. Though paid participation or covering costs of incidental expenses may not be socially acceptable in every culture or context,[71] and creating embryos for ESC research is illegal in many jurisdictions, Columbia’s program was effective because of the clear and honest communications with donors, IRBs, and related stakeholders. This example demonstrates that cultural acceptance of scientific research and of the idea that an egg or embryo does not have personhood is likely behind societal acceptance of donating eggs for ESC research. As noted, many countries do not permit the creation of embryos for research. Proper communication and education regarding the process and purpose of stem cell research may bolster comprehension and garner more acceptance. “Given the sensitive subject material, a complete consent process can support voluntary participation through trust, understanding, and ethical norms from the cultures and morals participants value. This can be hard for researchers entering countries of different socioeconomic stability, with different languages and different societal values.[72] An adequate moral foundation in medical ethics is derived from the cultural and religious basis that informs knowledge and actions.[73] Understanding local cultural and religious values and their impact on research could help researchers develop humility and promote inclusion. IV. Concerns Some may argue that if researchers all adhere to one ethics standard, protection will be satisfied across all borders, and the global public will trust researchers. However, defining what needs to be protected and how to define such research standards is very specific to the people to which standards are applied. We suggest that applying one uniform guide cannot accurately protect each individual because we all possess our own perceptions and interpretations of social values.[74] Therefore, the issue of not adjusting to the moral pluralism between peoples in applying one standard of ethics can be resolved by building out ethics models that can be adapted to different cultures and religions. Other concerns include medical tourism, which may promote health inequities.[75] Some countries may develop and approve products derived from ESC research before others, compromising research ethics or drug approval processes. There are also concerns about the sale of unauthorized stem cell treatments, for example, those without FDA approval in the United States. Countries with robust research infrastructures may be tempted to attract medical tourists, and some customers will have false hopes based on aggressive publicity of unproven treatments.[76] For example, in China, stem cell clinics can market to foreign clients who are not protected under the regulatory regimes. Companies employ a marketing strategy of “ethically friendly” therapies. Specifically, in the case of Beike, China’s leading stem cell tourism company and sprouting network, ethical oversight of administrators or health bureaus at one site has “the unintended consequence of shifting questionable activities to another node in Beike's diffuse network.”[77] In contrast, Jordan is aware of stem cell research’s potential abuse and its own status as a “health-care hub.” Jordan’s expanded regulations include preserving the interests of individuals in clinical trials and banning private companies from ESC research to preserve transparency and the integrity of research practices.[78] The social priorities of the community are also a concern. The ISSCR explicitly states that guidelines “should be periodically revised to accommodate scientific advances, new challenges, and evolving social priorities.”[79] The adaptable ethics model extends this consideration further by addressing whether research is warranted given the varying degrees of socioeconomic conditions, political stability, and healthcare accessibilities and limitations. An ethical approach would require discussion about resource allocation and appropriate distribution of funds.[80] CONCLUSION While some religions emphasize the sanctity of life from conception, which may lead to public opposition to ESC research, others encourage ESC research due to its potential for healing and alleviating human pain. Many countries have special regulations that balance local views on embryonic personhood, the benefits of research as individual or societal goods, and the protection of human research subjects. To foster understanding and constructive dialogue, global policy frameworks should prioritize the protection of universal human rights, transparency, and informed consent. In addition to these foundational global policies, we recommend tailoring local guidelines to reflect the diverse cultural and religious perspectives of the populations they govern. Ethics models should be adapted to local populations to effectively establish research protections, growth, and possibilities of stem cell research. For example, in countries with strong beliefs in the moral sanctity of embryos or heavy religious restrictions, an adaptive model can allow for discussion instead of immediate rejection. In countries with limited individual rights and voice in science policy, an adaptive model ensures cultural, moral, and religious views are taken into consideration, thereby building social inclusion. While this ethical consideration by the government may not give a complete voice to every individual, it will help balance policies and maintain the diverse perspectives of those it affects. Embracing an adaptive ethics model of ESC research promotes open-minded dialogue and respect for the importance of human belief and tradition. By actively engaging with cultural and religious values, researchers can better handle disagreements and promote ethical research practices that benefit each society. This brief exploration of the religious and cultural differences that impact ESC research reveals the nuances of relative ethics and highlights a need for local policymakers to apply a more intense adaptive model. - [1] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice. Orthopedic reviews, 14(3), 37498. https://doi.org/10.52965/001c.37498 [2] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice. Orthopedic reviews, 14(3), 37498. https://doi.org/10.52965/001c.37498 [3] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities. International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk; Kimmelman, J., Hyun, I., Benvenisty, N. et al. Policy: Global standards for stem-cell research. Nature 533, 311–313 (2016). https://doi.org/10.1038/533311a [4] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities. International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk [5] Concerning the moral philosophies of stem cell research, our paper does not posit a personal moral stance nor delve into the “when” of human life begins. To read further about the philosophical debate, consider the following sources: Sandel M. J. (2004). Embryo ethics--the moral logic of stem-cell research. The New England journal of medicine, 351(3), 207–209. https://doi.org/10.1056/NEJMp048145; George, R. P., & Lee, P. (2020, September 26). Acorns and Embryos. The New Atlantis. https://www.thenewatlantis.com/publications/acorns-and-embryos; Sagan, A., & Singer, P. (2007). The moral status of stem cells. Metaphilosophy, 38(2/3), 264–284. http://www.jstor.org/stable/24439776; McHugh P. R. (2004). Zygote and "clonote"--the ethical use of embryonic stem cells. The New England journal of medicine, 351(3), 209–211. https://doi.org/10.1056/NEJMp048147; Kurjak, A., & Tripalo, A. (2004). The facts and doubts about beginning of the human life and personality. Bosnian journal of basic medical sciences, 4(1), 5–14. https://doi.org/10.17305/bjbms.2004.3453 [6] Vazin, T., & Freed, W. J. (2010). Human embryonic stem cells: derivation, culture, and differentiation: a review. Restorative neurology and neuroscience, 28(4), 589–603. https://doi.org/10.3233/RNN-2010-0543 [7] Socially, at its core, the Western approach to ethics is widely principle-based, autonomy being one of the key factors to ensure a fundamental respect for persons within research. For information regarding autonomy in research, see: Department of Health, Education, and Welfare, & National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1978). The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research.; For a more in-depth review of autonomy within the US, see: Beauchamp, T. L., & Childress, J. F. (1994). Principles of Biomedical Ethics. Oxford University Press. [8] Sherley v. Sebelius, 644 F.3d 388 (D.C. Cir. 2011), citing 45 C.F.R. 46.204(b) and [42 U.S.C. § 289g(b)]. https://www.cadc.uscourts.gov/internet/opinions.nsf/6c690438a9b43dd685257a64004ebf99/$file/11-5241-1391178.pdf [9] Stem Cell Research Enhancement Act of 2005, H. R. 810, 109th Cong. (2001). https://www.govtrack.us/congress/bills/109/hr810/text; Bush, G. W. (2006, July 19). Message to the House of Representatives. National Archives and Records Administration. https://georgewbush-whitehouse.archives.gov/news/releases/2006/07/20060719-5.html [10] National Archives and Records Administration. (2009, March 9). Executive order 13505 -- removing barriers to responsible scientific research involving human stem cells. National Archives and Records Administration. https://obamawhitehouse.archives.gov/the-press-office/removing-barriers-responsible-scientific-research-involving-human-stem-cells [11] Hurlbut, W. B. (2006). Science, Religion, and the Politics of Stem Cells. Social Research, 73(3), 819–834. http://www.jstor.org/stable/40971854 [12] Akpa-Inyang, Francis & Chima, Sylvester. (2021). South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study. BMC Medical Ethics. 