Shizuko Takahashi

Background Social Egg Freezing (SEF), often promoted in Western contexts as a means to enhance reproductive autonomy, has seen varied uptake in countries with wider gender disparities. In such settings, where reproductive decisions are shaped by strong societal norms, SEF raises ethical concerns about whether it enables autonomy or reinforces prevailing expectations. Objectives This study examines how SEF is framed and regulated in countries ranking in the lowest quintile of the 2024 Gender Gap Index (GGI), where reproductive autonomy is emergent and SEF is increasingly promoted as a demographic intervention. Methods A scoping review was conducted on SEF literature published between 2013 and 2025 across 29 countries in the lowest GGI quintile. English-language sources were retrieved from PubMed, while Japanese (J-Stage, Ichushi-web) and Arabic (Arabase [al-manẓūma], E-Marefa) were searched. Supplementary materials—including government policies, religious texts, and professional guidelines—were identified through Google Advanced Search, manual screening, and documents from the International Islamic Fiqh Academy (IIFA). Eligible sources included empirical and normative publications addressing SEF in the countries under review. Three reviewers screened and extracted data. Themes were developed iteratively. Results Sixty-eight sources met inclusion criteria and were organized into five themes: (1) awareness and education; (2) sociocultural and religious values; (3) policy and legal frameworks; (4) clinical practices and outcomes; and (5) commercialization and autonomy. Most sources (73.9%) focused on themes (2)-(4), while awareness (12.2%) and commercialization (13.9%) received limited attention. In most Muslim-majority countries reviewed, religious frameworks restricted SEF to married women. Turkey is a notable exception, permitting SEF for single women though embryo transfer requires marriage. Only 23 of the 68 sources were empirical, and just four employed qualitative methods. Conclusion Although SEF is often framed as empowering, this promise is context-dependent and frequently illusory. Cultural and structural constraints shape women’s choices, limiting the autonomy SEF claims to offer. Rather than imposing hegemonic neo-liberal assumptions, future policy and research should engage with local moral reasoning while examining how norms may reinforce inequality. Empirical studies are urgently needed to illuminate lived realities and improve policy development.

The dominance of ableist assumptions in precision medicine has recently been challenged, notably by Mintz, Stramondo, and Tabor (2024). Yet a similarly radical critique exists in Daoist traditions, particularly in the philosophy of Zhuangzi. While Mintz, Stramondo, and Tabor call for greater disability inclusion in genetics and genomics, they do not fully engage with how cultural and philosophical worldviews shape responses to genetic intervention. Drawing on our research on preimplantation genetic testing for monogenic disorders (PGT-M), we argue that concepts like ziran (自然naturalness) and wuwei (無為non-action) can deepen our understanding of disability inclusion, particularly in Asian contexts. The comparatively restrictive approval of PGT-M in Asia reflects cultural discomfort with disrupting what is seen as nature’s course. Zhuangzi’s allegories—especially those illustrating “the usefulness of the useless”—challenge dominant hierarchies of ability and provide clinicians with tools to engage more sensitively with patients who may see genetic testing as ethically troubling. This paper integrates Daoist insights to propose a globally inclusive bioethics, one that affirms non-intervention as a legitimate stance and broadens how we conceive of naturalness, disability, and autonomy. By doing so, we aim to enrich debates around precision medicine and support ethically pluralistic genomic care.

Stigmatization and sharming of healthcare workers in Japan during the coronavirus 2019 pandemic reveal uniquely Japanese features. Seken, usually translated as ‘social appearance or appearance in the eyes of others,’ is a deep undercurrent woven into the fabric of Japanese life. It has led to providers who become ill with the SARS-CoV-2 virus feeling ashamed, while concealing their conditions from coworkers and public health officials. It also has led to healthcare providers being perceived as polluted and their children being told they were not welcome in schools. Although such experiences are not isolated to Japan and have appeared in other parts of the world, the cultural forces driving them in Japan are unique. Overcoming stigmatization and shaming of Japanese healthcare providers will require concerted efforts to understand cultural barriers and to view such practices as raising human rights issues affecting the safety and well-being of all.

