Assisted reproductive technology (ART) has become an important biomedical response to infertility, yet its social acceptance and ethical legitimacy vary across cultural contexts. In Nigeria, where reproduction is deeply embedded in religious, cultural, and familial expectations, ART occupies a contested space extending beyond medicine. This article examines ART as both an adaptive response to infertility and a transformative intervention that reshapes the moral, cultural, and institutional foundations of reproduction. Using a theoretical and interpretive approach, the article develops an integrated framework combining evolutionary theory, functionalism, social constructionism, medicalization theory, feminist theory, political economy, and cultural lag. The analysis shows that ART simultaneously supports reproductive continuity and generates social transformation by reshaping kinship, parenthood, gender relations, and reproductive responsibility. Persistent infertility stigma, unequal access to fertility services, weak regulatory oversight, and religious ambivalence demonstrate that technological innovation alone cannot resolve the structural and normative challenges surrounding reproduction. The article therefore conceptualizes ART not as a value-neutral biomedical technology but as a contested social institution situated at the intersection of science, culture, religion, morality, and political economy. It argues that ethically sustainable and socially equitable ART governance in Nigeria requires policies that integrate biomedical innovation with socio-cultural realities. The article contributes to bioethical scholarship by demonstrating the value of theoretically integrated approaches to reproductive technologies in Global South contexts.
In silico methods, artificial intelligence and network pharmacology increasingly translate traditional medicine knowledge into machine-readable evidence about molecular targets, phytochemical interactions and possible therapeutic mechanisms. These approaches can improve hypothesis generation, reduce unnecessary experimentation and clarify complex polyherbal mechanisms. They also create an under-examined bioethics problem: biological data and associated knowledge can become data assets whose provenance, community context and benefit-sharing implications are difficult to trace. This perspective defines digital biopiracy narrowly and distinguishes it from lawful open-data reuse, intellectual property infringement, data misappropriation, knowledge appropriation, provenance loss and ethical under-attribution. Legal permission to access an open repository is treated as a baseline rather than a complete ethical assessment; additional duties arise when candidate selection, novelty claims or downstream value materially depend on identifiable traditional knowledge or place-based biological context. The analysis is grounded in epistemic, relational and distributive justice, together with research integrity, and applies these principles to Asian settings including Indian systems, Chinese medicine, Japanese Kampo, Korean medicine, Indonesian jamu, Thai traditional medicine and community-governed knowledge in Southeast Asia. An illustrative PubMed/MEDLINE signal scan contextualises the visibility of computational traditional medicine research but is not presented as a systematic or scoping review. The paper proposes a minimum disclosure checklist and a phased, risk-proportionate editorial model. Ethical publication practice should report traditional knowledge sources, biological and database provenance, provenance uncertainty, model limitations, patent or commercial intent and benefit-sharing considerations without discouraging responsible open science.
Infectious diseases such as cholera remain pressing global health challenges that are deeply entangled with poverty, increasing climate change, and fragile health infrastructures. While their epidemiology and treatment are well studied, less attention has been paid to the ethical-legal questions that arise when novel medical technologies are introduced in low-resource settings. This article uses a case study on the use of water testing technologies in Nigeria to demonstrate how such gaps generate not only individual but also collective risks, including effects of stigmatisation, ambiguity of responsibility and dynamics of technological dependency. Considering these critical issues, a new regulatory framework is needed to overcome the limitations of conventional regulatory approaches. It proposes a decolonial approach that integrates international standards, human rights and a greater focus on power dynamics and meaningful and locally grounded participatory approaches in the democratisation of medical technologies.
The ethical justification of emerging reproductive technologies requires attention not only to their immediate medical objectives but also to their foreseeable social consequences. Uterus transplantation (UTx) provides a particularly illuminating case within contemporary Sunni bioethics because it extends the permissive principle established through IVF while raising questions about the limits of third-party reproductive involvement. This article reconstructs an influential contemporary Sunni framework for justifying UTx and critically examines its conceptual coherence, particularly its account of legally relevant third-party involvement and necessity. These difficulties provide the basis for the article’s central normative argument: that the justification of emerging biomedical interventions must extend beyond their immediate medical objectives to include their foreseeable interaction with existing social structures. To develop this argument, the article introduces the concept of structural risk and uses it to identify when foreseeable social consequences should become part of the justificatory assessment itself. It further argues that this proposal does not introduce an external normative standard into Sunni jurisprudence but develops an interpretive approach grounded in the doctrine of maṣlaḥa mursala, which already authorizes jurists to consider public welfare where the revealed sources provide no explicit ruling. Although developed through the case of UTx, the proposed framework applies more generally to the ethical justification of emerging interventions introduced into socially constraining environments.