22. 10.1186/s12910-021-00678-4. [13] Source for further reading: Tangwa G. B. (2007). Moral status of embryonic stem cells: perspective of an African villager. Bioethics, 21(8), 449–457. https://doi.org/10.1111/j.1467-8519.2007.00582.x , see also Mnisi, F. M. (2020). An African analysis based on ethics of Ubuntu - are human embryonic stem cell patents morally justifiable? African Insight, 49(4). [14] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324 [15] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324 [16] Jackson, C.S., Pepper, M.S. Opportunities and barriers to establishing a cell therapy programme in South Africa. Stem Cell Res Ther 4, 54 (2013). https://doi.org/10.1186/scrt204; Pew Research Center. (2014, May 1). Public health a major priority in African nations. Pew Research Center’s Global Attitudes Project. https://www.pewresearch.org/global/2014/05/01/public-health-a-major-priority-in-african-nations/ [17] Department of Health Republic of South Africa. (2021). Health Research Priorities (revised) for South Africa 2021-2024. National Health Research Strategy. https://www.health.gov.za/wp-content/uploads/2022/05/National-Health-Research-Priorities-2021-2024.pdf [18] Oosthuizen, H. (2013). Legal and Ethical Issues in Stem Cell Research in South Africa. In: Beran, R. (eds) Legal and Forensic Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32338-6_80, see also: Gaobotse G (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [19] United States Bureau of Citizenship and Immigration Services. (1998). Tunisia: Information on the status of Christian conversions in Tunisia. UNHCR Web Archive. https://webarchive.archive.unhcr.org/20230522142618/https://www.refworld.org/docid/3df0be9a2.html [20] Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [21] Kooli, C. Review of assisted reproduction techniques, laws, and regulations in Muslim countries. Middle East Fertil Soc J 24, 8 (2020). https://doi.org/10.1186/s43043-019-0011-0; Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142 [22] Pang M. C. (1999). Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. Journal of medical ethics, 25(3), 247–253. https://doi.org/10.1136/jme.25.3.247 [23] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences, 8(1). https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199 [24] Wang, Y., Xue, Y., & Guo, H. D. (2022). Intervention effects of traditional Chinese medicine on stem cell therapy of myocardial infarction. Frontiers in pharmacology, 13, 1013740. https://doi.org/10.3389/fphar.2022.1013740 [25] Li, X.-T., & Zhao, J. (2012). Chapter 4: An Approach to the Nature of Qi in TCM- Qi and Bioenergy. In Recent Advances in Theories and Practice of Chinese Medicine (p. 79). InTech. [26] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students. Stem cells international, 2021, 6667743. https://doi.org/10.1155/2021/6667743 [27] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students. Stem cells international, 2021, 6667743. https://doi.org/10.1155/2021/6667743 [28] Zhang, J. Y. (2017). Lost in translation? accountability and governance of Clinical Stem Cell Research in China. Regenerative Medicine, 12(6), 647–656. https://doi.org/10.2217/rme-2017-0035 [29] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences, 8(1). https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199 [30] Chen, H., Wei, T., Wang, H. et al. Association of China’s two-child policy with changes in number of births and birth defects rate, 2008–2017. BMC Public Health 22, 434 (2022). https://doi.org/10.1186/s12889-022-12839-0 [31] Azuma, K. Regulatory Landscape of Regenerative Medicine in Japan. Curr Stem Cell Rep 1, 118–128 (2015). https://doi.org/10.1007/s40778-015-0012-6 [32] Harris, R. (2005, May 19). Researchers Report Advance in Stem Cell Production. NPR. https://www.npr.org/2005/05/19/4658967/researchers-report-advance-in-stem-cell-production [33] Park, S. (2012). South Korea steps up stem-cell work. Nature. https://doi.org/10.1038/nature.2012.10565 [34] Resnik, D. B., Shamoo, A. E., & Krimsky, S. (2006). Fraudulent human embryonic stem cell research in South Korea: lessons learned. Accountability in research, 13(1), 101–109. https://doi.org/10.1080/08989620600634193. [35] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 [36]Association for the Advancement of Blood and Biotherapies. https://www.aabb.org/regulatory-and-advocacy/regulatory-affairs/regulatory-for-cellular-therapies/international-competent-authorities/saudi-arabia [37] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 [38] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6 Culturally, autonomy practices follow a relational autonomy approach based on a paternalistic deontological health care model. The adherence to strict international research policies and religious pillars within the regulatory environment is a great foundation for research ethics. However, there is a need to develop locally targeted ethics approaches for research (as called for in Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6), this decision-making approach may help advise a research decision model. For more on the clinical cultural autonomy approaches, see: Alabdullah, Y. Y., Alzaid, E., Alsaad, S., Alamri, T., Alolayan, S. W., Bah, S., & Aljoudi, A. S. (2022). Autonomy and paternalism in Shared decision‐making in a Saudi Arabian tertiary hospital: A cross‐sectional study. Developing World Bioethics, 23(3), 260–268. https://doi.org/10.1111/dewb.12355; Bukhari, A. A. (2017). Universal Principles of Bioethics and Patient Rights in Saudi Arabia (Doctoral dissertation, Duquesne University). https://dsc.duq.edu/etd/124; Ladha, S., Nakshawani, S. A., Alzaidy, A., & Tarab, B. (2023, October 26). Islam and Bioethics: What We All Need to Know. Columbia University School of Professional Studies. https://sps.columbia.edu/events/islam-and-bioethics-what-we-all-need-know [39] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics. Research Ethics, 17(2), 228-241. https://doi.org/10.1177/1747016120966779 [40] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics. Research Ethics, 17(2), 228-241. https://doi.org/10.1177/1747016120966779 [41] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [42] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [43] The EU’s definition of autonomy relates to the capacity for creating ideas, moral insight, decisions, and actions without constraint, personal responsibility, and informed consent. However, the EU views autonomy as not completely able to protect individuals and depends on other principles, such as dignity, which “expresses the intrinsic worth and fundamental equality of all human beings.” Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3 [44] Council of Europe. Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164) https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164 (forbidding the creation of embryos for research purposes only, and suggests embryos in vitro have protections.); Also see Drabiak-Syed B. K. (2013). New President, New Human Embryonic Stem Cell Research Policy: Comparative International Perspectives and Embryonic Stem Cell Research Laws in France. Biotechnology Law Report, 32(6), 349–356. https://doi.org/10.1089/blr.2013.9865 [45] Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3 [46] Tomuschat, C., Currie, D. P., Kommers, D. P., & Kerr, R. (Trans.). (1949, May 23). Basic law for the Federal Republic of Germany. https://www.btg-bestellservice.de/pdf/80201000.pdf [47] Regulation of Stem Cell Research in Germany. