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Engaging Students in Physical Education

Sarah sliwa.

Health scientist in the Division of Population Health at the Centers for Disease Control and Prevention in Atlanta, GA

Allison Nihiser

Health scientist in the Division of Nutrition, Physical Activity, and Obesity Prevention, at the Centers for Disease Control and Prevention in Atlanta, GA

Nathan McCaughtry

Assistant dean in the Division of Kinesiology, Health and Sport Studies at Wayne State University in Detroit, MI

Associate professor in the Department of Health Promotion and Physical Education at Kennesaw State University in Kennesaw, GA

Shannon Michael

A well-designed physical education (PE) program is inclusive, active, enjoyable and supportive (SHAPE America – Society of Health and Physical Educators, 2015 ). Irrespective of location, programs are affected by a host of issues in the midst of various school and community climates. Trends toward urbanization in the United States (U.S. Census Bureau, 2012 ) and worldwide ( World Health Organization, 2016 ) suggest that more and more PE teachers will be working in urban settings.

In October 2009, JOPERD published a special symposium about “Engaging Urban Youths in Physical Education and Physical Activity” (Murgia & McCullick, 2009). Seven years later, many of those considerations remain relevant, such as large class sizes ( Dyson, Coviello, DiCesare, & Dyson, 2009 ; Schmidlein, Vickers, & Chepyator-Thomson, 2014 ) and limited access to equipment ( Schmidlein et al., 2014 ), a dedicated gymnasium ( Fernandes & Sturm, 2010 ), or outdoor space ( Dyson et al., 2009 ; Hobin et al., 2013 ). These structural challenges matter. For example, some data suggest that larger class sizes and indoor lessons are associated with students spending significantly less time in moderate-to-vigorous physical activity and with teachers spending more time on classroom management ( Skala et al., 2012 ). In addition, high rates of teacher turnover ( Ingersoll, Merrill, & Stuckey, 2014 ), difficulties communicating with English language learners (ELLs; Kena et al., 2016 ), and low self-efficacy ( Fletcher, Mandigo, & Kosnik, 2013 ) affect teachers’ ability to engage students in PE in urban settings.

The purpose of this article is to identify attributes of urban settings that influence how PE is taught, and to provide action-oriented strategies for addressing challenges and making the most of available resources.

To start the process, the authors conducted a comprehensive literature search to identify journal articles about urban PE, published between 1980 and 2015 from CINAHL, PubMed, Sociological Abstracts, ERIC, PsycNET, SPORTDiscus, and Google Scholar. The search identified 135 articles on research that took place in the United States, Canada or the United Kingdom; that included urban settings; and that addressed PE. The research team reviewed and coded articles to identify recurrent themes. The authors then prioritized themes that they believed would be relevant and actionable for practitioners in urban settings and focused the review on actions that can be taken at the school level, where teachers have direct influence, as opposed to district-level strategies ( Tozer & Horsley, 2006 ).

The review was designed to look for articles featuring schools in urban areas. Still, some of these findings will likely resonate with readers who work outside of city spaces. For example, rural schools experience some of the same structural challenges (e.g., limited resources, shared space), demographic challenges (student mobility, ELL students), and contextual challenges (e.g., neighborhood safety, gang violence, high rates of child poverty) as many urban schools ( Hennessy et al., 2010 ; Hertz & Farrigan, 2016 ; Jacob, 2007 ; Moore et al., 2010 ). Similarly, teachers in all settings are likely to encounter disruptive behaviors ( Lavay, Henderson, French, & Guthrie, 2012 ).

The strategies discussed here highlight the importance of preservice training and ongoing professional development, reflective and responsive instructional practices, and partnerships with academic and community institutions.

Tailor Professional Development and Physical Education Teacher Education Training for Teachers in Urban Settings

Recent graduates of physical education teacher education (PETE) programs may be underprepared and overwhelmed when starting work in urban schools, especially new teachers who have had no prior professional experience in this setting ( O’Neill, 2009 ; Sato, Fisette, & Walton, 2013 ) and those whose sociodemographic and geographic backgrounds differ from those of their students ( Culp, 2011 ; O’Neill, 2009; Pope & O’Sullivan, 1998 ). Some research has suggested that veteran PE teachers may become frustrated when changing community demographics require adaptations to an established teaching approach ( Chen, 1999 ; Griffin, 1985 ). Several studies have described scenarios where white PE teachers in schools with a majority of minority students found it difficult to effectively connect with students ( Chen, 1999 ; Flory & McCaughtry, 2014 ; Griffin, 1985 ; O’Neill, 2009; Pope & O’Sullivan, 1998 ).