### The spirit in the word In Japanese tradition, kotodama (言霊) refers to the belief that words carry spiritual power capable of influencing reality. The term combines koto (言, word) and tama (霊, spirit). Japan was historically called kotodama no sakiwau kuni (言霊の幸わう国)—‘the land where the mysterious workings of language (words) brings bliss’.1 This was not a mere poetic flourish. Speaking certain words was understood to invite their manifestation. For instance, naming misfortune could summon it. The West, too, has long recognised the power of language—but differently. Among the ancient Greeks, this fascination produced the vast, meticulously worked-out art of rhetoric, the most comprehensive academic subject in Western culture for two thousand years.2 Where kotodama treats words as forces that shape reality directly, rhetoric treats words as tools for persuasion and precise communication. Western biomedicine has inherited this orientation: diagnosis names conditions definitively, informed consent requires accurate information transfer and clarity is assumed to produce better outcomes. ### Words that fix reality Japanese operates on different principles. Subjects (ie, pronouns) are routinely omitted. Meaning depends on context and relationship. Abundant homophones—exploited in classical poetry through devices like kakekotoba (pivot words)—create layered meanings where ambiguity is a resource rather than a …

Contemporary Western bioethics, informed by liberalism and utilitarianism, has developed alongside a proactive, interventionist model of medicine marked by the assumption that every illness has a cure and that pain is unnecessary. In contrast, medical practice in much of Asia reflects different philosophical roots. One of these, Daoism, embraces a very different attitude towards medical intervention. Within Daoist philosophy, the unique understanding of naturalness or spontaneity ( ziran, 自然) helps illuminate some anti-interventionist trends within medical practice in parts of Asia historically influenced by this tradition. We illustrate this through the relatively low uptake of epidural use among expectant mothers in Japan. Although Daoism originated in China, Daoist concepts influenced the formation of Zen Buddhism through the historical transmission of Chinese philosophy and medicine, particularly during the Tang and Song periods. Although often subtle, this influence has shaped modern cultural attitudes discussed below. Philosophical Daoism is usually discussed in relation to two main texts, the Laozi and the Zhuangzi. ‘Dao’ (道) is understood as the metaphysical source of all things and the guiding principle of nature. A closely related concept is ‘ziran’ (自然), often translated as spontaneity, naturalness or being ‘self-so’. If Dao is the guiding principle, ziran is the way it is expressed in the natural world. Importantly, ziran exists at multiple levels: an overarching ‘ziran’ of nature and a personal ‘ziran’ of each individual. In Daoist philosophy, there is a strong belief in the inherent goodness of nature and going with the flow of nature is often held up as an ethical ideal. Along with this, the concept of health is often understood less as the elimination of disease and more as …

BackgroundPrevious studies have found that the decision-making process for stored unused frozen embryos involves much emotional burden influenced by socio-cultural factors. This study aims to ascertain how Japanese patients make a decision on the fate of their frozen embryos: whether to continue storage discard or donate to research.MethodsTen Japanese women who continued storage, 5 who discarded and 16 who donated to research were recruited from our infertility clinic. Tape-recorded interviews were transcribed and analyzed for emergent themes.ResultsA model of patients’ decision-making processes for the fate of frozen embryos was developed, with a common emergent theme, “coming to terms with infertility” resulting in either acceptance or postponing acceptance of their infertility. The model consisted of 5 steps: 1) the embryo-transfer moratorium was sustained, 2) the “Mottainai”- embryo and having another child were considered; 3) cost reasonability was taken into account; 4) partner’s opinion was confirmed to finally decide whether to continue or discontinue storage. Those discontinuing, then contemplated 5): the effect of donation. Great emotional conflict was expressed in the theme, steps 2, 4, and 5.ConclusionsPatients’ 5 step decision-making process for the fate of frozen embryos was profoundly affected by various Japanese cultural values and moral standards. At the end of their decision, patients used culturally inherent values and standards to come to terms with their infertility. While there is much philosophical discussion on the moral status of the embryo worldwide, this study, with actual views of patients who own them, will make a significant contribution to empirical ethics from the practical viewpoint.