research paper about religion in the philippines

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Social Distancing as a Recontextualization of Filipino Values and Catholic Religious Practices: A Response to the COVID-19 Pandemic

Joseph renus f. galang.

1 Theology and Religious Education Department, De La Salle University, 2401 Taft Ave, 0922 Manila, Philippines

2 Graduate School, Angeles University Foundation, Mac-Arthur Hi-Way, 2009 Angeles City, Philippines

Jose Ma W. Gopez

3 Center for Christian Formation and Praxis, Angeles University Foundation, Mac-Arthur Hi-Way, 2009 Angeles City, Philippines

Ivan Efreaim A. Gozum

Philip joseph d. sarmiento.

4 Christian Living Education Department, Holy Angel University, 1 Holy Angel Avenue, Sto. Rosario St., 2009 Angeles City, Philippines

This paper investigates Catholic religious practices and Filipino values in the Philippines during the COVID-19 pandemic. It aims to show that religious practices conducted with proper social distancing help in the development of a renewed understanding of Filipino values without contributing to the spread of the virus. This qualitative study makes use of expository writing and content analysis. First, religious practices before the pandemic marked by maximum social interaction are presented. Then, the paper shows religious practices during the pandemic marked by social distancing. Thirdly, the paper looks into how Filipino values are recontextualized in relation to religious practices despite the need for social distancing during the COVID-19 pandemic. Ultimately, the researchers claim that those who participate in religious practices with social distancing do not contribute to the transmission of the virus while still developing a renewed understanding of Filipino values.

Introduction

Religion as a social institution.

Religion is a social institution. French sociologist Émile Durkheim ( 1912 ) defined religion as a “unified system of beliefs and practices relative to sacred things”. For many, religion is a fundamental dimension of human existence (Koenig, 2012 ). It teaches about practices and beliefs that serve the needs of a society, leading historians to believe that religion is a potent force to effect social change (del Castillo et al., 2021 ). Religion is something that is present, in one way or another, in all societies.

Religion also fulfils the human need for social interaction. Etymologically, the term “religion” may have come from the Latin religare , to bind (Galang et al., 2018 ). One of its main purposes, therefore, is to bring people together and form some level of connection and interaction. As human beings, social interaction is necessary in the upkeep of overall health and well-being. Engaging in social interaction, through a social support group, is crucial to physical and psychological health for the elderly (Steptoe et al., 2009 ). A study found that social interaction through support groups led to reduced levels of depression (Cohen et al., 1986 ). Another revealed that those who participated in social activities were more likely to report good or very good health status than those who did not participate (Sirven & Debrand, 2008 ). Many other studies have posited that belonging to and interacting with a social group help ease the innate burden of being alive.

The human need for social interaction is responded to by religious practices. Religion is one social institution which paves the way for the creation of social groups. Through religious practices conducted in churches, mosques or temples, people are able to engage in social interaction and find some level of social support. Religious practices, mostly communal in nature, vary from festivals and pilgrimages to matrimonial and funerary services to community engagement and outreach services. In religious practices, people are able to find two kinds of connection. First, through religious practices, people are able to connect with the supernatural, or what Durkheim ( 1912 ) calls the “sacred”. The “sacred” is that which is ideal and transcendent from quotidian existence; it is extraordinary, fear-inducing and awe-inspiring. This is closely similar to what William James describes as the “religious experience”, an aggregate of “the feelings, acts…of individual men…so far as they apprehend themselves to stand in relation to what they may consider the Divine” (James, 2004 ). In here is a human-divine connection, or what can be called a spiritual communion. But what is equally important in the practice of religion is the human–human connection. Humans are naturally relational beings. The relationships formed through religious practice promote a spirit of community, an idea that is commonly preached by almost all religions. It is from these human–human relationships that people draw a lot of strength, will and purpose to continue living. This gives religion its social dimension.

A recent study shows the importance of these human-divine communion, and human–human community (Chan et al., 2019 ). Initially, the study says that having a belief system, establishing an idea of what is “sacred”, can adequately substitute for some functions of human relationships. Essentially, it says that believing in God helps socially disconnected people have a better sense of, or restore their, purpose for living. The feeling of belonging is connected to one’s sense of purpose. “When people feel socially connected, their judgments of meaning in life are primarily derived from the highly salient information about their social belongingness” (Chan et al., 2019 , p. 4). The same researchers disclaim, however, that though God and religion provide a “substitutive connection”, quality human-to-human relationships still remain as the primary source of purpose in living. Religious practices provide avenues in establishing and enhancing these human-to-human connections, thereby forming part of a certain religious culture.

Filipino Cultural Values in Context

In the Philippine context, many cultural values are also strongly linked to religion and religious practices. “Filipino culture affords many traditional values that are deeply consonant with the Christian vision” ( Catechism for Filipino Catholics , 1997, #792). A Filipino value system starts with pagsasarili , or self-reliance, which is the prerequisite for any kind of moral responsibility ( Catechism for Filipino Catholics , 1997, #792;). Pagsasarili is the sense of developing oneself to become responsible (de la Costa,  1971 ) not only of oneself, but also of others. Pagsasarili , however, is quickly transcended in pakikisama . On the surface, pakikisama is about getting along with others ( Catechism for Filipino Catholics , 1997, #792; National Catechetical Directory of the Philippines , 1985, #28); more deeply, it is an authentic appreciation of being together, where unity and harmony are evident (Macaraan, 2019 ). There is also pakikiramay , or empathy, expressed in emotional mutual assistance when in need (Sarmiento, Sibug, Lumanlan, Bonus, & Samia, 2017 ). From pakikisama and pakikiramay develop pagkakaisa , or communal oneness (Lanaria, 2014 ). Above all, the umbrella term for all these Filipino values is pakikipagkapwa-tao , or being there for the other ( Catechism for Filipino Catholics , 1997, #792; New National Catechetical Directory of the Philippines , 2007, #40, #89), practicing solidarity in support of each other (Enriquez, 1992 ). In pakikipagkapwa-tao is an interpersonal behaviour which sees the other as another self.