Increasing teachers’ cultural competency may help ease some, but not all, of this friction. Although PE teachers from communities of color may demonstrate greater cultural competency than their white counterparts ( Harrison, Carson, & Burden, 2010 ), starting work in a new school underprepared is challenging nonetheless ( Sato, et al., 2013 ). In one qualitative study, several black PE teacher candidates reported feeling unsure of how to navigate cultural norms and stereotypes, including students’ perceptions of “white” and “suburban” sports (e.g., lacrosse), after starting to work in urban areas without relevant preservice training ( Sato et al., 2013 ). Recognizing this reality, faculty at multiple institutions have called for more specialized training that better prepares preservice students and early-career teachers for working in urban settings by including coursework and readings that address sociocultural issues, by placing less emphasis on team sports, and by increasing preservice teachers’ exposure to schools in urban communities ( Chase et al., 2011 ; Flory & McCaughtry, 2014 ).

Enhance Participation by Communicating Relevance, Creating a Mastery Climate, and Connecting with Students

Identify relevant content and instructional practices.

Some PE teachers in urban settings have difficulty determining appropriate content to teach and have identified a tension between wanting to introduce students to a variety of ways to be active and deferring to games and sports that students identify with culturally and locally in order to maximize engagement and minimize conflict (i.e., “culture of basketball”; Culp, 2011 ; McCaughtry, Barnard, Martin, Shen, & Kulinna, 2006 ). Indeed, many students who do not perceive PE content to be personally relevant are inclined to disengage from the learning process, regardless of the setting. Finding the contextually appropriate balance between selecting PE content that resonates with student culture and exposing students to new movement opportunities can be challenging ( McCaughtry, Barnard, et al., 2006 ). Nevertheless, teachers should consider this seriously to maximize students’ connection and engagement with content ( McCaughtry, Barnard, et al., 2006 ).

As in many areas, especially those with large class sizes ( Bevans et al., 2010 ), urban PE teachers often spend large portions of PE classes on classroom management ( Dyson et al., 2009 ; Skala et al., 2012 ). Although PE teachers may be unable to directly address some of the underlying “outside of the classroom” challenges to student engagement (e.g., food insecurity, community violence; Borofsky, Kellerman, Baucom, Oliver, & Margolin, 2013 ; Culp, 2011 ; Lawson & Lawson, 2013 ), increasing teachers’ toolbox of pedagogical strategies and self-efficacy can assist teachers in maintaining a strong, learning-focused climate ( Martin, McCaughtry, Kulinna, & Cothran, 2009 ).

Some researchers have found that teacher interactions that support students’ personal and social responsibility and accountability are associated with fewer disruptions, increased participation, and greater enjoyment of PE ( Balderson & Sharpe, 2005 ; Garn, McCaughtry, Shen, Martin, & Fahlman, 2011 ; Li, Wright, Rukavina, & Pickering, 2008 ). In an effort to support active participation and to limit off-task activities, some teachers offer games over skills-based activities because students might enjoy games more than repetitive skill learning. However, students who seek attention from peers may see large-sided games as an opportunity to showcase disruptive behavior for a ready audience ( Garn et al., 2011 ; Rovegno, 2008 ). Reducing the visibility of any one child’s performance or skill via small-sided games or activities may reduce some disruptions when students feel less on display ( Garn et al., 2011 ). Researchers and teachers alike have also identified split-gym, smaller-group activities, and circuits as effective ways of increasing movement in a large class within limited outdoor or indoor space ( Chase et al., 2011 ). How teachers communicate with students and the kinds of feedback they give can further influence student engagement ( Kahan, 2013 ; Morgan & Kingston 2008 ).

Create a Mastery Climate

Previous reviews have highlighted the importance of a mastery-focused environment ( Rovegno, 2008 ) that supports student engagement, effort and enjoyment in PE ( Gutierrez & Ruiz, 2009 ; Martinek & Williams, 1997 ; Morgan & Kingston, 2008 ). Providing feedback and input regarding student progress is an important piece of creating a mastery climate, and PE teachers should be mindful of the kinds of comments they give in public and what attributes they emphasize (e.g., effort versus performance; Morgan & Kingston, 2008 ).

Other mastery-supportive practices include ( Kahan, 2013 ):

• providing students with opportunities to practice in small groups or with a partner;
• placing less importance on winning; and
• teaching activities that do not favor the most skilled students.

Connect with Students

Building a sense of relatedness, that is, students’ perceived connection to their PE teachers and classmates, can enhance motivation for physical activity in PE ( Cothran & Ennis, 1999 ; Shen, McCaughtry, Fahlman, & Garn, 2012 ). Showing interest in students can help build that sense of relatedness and also boost teachers’ own satisfaction ( Culp, 2011 ). Conversations with students can also help teachers gather information to increase the relevance of their lessons. For teachers with a large proportion of ELLs, learning a few phrases in students’ native languages can help foster a connection ( Flory & McCaughtry, 2011 ). Researchers have also called for increased cultural competency ( Harrison et al., 2010 ) and culturally relevant PE curricula in urban settings ( Flory & McCaughtry, 2014 ) and more generally ( Choi & Chepyator-Thomson, 2011 ; Culp, 2013 ), in recognition of the growing ethnic and racial diversity across the United States ( Colby & Ort-man, 2015 ; Johnson & Lichter, 2010 ). Cultural competency requires teachers to become knowledgeable about their students, and to continuously observe, reflect and adapt ( Flory & McCaughtry, 2014 ; Harrison et al., 2010 ). This process seems broadly relevant to increasing student engagement.