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-germany [48] Regulation of Stem Cell Research in Finland. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-finland [49] Regulation of Stem Cell Research in Spain. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-spain [50] Some sources to consider regarding ethics models or regulatory oversights of other cultures not covered: Kara MA. Applicability of the principle of respect for autonomy: the perspective of Turkey. J Med Ethics. 2007 Nov;33(11):627-30. doi: 10.1136/jme.2006.017400. PMID: 17971462; PMCID: PMC2598110. Ugarte, O. N., & Acioly, M. A. (2014). The principle of autonomy in Brazil: one needs to discuss it ... Revista do Colegio Brasileiro de Cirurgioes, 41(5), 374–377. https://doi.org/10.1590/0100-69912014005013 Bharadwaj, A., & Glasner, P. E. (2012). Local cells, global science: The rise of embryonic stem cell research in India. Routledge. For further research on specific European countries regarding ethical and regulatory framework, we recommend this database: Regulation of Stem Cell Research in Europe. Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-europe [51] Klitzman, R. (2006). Complications of culture in obtaining informed consent. The American Journal of Bioethics, 6(1), 20–21. https://doi.org/10.1080/15265160500394671 see also: Ekmekci, P. E., & Arda, B. (2017). Interculturalism and Informed Consent: Respecting Cultural Differences without Breaching Human Rights. Cultura (Iasi, Romania), 14(2), 159–172.; For why trust is important in research, see also: Gray, B., Hilder, J., Macdonald, L., Tester, R., Dowell, A., & Stubbe, M. (2017). Are research ethics guidelines culturally competent? Research Ethics, 13(1), 23-41. https://doi.org/10.1177/1747016116650235 [52] The Qur'an (M. Khattab, Trans.). (1965). Al-Mu’minun, 23: 12-14. https://quran.com/23 [53] Lenfest, Y. (2017, December 8). Islam and the beginning of human life. Bill of Health. https://blog.petrieflom.law.harvard.edu/2017/12/08/islam-and-the-beginning-of-human-life/ [54] Aksoy, S. (2005). Making regulations and drawing up legislation in Islamic countries under conditions of uncertainty, with special reference to embryonic stem cell research. Journal of Medical Ethics, 31:399-403.; see also: Mahmoud, Azza. "Islamic Bioethics: National Regulations and Guidelines of Human Stem Cell Research in the Muslim World." Master's thesis, Chapman University, 2022. https://doi.org/10.36837/ chapman.000386 [55] Rashid, R. (2022). When does Ensoulment occur in the Human Foetus. Journal of the British Islamic Medical Association, 12(4). ISSN 2634 8071. https://www.jbima.com/wp-content/uploads/2023/01/2-Ethics-3_-Ensoulment_Rafaqat.pdf. [56] Sivaraman, M. & Noor, S. (2017). Ethics of embryonic stem cell research according to Buddhist, Hindu, Catholic, and Islamic religions: perspective from Malaysia. Asian Biomedicine,8(1) 43-52. https://doi.org/10.5372/1905-7415.0801.260 [57] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [58] Lecso, P. A. (1991). The Bodhisattva Ideal and Organ Transplantation. Journal of Religion and Health, 30(1), 35–41. http://www.jstor.org/stable/27510629; Bodhisattva, S. (n.d.). The Key of Becoming a Bodhisattva. A Guide to the Bodhisattva Way of Life. http://www.buddhism.org/Sutras/2/BodhisattvaWay.htm [59] There is no explicit religious reference to when life begins or how to conduct research that interacts with the concept of life. However, these are relevant verses pertaining to how the fetus is viewed. ((King James Bible. (1999). Oxford University Press. (original work published 1769)) Jerimiah 1: 5 “Before I formed thee in the belly I knew thee; and before thou camest forth out of the womb I sanctified thee…” In prophet Jerimiah’s insight, God set him apart as a person known before childbirth, a theme carried within the Psalm of David. Psalm 139: 13-14 “…Thou hast covered me in my mother's womb. I will praise thee; for I am fearfully and wonderfully made…” These verses demonstrate David’s respect for God as an entity that would know of all man’s thoughts and doings even before birth. [60] It should be noted that abortion is not supported as well. [61] The Vatican. (1987, February 22). Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation Replies to Certain Questions of the Day. Congregation For the Doctrine of the Faith. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html [62] The Vatican. (2000, August 25). Declaration On the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells. Pontifical Academy for Life. https://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/rc_pa_acdlife_doc_20000824_cellule-staminali_en.html; Ohara, N. (2003). Ethical Consideration of Experimentation Using Living Human Embryos: The Catholic Church’s Position on Human Embryonic Stem Cell Research and Human Cloning. Department of Obstetrics and Gynecology. Retrieved from https://article.imrpress.com/journal/CEOG/30/2-3/pii/2003018/77-81.pdf. [63] Smith, G. A. (2022, May 23). Like Americans overall, Catholics vary in their abortion views, with regular mass attenders most opposed. Pew Research Center. https://www.pewresearch.org/short-reads/2022/05/23/like-americans-overall-catholics-vary-in-their-abortion-views-with-regular-mass-attenders-most-opposed/ [64] Rosner, F., & Reichman, E. (2002). Embryonic stem cell research in Jewish law. Journal of halacha and contemporary society, (43), 49–68.; Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [65] Schenker J. G. (2008). The beginning of human life: status of embryo. Perspectives in Halakha (Jewish Religious Law). Journal of assisted reproduction and genetics, 25(6), 271–276. https://doi.org/10.1007/s10815-008-9221-6 [66] Ruttenberg, D. (2020, May 5). The Torah of Abortion Justice (annotated source sheet). Sefaria. https://www.sefaria.org/sheets/234926.7?lang=bi&with=all&lang2=en [67] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005 [68] Gert, B. (2007). Common morality: Deciding what to do. Oxford Univ. Press. [69] World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA, 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 Declaration of Helsinki – WMA – The World Medical Association.; see also: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. U.S. Department of Health and Human Services. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html [70] Zakarin Safier, L., Gumer, A., Kline, M., Egli, D., & Sauer, M. V. (2018). Compensating human subjects providing oocytes for stem cell research: 9-year experience and outcomes. Journal of assisted reproduction and genetics, 35(7), 1219–1225. https://doi.org/10.1007/s10815-018-1171-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063839/ see also: Riordan, N. H., & Paz Rodríguez, J. (2021). Addressing concerns regarding associated costs, transparency, and integrity of research in recent stem cell trial. Stem Cells Translational Medicine, 10(12), 1715–1716. https://doi.org/10.1002/sctm.21-0234 [71] Klitzman, R., & Sauer, M. V. (2009). Payment of egg donors in stem cell research in the USA. Reproductive biomedicine online, 18(5), 603–608. https://doi.org/10.1016/s1472-6483(10)60002-8 [72] Krosin, M. T., Klitzman, R., Levin, B., Cheng, J., & Ranney, M. L. (2006). Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa. Clinical trials (London, England), 3(3), 306–313. https://doi.org/10.1191/1740774506cn150oa [73] Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict. Georgetown University Press, 2012. [74] Msoroka, M. S., & Amundsen, D. (2018). One size fits not quite all: Universal research ethics with diversity. Research Ethics, 14(3), 1-17. https://doi.org/10.1177/1747016117739939 [75] Pirzada, N. (2022). The Expansion of Turkey’s Medical Tourism Industry. Voices in Bioethics, 8. https://doi.org/10.52214/vib.v8i.9894 [76] Stem Cell Tourism: False Hope for Real Money. Harvard Stem Cell Institute (HSCI). (2023). https://hsci.harvard.edu/stem-cell-tourism, See also: Bissassar, M. (2017). Transnational Stem Cell Tourism: An ethical analysis. Voices in Bioethics, 3. https://doi.org/10.7916/vib.v3i.6027 [77]Song, P. (2011) The proliferation of stem cell therapies in post-Mao China: problematizing ethical regulation, New Genetics and Society, 30:2, 141-153, DOI: 10.1080/14636778.2011.574375 [78] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a [79] International Society for Stem Cell Research. (2024). Standards in stem cell research. International Society for Stem Cell Research. https://www.isscr.org/guidelines/5-standards-in-stem-cell-research [80] Benjamin, R. (2013). People’s science bodies and rights on the Stem Cell Frontier. Stanford University Press.