A human leukocyte antigen-matched sibling is often the preferred donor in paediatric haematopoietic stem cell transplantation. However, ethical and legal concerns arise when the matched sibling is a minor, as the donor undergoes a medical procedure primarily for the benefit of another person and may be subject to significant familial and emotional pressure. In Malaysia, recently updated professional guidance addresses minor donor assent and independent advocacy. However, these provisions remain recommendatory rather than legally enforceable, and the guidance is silent on psychosocial assessment and post-donation care. This article examines how healthcare professionals in a Malaysian transplant setting understand and navigate the protection of minor sibling donors. Drawing on semi-structured interviews with 15 clinicians, nurses, and coordinators at a public hospital, the study identifies five interrelated themes: biologically driven donor selection, informal and inconsistent assent practices, constrained voluntariness within families, reliance on institutional discretion, and professional support for regulatory reform. The findings suggest that donor protection is shaped by a recipient-centred clinical framework in which safeguards are applied unevenly, inadequately documented, and largely dependent on local professional judgement. Using the Convention on the Rights of the Child, relational autonomy, and structural vulnerability as analytical lenses, the article explores how key safeguards such as assent, voluntariness, best interests, and donor welfare may be reduced from rights-based safeguards to matters of clinical discretion when they lack formal legal and institutional support. It argues that safeguards for minor donors, including independent advocacy external to the treating team, mandatory psychosocial assessment, and post-donation follow-up care, should be embedded within a binding regulatory framework rather than left to professional recommendation alone.
The paper presents a comparative and doctrinal discourse on surrogacy laws in India and places the Surrogacy (Regulation) Act, 2021, into the context of more general constitutional and ethical as well as transnational policies. It contends that the transformation of a commercial into an altruistic exclusive regime is indicative of a protective legislative motivation but creates strains around reproductive autonomy, equality and feasibility of regulations. The paper will show how various districts strike a balance between autonomy, concerns of exploitation and child welfare through structured comparison with two contrasting models of state regulation in the United States and the United Kingdom, which are contract driven or welfare driven. Going beyond the descriptive comparison, this paper critically assesses the proportionality as well as constitutional coherence of India exclusions and compensation ban especially against the backdrop of privacy and equality jurisprudence. It also evaluates enforcement realities, which emphasise the impacts of restrictive formal law on informal or cross-border surrogacy practice in a setting where there is limited institutional capacity. The article proposes a balanced reform agenda that is based on compensated altruism, institutional control, procedural protection as well as harmonisation of the standards with the international human rights. The paper provides a rights-based avenue to a balanced and workable system of surrogacy regulation by combining the doctrinal reasoning and comparative institutional analysis.
This paper develops the figure of the zhenyi (真医, “True Physician”), as a model of clinical excellence grounded in the philosophy of the Zhuangzi. Through the interrelated concepts of Dao (道), De (德), and Tian (天), and the practices of wuwei (无为) and xinzhai (心斋), the True Physician learns to perceive a patient’s life with sensitivity to its particularity, context, and natural unfolding. Contemporary medical ethics has done substantial work mapping the moral obligations and relational commitments of clinical practice. Such inquiries have tended to presuppose a prior capacity for perception and judgment, leaving comparatively underexplored the formation of that capacity and the habits and conceptual frameworks that shape what a clinician is able to notice. The Zhuangzian resources developed here, address this dimension, articulating how perceptual openness can be cultivated and rigid categories cleared, so that clinical action arises from true attunement to a patient’s life. The resulting account complements existing approaches by foregrounding the perceptual formation on which deliberation and care depend.