Many Filipinos are aware that these values are the proper building blocks to a genuine community. Catholic Filipinos are frequently reminded by priests in homilies about how essential these values are in proclaiming God’s kingdom on earth. It is, therefore, through the practice of religion, in the context of the family, that these unique Filipino values are first developed and then honed (Gozum, 2020 ).

The Emergence of the COVID-19 Pandemic

The spread of the 2019 coronavirus disease (COVID-19), however, has put a halt to the conduct of these religious practices. Communal religious practices, by their very nature, promote social interaction since they involve mass gatherings. While participation in long-duration mass gatherings is beneficial to well-being (Tewari et al., 2012 ), joining religious gatherings involving masses of people may do more harm than good to one’s health and well-being (Wildman et al., 2020 ). According to the World Health Organization (WHO) ( 2020 ), the coronavirus disease, named COVID-19, is an “infectious disease caused by a newly discovered coronavirus” originating in Wuhan province in China. The virus has not been previously identified in humans (Ocampo & Yamagishi, 2020 ). It spreads primarily through salivary droplets or nasal discharges during coughing, sneezing or simple exhaling by an infected person. Any person can be infected when the virus is inhaled if one is within close proximity of an infected person. According to the Centers for disease control and prevention (CDC), transmission can also happen when a person touches a contaminated surface and makes contact with the mucous membranes on the face such as on the mouth, on the nose or on the eyes. This is because droplets and discharges which may contain the virus are not able to remain airborne and instead land on the floor and other surfaces surrounding the infected person (Singhal, 2020 ).

Though there are still debates on how the virus emerged, COVID-19 has been declared as a pandemic and has halted most forms of operations throughout the world, including religious practices. After the expiration of stay-at-home orders, various governments have enforced social distancing, alternatively known as physical distancing, which involves keeping a safe distance of about six feet, or approximately two metres, between oneself and people not from one’s household, in both indoor and outdoor spaces. With social distancing in full implementation, naturally, this would mean the inability of religious organizations to perform the usual religious practices which involve mass gatherings of people in small spaces in churches, mosques and temples (Baker et al., 2020 ).

The Philippine Government’s Response to the Pandemic

The Inter-agency task force (IATF) for the Management of Emerging infectious diseases (EID) in the Philippines convened in January 2020 to make recommendations in addressing the coronavirus pandemic. The IATF is mandated to assist those infected with the virus, minimize the entry of possible carriers in the country, and prevent the local spread of the virus in the country. Living up to its name, the IATF is chaired by the Department of Health, and composes of a majority of agencies which comprise the executive department of the Philippine government, including agriculture, finance, education, foreign affairs, communications, labour and employment, security, social welfare, tourism, transportation and others.

The IATF recommended community quarantine measures to curb the transmission of the virus. On 16 March 2020, the President imposed what was called an “Enhanced community quarantine” (ECQ) in the main island of Luzon, effectively a total lockdown. This involved the restriction of people’s movement except from necessity for work and health emergencies. Also, this mandated the temporary closure of what were considered as non-essential business and establishments, including churches. As the quarantines eased about two months after the lockdown, the IATF formulated a “Modified enhanced community quarantine” (MECQ), where church activities are limited to a gathering of 10 persons; then, a “General community quarantine” (GCQ), where venues for religious activities can be filled up to 30% of their capacity; and finally, a “Modified general community quarantine” (MGCQ), where seating capacity was allowed at 50%. More than a year later, the country saw a surge of COVID-19 cases in April, forcing the government to impose tighter restrictions to control mobility for another two weeks (Jalea, 2021 ).

Philippine Catholic Church’s Response to the Pandemic

In an effort to safeguard their members while still fulfilling their spiritual needs, the Catholic Church in the Philippines has religiously followed these government protocols. A circular letter by the Catholic bishops’ conference of the Philippines (CBCP) on 16 May 2020 issued recommendations and guidelines for liturgical celebrations amidst the quarantine protocols. The letter said that two ways have “emerged and become effective ministerial channels” (p. 1) during the quarantine: the use of social media through livestreamed and televised liturgy, and the liturgy with the faithful in attendance (Valles, 2020 ). Later, Church authorities cancelled processions, visits to cemeteries and other religious mass gatherings (Calleja, 2020b ). Archbishop Romulo Valles, CBCP President, echoed Pope Francis April 17 homily: “This is the Church in a difficult situation that the Lord is allowing, but the ideal of the Church is always with the people and with the sacraments—always” (Glatz, 2020 , n.p.). While the virus has stopped Filipinos from physically going to church, it has brought them new ways of promoting the Filipino values while practicing their faith which can never be taken away from them.

This paper, then, aims to understand the religious practices and Filipino values during the COVID-19 pandemic in the Philippine context. First, the paper presents Filipino religious practices before the COVID-19 pandemic; then, compared to the religious practices during the same pandemic. Finally, the paper looks into how Filipino values are recontextualized in relation to religious practices despite the need for social distancing during the COVID-19 pandemic.