Kangatarianism is the rather inelegant word coined in the first decade of the twenty-first century to describe an omnivorous diet in which the only meat consumed is that of the kangaroo. First published in the media in 2010 (Barone; Zukerman), the term circulated in Australian environmental and academic circles including the Global Animal conference at the University of Wollongong in July 2011 where I first heard it from members of the Think Tank for Kangaroos (THINKK) group. By June 2017, it had gained enough attention to be named the Oxford English Dictionary’s Australian word of the month (following on from May’s “smashed avo,” another Australian food innovation), but it took the Nine Network reality television series Love Island Australia to raise kangatarian to trending status on social media (Oxford UP). During the first episode, aired in late May 2018, Justin, a concreter and fashion model from Melbourne, declared himself to have previously been a kangatarian as he chatted with fellow contestant, Millie. Vet nurse and animal lover Millie appeared to be shocked by his revelation but was tentatively accepting when Justin explained what kangatarian meant, and justified his choice on the grounds that kangaroo are not farmed. In the social media response, it was clear that eating only the meat of kangaroos as an ethical choice was an entirely new concept to many viewers, with one tweet stating “Kangatarian isn’t a thing”, while others variously labelled the diet brutal, intriguing, or quintessentially Australian (see #kangatarian on Twitter).There is a well developed literature around the arguments for and against eating kangaroo, and why settler Australians tend to be so reluctant to do so (see for example, Probyn; Cawthorn and Hoffman). Here, I will concentrate on the role that ethics play in this food choice by examining how the adoption of kangatarianism can be understood as a bargain struck to help to manage grief in the Anthropocene, and the limitations of that bargain. As Lesley Head has argued, we are living in a time of loss and of grieving, when much that has been taken for granted is becoming unstable, and “we must imagine that drastic changes to everyday life are in the offing” (313). Applying the classic (and contested) model of five stages of grief, first proposed by Elisabeth Kübler-Ross in her book On Death and Dying in 1969, much of the population of the western world seems to be now experiencing denial, her first stage of loss, while those in the most vulnerable environments have moved on to anger with developed countries for destructive actions in the past and inaction in the present. The next stages (or states) of grieving—bargaining, depression, and acceptance—are likely to be manifested, although not in any predictable sequence, as the grief over current and future losses continues (Haslam).The great expansion of food restrictive diets in the Anthropocene can be interpreted as part of this bargaining state of grieving as individuals attempt to respond to the imperative to reduce their environmental impact but also to limit the degree of change to their own diet required to do so. Meat has long been identified as a key component of an individual’s environmental footprint. From Frances Moore Lappé’s 1971 Diet for a Small Planet through the United Nations’ Food and Agriculture Organisation’s 2006 report Livestock’s Long Shadow to the 2019 report of the EAT–Lancet Commission on Healthy Diets from Sustainable Food Systems, the advice has been consistent: meat consumption should be minimised in, if not eradicated from, the human diet. The EAT–Lancet Commission Report quantified this to less than 28 grams (just under one ounce) of beef, lamb or pork per day (12, 25). For many this would be keenly felt, in terms of how meals are constructed, the sensory experiences associated with eating meat and perceptions of well-being but meat is offered up as a sacrifice to bring about the return of the beloved healthy planet.Rather than accept the advice to cut out meat entirely, those seeking to bargain with the Anthropocene also find other options. This has given rise to a suite of foodways based around restricting meat intake in volume or type. Reducing the amount of commercially produced beef, lamb and pork eaten is one approach, while substituting a meat the production of which has a smaller environmental footprint, most commonly chicken or fish, is another. For those willing to make deeper changes, the meat of free living animals, especially those which are killed accidentally on the roads or for deliberately for environmental management purposes, is another option. Further along this spectrum are the novel protein sources suggested in the Lancet report, including insects, blue-green algae and laboratory-cultured meats.Kangatarianism is another form of this bargain, and is backed by at least half a century of advocacy. The Australian Conservation Foundation made calls to reduce the numbers of other livestock and begin a sustainable harvest of kangaroo for food in 1970 when the sale of kangaroo meat for human consumption was still illegal across the country (Conservation of Kangaroos). The idea was repeated by biologist Gordon Grigg in the late 1980s (Jackson and Vernes 173), and again in the Garnaut Climate Change Review in 2008 (547–48). Kangaroo meat is high in protein and iron, low in fat, and high in healthy polyunsaturated fatty acids and conjugated linoleic acid, and, as these authors showed, has a smaller environmental footprint than beef, lamb, or pork. Kangaroo require less water than cattle, sheep or pigs, and no land is cleared to grow feed for them or give them space to graze. Their paws cause less erosion and compaction of soil than do the hooves of common livestock. They eat less fodder than ruminants and their digestive processes result in lower emissions of the powerful greenhouse gas methane and less solid waste.As Justin of Love Island was aware, kangaroo are not farmed in the sense of being deliberately bred, fed, confined, or treated with hormones, drugs or chemicals, which also adds to their lighter impact on the environment. However, some pastoralists argue that because they cannot prevent kangaroos from accessing the food, water, shelter, and protection from predators they provide for their livestock, they do effectively farm them, although they receive no income from sales of kangaroo meat. This type of light touch farming of kangaroos has a very long history in Australia going back to the continent’s first peopling some 60,000 years ago. Kangaroos were so important to Aboriginal people that a wide range of environments were manipulated to produce their favoured habitats of open grasslands edged by sheltering trees. As Bill Gammage demonstrated, fire was used as a tool to preserve and extend grassy areas, to encourage regrowth which would attract kangaroos and to drive the animals from one patch to another or towards hunters waiting with spears (passim, for example, 58, 72, 76, 93). Gammage and Bruce Pascoe agree that this was a form of animal husbandry in which the kangaroos were drawn to the areas prepared for them for the young grass or, more forcefully, physically directed using nets, brush fences or stone walls. Burnt ground served to contain the animals in place of fencing, and regular harvesting kept numbers from rising to levels which would place pressure on other species (Gammage 79, 281–86; Pascoe 42–43). Contemporary advocates of eating kangaroo have promoted the idea that they should be deliberately co-produced with other livestock instead of being killed to preserve feed and water for sheep and cattle (Ellicott; Wilson 39). Substituting kangaroo for the meat of more environmentally damaging animals would facilitate a reduction in the numbers of cattle and sheep, lessening the harm they do.Most proponents have assumed that their audience is current meat eaters who would substitute kangaroo for the meat of other more environmentally costly animals, but kangatarianism can also emerge from vegetarianism. Wendy Zukerman, who wrote about kangaroo hunting for New Scientist in 2010, was motivated to conduct the research because she was considering becoming an early adopter of kangatarianism as the least environmentally taxing way to counter the longterm anaemia she had developed as a vegetarian. In 2018, George Wilson, honorary professor in the Australian National University’s Fenner School of Environment and Society called for vegetarians to become kangatarians as a means of boosting overall consumption of kangaroo for environmental and economic benefits to rural Australia (39).Given these persuasive environmental arguments, it might be expected that many people would have perceived eating kangaroo instead of other meat as a favourable bargain and taken up the call to become kangatarian. Certainly, there has been widespread interest in trying kangaroo meat. In 1997, only five years after the sale of kangaroo meat for human consumption had been legalised in most states (South Australia did so in 1980), 51% of 500 people surveyed in five capital cities said they had tried kangaroo. However, it had not become a meat of choice with very few found to eat it more than three times a year (Des Purtell and Associates iv). Just over a decade later, a study by Ampt and Owen found an increase to 58% of 1599 Australians surveyed across the country who had tried kangaroo but just 4.7% eating it at least monthly (14). Bryce Appleby, in his study of kangaroo consumption in the home based on interviews with 28 residents of Wollongong in 2010, specifically noted the absence of kangatarians—then a very new concept. A