Actions to Support Student Engagement

Here are some actions PE teachers can take to support student engagement.

Ask your students! Do what you can to know your students and to become known by students, parents and the community ( Flory & McCaughtry, 2014 ). Learn about the activities that students like and want to learn and use this feedback to inform lesson plans ( Doolittle & Rukavina, 2014 ; Kahan, 2013 ; Stride, 2014 ). For example, when developing a coordinated school physical activity program in an urban middle school, one PE teacher offered volleyball and table tennis as sports early on due to strong interest from students, including many ethnic Chinese students, at the school ( Doolittle & Rukavina, 2014 ).

Increasing cultural competence involves becoming aware of one’s own assumptions, beliefs and biases ( Culp, 2013 ). Hidden biases may be influencing your performance expectations and interactions with students in ways you do not realize. Project Implicit ( https://implicit.harvard.edu/implicit/ ) provides validated assessments that have been widely used to test such hidden associations ( Nosek, Greenwald, & Banaji, 2005 ; Nosek & Smyth, 2007 ). These include no-cost assessments that are related to race, sex and weight.

Listen and “Bridge the Distance.”

Try to provide context for students’ comments and tie the conversation back to the curriculum ( Culp, 2011 ). Look for “teachable moments” that can both show respect for students’ experiences and advance understanding and learning ( Culp, 2013 ).

Brian Culp described how a teacher who taught in the southeastern United States, but who grew up playing ice hockey in Canada, reacted to his students when they laughed and said, “Black people don’t play hockey” ( Culp, 2011 ). Instead of ignoring the comment, the instructor came back to class with examples of black athletes in the National Hockey League and continued the planned lessons. He communicated relevance while providing an opportunity for students to develop skills related to a new sport ( Culp, 2011 ). Seeing someone who students believe is similar to them perform an action provides a “vicarious experience,” which can increase their confidence to perform that same action ( Bandura, 1977 ). Visual aids can be used to promote self-efficacy. As an example, teachers have reported greater participation among African-American girls in PE activities when presented with images/posters of black female athletes ( McCaughtry, Martin, Kulinna, & Cothran, 2006 ).

Address Challenges through Strategic Partnerships

Institutions of higher education are often an important asset in urban areas. Partnerships with these institutions can enhance PE by:

• training future leaders through PETE programs;
• providing professional development opportunities to current teachers and coordinating the development of professional learning communities ( Hemphill, Richards, Blankenship, Beck, & Keith, 2012 ; Tozer & Horsley, 2006 ) and teacher mentoring programs ( Cothran et al., 2009 ; Hemphill et al., 2012 ; Martin, McCaughtry, Kulinna, Cothran, & Faust, 2008 );
• piloting and evaluating new programs and curricula to help build the evidence base ( McCaughtry, Krause, McAuliffe, Miotke, & Price, 2012 ); and
• collaborating on competitive grant applications ( Hemphill et al., 2012 ; O’Sullivan, Tannehill, Knop, Pope, & Henninger, 1999 ).

Engaging preservice students in professional development opportunities with practicing urban PE teachers can yield mutual gains ( Hemphill et al., 2012 ; LaMaster, 2005 ). Through such partnerships, preservice students have gained more experience in school settings and have learned from veteran teachers who, in turn, were exposed to new activities and teaching approaches ( LaMaster, 2005 ). Similarly, school–university partnerships can enhance professional development opportunities.

One-day trainings risk overloading teachers with information ( Kulinna, McCaughtry, Cothran, & Martin, 2006 ). Additional supports and follow-up are needed to help teachers put into practice changes in curricula and assessments ( Kulinna et al., 2006 ; Kulinna, McCaughtry, Martin, & Cothran, 2011 ) or pedagogy (e.g., increase student-driven decision making; Ko, Wallhead, & Ward, 2006 ). Urban PE teacher–mentoring programs and peer learning opportunities can help fill the gap by providing support beyond inservice trainings ( Cothran et al., 2009 ; Martin et al., 2008 ).

Realistically, these collaborations take years to develop and multiple iterations to refine and troubleshoot ( Hemphill et al., 2012 ; LaMaster, 2005 ; McCaughtry et al., 2012 ; O’Sullivan et al., 1999 ). One example of an urban university–public school partnership is the Detroit Healthy Youth Initiative between faculty and staff at Wayne State University and the PE teachers and administrators at Detroit public schools. The initiative has been in action for about 15 years, and through this relationship a range of professional development opportunities and at-school support, including a mentor system, were created, and grant funding was secured to enhance teachers’ knowledge of wellness curricula, instructional technologies, and individualized lifetime-fitness activities ( McCaughtry et al., 2012 ). More information about this partnership and other successful university–school partnerships can be found in the JOPERD feature, “The Dynamics of Promoting Sustained School–University Partnerships” ( Patton, 2012 ).