Methodology

This qualitative study uses expository writing in the form of content analysis as its method. Expository writing is designed to explain a topic to give facts, explain ideas or define conditions to provide deeper insights to readers (Hubbard, 2012). Furthermore, as a method which analyzes data and interprets its meaning, the qualitative content analysis done in this paper involves three methods: preparation, organization, and reporting of results (Elo et al., 2014 ). In this process, to enhance the integrity of knowledge-building systematic reviews, the researchers made rigorous literature search processes on religion, Filipino values and the COVID-19 pandemic, as transparent as possible (Finfgeld-Connett & Johnson, 2013 ). The used documents in this paper were online journal articles downloaded from the world wide web through accessing electronic databases such as SCOPUS, EbscoHost, ProQuest Online, Google Scholar and other sources.

This study analyses values that are deeply embedded in Filipino culture in order to recontextualize them. Culture has both explicit and implicit characters (Nuncio et al., 2016 ). The explicit characters include the observable behaviours, symbols and rituals, such as the way people dress, the kind of food they eat, the way they express their beliefs. The implicit characteristics include a group of people’s underlying values and unwritten norms which guide people as to how to act appropriately (Miller, 2005 ). Considering this, even Filipinos who do not observe the health protocols and those who do not have the values under analysis in mind are still included in the recontextualization process. This interpretation and recontextualization of Filipino values are not accomplished only through positive evidence, but also by recognizing the negative, even contradicting, realities that permeate Filipino society.

Results & Discussion

Filipino religious practices before the covid-19 pandemic.

According to Vatican News (“Philippine Church releases logo for 500 years of Christianity”, 2019 ), the Philippines has about 81% of its estimated population of some 100 million identifying themselves as Catholics, considered to be the home to Asia’s largest Catholic population. The coming of the Spaniards during the early sixteenth century paved the way to the birth of Christianity in the country (del Castillo, 2015a , 2015b ). In fact, each barangay , or village, in the country honours a particular patron saint. In the northern part of the country, millions of devotees of the Black Nazarene flock the feast every 9 th of January. The festive celebration is called the traslacion , from the Spanish for transfer , the most massive procession in the country. The miraculous mid-eighteenth-century image of the suffering Christ, a dark-skinned, kneeling Jesus carrying the cross, is usually set in an all-day procession for public adoration brought by millions of barefooted devotees to and from the Minor Basilica of the Black Nazarene in Quiapo, Manila (Aguinaldo, 2002 ). Based on the numbers recorded from 2004–2014, a significant increase of 4,000%, from 300,000–12,000,000 devotees attended the yearly celebration (Guidaben, 2014 ). Because of the massive attendance in this feast, January 9 is declared as a holiday in the city of Manila, suspending work and classes in both public and private sectors (Aguilar, 2021 ). Meanwhile, the southern region of the country celebrates the Sinulog festival in honour of the Santo Niño or the Holy Child Jesus every third Sunday of January. This annual religious and cultural festival commemorates the historic background of the Filipinos in becoming Christians through Spanish colonialism from their indigenous animistic beliefs (Reyes, 1985 ). The recent festival held in 2019 reported at least 1.5 million devotees who joined the foot procession (Mayol & Mondragon, 2019 ) wherein all pilgrims repeatedly shout, “Viva Pit Señor!” , meaning “Hail Lord, listen to our prayers”. These two major religious festivities in the country go along with a nine-day preparation with the celebration of the Holy Eucharist—the novena Masses—with a big crowd awaiting the day of the celebration itself. Thus, the expression of communal faith of the Filipino people is in itself a manifestation of the constant need for social interaction.

The apostolic visits of Roman pontiffs in the country were also venues of social gathering and interaction among the Filipinos. So far, there have been three popes who have visited the Philippines, namely: Paul VI, John Paul II, and Francis. Undoubtedly, all their historic visits attracted public gatherings among Filipino Catholics. The second visit of the late John Paul II as a pope was in January 1995 to celebrate the 10 th World Youth Day. During his last day of visit, there were more than four million Filipinos who participated in the Mass of John Paul II (Medina & Antonio, 2014 ). This visit set the record as the largest papal crowd in history at that time. The coming of Francis to the country in January 2015, in the same place where John Paul II celebrated the Mass, broke the record. A Vatican official mentioned that Pope Francis’ Holy Mass in the Philippines surpassed the present record of the largest papal crowd in history, with an estimated 6 to 7 million Filipinos gathering in Manila (Pullella & Francisco, 2015 ). Despite the heavy rains, Filipinos managed to stay just to receive the papal blessing. Truly, papal visits, which rarely happen in the life of a Filipino, are social expressions of the communal faith of Filipinos.

Another form of public religious gathering in the country is the celebration of Misa de Gallo and Semana Santa . Misa de Gallo, or Simbang Gabi in Filipino, is an enduring religious tradition in the Philippines as a spiritual preparation for Christmas Day (Pateña, 2018 ). This famous Filipino pre-Christmas tradition begins on December 16 and ends on December 24, when massive hordes of faithful attend the nine-day dawn Masses. Despite being set in the wee hours of the morning, usually at 4o’clock, both the interiors and exteriors of churches are filled with Filipino Mass-goers, going in as entire families. Simbang Gabi is also recognized by Catholic Filipino communities who are living around the world because this Filipino tradition is a strong indication of the depth of Catholicism among the Filipino people (Mendiola, 2018 ). Similarly, the Simbang Gabi honours Inang Maria, or Mother Mary, highlighting her contribution in the history of salvation and emphasizes her important virtues in Filipino culture (Carbayas & del Castillo, 2020 ). In the Philippines today, the Misa de Gallo is celebrated for the perseverance of a nation in the Christian faith and the preservation of religion in the world.