study of 261 Sydney university students in 2014 found that half had tried kangaroo meat and 10% continued to eat it with any regularity. Only two respondents identified themselves as kangatarian (Grant 14–15). Kangaroo meat advocate Michael Archer declared in 2017 that “there’s an awful lot of very, very smart vegetarians [who] have opted for semi vegetarianism and they’re calling themselves ‘kangatarians’, as they’re quite happy to eat kangaroo meat”, but unless there had been a significant change in a few years, the surveys did not bear out his assertion (154).The ethical calculations around eating kangaroo are complicated by factors beyond the strictly environmental. One Tweeter advised Justin: “‘I’m a kangatarian’ isn’t a pickup line, mate”, and certainly the reception of his declaration could have been very cool, especially as it was delivered to a self declared animal warrior (N’Tash Aha). All of the studies of beliefs and practices around the eating of kangaroo have noted a significant minority of Australians who would not consider eating kangaroo based on issues of animal welfare and animal rights. The 1997 study found that 11% were opposed to the idea of eating kangaroo, while in Grant’s 2014 study, 15% were ethically opposed to eating kangaroo meat (Des Purtell and Associates iv; Grant 14–15). Animal ethics complicate the bargains calculated principally on environmental grounds.These ethical concerns work across several registers. One is around the flesh and blood kangaroo as a charismatic native animal unique to Australia and which Australians have an obligation to respect and nurture. Sheep, cattle and pigs have been subject to longterm propaganda campaigns which entrench the idea that they are unattractive and unintelligent, and veil their transition to meat behind euphemistic language and abattoir walls, making it easier to eat them. Kangaroos are still seen as resourceful and graceful animals, and no linguistic tricks shield consumers from the knowledge that it is a roo on their plate. A proposal in 2009 to market a “coat of arms” emu and kangaroo-flavoured potato chip brought complaints to the Advertising Standards Bureau that this was disrespectful to these native animals, although the flavours were to be simulated and the product vegetarian (Black). Coexisting with this high regard to kangaroos is its antithesis. That is, a valuation of them informed by their designation as a pest in the pastoral industry, and the use of the carcasses of those killed to feed dogs and other companion animals. Appleby identified a visceral, disgust response to the idea of eating kangaroo in many of his informants, including both vegetarians who would not consider eating kangaroo because of their commitment to a plant-based diet, and at least one omnivore who would prefer to give up all meat rather than eat kangaroo. While diametrically opposed, the end point of both positions is that kangaroo meat should not be eaten.A second animal ethics stance relates to the imagined kangaroo, a cultural construct which for most urban Australians is much more present in their lives and likely to shape their actions than the living animals. It is behind the rejection of eating an animal which holds such an iconic place in Australian culture: to the dexter on the 1912 national coat of arms; hopping through the Hundred Acre Wood as Kanga and Roo in A.A. Milne’s Winnie-the-Pooh children’s books from the 1920s and the Disney movies later made from them; as a boy’s best friend as Skippy the Bush Kangaroo in a fondly remembered 1970s television series; and high in the sky on QANTAS planes. The anthropomorphising of kangaroos permitted the spectacle of the boxing kangaroo from the late nineteenth century. By framing natural kangaroo behaviours as boxing, these exhibitions encouraged an ambiguous understanding of kangaroos as human-like, moving them further from the category of food (Golder and Kirkby). Australian government bodies used this idea of the kangaroo to support food exports to Britain, with kangaroos as cooks or diners rather than ingredients. The Kangaroo Kookery Book of 1932 (see fig. 1 below) portrayed kangaroos as a nuclear family in a suburban kitchen and another official campaign supporting sales of Australian produce in Britain in the 1950s featured a Disney-inspired kangaroo eating apples and chops washed down with wine (“Kangaroo to Be ‘Food Salesman’”). This imagining of kangaroos as human-like has persisted, leading to the opinion expressed in a 2008 focus group, that consuming kangaroo amounted to “‘eating an icon’ … Although they are pests they are still human nature … these are native animals, people and I believe that is a form of cannibalism!” (Ampt and Owen 26). Figure 1: Rather than promoting the eating of kangaroos, the portrayal of kangaroos as a modern suburban family in the Kangaroo Kookery Book (1932) made it unthinkable. (Source: Kangaroo Kookery Book, Director of Australian Trade Publicity, Australia House, London, 1932.)The third layer of ethical objection on the ground of animal welfare is more specific, being directed to the method of killing the kangaroos which become food. Kangaroos are perhaps the only native animals for which state governments set quotas for commercial harvest, on the grounds that they compete with livestock for pasturage and water. In most jurisdictions, commercially harvested kangaroo carcasses can be processed for human consumption, and they are the ones which ultimately appear in supermarket display cases.Kangaroos are killed by professional shooters at night using swivelling spotlights mounted on their vehicles to locate and daze the animals. While clean head shots are the ideal and regulations state that animals should be killed when at rest and without causing “undue agonal struggle”, this is not always achieved and some animals do suffer prolonged deaths (NSW Code of Practice for Kangaroo Meat for Human Consumption). By regulation, the young of any female kangaroo must be killed along with her. While averting a slow death by neglect, this is considered cruel and wasteful. The hunt has drawn international criticism, including from Greenpeace which organised campaigns against the sale of kangaroo meat in Europe in the 1980s, and Viva! which was successful in securing the withdrawal of kangaroo from sale in British supermarkets (“Kangaroo Meat Sales Criticised”). These arguments circulate and influence opinion within Australia.A final animal ethics issue is that what is actually behind the push for greater use of kangaroo meat is not concern for the environment or animal welfare but the quest to turn a profit from these animals. The Kangaroo Industries Association of Australia, formed in 1970 to represent those who dealt in the marsupials’ meat, fur and skins, has been a vocal advocate of eating kangaroo and a sponsor of market research into how it can be made more appealing to the market. The Association argued in 1971 that commercial harvest was part of the intelligent conservation of the kangaroo. They sought minimum size regulations to prevent overharvesting and protect their livelihoods (“Assn. Backs Kangaroo Conservation”). The Association’s current website makes the claim that wild harvested “Australian kangaroo meat is among the healthiest, tastiest and most sustainable red meats in the world” (Kangaroo Industries Association of Australia). That this is intended to initiate a new and less controlled branch of the meat industry for the benefit of hunters and processors, rather than foster a shift from sheep or cattle to kangaroos which might serve farmers and the environment, is the opinion of Dr. Louise Boronyak, of the Centre for Compassionate Conservation at the University of Technology Sydney (Boyle 19).Concerns such as these have meant that kangaroo is most consumed where it is least familiar, with most of the meat for human consumption recovered from culled animals being exported to Europe and Asia. Russia has been the largest export market. There, kangaroo meat is made less strange by blending it with other meats and traditional spices to make processed meats, avoiding objections to its appearance and uncertainty around preparation. With only a low profile as a novelty animal in Russia, there are fewer sentimental concerns about consuming kangaroo, although the additional food miles undermine its environmental credentials. The variable acceptability of kangaroo in more distant markets speaks to the role of culture in determining how patterns of eating are formed and can be shifted, or, as Elspeth Probyn phrased it “how natural entities are transformed into commodities within a context of globalisation and local communities”, underlining the impossibility of any straightforward ethics of eating kangaroo (33, 35).Kangatarianism is a neologism which makes the eating of kangaroo meat something it has not been in the past, a voluntary restriction based on environmental ethics. These environmental benefits are well founded and eating kangaroo can be understood as an Anthropocenic bargain struck to allow the continuation of the consumption of red meat while reducing one’s environmental footprint. Although superficially attractive, the numbers entering into this bargain remain small because environmental ethics cannot be disentangled from animal ethics. The anthropomorphising of the kangaroo and its use as a national symbol coexist with its categorisation as a pest and use of its meat as food for companion animals. Both understandings of kangaroos made their meat uneatable for many Australians. Paired with concerns over how kangaroos are killed and the commercialisation of a native species, kangaroo meat has a very mixed reception despite decades of advocacy for eating its meat in favour of that of more harmed and more harmful introduced species. Given these constraints, kangatarianism is unlikely to become widespread and indeed it should be viewed as at best a temporary exigency. As the climate warms and rainfall becomes more erratic, even animals which have evolved to suit Australian conditions will come under increasing pressure, and humans will need to reach Kübler-Ross’ final state of grief: acceptance. In this case, this would mean acceptance that our needs cannot be placed ahead of those of other animals.ReferencesAmpt, Peter, and Kate Owen. Consumer Attitudes to Kangaroo Meat Products. Canberra: Rural Industries Research and Development Corporation, 2008.Appleby, Bryce. “Skippy the ‘Green’ Kangaroo: Identifying Resistances to Eating Kangaroo in the Home in a Context of Climate Change.” BSc Hons, U of Wollongong, 2010 <http://ro.uow.edu.au/thsci/103>.Archer, Michael. “Zoology on the Table: Plenary Session 4.” Australian Zoologist 39, 1 (2017): 154–60.