The Carol M. White PEP Grant Program is one example of a funding mechanism that has been highlighted as a catalyst for collaboration between schools and universities ( Deglau & Barnes, 2009 ; Hemphill et al., 2012 ; Rovegno, 2008 ). This program is not currently authorized for funding under the Every Student Succeeds Act (ESSA), which means it lacks legal support to operate at this time. There are still opportunities to collaborate with academic partners on funding applications, as well as advocacy efforts and research initiatives to help make the case for dedicating more resources to PE.

Engage Community Partners to Address Structural Challenges

Schools located in urban settings are less likely to have a dedicated gymnasium or access to outdoor spaces ( Dyson et al., 2009 ; Fernandes & Sturm, 2010 ; Hobin et al., 2013 ). Just as joint-use agreements can extend the use of school facilities to parents and community members ( Jones & Wendel, 2015 ), agreements or permits with nearby community parks and playgrounds, universities, or recreation centers can support students’ use of facilities that are not available at school in order to connect students with community opportunities for physical activity to extend their learning in PE ( Chase et al., 2011 ; Doolittle & Rukavina, 2014 ). Applying for permits takes both time and knowledge of local government policies and personnel, yet this process can be taken on by a motivated teacher ( Doolittle & Rukavina, 2014 ).

It is not uncommon for PE teachers to purchase equipment with their own money ( McCaughtry, Barnard, et al., 2006 ). Though it may take time to establish them, partnerships with local businesses can secure in-kind donations or funding to support equipment purchases ( Chase et al., 2011 ). Similarly, university support on grant applications and funding requests can be leveraged to provide professional development and new equipment for PE ( Deglau & Barnes, 2009 ; McCaughtry et al., 2012 ). School fundraisers, organized through parent-led organizations or associations, can benefit PE programs ( Doolittle & Rukavina, 2014 ). Individual PE teachers or other school champions can apply to grant programs that are awarded at the school level ( Doolittle & Rukavina, 2014 ). These include national initiatives, such as Let’s Move! Active Schools, the Presidential Youth Fitness Program, Fuel Up to Play 60, state SHAPE/AHPERD organizations, and even private organizations that support causes related to physical activity, sport and children’s health (e.g., hospital networks, health insurance providers and their affiliated foundations).

Forming Partnerships with Institutions of Higher Education and Community Organizations

Much has been written about how successful university and K–12 school partnerships can develop and flourish ( Catelli, 1992 ; Hemphill et al., 2012 ; McCaughtry et al., 2012 ; O’Sullivan et al., 1999 ; VanSickle & Schaumleffel, 2015 ). School- and district-level administrators may already have relationships with university contacts. Teachers can approach school leaders with ideas for university collaborations to identify next steps.

Here are some dynamics to keep in mind:

• Before reaching out, assess your needs. What are you looking to gain through this partnership? Collect some information to back up your request. This could be as simple as reviewing your equipment and space, and then conducting a local inventory to identify nearby playgrounds, fields or recreation centers that could help meet needs through permits.
• Outline and agree to shared expectations. Create a memorandum of understanding before launching your work with a college or university. Consider what it would take to make the time investment worthwhile ( VanSickle & Schaumleffel, 2015 ). What outcomes does each organization expect will stem from this collaboration? Look for faculty members who have experience working in your community and a demonstrated interest in the goals and objectives of the proposed collaboration.
• Recognize the importance of different roles. Academic partners often bring knowledge of evaluation design and experience developing curricula and applying behavioral theories. Yet, school staff are experts on their school context, processes and interpersonal dynamics. It may take time to develop the relationships needed to communicate openly and to trust one another, but this is an essential step ( O’Sullivan et al., 1999 ).
• Make time to plan. Frequent meetings are seen as a valuable way to share and respond to successes and challenges ( LaMaster, 2005 ). Though time-intensive, retreats can be highly productive and can help to strengthen relationships and understanding ( O’Sullivan et al., 1999 ).

Looking Forward

It is clear from the literature that teachers in urban settings work within many of the same constraints as they did 30 years ago. Further, many of these challenges are similar to those faced by teachers in other contexts. Two features stand out.

First, to be effective, PE teachers in urban settings have to understand the unique dynamics of their communities, families and students, and take what they learn and incorporate it into their curriculum and pedagogy. Knowing students allows teachers to tailor their pedagogical approach so that students find the educational process relevant, engaging and motivating. After all, student engagement is an essential component of any educational effort ( Lawson & Lawson, 2013 ; Zepke & Leach, 2010 ).

Second, K–12 schools do not exist in isolation. They are part of a wider community and network of potential resources, including parks, universities, community recreation programs, and funding opportunities. The key is having teachers and administrators recognize the opportunities that exist in their area and seek out partnerships that can help advance their goal of teaching children to be active and healthy. The density of potential partners in urban settings is a tremendous asset. Collaborative efforts with school, community and academic partnerships are expected to help school districts secure and make the most of funding opportunities — including evaluations to identify what works and dissemination efforts to make findings accessible.

Contributor Information

Sarah Sliwa, Health scientist in the Division of Population Health at the Centers for Disease Control and Prevention in Atlanta, GA.