After the Christmas season, the next most highlighted religious Filipino tradition is the observance of the Semana Santa —the Holy Week (Sarmiento et al., 2017 ). This occasion is just as special to Filipinos as Christmas is (Thomas, 2017 ). Semana Sanata is traditionally a solemn occasion and a time for serious atonement in the Philippines. Many Filipinos during Semana Santa observe religious practices as an expression of gratitude to God. Devout Filipino Catholics even go to church the entire Holy Week while observing fasting and abstinence. It begins with the celebration of Palm Sunday that commemorates the triumphant entry of Jesus Christ in Jerusalem, bringing their palaspas, palm fronds, to church to be blessed by the priest during the Mass. Then, they bring the blessed fronds back home with them. After the Palm Sunday celebration, the traditional Pasyon, the uninterrupted reading or chanting of verses about the suffering of Christ, starts, and ends on Holy Wednesday in most places. In some other parts of the country, however, the chanting of the Pasyon extends up to Good Friday, the day commemorating Jesus’ burial; those singing believe that they are accompanying the grieving mother of Jesus. Maundy Thursday, the day commemorating Jesus’ last supper with his disciples, is mostly celebrated by the Filipino community through Visita Iglesia wherein they visit at least seven churches’ altars of repositories, embellished with fresh and beautiful flowers, and the consecrated host as the showpiece. The most striking feature of holy week celebrations in the Philippines is observed every Good Friday. It is one of the holiest days in the country. In the morning, Filipino catholics, mostly barefooted, pray the way of the cross on Good Friday. Some Filipino penitents self-flagellate in public, a form of re-enactment of the suffering and death of Jesus. They whip their backs full of blood while others carry heavy wooden crosses along the streets. Provinces such as Pampanga and Nueva Ecija are famous for their flagellants who cover their faces with a white cotton hood with crowned thorns on their heads. Good Friday stages a re-enactment play— Senakulo, from the Spanish cenáculo – that depicts the story of life, passion, and resurrection of Jesus Christ. The dramatization is oftentimes held in a hilly area in the town, sometimes just within the church, where curious tourists could watch (Thomas, 2017 ). In San Pedro Cutud, a barangay in Pampanga, a popular expression of faith and religiosity happens every three in the afternoon of Good Friday—the ritual of nailing on the cross of some penitents who promise to do a sacrifice for their faith in the hopes of being rewarded by a divine response to their prayers (Tiatco & Bonifacio-Ramolete, 2008 ). This is witnessed by thousands of spectators from all over the country, even from abroad. On the evening of Good Friday, faithful gather for the long procession of life-sized statues of the Santo Entierro (dead Christ) and Mater Dolorosa (sorrowful mother) as a preparation for Black Saturday when Christ is buried and entombed. Filipinos spend the day preparing for the night vigil leading up to Easter Sunday—the resurrection of Christ. The holy week celebration in the Philippines is culminated by attending a salubong —literally welcoming—ceremony commemorating how the Blessed Virgin Mary met her son Jesus who has come back to life. This coincides with the Easter Sunday liturgy. The Semana Santa attracts not only Filipinos, but also a good number of tourists around the world to witness this long-standing tradition of the Filipinos (Table ​ (Table1 1 ).

Summary of recontextualization of Filipino values during the COVID-19 pandemic

Filipino religious practices are not celebrated alone. Faith, in the Filipino perspective, is more communal than personal. These religious events are manifestations of the Filipino community’s faith in God. Social gatherings are inseparable from the faith experiences of Filipinos.

What happens, now, when Filipinos are not allowed to gather to express their faith?

Filipino Religious Practices during the COVID-19 Pandemic

On 16 March 2020, Philippine President Rodrigo Duterte imposed an enhanced community quarantine in the main island of Luzon to mitigate the spread of the coronavirus. With this, worship places for the diverse religions in the country were forced to close. As a preventive measure, instead of worship places being opened for the public, during the pandemic, religious services were held online (Meza, 2020 ). Quickly and efficiently, religious activities from the catholic Church, such as Masses, were now streamed through Facebook or YouTube so that the faithful can still attend such activities. These actions, which go towards virtualization and online contacts, are done by the Church because social distancing is required so that the transmission of COVID-19 will be lessened (Sulkowski & Ignatowski, 2020 ).

For this reason, the suspension of public gatherings changed the liturgical life of the Catholic Church since the usual physical participation in the church is prohibited (Corpuz & Sarmiento, 2021 ). Following this, the faithful are given an option to attend Masses at home by watching online. Even the World Health Organization proposed guidelines which require members of the Church to maintain physical distance, hold online celebrations, and prevent touching and kissing devotional or other objects (World Health Organization, 2020 ). Thus, this shift from physical to virtual celebrations is a collaborative effort for the Church and the government to curb the spread of the virus.

During the ECQ in the country, going outside one’s home, unless one is part of the skeletal workforce and healthcare, is strictly prohibited. This setup made one’s home as the place of worship since those who attend Masses are just at home participating in the online worship (Corpuz & Sarmiento, 2021 ). In fact, Valles proposed recommendations and guidelines on how the liturgical celebrations during the pandemic should be held. Valles ( 2020 ) accentuated that during this new setup, the use of social media and rediscovery of the domestic church has been the ways in which the Church can still fulfil the mission of evangelization. As an example, the Holy Father Francis live streamed from the Library of the Apostolic Palace last 7 March 2020 for the praying of the Angelus (Corpuz & Sarmiento, 2021 ). Hence, social media has been the primary platform for evangelization and liturgical celebrations during the ECQ.