“Assn. Backs Kangaroo Conservation.” The Beverley Times 26 Feb. 1971: 3. 22 Feb. 2019 <http://nla.gov.au/nla.news-article202738733>.Barone, Tayissa. “Kangatarians Jump the Divide.” Sydney Morning Herald 9 Feb. 2010. 13 Apr. 2019 <https://www.smh.com.au/lifestyle/kangatarians-jump-the-divide-20100209-gdtvd8.html>.Black, Rosemary. “Some Australians Angry over Idea for Kangaroo and Emu-Flavored Potato Chips.” New York Daily News 4 Dec. 2009. 5 Feb. 2019 <https://www.nydailynews.com/life-style/eats/australians-angry-idea-kangaroo-emu-flavored-potato-chips-article-1.431865>.Boyle, Rhianna. “Eating Skippy.” Big Issue Australia 578 11-24 Jan. 2019: 16–19.Cawthorn, Donna-Mareè, and Louwrens C. Hoffman. “Controversial Cuisine: A Global Account of the Demand, Supply and Acceptance of ‘Unconventional’ and ‘Exotic’ Meats.” Meat Science 120 (2016): 26–7.Conservation of Kangaroos. Melbourne: Australian Conservation Foundation, 1970.Des Purtell and Associates. Improving Consumer Perceptions of Kangaroo Products: A Survey and Report. Canberra: Rural Industries Research and Development Corporation, 1997.Ellicott, John. “Little Pay Incentive for Shooters to Join Kangaroo Meat Industry.” The Land 15 Mar. 2018. 28 Mar. 2019 <https://www.theland.com.au/story/5285265/top-roo-shooter-says-harvesting-is-a-low-paid-job/>.Garnaut, Ross. Garnaut Climate Change Review. 2008. 26 Feb. 2019 <http://www.garnautreview.org.au/index.htm>.Gammage, Bill. The Biggest Estate on Earth: How Aborigines Made Australia. Sydney: Allen and Unwin, 2012.Golder, Hilary, and Diane Kirkby. “Mrs. Mayne and Her Boxing Kangaroo: A Married Woman Tests Her Property Rights in Colonial New South Wales.” Law and History Review 21.3 (2003): 585–605.Grant, Elisabeth. “Sustainable Kangaroo Harvesting: Perceptions and Consumption of Kangaroo Meat among University Students in New South Wales.” Independent Study Project (ISP). U of NSW, 2014. <https://digitalcollections.sit.edu/isp_collection/1755>.Haslam, Nick. “The Five Stages of Grief Don’t Come in Fixed Steps – Everyone Feels Differently.” The Conversation 22 Oct. 2018. 28 Mar. 2019 <https://theconversation.com/the-five-stages-of-grief-dont-come-in-fixed-steps-everyone-feels-differently-96111>.Head, Lesley. “The Anthropoceans.” Geographical Research 53.3 (2015): 313–20.Kangaroo Industries Association of Australia. Kangaroo Meat. 26 Feb. 2019 <http://www.kangarooindustry.com/products/meat/>.“Kangaroo Meat Sales Criticised.” The Canberra Times 13 Sep. 1984: 14. 22 Feb 2019 <http://nla.gov.au/nla.news-article136915919>.“Kangaroo to Be Food ‘Salesman.’” Newcastle Morning Herald and Miners’ Advocate, 2 Dec. 1954. 22 Feb 2019 <http://nla.gov.au/nla.news-article134089767>.Kübler-Ross, Elisabeth. On Death and Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, and their own Families. New York: Touchstone, 1997.Jackson, Stephen, and Karl Vernes. Kangaroo: Portrait of an Extraordinary Marsupial. Sydney: Allen and Unwin, 2010.Lappé, Frances Moore. Diet for a Small Planet. New York: Ballantine Books, 1971.N’Tash Aha (@Nsvasey). “‘I’m a Kangatarian’ isn’t a Pickup Line, Mate. #LoveIslandAU.” Twitter post. 27 May 2018. 5 Apr. 2019 <https://twitter.com/Nsvasey/status/1000697124122644480>.“NSW Code of Practice for Kangaroo Meat for Human Consumption.” Government Gazette of the State of New South Wales 24 Mar. 1993. 22 Feb. 2019 <http://nla.gov.au/nla.news-page14638033>.Oxford University Press, Australia and New Zealand. Word of the Month. June 2017. <https://www.oup.com.au/dictionaries/word-of-the-month>.Pascoe, Bruce. Dark Emu, Black Seeds: Agriculture or Accident? Broome: Magabala Books, 2014.Probyn, Elspeth. “Eating Roo: Of Things That Become Food.” New Formations 74.1 (2011): 33–45.Steinfeld, Henning, Pierre Gerber, Tom Wassenaar, Vicent Castel, Mauricio Rosales, and Cees d Haan. Livestock’s Long Shadow: Environmental Issues and Options. Rome: Food and Agriculture Organisation of the United Nations, 2006.Trust Nature. Essence of Kangaroo Capsules. 26 Feb. 2019 <http://ncpro.com.au/products/all-products/item/88139-essence-of-kangaroo-35000>.Victoria Department of Environment, Land, Water and Planning. Kangaroo Pet Food Trial. 28 Mar. 2019 <https://www.wildlife.vic.gov.au/managing-wildlife/wildlife-management-and-control-authorisations/kangaroo-pet-food-trial>.Willett, Walter, et al. “Food in the Anthropocene: The EAT–Lancet Commission on Healthy Diets from Sustainable Food Systems.” The Lancet 16 Jan. 2019. 26 Feb. 2019 <https://www.thelancet.com/commissions/EAT>.Wilson, George. “Kangaroos Can Be an Asset Rather than a Pest.” Australasian Science 39.1 (2018): 39.Zukerman, Wendy. “Eating Skippy: The Future of Kangaroo Meat.” New Scientist 208.2781 (2010): 42–5.

Photo by Waranont (Joe) on Unsplash INTRODUCTION The age-adjusted COVID-19 mortality rate among Black Americans is twice as high as White Americans.[1] This shocking evidence of health disparities, coincident to a public reckoning with the history of racism in the US, highlights the inverse relationship between race and health. Public sentiment may now favor addressing these pressing public health issues, but the sprawling healthcare system largely focuses on clinical care; it lacks tools to influence the social determinants of health at the point of the healthcare institution. Reinvigorating organizational ethics, sometimes called institutional ethics, may provide such a tool. BACKGROUND Organizational ethics became part of the healthcare system during the upheavals in financing and organization of health care in the 1990s. Yet organizational ethics in a medical setting must be more than simple business ethics.[2] Just as health care professionals are granted special privileges in society in exchange for adherence to a code of medical ethics and duties, healthcare organizations and systems also must now adhere to ethical requirements in exchange for their privileged position that includes the right to provide, and be reimbursed for, health care.[3] In the 1990s, ethicists began to discuss how clinical ethics committees might develop an understanding of business ethics in order to provide comprehensive organizational ethics reviews.[4] Some bioethicists even believed that the challenges of integrating business and medical care would compel ethics committees to look outward, engaging in public advocacy around ethical issues in health care.[5] To fulfill the mission of maintaining organizational ethics standards within the healthcare system, ethics committees would need to advocate for patients in the public sphere. Ethics committees might even take positions at odds with those of the healthcare institutions in which they work. Organizational ethics committees might have served as watchdogs, ensuring that healthcare organizations fulfill their fiduciary duties to their patients and communities. Bioethicists soon realized that the vision of a robust ethics committee involving administrators, bioethicists, and medical staff advising multiple divisions of large organizations and policy makers would fall short.[6] The two ethical systems remained separate: most organizations developed a combination of a clinical ethics committee adjunct to the medical staff with a compliance department to oversee organizational ethics. However, organizational ethics really goes beyond compliance; it “cannot be addressed by focusing narrowly on business matters or by quasi-legal mechanisms to assure that behavior conforms to pre-established codes or rules.”[7] As a result, there is no centralized entity with power in each healthcare institution that can treat healthcare inequities as an institutional ethical failure that must be addressed. Current research on specific inequitable outcomes due to bias in clinical care includes specialties such as maternal care,[8]cardiac care,[9] pain management, and technology.[10] Implicit bias and racist clinical interactions, once identified, may be addressed through staff training and other interventions. Yet the ethics of clinical care requires little attention to the social determinants of health such as high levels of police surveillance in the community which may cause increased rates of hypertension,[11] pre-term birth,[12] and may affect mental health. Leaving these problems to the public health realm disconnects health practitioners and institutions from the ability to remedy some of the causes of health problems in their patients. Simply treating the effects of racism in the practice of medicine is not curative – it is really palliative care.