Allison Nihiser, Health scientist in the Division of Nutrition, Physical Activity, and Obesity Prevention, at the Centers for Disease Control and Prevention in Atlanta, GA.

Sarah Lee, Health scientist in the Division of Population Health at the Centers for Disease Control and Prevention in Atlanta, GA.

Nathan McCaughtry, Assistant dean in the Division of Kinesiology, Health and Sport Studies at Wayne State University in Detroit, MI.

Brian Culp, Associate professor in the Department of Health Promotion and Physical Education at Kennesaw State University in Kennesaw, GA.

Shannon Michael, Health scientist in the Division of Population Health at the Centers for Disease Control and Prevention in Atlanta, GA.

• Balderson D, Sharpe T. The effects of personal accountability and personal responsibility instruction on select off-task and positive social behaviors. Journal of Teaching in Physical Education. 2005; 24 :66–87. [ Google Scholar ]
• Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review. 1977; 84 :191. [ PubMed ] [ Google Scholar ]
• Bevans KB, Fitzpatrick LA, Sanchez BM, Riley AW, Forrest C. Physical education resources, class management, and student physical activity levels: A structure-process-outcome approach to evaluating physical education effectiveness. Journal of School Health. 2010; 80 :573–580. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Borofsky LA, Kellerman I, Baucom B, Oliver PH, Margolin G. Community violence exposure and adolescents’ school engagement and academic achievement over time. Psychology of Violence. 2013; 3 :381. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Catelli LA. Against all odds: A holistic urban school/college partnership — Project SCOPE. Action in Teacher Education. 1992; 14 :42–51. [ Google Scholar ]
• Chase MC, Vollum M, Toebbe J, Clark GE, Magnotta J, Culp B, Ladda S. Ideas exchange: What are some suggestions for overcoming any unique challenges found in an urban physical education class? How might we better prepare physical educators for teaching in an urban setting? Strategies. 2011; 24 :6–9. [ Google Scholar ]
• Chen A. The impact of social change on inner-city high school physical education: An analysis of a teacher’s experiential account. Journal of Teaching in Physical Education. 1999; 18 :312–335. [ Google Scholar ]
• Choi W, Chepyator-Thomson R. Multiculturalism in teaching physical education: A review of U.S. based literature. ICHPER-SD Journal of Research in Health, Physical Education, Recreation, Sport & Dance. 2011; 6 :14. [ Google Scholar ]
• Colby SL, Ortman JM. (U.S. Census Bureau population estimates and projections). Projections of the size and composition of the US population: 2014 to 2060. 2015 Retrieved from https://www.census.gov/content/dam/census/library/publications/2015/demo/p25-1143.pdf .
• Cothran DJ, Ennis CD. Alone in a crowd: Meeting students’ needs for relevance and connection in urban high school physical education. Journal of Teaching in Physical Education. 1999; 18 :234. [ Google Scholar ]
• Cothran D, McCaughtry N, Faust R, Garn A, Kulinna PH, Martin J. E-mentoring in physical education: Promises and pitfalls. Research Quarterly for Exercise and Sport. 2009; 80 :552–562. [ PubMed ] [ Google Scholar ]
• Culp B. The archetypes and philosophical motivations of urban elementary physical educators. ICHPER-SD Journal of Research. 2011; 6 :40–47. [ Google Scholar ]
• Culp B. Eliminating barriers to physical activity: Using cultural negotiation and competence. Strategies. 2013; 26 :35–40. [ Google Scholar ]
• Deglau DA, Barnes D. Meeting the needs of urban youths in Columbus city schools. Journal of Physical Education, Recreation & Dance. 2009; 80 (8):41–45. [ Google Scholar ]
• Doolittle SA, Rukavina PB. Case study of an institutionalized urban comprehensive school physical activity program. Journal of Teaching in Physical Education. 2014; 33 :528–557. [ Google Scholar ]
• Dyson B, Coviello N, DiCesare E, Dyson L. Students’ perspectives of urban middle school physical education programs. Middle Grades Research Journal. 2009; 4 :31–52. [ Google Scholar ]
• Fernandes M, Sturm R. Facility provision in elementary schools: Correlates with physical education, recess, and obesity. Preventive Medicine. 2010; 50 (Suppl. 1):S30–S35. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Fletcher T, Mandigo J, Kosnik C. Elementary classroom teachers and physical education: Change in teacher-related factors during pre-service teacher education. Physical Education and Sport Pedagogy. 2013; 18 :169–183. [ Google Scholar ]
• Flory SB, McCaughtry N. Culturally relevant physical education in urban schools: reflecting cultural knowledge. Research Quarterly for Exercise and Sport. 2011; 82 :49–60. [ PubMed ] [ Google Scholar ]
• Flory SB, McCaughtry N. The influences of pre-professional socialization on early career physical educators. Journal of Teaching in Physical Education. 2014; 33 :93–111. [ Google Scholar ]
• Garn AC, McCaughtry N, Shen B, Martin JJ, Fahlman M. Social goals in urban physical education: Relationships with effort and disruptive behavior. Journal of Teaching in Physical Education. 2011; 30 :410–423. [ Google Scholar ]