This paper argues that global public health ethics remains normatively incomplete, privileging Euro-American moral ontologies centered on individual autonomy, institutional authority, and procedural rationality, while marginalizing relational, communal, and character-based dimensions of moral life. It develops a relational ethical framework informed by Filipino moral philosophy, grounded in the interrelated concepts of kapwa (shared personhood), bayanihan (collective moral agency), and pagpapakatao (relational moral character), and advances these not merely as cultural descriptors but as normative responses that generate evaluative standards, guide ethical judgment, and justify action in public health contexts. The paper situates its contribution within existing debates on epistemic injustice and relational ethics while explicitly acknowledging the heterogeneity of moral traditions across the Global South. It further develops a sustained objection–reply engagement addressing relativism and defends a model of context-sensitive normativity grounded in shared human conditions of vulnerability and interdependence. The argument is supported through empirical illustrations drawn from disaster response, caregiving practices, and community health systems beyond the COVID-19 pandemic. Finally, the paper advances a methods–normativity bridge, demonstrating how participatory approaches such as Participatory Action Research (PAR) generate ethical validity through co-produced standards. The paper concludes by proposing a methodologically transferable model for global bioethics that advances relational, pluralistic, and contextually grounded ethical practice without collapsing into relativism or cultural exceptionalism.
Research ethics committees are often perceived by researchers as bureaucratic obstacles rather than as integral contributors to ethical research practice. Drawing on the authors’ dual roles as supervisors of research and ethics committee members, this commentary challenges that perception by situating ethics review within its historical, social, and political foundations. Tracing the evolution of modern research ethics from the Nuremberg Code and the Declaration of Helsinki tfvhrough landmark ethical failures such as the Tuskegee Syphilis Study and the Cartwright Inquiry, the paper underscores the enduring necessity of independent ethical oversight. It further examines contemporary ethical challenges in global health research, particularly the exploitation of vulnerable populations in low- and middle-income countries, highlighting persistent inequities around consent, standards of care, and post-trial access. At the same time, the commentary critiques overly procedural approaches to ethics review that may inadvertently marginalise communities, silence participant voices, or constrain culturally responsive research. The paper argues for a shift from viewing ethics committees as gatekeepers to recognising them as collaborative stewards of ethical research. By foregrounding reflexivity, situational ethics, and participatory approaches, it calls for a reimagining of ethics review as a dynamic, co-creative process that supports inclusive, socially responsible, and ethically robust research across diverse contexts.
In 2021, the Government of India amended the “Medical termination of pregnancy (MTP) act, 1971”, increasing the legal limit of gestational age (GA) from 20 to 24 weeks. We present data of 51 women who underwent MTP beyond the GA of 24 weeks. This study includes a retrospective analysis of 51 consecutive women who underwent MTP beyond the GA of 24 weeks from July 2023 to April 2024 after getting the necessary permission from the permanent medical board for abortion (beyond GA of 24 weeks) of our institute. The reason for the delayed presentation was ascertained by detailed interviews and the review of medical records. The MTP was conducted as per standard protocol. The study was approved by the institutional ethics committee (INT/IEC/2025/SPL-1175, dated 17 October 2025). The mean age was 27.4 ± 4.4 years. The mean (± SD) GA at MTP was 28.2 (± 2) weeks. 38 (74.5
Achieving universal health coverage (UHC) by the year 2030 is a major goal in global health. Recently, there has been an increasing recognition that dental care should be an integral part of national UHC insurance schemes. The recommendations from international groups such as WHO and the World Bank are that UHC for dental health care services should follow the general recommended model for UHC: Defining an essential package of health care services primarily by cost-effectiveness criteria that is gradually expanded over time. In this article, we show that countries such as Thailand and Indonesia, which have formal UHC, nevertheless still have persistent barriers of access and inequalities. In this article, we argue, by using Indonesia as a case study, that governments should, after they have provided a formal right to an extensive range of health care services to everyone, constantly identify gaps in coverage, and then systematically remove those gaps, not by attempting to identify additional interventions to be covered, but by focusing on how feasible the interventions are at increasing access to population groups that currently lack access, and by demonstrating that over time their policies with reduce inequality between groups.
Debates on end-of-life decision-making in Japan have often centered on treatment limitation—particularly the withholding and contested withdrawal of life-sustaining treatment—and on questions of permissibility, autonomy, and legal safeguards. While ethically important, this focus has tended to privilege rare and highly visible decision moments, leaving comparatively underexamined the everyday structuring of care that shapes treatment trajectories for far larger numbers of patients. This article introduces quiet large-scale triage (QLT) as a diagnostic framework for understanding how end-of-life trajectories are shaped within the institutional and practice-based structuring of care. Under QLT, options are filtered outside explicit deliberation—often before they become candidates for consent or refusal—through referral thresholds, resource constraints, care pathways, and routinized expectations. Here, “quiet” denotes ethical invisibility rather than intentional concealment, capturing how cumulative constraints limit feasible options without becoming recognizable as ethical decisions. The framework also clarifies how autonomy-supporting practices, such as advance care planning and do-not-resuscitate decisions, may become normatively entangled with institutional and practice-based constraints. Rather than adjudicating the permissibility of life-ending interventions, this perspective redirects ethical inquiry toward where accountability should lie when the structuring of care shapes options prior to explicit deliberation. By foregrounding routine allocation effects, the article provides a concise basis for ethical reflection on explanation, reviewability, and institutional responsibility in end-of-life care.