[13] ANALYSIS The term “organizational ethics” is too limited to encompass the scope of change needed to address structural racism and the social determinants of health in today’s healthcare institutions. Structural Justice Ethics[14] better describes a plan and a process that requires the healthcare system and professionals to look both inward and outward to take on the structural causes of racism and health disparities. Building on organizational and clinical ethics, Structural Justice Ethics could amplify the research on systemic issues such as the effects of social determinants of health, racism in clinical care, and necessary advocacy with the local community. To be effective and complete, organizations should recognize duties to patients that arrive at their doorstep, damaged by generations of subordination and racism. To ethically treat patients who have experienced racism, the system and health practitioners must acknowledge and work to reduce the inequities in society that cause harm to their health in the clinical setting. Accreditation companies such as The Joint Commission could amend their standards to require top-rated healthcare organizations to form new Structural Justice Ethics committees in their organizations, taking affirmative steps to acknowledge the ethical implications of racism and the social determinants of health. Many bioethicists have already called for the field of bioethics to address racism as an ethical issue in healthcare, some even calling for a new Black Bioethics.[15] This frustration with the profession of bioethics has developed in other areas, such as disability ethics and feminist ethics, and reflects a belief that mainstream bioethics is a rigidly principlist endeavor. The education of new bioethicists is grounded in practical philosophy graduate programs, entwined with academia’s history of exclusivity. As a relatively young academic subject, bioethics has the potential to expand and grow into a more practical and justice-oriented tool, learning how to counter the overly individualistic bioethics that has roots in our racist and Protestant-dominant history.[16] Expanding organizational ethics into Structural Justice Ethics in health care could bring Black bioethicists into the center of healthcare ethics and provide the tools to implement changes needed to address racism in health care. Healthcare organizations should not expect Black healthcare practitioners to take on these Structural Justice Ethics roles as “extra” work. Too often, people of color are expected to bear the burden of explaining racism and working to eradicate it.[17]The Structural Justice Ethics committee should be a new model, centered in ethics and policy, with professional-level staffing that reflects the racial and ethnic makeup of the community it serves. Calling on bioethicists as moral agents in the world, and particularly within the medical system, to act as social justice advocates against systemic injustice in a system where they have privilege and power seems logical and surprisingly necessary. “Going forward, bioethics needs to engage with the nuances of race with the same vigor that it has approached discussions of moral theories and biotechnologies.”[18] Graduate-level bioethics programs have expanded significantly in recent years, with 45 current master’s level programs,[19] and there should be a wealth of professionals ready to oversee the role of encouraging and monitoring justice in the system. These programs focus primarily if not exclusively on the dominant paradigm of bioethics, yet as ethics programs, they should be able to course-correct and embrace greater diversity in people and thought. Structural Justice Ethicists can guide healthcare organizations to become learning institutions open to the idea that bias and inequity are ethical harms that they can and should address. Some may question whether such close attention to Black health care needs amounts to reparations or “reverse” discrimination, a controversial topic in our political discussions. However, when posed as an ethical duty of health care, there is no option to continue to treat Black people unethically. Of course, healthcare systems will have to balance competing budgetary interests; even with unlimited funding, disparities in health care would not disappear overnight.[20] In a fair process where decisionmakers must weigh the demands of stakeholders, the ethical obligation to address the social determinants of health must have an advocate. Moreover, setting high ethical standards is not the same as government spending to make reparations for past harms. In fact, Structural Justice Ethics does not look to the past at all but looks to the needs of subordinated communities of patients as they exist today. Any community that is harmed by structural injustice in health care can be the focus of a Structural Justice Ethics review. The Joint Commission and other accrediting organizations can require healthcare organizations to meet the challenges of health inequities by adopting new Structural Justice Ethics committees, just as The Joint Commission added organizational ethics to its requirements in 1995. Admittedly, Structural Justice Ethics is an amorphous concept and its role within healthcare institutions needs to be refined and assigned specific tasks. However, there is substantial research on the social determinants of health; the challenge for the Structural Justice Ethics is to recommend systemic changes from within, rather than beginning this research anew. The Joint Commission’s Center for Transforming Healthcare, as a data-driven and process-oriented patient safety organization, is well-primed to take on this task. The Center can collaborate with existing academic and governmental health equity researchers to set short- and long-term goals for Structural Justice Ethics committees. To begin with, a Structural Justice Ethics committee can pose the question of “how is racism operating here” and: a. connect with current research on specific inequitable outcomes due to bias in medicine and bring best practices to the attention of medical staff. b. work with human resources and medical staff to support and increase diverse populations in the workforce. c. ensure that implicit bias and other trainings are properly provided to all staff, as well as expanding the scope of such trainings to address developing areas such as epistemic harm, or the harm of one’s own physical experience being discounted by medical professionals.[21] The health care workforce should also be trained in Title VI law.[22] d. evaluate research data on the organization’s own potential disparate outcomes due to race, to determine areas for improvement both within and outside of the organization. e. invite the local community to come in for listening and learning sessions, to better understand the community’s concerns and perspective on health equity. f. improve advocacy on behalf of community members to state and local authorities, effectively taking a stand for health care equity for local stakeholders. Dr. Camara P. Jones describes a collaborative endeavor like this as critical to anti-racist work and likens it to adopting a community health center model where the health facility takes responsibility for the health and well-being of the local community.[23] AMA policy already encourages this type of effort in opinion 8.11 of the AMA Code, which states that, alongside diagnosis and treatment, “physicians also have a professional commitment to prevent disease and promote health and well-being for their patients and the community.”[24] A theoretical framework and concrete plan for radical improvement in the ethics of the healthcare system will help all healthcare professionals. Some healthcare practitioners may not recognize their own biases and need training to meet best practices standards in light of health inequities. Other healthcare practitioners may feel disillusioned because they know they face individual patients suffering the effects of structural racism, yet they can treat only the illness.[25] The scope of the problem may overwhelm practitioners, and without a belief that the system is committed to improvement, practitioners may become numb to the suffering, a trauma reaction that affects both the practitioners and their patients. Unfortunately, when current medical students ask the question, “what can I do to fight systemic racism?” the answer is usually “call it out.” But putting the onus on newly minted individual practitioners to call out racism in an established structure is unrealistic, unfair, and destined to be unsuccessful. Just as we should not expect subordinated individuals to “overcome” their social determinants of health, we should not expect health professionals to make this change individually. Addressing injustices in the institution and adjusting medical ethics accordingly can alleviate the burden of these ethical dilemmas. CONCLUSION Structural Justice Ethics must be woven into the ethics committees at the institutional level. Organizational ethics committees can evaluate healthcare organizations by their integrity, i.e., how well their actions fulfill the moral obligations they have undertaken.