• Griffin PS. Teaching in an urban, multiracial physical education program: The power of context. Quest. 1985; 37 :154–165. [ Google Scholar ]
• Gutierrez M, Ruiz LM. Perceived motivational climate, sportsmanship, and students’ attitudes toward physical education classes and teachers. Perceptual and Motor Skills. 2009; 108 :308–326. [ PubMed ] [ Google Scholar ]
• Harrison L, Jr, Carson RL, Burden J., Jr Physical education teachers’ cultural competency. Journal of Teaching in Physical Education. 2010; 29 :184–198. [ Google Scholar ]
• Hemphill MA, Richards AK, Blankenship BT, Beck S, Keith D. Making PALS through partnerships. Journal of Physical Education, Recreation & Dance. 2012; 83 (9):23–236. [ Google Scholar ]
• Hennessy E, Kraak VI, Hyatt RR, Bloom J, Fenton M, Wagoner C, Economos CD. Active living for rural children: Community perspectives using PhotoVOICE. American Journal of Preventive Medicine. 2010; 39 :537–545. [ PubMed ] [ Google Scholar ]
• Hertz T, Farrigan T. Understanding the rise in rural child poverty, 2003–2014. Washington, DC: U.S. Department of Agriculture; 2016. (Economic Research Service). Retrieved from https://www.ers.usda.gov/publications/pub-details/?pubid=45543 . [ Google Scholar ]
• Hobin EP, Leatherdale S, Manske S, Dubin JA, Elliott S, Veugelers P. Are environmental influences on physical activity distinct for urban, suburban, and rural schools? A multilevel study among secondary school students in Ontario, Canada. Journal of School Health. 2013; 83 :357–367. [ PubMed ] [ Google Scholar ]
• Ingersoll R, Merrill L, Stuckey D. Seven trends: The transformation of the teaching force. Philadelphia, PA: Consortium for Policy Research in Education; 2014. (CPRE research report #RR-80). [ CrossRef ] [ Google Scholar ]
• Jacob BA. The challenges of staffing urban schools with effective teachers. Future of Children. 2007; 17 (1):129–153. [ PubMed ] [ Google Scholar ]
• Johnson KM, Lichter DT. Growing diversity among America’s children and youth: Spatial and temporal dimensions. Population and Development Review. 2010; 36 :151–176. [ Google Scholar ]
• Jones SE, Wendel AM. Characteristics of joint use agreements in school districts in the United States: Findings from the school health policies and practices study, 2012. Preventing Chronic Disease. 2015; 12 doi: 10.5888/pcd12.140560. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kahan D. Here is what interests us! Students’ reconceived physical education activity offerings in an inner-city middle school. Physical Educator. 2013; 70 :243. [ Google Scholar ]
• Kena G, Hussar W, McFarland J, de Brey C, Musu-Gillette L, Wang X, Dunlop Velez E. The condition of education 2016. Washington, DC: U.S. Department of Education, National Center for Education Statistics; 2016. (NCES 2016–144). Retrieved from http://nces.ed.gov/pubs2016/2016144.pdf . [ Google Scholar ]
• Ko B, Wallhead T, Ward P. Chapter 4: Professional development workshops —What do teachers learn and use? Journal of Teaching in Physical Education. 2006; 25 :397–412. [ Google Scholar ]
• Kulinna PH, McCaughtry N, Cothran D, Martin J. What do urban/inner-city physical education teachers teach? A contextual analysis of one elementary/primary school district. Physical Education and Sport Pedagogy. 2006; 11 :45–68. [ Google Scholar ]
• Kulinna PH, McCaughtry N, Martin J, Cothran D. Effects of continuing professional development on urban elementary students’ knowledge. Research Quarterly for Exercise and Sport. 2011; 82 :580–4. [ PubMed ] [ Google Scholar ]
• LaMaster K. Collaboration in preservice physical education programs: Mutual gains. ICHPER — SD Journal. 2005; 41 :5–7. [ Google Scholar ]
• Lavay B, Henderson H, French R, Guthrie S. Behavior management instructional practices and content of college/university physical education teacher education (PETE) programs. Physical Education and Sport Pedagogy. 2012; 17 :195–210. [ Google Scholar ]
• Lawson MA, Lawson HA. New conceptual frameworks for student engagement research, policy, and practice. Review of Educational Research. 2013; 83 :432–479. [ Google Scholar ]
• Li W, Wright PM, Rukavina PB, Pickering M. Measuring students’ perceptions of personal and social responsibility and the relationship to intrinsic motivation in urban physical education. Journal of Teaching in Physical Education. 2008; 27 :167–178. [ Google Scholar ]
• Martin JJ, McCaughtry N, Kulinna PH, Cothran D. The impact of a social cognitive theory-based intervention on physical education teacher self-efficacy. Professional Development in Education. 2009; 35 :511–529. [ Google Scholar ]
• Martin JJ, McCaughtry N, Kulinna P, Cothran D, Faust R. The effectiveness of mentoring-based professional development on physical education teachers’ pedometer and computer efficacy and anxiety. Journal of Teaching in Physical Education. 2008; 27 :68–82. [ Google Scholar ]
• Martinek TJ, Williams L. Goal orientation and task persistence in learned helpless and mastery oriented students in middle school physical education classes. International Sports Journal. 1997; 1 :63–76. [ Google Scholar ]