Holy Week celebrations were also held online. Masses, retreats, and other practices were held virtually. Esmaquel ( 2020 , n.p.) states that “videos of how to make their own palaspas or palm fronds circulated in Catholic social media circles, while families prepared their makeshift altars and priests readied their laptops and webcams”. These videos that circulated online showed that the holy week is not an exemption to breach the quarantine protocols. Even the famous Visita Iglesia, the Lenten tradition to visit seven different churches on Maundy Thursday, and Pasyon, the uninterrupted chanting of the passion narrative of Jesus, were held online. In an article published in 2014, Paje ( 2014 , p. 32) reports that “the Visita Iglesia online featured 11 churches during the Lenten Season of 2013 which a devotee could “visit” through short video documentaries uploaded using youtube”. The idea that was discussed by Paje years ago regarding a website for visita iglesia became relevant and useful in celebrating the holy week during the ECQ. Several Facebook pages from different parishes and vicariates in the country posted photos of different parishes so that the faithful can visit them virtually. To support this practice, the CBCP launched a website so that, even while staying in the safety of their homes, the Catholic faithful can do a virtual church visit on Holy Thursday (Santos, 2020 ).

Apart from this, death and burial practices were also changed. Recognizing that death and burial practices are spiritual interventions by the Church, they must be done with strict compliance with the health protocols against COVID-19 (Sarmiento, 2021 ). Due to the COVID-19 pandemic, the bereaved are to hold wakes for a shorter period of time. Also, the guidelines during the pandemic forced the families of the people who died—or suspectedly died—due to the coronavirus, to cremate the remains of their loved ones (Sarmiento, 2021 ). This change in practices clearly shows that the Church is sincere in collaborating with the government to lessen the spread of the virus. This is rooted in the willingness of the leaders of the Church so that they can contribute for the greater good during the pandemic (Sulkowski & Ignatowski, 2020 ).

Then, from 16 May 2020–1 June 2020, the government placed some provinces in GCQ and MGCQ. With this, those provinces that are under GCQ can let their churches accept churchgoers up to 30% of the seating capacity. On the other hand, those provinces that are under MGCQ can let their churches accept churchgoers up to 50% of the seating capacity. While attending Masses, churchgoers are required to maintain physical distance. Also, it was emphasized that churchgoers should follow the IATF guideline which prohibits the elderly, the young, the sick, and the children since they are outside the allowed age range to go out of their houses (Valles, 2020 ). Moreover, live streamed and televised Masses are encouraged to be continued so that the faithful will not be urged to go out of their homes just to fulfil their church obligation. Meanwhile, in regard with the priest and lay ministers, the CBCP recommended that they should wash and sanitize their hands before and after each celebration, wear face masks always, practice social distancing in the sanctuary, and limit lectors, altar servers, and choir members to a minimal number (Valles, 2020 ).

In addition, all church goers must always wear face masks and face shields. Markers should be provided by the church so that the faithful can maintain the allowed distance while seating. Moreover, the CBCP recommends augmenting the schedule of Masses to lessen the number of attendees in each Mass (Valles, 2020 ). Also, the entry and exit points should be well supervised by ushers so that physical distancing will be maintained. To further supervise the proper protocols at the entry and exit points, thermal scanners, foot baths, and hand sanitizers should be provided. In regards with the offertory and preparation of gifts, the CBCP recommends that “a deacon (if present) or a server may bring the missal, chalice, paten/ciborium, and cruets of wine and water to the altar, while the priest remains at the chair. (Alternatively, the priest could do this himself.) After the deacon or servers move away, the priest could come to the altar and arrange the items on the altar. The lavabo should be done by the priest alone, without assistance, at the credence table near the altar” (Valles, 2020 ). For the collection, long-handled baskets could only be acceptable if the ushers can remain at a suitable distance from others (Valles, 2020 ). If not available, designated boxes or collection points should be provided so that social distancing can be observed.

Apart from these, the Holy Communion will only be distributed on the hand so that the faithful will not remove their face masks while receiving the body of Christ. However, as long as they are in an accepted distance, they are asked to consume the sacramental bread immediately. To ensure the safety of those who will receive communion, the eucharistic ministers should wear face masks and sanitize their hands before distribution of Holy Communion (Valles, 2020 ). Also, tapes should be placed on the floor to indicate the proper spacing between the people so that they will be properly guided while standing in line. Moreover, holding of hands during the Lord’s prayer and shaking of hands during the sign of peace are to be prohibited (Valles, 2020 ). Lastly, proper disinfection of the place of worship should be done before and after the Mass.

For the rite of baptism, the CBCP recommends that the attendees inside the church should be limited to immediate family members and to one or two godparents (Valles, 2020 ). While attending baptism, the people inside the church should always wear face masks and face shields and observe social distancing. Also, the baptismal water should be clean and blessed, while the holy oils should be applied, using cotton, on the one being baptized (Valles, 2020 ). The used cotton with holy oils should be burned immediately after the celebration. As for the rite of confirmation, the confirmation Mass for the year can be foregone except for those who will be married. If this is the case, the parish priest should be the one to administer the sacrament. Apart from this, weddings will be simpler because of the required social distancing. The secondary elements of the wedding ceremony will be foregone. Only the bride and the groom, the parents of the couple, and one set of sponsors are to be present in the ceremony (Valles, 2020 ). Because confession requires a face-to-face meeting between the confessor and the penitent, it is preferable that they be heard outdoors, where there is better circulation of air and additional space for safe distance (Valles, 2020 ). Also, it is highly recommended that the Oratio Imperata against COVID-19 be prayed after communion. The Mass in Time of Pandemic, a plea “for God's mercy and gift of strength in the midst of the coronavirus pandemic” (Wooden, 2020 ), can also be celebrated.