Although ethical decision-making in rehabilitation is increasingly complex, physical therapy remains marginal in mainstream philosophical bioethics. This paper critically interrogates the normative limitations of principlism, particularly the framework articulated by Beauchamp and Childress, in addressing moral dilemmas within physical therapy practice, especially in contexts characterized by systemic inequities, cultural plurality, and hierarchical institutional structures. Drawing upon my clinical experience as a licensed physical therapist in both the Philippines and the United States, I analyze ethically charged scenarios involving premature discharge, coerced consent, and institutional practices that undermine therapeutic justice. While principlism offers a widely accepted ethical schema, its abstraction and proceduralism often render it inadequate in morally ambiguous and relationally complex clinical situations. To respond to these limitations, I propose a more context-sensitive and philosophically robust framework by integrating Hare’s two-level utilitarianism, Habermas’s discourse ethics, feminist care ethics, and Kohlberg’s theory of moral development. These perspectives collectively reconceptualize ethical reasoning as dialogical, developmental, and attentive to the affective and political dimensions of care. Through philosophical analysis, narrative reflection, and engagement with lived clinical experience, I argue that physical therapists must be recognized not merely as technical practitioners, but as moral agents engaged in situated ethical judgment. This paper contributes to the evolving discourse on bioethics in allied health professions by foregrounding moral ingenuity, structural critique, and relational accountability as essential to ethical excellence in rehabilitative practice.
Human brain organoids (HBOs) are three-dimensional structures derived from human stem cells that model aspects of brain development and function, offering potentially unprecedented opportunities for studying neurological disorders and for developing treatments. This consensus paper presents recommendations from the Asia Pacific Neuroethics Working Group, developed through interdisciplinary collaboration among scientists, bioethicists, philosophers, and legal scholars who convened in Singapore in November 2024. We provide a comprehensive analysis of the ethical, legal, and sociocultural dimensions of HBO research, addressing both current realities and future possibilities. The paper examines key ethical considerations, including the potential moral status of HBOs, particularly regarding sentience and consciousness, while identifying and dispelling common misconceptions and “ethical red herrings” arising from sensationalized portrayals. We analyze consent frameworks for cell donation, privacy concerns, dual-use risks, and questions of distributive justice. Legal challenges are explored, including the categorical ambiguity of HBOs within existing regulatory frameworks, intellectual property issues, and cross-border inconsistencies in standards. Sociocultural perspectives emphasize the importance of public understanding, cross-cultural engagement, and empirical research on diverse community attitudes toward HBO research. In our recommendations, we advocate for evidence-based ethical discussions, anticipatory frameworks addressing potential future developments, contextualized analysis comparing HBOs to related experimental models, robust informed consent processes, proportionate responses to consciousness concerns, development of adaptive regulatory frameworks, responsible science communication to manage public expectations, and sustained interdisciplinary collaboration. We emphasize a balanced approach that promotes scientific innovation while maintaining rigorous ethical oversight, recognizing HBOs’ significant potential for advancing neuroscience and medicine. This represents the first comprehensive ethical framework for HBO research from the Asia Pacific region, helping to establish foundational principles for responsible development of this rapidly advancing field.
This article examines the ethical and pedagogical significance of integrating historical memory into medical education, drawing on the author’s visit to the former site of Unit 731 in Harbin, China, and a subsequent dialogue with a Chinese medical student. Unit 731 was a covert division of the Imperial Japanese Army that conducted fatal biological experiments during World War II. Despite its historical gravity, this topic remains largely absent from Japanese medical curricula. Through a reflective narrative, the article explores how experiential learning at historical sites and cross-cultural peer engagement can promote ethical sensitivity, emotional awareness, and professional identity formation among medical students. The paper situates this case within broader debates surrounding academic freedom, political restraint, and moral responsibility in ethics education. It highlights the dilemmas of balancing psychological safety with the necessity of confronting historical wrongdoing and of maintaining educator neutrality while taking moral stances. Drawing on frameworks such as narrative medicine and Hans Jonas’s imperative of responsibility, the author argues for a model of ethics education that transcends rote normative instruction, emphasizing reflective engagement with ethically complex histories. While based on a single case, the paper offers a broader call to rethink how ethically sensitive history can be addressed in medical training. Ethics education that critically engages with the past and fosters international dialogue is indispensable for nurturing physicians with ethical autonomy, committed to human rights, peace, and global responsibility.