• McCaughtry N, Barnard S, Martin J, Shen B, Kulinna PH. Teachers’ perspectives on the challenges of teaching physical education in urban schools: The student emotional filter. Research Quarterly for Exercise and Sport. 2006; 77 :486–497. [ PubMed ] [ Google Scholar ]
• McCaughtry N, Krause J, McAuliffe P, Miotke R, Price F. Detroit healthy youth initiative: Creating successful school–university partnerships. Journal of Physical Education, Recreation & Dance. 2012; 83 (9):28–36. [ Google Scholar ]
• McCaughtry N, Martin J, Kulinna PH, Cothran D. What makes teacher professional development work? The influence of instructional resources on change in physical education. Journal of In-service Education. 2006; 32 (9):221–235. [ Google Scholar ]
• Moore JB, Jilcott SB, Shores KA, Evenson KR, Brownson RC, Novick LF. A qualitative examination of perceived barriers and facilitators of physical activity for urban and rural youth. Health Education Research. 2010; 25 :355–367. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Morgan K, Kingston K. Development of a self-observation mastery intervention programme for teacher education. Physical Education and Sport Pedagogy. 2008; 13 :109–129. [ Google Scholar ]
• Murgia C, McCullick B, editors. Engaging urban youths in physical education and physical activity [Special symposium] Journal of Physical Education, Recreation & Dance. 2008; 80 (8) Retrieved from http://www.tandfonline.com/toc/ujrd20/80/8 . [ Google Scholar ]
• Nosek BA, Greenwald AG, Banaji MR. Understanding and using the Implicit Association Test: II. Method variables and construct validity. Personality and Social Psychology Bulletin. 2005; 31 :166–180. [ PubMed ] [ Google Scholar ]
• Nosek BA, Smyth FL. A multitrait-multimethod validation of the implicit association test. Experimental Psychology. 2007; 54 :14–29. [ PubMed ] [ Google Scholar ]
• O’Neill A. Struggling to engage urban youths in meaningful physical education: A bailout plan to survive and thrive. Journal of Physical Education, Recreation & Dance. 2009; 80 (8):43–45. [ Google Scholar ]
• O’Sullivan M, Tannehill D, Knop N, Pope C, Henninger M. A school–university collaborative journey toward relevance and meaning in an urban high school physical education program. Quest. 1999; 51 :225–243. [ Google Scholar ]
• Patton K. The dynamics of promoting sustained school–university partnerships [Special feature] Journal of Physical Education, Recreation & Dance. 2012; 83 (9) Retrieved from http://www.tandfonline.com/toc/ujrd20/83/9 . [ Google Scholar ]
• Pope CC, O’Sullivan M. Culture, pedagogy and teacher change in an urban high school: How would you like your eggs done? Sport, Education & Society. 1998; 3 :201–226. [ Google Scholar ]
• Rovegno I. Learning and instruction in social, cultural environments: Promising research agendas. Quest. 2008; 60 :84–104. [ Google Scholar ]
• Sato T, Fisette J, Walton T. The experiences of African American physical education teacher candidates at secondary urban schools. Urban Review. 2013; 45 :611–631. [ Google Scholar ]
• Schmidlein R, Vickers B, Chepyator-Thomson R. Curricular issues in urban high school physical education. Physical Educator. 2014; 71 :273–302. [ Google Scholar ]
• Shen B, McCaughtry N, Martin J, Fahlman M, Garn AC. Urban high-school girls’ sense of relatedness and their engagement in physical education. Journal of Teaching in Physical Education. 2012; 31 :231–245. [ Google Scholar ]
• Skala KA, Springer AE, Sharma SV, Hoelscher DM, Kelder SH. Environmental characteristics and student physical activity in PE class: Findings from two large urban areas of Texas. Journal of Physical Activity & Health. 2012; 9 :481–491. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Society of Health and Physical Educators. The essential components of physical education. Reston, VA: Author; 2015. (Guidance document). [ Google Scholar ]
• Stride A. Let US tell YOU! South Asian, Muslim girls tell tales about physical education. Physical Education and Sport Pedagogy. 2014; 19 :398–417. [ Google Scholar ]
• Tozer S, Horsley H. Chapter 8: Professional development of teachers in physical education — Where are we now? Journal of Teaching in Physical Education. 2006; 25 :450–457. [ Google Scholar ]
• Census Bureau US. (Census Bureau reports). Growth in urban population outpaces rest of nation. 2012 Retrieved from https://www.census.gov/newsroom/releases/archives/2010_census/cb12-50.html .
• VanSickle JL, Schaumleffel NA. Putting partnerships on paper: Creating service engagement opportunities in kinesiology and recreation. Journal of Physical Education, Recreation & Dance. 2015; 86 (4):24–33. [ Google Scholar ]
• World Health Organization. Urban population growth. 2016 Retrieved from http://www.who.int/gho/urban_health/situation_trends/urban_population_growth_text/en/
• Zepke N, Leach L. Improving student engagement: Ten proposals for action. Active Learning in Higher Education. 2010; 11 :167–177. [ Google Scholar ]