Additionally, since Catholicism in the country is known for festive events, such as fiestas , parishes are asked to not hold any celebration. Instead of processions in which many people attend, images of Jesus, Mary, and saints will have a motorcade. This is done while the faithful prayerfully wait for the motorcades of devotional images pass-by. Some of the events that were affected by the pandemic were the annual re-enactment of the coronation of the blessed Virgin Mary in her title “ Virgen De Los Remedios” in the province of Pampanga every September 8 (Manabat, 2020 ), the annual feast of Our Lady of Penafrancia in Bicol region, and the many feast day celebrations in various villages and towns especially during the month of May. Instead of the usual celebration wherein thousands of devotees attend, these events were streamed on Facebook and broadcasted on TV and radio stations. To add, the simbang gabi and Christmas Eve Mass were live streamed while those who attended physically followed the safety protocols and guidelines released by the CBCP.

Moreover, a more famous feast in the country affected by the pandemic is the feast of the Black Nazarene. This event usually gathers millions of attendees in Manila yearly. For the celebration, the Quiapo Church has instilled a 400-person cap for each of the 15 masses that will take place on the January 9 feast, which means only 6,000 will be able to attend services inside the church (Catholic News Agency 2021). This is the allowed number of attendees because Manila was still under GCQ by then. To aid those who were not able to enter the church, large screens outside the church were displayed. Also, instead of kissing the statue, a practice also known as pahalik , attendees were able to venerate and pray with the statue, which was visible on the church’s balcony (“Attendance limited at Black Nazarene Masses in Philippines”, 2021 ). To add, smaller images were suggested to be brought by the attendees instead of the usual large replicas. Even though the feast was still celebrated, the traslacion , the yearly 19–24 h procession, was cancelled.

The following actions by the Catholic Church were done so that the transmission of COVID-19 will be mitigated. However, with this setup, the experience and values that the people gain from attending religious practices might have changed. With this, the next part of this paper tackles a recontextualization of Filipino values in religious practices during the COVID-19 pandemic.

Recontextualizing Filipino Values during the COVID-19 Pandemic

An individual’s decision-making regarding their social mobility during the pandemic is highly influenced by cultural traits such as religious practices and values (Deopa & Forunato, 2020 ). “[C]ulture is seen as a connection to each individual, and it expresses the collective sense of the behaviour of people which in return this behaviour contributes to spreading or suppressing the COVID-19 virus” (Lagman et al.,  2021 ). So, how can Filipino values and religious practices be understood during the COVID-19 pandemic?

The value of pagsasarili , or self-reliance, was manifested during the early days of the pandemic. When there was little information about the virus and how it was transmitted, Filipinos were quick to follow stay-at-home orders by the government. Through this, Filipinos were, to a certain extent, forced to rely on their ingenuity in terms of satisfying their basic needs, ranging from physical to social. Pagsasarili is also expressed in quarantining at home. In these early days of darkness, Filipinos’ religious and spiritual needs were fulfilled through attendance in the Holy Mass live streamed on social media platforms. Pagsasarili is also when the faithful’s involvement in the liturgy was transformed from a communal church service to a house church (Corpuz & Sarmiento, 2021 ). What was supposed to be a communal celebration in the flesh, in the actual presence of the faithful, turned into a virtual ceremony in the spirit. For the priest, there was no visible congregation; for the congregation, there was only the priest, and a few select individuals such as readers and sacristans. Unusual, but Filipinos carried on, for they recognized that pagsasarili is also the foundation for any moral responsibility (Catechism for Filipino Catholics, 1997 , #792). To practice pagsasarili , therefore, means taking responsibility for any spread or transmission of the virus, and the most morally responsible action to avoid any of this is to stay at home.

Transcending pagsasarili as quarantine protocols relaxed, Filipinos were allowed to go out of their homes, but were frequently reminded to follow minimum health protocols. During the pandemic, pakikisama as getting along with others has been translated into wearing of face masks and face shields, and frequent hand washing and sanitation. Whether in the workplace or in restaurants, one cannot get along with another without the necessary protection from the virus. In church, pakikisama is expressed in the avoidance of kissing and touching of sacred images. Pakikisama is taking time and effort to fill-in contact tracing forms and having one’s temperature checked; some parishes have utilized technology such as QR (Quick response) codes in tracking the flow of worshippers. In welcoming the congregation, church administrators have ensured the disinfection of the place of worship. On a higher level, pakikisama is the genuine appreciation of togetherness. Filipinos are a highly sociable people. So, when each person is considered as a potential carrier of the virus, there can be no genuine appreciation of togetherness without the proper health protection. One cannot focus on the practice of one’s faith if the other is without proper protection.

For Filipinos, getting along means maintaining interpersonal relationship both in good times and in bad; hence, there is pakikiramay , or mutual assistance in various forms. As the quarantine protocols went on, more and more Filipinos became unemployed (de Vera, 2020 ), with families going hungry. The Filipino value of pakikiramay was evidently at play as various religious organizations rapidly provided emergency supplies such as food, clothing, and cash (Calleja, 2020a ). Some relief responses during the pandemic were organized by private individuals, but most were coordinated with the social action centres of parish churches or dioceses. Termed as ayuda , from the Spanish help , donations both in the form of cash and goods flowed freely from donor to beneficiary, with parish churches acting as mere passages for distribution, while also integrating its own contributions. Especially in the midst of a world crisis, the Catholic Church in the Philippines again proved to be a trustworthy agent of human generosity. The spirit of pakikiramay brought both food and hope to the Filipino dining table. Caritas Manila, the social action arm of the Archdiocese of Manila, distributed gift certificates which can be used to buy food and other basic needs (Patinio, 2021 ). In pakikisama and pakikiramay is pagkakaisa , or communal oneness, in times of plenty and paucity. One concrete example of pagkakaisa was the emergence of community pantries which are the results of the efforts of concerned citizens to meet the primary needs of people (Gozum et al., 2021 ), such as food and hygiene essentials (del Castillo & Maravilla, 2021 ).

