Promoting Dialogue through Diversity in Bioethics

The articles that open and close this January 2023 issue of the Asian Bioethics Review each advocate for greater dialogue in bioethics, both in the realm of academia and more broadly in practice. As such, they frame the other contributions in this issue that amply demonstrate how diverse understandings of the role of bioethics across and within human cultures can inform and drive any such commitment to dialogue. The objective of promoting dialogue through diversity is central to the mission of the Asian Bioethics Review. We are very pleased to publish such a representative range of contributions that support this objective.

The first article of this new year issue is published on the first anniversary of the coming into force of the piece of legislation that it critiques. In their piece, Kashyap and Tripathi offer insightful commentary on India’s Surrogacy (Regulation) Act 2021, which came into effect on 25 January 2022 [https://link.springer.com/article/10.1007/s41649-022-00222-5]. Against the social and commercial backdrop of the growing Indian reproductive sector, this piece of legislation was introduced ostensibly as a response to concerns about exploitation of women, abuses of human rights, and the so-called ‘commodification’ of motherhood. While undoubtedly stronger protections have been introduced in some respects, the authors highlight multiple ways in which this new law—driven by a ‘moral conservatism’—continues to fail groups and communities within India, particularly members of the LGBTQ+ population. In doing so, the authors argue for a wider, more realistic, and more inclusive dialogue about what kind of laws of this nature are required for India, now and in the future. A failure to engage robustly risks a failure to protect the rich diversity of human and cultural identities that make up modern India.

Risks of a different kind are the focus of the paper by Silva and Smith that examines the imposition of risk on some groups in an effort to promote public health for all [https://link.springer.com/article/10.1007/s41649-022-00218-1]. The authors point out that a robust account of the circumstances in which such risk imposition is legitimate remains elusive, and they argue for an approach that combines relational autonomy and relational justice to begin to remedy this concern. The explanatory power of such an approach lies partly in the ways in which it can be deployed to reveal imbalances of power and to inform dialogue and decision-making dynamics accordingly. The theoretical and practical unpacking of this approach is done through two examples drawn from (i) the ongoing COVID-19 pandemic and (ii) the regulation of sugar-sweetened beverages.

Informed consent has long been understood as having risk communication at its centre. And while this remains true today, ethical and legal developments now emphasise the equal importance of seeing consent as a dialogic process rather than a ‘moment’ in the provision of healthcare or recruitment to a research protocol. But understandings of the nature of informed consent, what is involved, the role of risk communication, and the respective rights and responsibilities of the parties involved invariably change across countries and cultures. This is well illustrated by the paper from Aluko-Arowolo et al. [https://link.springer.com/article/10.1007/s41649-022-00223-4] in the context of clinical trials in Nigeria. Using well-established empirical research methodology, the authors engaged with members of a local community involved in running clinical trials (or in supporting participants) to reveal rich data about understandings of informed consent. Then, through a lens of ethical relativism, they argue for practical ways in which researchers can be more sensitised to local ethical issues and better supported to design research accordingly, all the while under the appropriate scrutiny of a legitimate ethics review body.

The next two papers in this issue continue a theme that necessarily cuts across the work of a journal like the Asian Bioethics Review: capturing and understanding diversity of understandings and approaches to bioethics, particularly as these are informed by religious faith. The paper by Farid and Tasnim is an excellent illustration of this for its engagement with Judaism, Christianity, and Islam on various aspects of artificial reproductive technologies (ARTs) [https://link.springer.com/article/10.1007/s41649-022-00224-3]. The paper is valuable in two key respects; first, it reveals nuance and difference even within each of these Abrahamic faiths concerning ethico-religious responses to increasingly novel ARTs and practices, and secondly, it exposes many commonalities between these three leading global religions as well. This last point is particularly important because it suggests that productive dialogue about how to move forward cross-culturally might be more achievable than perhaps first thought.

Invariably, religious perspectives are most acutely called into question with the advent of new technological developments. The paper by Sabri et al. illustrates this well with respect to its discussion of Islamic law in the face of three-dimensional (3D) printing of organs for transplantation purposes [https://link.springer.com/article/10.1007/s41649-022-00210-9]. This technological possibility returns Islamic scholars and bioethicists to the enduring question under Islam: when, if at all, is it permissible to change the creation of Allah? Deploying various methods used under Islamic law, the authors make the case that necessary uses of this technology are permissible to save a life. They acknowledge, however, that this itself raises questions about what counts as ‘necessary’ in the context of elective use of a new technology, and it also leaves open some doubt as to whether ‘desirable’ uses then raise problems from Islamic law and its followers.

The authors of the previous article adopt a first principles approach to their interpretation of Islamic law. In much the same way, we see a similar approach being followed by Park in their analysis of the justification of a policy of mandatory vaccination for COVID-19 in South Korea [https://link.springer.com/article/10.1007/s41649-022-00221-6]. Here, however, the analysis is not of law but of the foundational principles concerning utilitarianism, as expounded in some of the classic texts that define this area of philosophical and bioethical scholarship. Park characterises the policy approach of South Korea as determinedly utilitarian, and then proceeds to dissect it by reference to the two levels of utilitarianism presented by R.M. Hare. This policy is found wanting, and this is doubly so when subjected to critique from the principles of fairness laid down in the works by Rawls and Hart. The author invites all of us, but law and policy-makers in particular, to think harder and more deeply about how to justify intrusive policies such as this one.

Our final contribution is a Perspectives Article that engages directly with recent work by Crump et al. (2022) that has sought to improve on models and guidelines relating to the evaluation of whether animals can feel pain. In the present piece, Veit applauds these efforts but seeks to go further [https://link.springer.com/article/10.1007/s41649-022-00230-5]. In particular, the author argues that more must be done to bridge the divide between scientific understandings of sentience and the downstream legal and ethical protections that might—eventually—result. To overcome any such divide, Veit argues for a multi-method and multidisciplinary approach that acknowledges that animal sentience itself is a multidimensional phenomenon. Ethical discourse, debate, and dialogue are central to the approach. Moreover, and to return to the theme of dialogue that frames this editorial, this last paper is an excellent example of the kind of dialogue we wish to support and promote in this journal. It is through direct engagement with the ideas and perspectives of others that the best hope emerges of identifying productive ways forward in bioethics.

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