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PSEB 12th Physical Education and Sports Syllabus 2025: Download Punjab Board Class 12 Physical Education and Sports Syllabus 2024-2025 PDF Here

Pseb class 12 physical education syllabus 2025: in this article, students can find the punjab board class 12 physical education and sports syllabus 2024-2025 along with a pdf download link of the same..

Punjab Board Class 12th Physical Education Syllabus: The Punjab School Education Board has updated the PSEB Class 12 syllabus for students of academic session 2024-2025. In this article, you can find the PSEB Class 12 Physical Education and Sports Syllabus 2025 along with a PDF download link of the same. Also, check the theory and practical syllabus of PSEB 12th physical education here along with the complete list of chapters, practicals, and other assessment types. The PDF can be easily downloaded by students and saved for future reference. 

Punjab Board PSEB Class 12th Physical Education and Sports Syllabus 2025

Pseb class 12 physical education and sports practical syllabus 2025 , pseb class 12 physical education and sports syllabus 2024-2025 pdf .

During practicals, all the students are requested to be in their sports uniform with the appropriate and required sports kit. The board has yet to display the marking scheme, evaluation scheme, exam pattern, and details regarding internal assessments. All of it will be soon updated by the board, through various resources. We will bring each and every update to you, as soon as the board releases it. 

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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

[66] Ruttenberg, D. (2020, May 5). The Torah of Abortion Justice (annotated source sheet) . Sefaria. https://www.sefaria.org/sheets/234926.7?lang=bi&with=all&lang2=en

[67] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[68] Gert, B. (2007). Common morality: Deciding what to do . Oxford Univ. Press.

[69] World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA , 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 Declaration of Helsinki – WMA – The World Medical Association .; see also: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979).  The Belmont report: Ethical principles and guidelines for the protection of human subjects of research . U.S. Department of Health and Human Services.  https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html

[70] Zakarin Safier, L., Gumer, A., Kline, M., Egli, D., & Sauer, M. V. (2018). Compensating human subjects providing oocytes for stem cell research: 9-year experience and outcomes.  Journal of assisted reproduction and genetics ,  35 (7), 1219–1225. https://doi.org/10.1007/s10815-018-1171-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063839/ see also: Riordan, N. H., & Paz Rodríguez, J. (2021). Addressing concerns regarding associated costs, transparency, and integrity of research in recent stem cell trial. Stem Cells Translational Medicine , 10 (12), 1715–1716. https://doi.org/10.1002/sctm.21-0234

[71] Klitzman, R., & Sauer, M. V. (2009). Payment of egg donors in stem cell research in the USA.  Reproductive biomedicine online ,  18 (5), 603–608. https://doi.org/10.1016/s1472-6483(10)60002-8

[72] Krosin, M. T., Klitzman, R., Levin, B., Cheng, J., & Ranney, M. L. (2006). Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa.  Clinical trials (London, England) ,  3 (3), 306–313. https://doi.org/10.1191/1740774506cn150oa

[73] Veatch, Robert M.  Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict . Georgetown University Press, 2012.

[74] Msoroka, M. S., & Amundsen, D. (2018). One size fits not quite all: Universal research ethics with diversity.  Research Ethics ,  14 (3), 1-17.  https://doi.org/10.1177/1747016117739939

[75] Pirzada, N. (2022). The Expansion of Turkey’s Medical Tourism Industry.  Voices in Bioethics ,  8 . https://doi.org/10.52214/vib.v8i.9894

[76] Stem Cell Tourism: False Hope for Real Money . Harvard Stem Cell Institute (HSCI). (2023). https://hsci.harvard.edu/stem-cell-tourism , See also: Bissassar, M. (2017). Transnational Stem Cell Tourism: An ethical analysis.  Voices in Bioethics ,  3 . https://doi.org/10.7916/vib.v3i.6027

[77] Song, P. (2011) The proliferation of stem cell therapies in post-Mao China: problematizing ethical regulation,  New Genetics and Society , 30:2, 141-153, DOI:  10.1080/14636778.2011.574375

[78] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East.  Nature  510, 189. https://doi.org/10.1038/510189a

[79] International Society for Stem Cell Research. (2024). Standards in stem cell research . International Society for Stem Cell Research. https://www.isscr.org/guidelines/5-standards-in-stem-cell-research

[80] Benjamin, R. (2013). People’s science bodies and rights on the Stem Cell Frontier . Stanford University Press.

Olivia Bowers

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

Mifrah Hayath

SM Candidate Harvard Medical School, MS Biotechnology Johns Hopkins University

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