[26] Our healthcare system has avoided the moral obligation to address racism and the social determinants of health by focusing on clinical ethics, leaving public health to academics and the government. Expanding organizational ethics to take on the issues of structural injustice within each healthcare institution will help organizations better measure, change, and ultimately fulfill their moral obligations to their patients and communities. [1] “Color of Coronavirus: COVID-19 Deaths Analyzed by Race and Ethnicity,” APM Research Lab, accessed June 1, 2021, https://www.apmresearchlab.org/covid/deaths-by-race. [2] M. Constantinescu, “Seeing the Forest beyond the Trees: A Holistic Approach to Health-Care Organizational Ethics,” in Contemporary Debates in Bioethics: European Perspectives, 2018, 86–96, https://doi.org/10.2478/9783110571219-009. [3] See Norman Daniels, Just Health: Meeting Health Needs Fairly (Cambridge: Cambridge University Press, 2008) at 219. [4] Elizabeth Heitman and Ruth Ellen Bulger, “The Healthcare Ethics Committee in the Structural Transformation of Health Care: Administrative and Organizational Ethics in Changing Times,” HEC Forum 10, no. 2 (June 1, 1998): 152–76, 162, https://doi.org/10.1023/A:1008865603499. [5] Cohen, Cynthia B. "Ethics Committees as Corporate and Public Policy Advocates." The Hastings Center Report 20, no. 5 (1990): 36+. Gale Academic OneFile (accessed May 6, 2021). https://link.gale.com/apps/doc/A8998890/AONE?u=nysl_oweb&sid=AONE&xid=84a1cade. [6] Linda L. Emanuel, “Ethics and the Structures of Healthcare Special Section: Issues in Organization Ethics and Healthcare,” Cambridge Quarterly of Healthcare Ethics 9, no. 2 (2000): 151–68, 166. [7] George Khushf and Rosemarie Tong, “Setting Organizational Ethics within a Broader Social and Legal Context,” HEC Forum 14, no. 2 (June 2002): 77–85, 78. [8] Olivia Pham, Usha Ranji Published: Nov 10, and 2020, “Racial Disparities in Maternal and Infant Health: An Overview - Issue Brief,” KFF (blog), November 10, 2020, https://www.kff.org/report-section/racial-disparities-in-maternal-and-infant-health-an-overview-issue-brief/. [9] Eberly Lauren A. et al., “Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center,” Circulation: Heart Failure 12, no. 11 (November 1, 2019): e006214, https://doi.org/10.1161/CIRCHEARTFAILURE.119.006214. [10] Michael W. Sjoding et al., “Racial Bias in Pulse Oximetry Measurement,” New England Journal of Medicine 383, no. 25 (December 17, 2020): 2477–78, https://doi.org/10.1056/NEJMc2029240. [11] Alyasah Ali Sewell et al., “Illness Spillovers of Lethal Police Violence: The Significance of Gendered Marginalization,” Ethnic and Racial Studies 44, no. 7 (July 22, 2020): 1–26, https://doi.org/10.1080/01419870.2020.1781913. [12] Brad N. Greenwood et al., “Physician–Patient Racial Concordance and Disparities in Birthing Mortality for Newborns,” Proceedings of the National Academy of Sciences 117, no. 35 (September 1, 2020): 21194–200, https://doi.org/10.1073/pnas.1913405117. [13] The term “palliative care” as applied to patients suffering from the social determinants of health was used by Dr. Michelle Morse at a webinar entitled “Medical Stereotypes: Confronting Racism and Disparities in US Health Care: A Health Policy and Bioethics Consortium” presented by the Harvard Petrie-Flom Center on February 12, 2021. [14] Linda L. Emanuel coined the term “Structural Ethics” in 2000. This term did not seem to generate much interest from the bioethics community at the time. Her explanation of this term is consistent with my thinking, although I expand it to address the health system as an entity, and focus on improving health equity. [15] Keisha Shantel Ray, “Black Bioethics and How the Failures of the Profession Paved the Way for Its Existence | Bioethics.Net,” www.bioethics.net, August 6, 2020, http://www.bioethics.net/2020/08/black-bioethics-and-how-the-failures-of-the-profession-paved-the-way-for-its-existence/; Yolonda Y. Wilson, “Racial Injustice and Meaning Well: A Challenge for Bioethics,” The American Journal of Bioethics 21, no. 2 (February 1, 2021): 1–3, https://doi.org/10.1080/15265161.2020.1866875. [16] See Catherine Myser, “Differences from Somewhere: The Normativity of Whiteness in Bioethics in the United States,” The American Journal of Bioethics 3, no. 2 (May 2003): 1–11, https://doi.org/10.1162/152651603766436072. [17] Ushe Blackstock, “Why Black Doctors like Me Are Leaving Academic Medicine,” STAT (blog), January 16, 2020, https://www.statnews.com/2020/01/16/black-doctors-leaving-faculty-positions-academic-medical-centers/. [18] Zamina Mithani, Jane Cooper, and Boyd J. Wesley, “Race, Power, and COVID-19: A Call for Advocacy within Bioethics,” The American Journal of Bioethics21, no. 2 (2021): 11–18, 13 https://doi.org/10.1080/15265161.2020.1851810. [19] “Graduate Programs,” The Hastings Center, accessed 2 June, 2021, https://www.thehastingscenter.org/publications-resources/bioethics-careers-education/graduate-programs-2/. [20] Norman Daniels, Just Health: Meeting Health Needs Fairly, at 299. [21] Ian James Kidd and Havi Carel, “Epistemic Injustice and Illness,” Journal of Applied Philosophy 34, no. 2 (2017): 172–90, https://doi.org/10.1111/japp.12172. [22] Ruqaiijah Yearby, “Sick and Tired of Being Sick and Tired: Putting an End to Separate and Unequal Health Care in the United States 50 Years after the Civil Rights Act of 1964,” Health Matrix 25, no. 1 (January 1, 2015): 1–33, at 11. [23] Jones CP, Maybank A, Nolen L, Fields N, Ogunwole M, Onuoha C, Williams J, Tsai J, Paul D, Essien UR, Khazanchi, R. “Episode 5: Racism, Power, and Policy: Building the Antiracist Health Systems of the Future.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. January 19, 2021. [24] Sienna Moriarty, “AMA Policies and Code of Medical Ethics’ Opinions Related to Health Promotion and Community Development,” AMA Journal of Ethics 21, no. 3 (March 1, 2019): 259–61, https://doi.org/10.1001/amajethics.2019.259. [25] Constantinescu, “Seeing the Forest beyond the Trees,” at 92. [26] Ana Smith Iltis, “Organizational Ethics: Moral Obligation and Integrity,” in Institutional Integrity in Health Care, ed. Ana Smith Iltis, Philosophy and Medicine (Dordrecht: Springer Netherlands, 2003), 175–82, https://doi.org/10.1007/978-94-017-0153-2_10.

Abstract The “Basic Principles and Guidelines on the Right to Remedy and Reparation for Victims of Gross Violations of International Human Rights Law and Serious Violations of lnternational Humanitarian Law” (“Principles and Guidelines”) are the first international instrument codifying the rights of victims in international law. Their recent adoption, on April 19, 2005, by the 61st session of the United Nations Commission on Human Rights (the “Commission”), has contributed greatly to the consolidation of international law and practice governing the rights of victims to a remedy and reparations. During the past two decades, various UN Charter-based human rights bodies have struggled with complex legal issues emerging from demands for remedial justice.

The World Summit on the Information Society (WSIS) was organized by the United Nations (UN) and the International Telecommunications Union to address the need for international policy and agreement on ICT governance, rights, and responsibilities. It convened in two phases: Geneva in 2003 and Tunis in 2005. International representatives of governments, businesses, and civil society raised issues, and debated and formed policy recommendations. The WSIS Gender Caucus (2003) and other civil-society participants advocated for gender equality to be included as a fundamental principle for action and decision making. The voting plenary session of delegates produced the WSIS Declaration of Principles (UN, 2003a) and WSIS Plan of Action (UN, 2003b) in Geneva, with gender included in many of the articles. Two major issues WSIS addressed in Geneva and Tunis were Internet governance and the Digital Solidarity Fund. UN secretary general Kofi Annan established the Working Group on Internet Governance (WGIG) to define Internet and Internet governance to “navigate the complex terrain” (GKP, 2002, p. 6) and to make recommendations for WSIS in Tunis in 2005. WGIG addressed three Internet-governance functions: technical standardization; resources allocation and assignment, such as domain names; and policy formation and enforcement, and dispute resolution. Relevant issues not initially addressed by WGIG included gender, voice, inclusiveness, and other issues rooted in unequal access to ICT and to the decision-making process including governance, now shaping the information society. On February 23, a joint statement on Internet governance was presented in Geneva at the Tunis Prepcom by the Civil Society Internet Governance Caucus, the Gender Caucus, Human Rights Caucus, Privacy Caucus, and Media Caucus on behalf of the Civil Society Content and Themes Group. The statement asserts, “gender balanced representation in all aspects of Internet Governance is vital for the process and for its outcomes to have legitimacy” (WSIS Gender Caucus, 2005a). The Digital Solidarity Fund was proposed at WSIS, and the UN Task Force on Financial Mechanisms for ICT for Development was formed. In the 1990s, official development-assistance (ODA) support declined for ICT infrastructure development. In the new millennium, this decline has been offset by funds to integrate ICT programs into development (Hesselbarth & Tambo, 2005). The WSIS Gender Caucus (2003) statement on financing mechanisms affirmed that ICT for development must be framed as a development issue, “encompassing market-led growth but fundamentally a public policy issue.” Public finance is central to achieving “equitable and gender just outcomes in ICT for development.” This article examines the WSIS political dynamics over the issue of gender equality as a fundamental principle for action in ICT policy. The WSIS civil-society participants, particularly the Gender Caucus, continued to advocate for gender equality as a fundamental principle for action and decision making within the multiple-stakeholder WSIS process of government delegates and private-sector representatives.