Finally, there is the overarching principle of pakikipagkapwa-tao that pulls together all these Filipino values. In pakikipagkapwa-tao is the ultimate cultural value since it shapes an individual’s shared identity where the self and the other become one (Sapitula, 2013 ). The primary basis for individuality, then, is not only in one’s self-reflection, but also in one’s regard for the other. Additionally, pakikipagkapwa-tao has a reflexive nature in the sense that what is good for oneself is good for the other and, therefore, shared; in parallel, what is detrimental for one is also accepted as detrimental for the other (Enriquez, 1992 ). Therefore, in the context of religious practices during the COVID-19 pandemic, pakikipagkapwa-tao can be understood as social distancing, as simply keeping a healthy and necessary separation between each other in order to avoid viral transmission. Filipinos have a high level of sensitivity to the quality and nature of their interpersonal relationships since much of their happiness and security come from these. They are a religious people. It is in their nature to desire to engage in religious practices as much as possible, while at the same time ensuring the observance of the two-metre separation, thereby helping curb the transmission of the virus. During the pandemic, the relationship between sarili , the self, and kapwa , the other, exists in an empty, “socially distanced”, space. Paradoxically, it is this distance that connects the self with the other. It is in this empty space—that which is inherently intangible, but when shared becomes tangible—where pakikipagkapwa-tao lies.

Filipino culture and the Catholic faith are deeply intertwined. Even prior to the Christianization of the Philippines, early traditional Filipino religion practiced by natives shared similar religious constructs with Catholicism (del Castillo, 2015a , 2015b ). The natives, however, were confronted with a foreign culture and religious tradition, giving way to the misappropriation of faith. To authentically send the message of the Gospel, “the Church [must establish] in such a way that it [the Gospel] makes sense to the people’s local cultural context. It is necessary for Christianity to meet the people’s deepest needs and penetrate their worldview” (F. A. del Castillo, 2015a , 2015b ). Similarly, today, there is a need to recontextualize. Filipinos face the need to understand the importance of religious practices during the pandemic, while at the same time making sense of Filipino values in the current situation, for these values are in consonance with their Catholic faith.

The Filipino values of pagsasarili , pakikisama , pakikiramay , pagkakaisa and pakikipagkapwa-tao lead to an experience of kagandahang-loob , a culturally appropriated term referring to God’s “gracious goodness” (de Mesa, 1988 ). From a Filipino lens, God’s identity is revealed through a person’s own kagandahang-loob , interpreted as the “goodness and benevolence that arises from the very core of one’s personhood” (de Mesa, 1988 ). Filipinos have a high regard for the other, as evidenced by these values, since the kapwa , the other, reflects the goodness of God. Ultimately, there is nothing unique in how Filipinos find their values as motivations to do good, nor in how Filipinos faced the pandemic. What is to be pointed out, however, is that Filipino religious practices and Filipino values are so closely intertwined that an understanding of both, and their relationship, is necessary and crucial to a strong Filipino response to the COVID-19 pandemic.

The Philippine Catholic Church is well known for the grand festivities and mass gatherings. In some parishes in the country, different individuals devote themselves to daily Masses, rosary, and novenas. On Sundays, churches are known to be full since the faithful attend Mass together with their families as part of their Sunday obligations. However, the sudden outbreak of COVID-19 altered the way Catholics attend their usual expressions of their religiosity. Because of the ECQ, instead of participating in Holy Masses and other religious gatherings physically, they attend virtually through the aid of technology. Attending Masses, praying the rosary, and praying novenas are done through Facebook and YouTube live streams. In this manner, even though the faithful are in the comforts of their homes, they can still fulfil their obligation and devotion in their faith.

When the IATF shifted quarantine measures from ECQ–MGCQ, attending Masses physically was allowed but with strict restrictions on the number of attendees and implementation of safety measures. Parishes whose province is under MGCQ strictly followed and observed the safety protocols of IATF. This cooperation between the Philippine Catholic Church and the government was an avenue for both institutions to lessen the transmission of COVID-19. However, the question remains: with social distancing during religious practices, can Filipinos still have a grounded understanding of their values? Filipinos need to redeem their cultural values to re-appropriate the Christian values brought to them by their western colonizers, especially during the COVID-19 pandemic. It is through a recontextualization of these values that Filipinos are able to assert their cultural and religious identity.

Due to the lockdown, Filipinos showed the value of pagsasarili. This is evident during the initial stages of the community quarantine wherein they relied solely on themselves. Even when attending religious celebrations, they are at home isolated from other people outside. Though this value seems selfish at first glance, it is really being selfless at the same time. Staying at home and isolating oneself from others is, therefore, the most morally responsible action so that one does not contribute to the spread of the coronavirus. Even as quarantine protocols relaxed, the value of pakikisama was proven by following the necessary health practices.

Apart from these, the Filipino value of pakikiramay was experienced during the pandemic. Pakikiramay was expressed through giving aid to the poor and the sick. The Philippine Catholic Church also showed this value when they provided programs to aid those who are greatly affected by the pandemic. These actions showed pakikiisa or unity among Filipinos. Also, the value of pakikipagkapwa-tao was proven strong by Filipinos since they became responsible towards one another during the pandemic. Social distancing, even though difficult at first, became the avenue for Filipinos to practice the value of pakikipagkapwa-tao. In attending Masses, following the safety measures and protocols before, during and after the mass is the Filipino expression of pakikipagkapwa-tao.

Lastly, these values are all rooted in the human person’s kagandahang-loob, which is their innate goodness. As a country filled with people inclined towards religion, Filipinos showed their goodness during the pandemic by becoming responsible citizens. In these religious practices they participate in, Filipinos do their best to show their goodness by maintaining social distancing and following safety protocols. During the pandemic, the Filipinos highly manifest the values of pakikisama , pakikiramay and pagkakaisa not only through physical distancing, but also by concretely reaching out to those in need amidst the fear of infections. The religiosity of the people is a lived experience of God’s kagandahang-loob .