Rituals in medical practice have either been seen as an anthropological aspect of current biomedical processes or as a pre-scientific aspect of complementary and alternative medicine (CAM). In either tendency, the literature has since failed to account for these rituals as rituals—conveyors of meaning, expressions of identity, and even as a rite of passage from illness to wellness. As an alternative to current discussions, this paper presents the case study of tawas, a diagnostic ritual from Philippine traditional medicine that determines personalistic and mystical causes of illnesses. As a non-intrusive procedure, tawas involves incantations and some ritual objects, e.g., rice, candle, axe, etc., that do not pose any direct harm nor benefit to the patient. While complete reliance on tawas at the expense of proper medical procedures could harm patients, the very ritual of tawas itself occupies a limbo within non-beneficence and non-maleficence. Following a Wittgensteinian perspective of treating rituals as meaning-laden human activities, this paper argues that rituals like tawas, much like other rituals embedded in biomedical practices, should be understood as rituals and not as empirical cures, thereby allowing their tolerance in medical practice in general.
This study explored challenges experienced by healthcare providers (HCPs) in intensive care units (ICUs) during the COVID-19 pandemic, focusing specifically on communication and care interactions, and examined how these experiences impacted ICU practices and provided opportunities for improvements. Semi-structured interviews were conducted with 16 ICU physicians and nurses from October 2022 to March 2023. Interview data were analyzed through thematic analysis. Nine themes emerged, categorized into three key areas. (1) “Challenges and Adaptations Experienced by HCPs” described how stringent infection-control measures created emotional and practical difficulties, prompting adaptive strategies to maintain effective care. The pandemic reinforced the critical role of interdisciplinary cooperation; in response, an interdisciplinary conference was organized, and HCPs intentionally sought closer collaboration than was usual to ensure coordinated decision-making and the continuity of care. (2) “Interactions Among Patients, Families, and HCPs” emphasized that visitation restrictions impaired family involvement, although proactive measures by nurses, such as the introduction of remote visits, significantly facilitated family engagement and emotional support. (3) “Lessons Learned from the Pandemic” highlighted improved healthcare practices and reinforced the value of interdisciplinary collaboration and family-centered approaches in ICU care. The findings underscore the necessity of robust communication practices and interdisciplinary teamwork within ICUs. These pandemic-related experiences offer valuable insights for improving communication, supporting flexible visitation policies, and promoting patient- and family-centered approaches. Collectively, these lessons offer essential guidance for developing more resilient and compassionate ICU care strategies, applicable in future crises and in everyday practice.
The use of Artificial Intelligence (AI) in healthcare is increasing in Indonesia, but faces challenges related to Indonesia’s communal and hierarchical cultural context. Ethical issues are becoming increasingly complex, not only in terms of the principles of beneficence and non-maleficence, but also in relation to humanization and care in doctor-patient relationships. The position of AI in healthcare is determined by doctors’ perceptions. This study captures doctors’ perceptions of the use of AI in healthcare services in relation to the principles of bioethics and ethics of care, within the context of Indonesia’s culture. The study used a descriptive qualitative approach through in-depth semi-structured interviews with twenty-five doctor participants practicing emergency services in Indonesia. The results revealed four spectrums of AI integration within the clinical autonomy of doctor: (1) as a doctor’s assistant/tool, (2) as a co-pilot with a specific role, (3) as a doctor’s discussion partner, and (4) as a reinforcement of doctor recommendations. These four spectrums reflect ethical issues between the basic principles of bioethics and the humanism of doctor-patient relationships influenced by communal and hierarchical culture. A collaborative approach between the basic principles of bioethics and the ethics of care is seen as more contextual to Indonesia’s communal and hierarchical culture, to minimize the risk of dehumanization. The practical implication of these findings is the need for training for doctors, not only about AI, but also ethics of care and empathetic communication.