This study analysed values that are deeply embedded in Filipino culture in order to recontextualize them. Even Filipinos who do not observe the health protocols and those who do not have the values under analysis in mind are still included in the recontextualization process. This interpretation and recontextualization of Filipino values are not accomplished only through positive evidence, but also by recognizing the negative, even contradicting, realities that permeate Filipino society. Looking at these values, one realizes how flexible and multi-dimensional they are in certain contexts or situations. The pandemic showed that Filipino values, no matter how distant people are with one another, will always be lived because they are at the core of every Filipino. Ultimately, in religious practices and values, Filipinos show that there is still hope amidst the pandemic.

Authors’ Contribution

All authors contributed to all aspects of the paper.

No funding was received from this paper.

Declaration

The authors declare no conflict of interest in this paper.

The paper is compliant with ethical standard as it does not involve human or animal subjects.

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Joseph Renus F. Galang, Email: [email protected] .

Jose Ma W. Gopez, Email: [email protected] .

Ivan Efreaim A. Gozum, Email: [email protected] .

Philip Joseph D. Sarmiento, Email: hp.ude.uah@otneimrasjp .

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The quincentenary of the Catholic Church in the Philippines is a testimony to the Christian mission’s value. This study explores the various perspectives on faith and the Catholic Church in the Philippines by elaborating the 1) Christianization of the Philippines, 2) Religious Articulations of Filipino Youth, 3) Basic Ecclesial Communities, and 4) Tracing God’s Presence and the Christian Mission. It aims to unravel the salience of religion among Filipinos, the embedment of Christian faith in culture and society, and its various articulations in modern times. The paper concluded that the commemoration of the 500 years of Christianity continues to challenge the Filipino Catholics to lead lives of heroic love and become modern witnesses to the love of Christ.

Eric Eusebio

This essay is a sequel to a previous article on “The Object and Means of Catechesis in Contemporary Philippine Catechetical Magisterium,” published in the preceding issue of East Asian Pastoral Review. The first part presents concrete examples of catechetical programs and manuals that seek to apply the principle of integration expressed in Philippine magisterial documents, especially in the National Catechetical Directory for the Philippines of 1984 (NCDP) and its 2007 revised edition, the New National Catechetical Directory for the Philippines (NNCDP). These manuals under study are used primarily for family, parish, and school catechesis, respectively. The second part of this essay provides some recommendations directed towards the further improvement of catechesis in the Philippines.

This essay examines the reality of “multiplicity” to someone engaged in grassroots missions in the Philippines. After introducing the notion of multiplicity, I use three stories to explore its implications for doing theology in diverse Filipino contexts.

Doing Theology in the Philippines, J. Suk (ed.) Mandaluyong City: OMF Lit; Quezon City: Asian Theological Seminary, 2005. 3-23

Timoteo Gener

Every Filipino Christian can do theology and this practice of theology will result in a more dynamic mission-oriented, culture-engaging faith. I will be making three points. First, I will define what I mean by local theology or-as I will more commonly call it-contextualization. Here I claim that participation is both an Evangelical ("every believer, a minister") and also a Filipino value (pakikiisa, pakikilahok). Second, I will assert the urgency of making local theology more accessible, participatory and practical for Filipino churches. Finally, I will suggest how every Filipino Christian can practice local theology.

Victor Korniejczuk

This paper summarizes some stage theories of religious development which are rooted in the Piagetian tradition. Some of the assumptions and presuppositions of R. Goldman, D. Elkind, J. Fowler, F. Oser are discussed. On the basis of exploratory studies about the development of the concept of salvation in children and adolescents among the SDA population, some suggestions are presented as a new theoretical model of religious development applicable to many religious populations.

Imron Widjaja

This study examines the management of christian religious education as one form of shepherding service formation in cell groups in maturing, guiding and directing to apply the word of God. Christian religious education management as a model and example in the formation of church pastors in reaching sinners for Christ. This research was conducted at GBI Graha Pena with a total sample of 88 people who were active in participating in cell groups. The results of this study indicate that educational services are good that have led to pastoral care in realizing the Quality of Faith of GBI Graha Pena congregation members to reach people who do not yet believe in Christ. The effectiveness of the implementation of pastoral services that lead to the tasks and objectives of the church's mission through cell groups seen from members of cell groups who see the effectiveness of the service is supported by effectiveness: 58 respondents visitation (65.9%), help of sick people 88 respondents (10...

The Reflection (ISSN 2546-0544)

Philip Joseph Sarmiento

This paper articulates the possible emerging themes of Catholic education in the Philippines. A profile review of some well-known Catholic educational institutions was done to analyze their own charism or identity. The paper concludes that Catholic educational institutions formulated their charisms based on the life and teachings of their patron saints or founders making their institutions unique but they adhered to the same principles of Catholic education. Though many but one heart and mind in mission, Catholic educational institutions bring Filipinos closer to Jesus. After all, they only serve their true purpose when they can turn their students to emulate Christ. Catholic educational institutions should also make it a point that they remain " Catholic " and " Filipino " in fulfilling their mission to the society.

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Cultural Relativity and Acceptance of Embryonic Stem Cell Research

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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.

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]

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, 109 th 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

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[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

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[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

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Mifrah Hayath

SM Candidate Harvard Medical School, MS Biotechnology Johns Hopkins University

Olivia Bowers

MS Bioethics Columbia University (Disclosure: affiliated with Voices in Bioethics)

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