The Ethics of International Bioethics Conferencing: Continuing the Conversation

Our article, “Proposed Principles for International Bioethics Conferencing: Anti-Discriminatory, Global, and Inclusive,” urged a critical conversation with bio-ethicists around the globe on the ethics of international bioethics conferencing (Jecker et al. 2024). Focusing on site selection, we tentatively set forth seven principles: anti-discriminatory, international, green, fair-minded, leave no one behind, free exchange of ideas

Our article, "Proposed Principles for International Bioethics Conferencing: Anti-Discriminatory, Global, and Inclusive, " urged a critical conversation with bioethicists around the globe on the ethics of international bioethics conferencing (Jecker et al. 2024).Focusing on site selection, we tentatively set forth seven principles: anti-discriminatory, international, green, fair-minded, leave no one behind, free exchange of ideas, and epistemic justice.We appreciate the vigorous response our proposal generated, and the overall recognition of the ethical importance of the topic.We are grateful to Van Der Graaf and colleagues, who were the first in the literature to pinpoint the need for sustained debate within bioethics on the ethics of ethics conferencing (Van Der Graaf et al. 2023).We cannot do justice to all points colleagues raised across 15 separate commentaries.In this short response, we focus on objections and proposed addenda to the seven principles.

OBJECTIONS
This section considers seven objections, summarized in Table 1 and discussed below, related to the seven principles we previously set forth and applied to the decision of the International Association of Bioethics (IAB) to site the World Congress of Bioethics (WCB) 2024 in Qatar.

What Is the Relevance of Islamophobia? Who Is
Accused of It? Schüklenk (2024) claims our reference to Islamophobia is "gratuitous, " and argues we gave no evidence that Islamophobia was the cause of anyone's objections to IAB's choice of a Qatari-based host.In reply, we are not accusing critics of being Islamophobic.We assume people with concerns about congressing in Qatar have good-faith reasons for their concerns.Our point is instead that the debate over siting the WCB in Qatar does not occur in a vacuum.It occurs in a context of structural racism.We cited robust evidence that Islamophobia is globally pervasive.We reiterate that there is a structure of Islamophobia in the world, and it does a lot of harm.While overt racists can be readily discredited, racist structures are subtler and harder to undo.They are embedded in the social and institutional environments in which people live and work, and in the very language people use to think and communicate.Unless actively dismantled, inertial forces reproduce these structures.
Other commentators share our concern about Islamophobia.Schiff and Kearns (2024), who have collaborated with people in the Middle East and North Africa (MENA) region, noticed reluctance among their Western colleagues to partner with people in predominantly Muslim countries and thought such reluctance might reflect and perpetuate Islamophobia.Blackshaw, Rodger and Hurst (2024) argued that Islamophobia comprises part of a broader tendency in bioethics to disregard religious beliefs and values.Viaña (2024) emphasized the "whiteness of bioethics" and called for continuous effort to decolonize and diversify the field, including efforts beyond conferencing.Outside this debate, others have reflected on "the unbearable whiteness of bioethics" (Parsi 2016).We maintain that the "unbearable whiteness" of bioethics is not random, but built-in to the structures in which bioethics is practiced.It presents "a frustratingly intractable problem, " requiring "multidisciplinary engagement and persistent attention" (Danis, Wilson, and White 2016, 9).Schüklenk (2024) finds selection of a religious theme-Religion, Culture, and Global Bioethics-for WCB 2024 "disappointing, " and finds it "disappointing that the IAB acceded to this for a global academic event." In response, we take "public reason" to be the general requirement that "the moral or political rules that regulate our common life be, in some sense, justifiable or acceptable to all those persons over whom they have authority" (Quong 2022).Public reason-based arguments obviously look different in different parts of the world.Notably, most of the global population is religious (Gallup International 2017).Invoking religion aligns with public reason in societies where the government and most people endorse religion.For example, in Tunisia, "the state justifies a law in terms of a religious argument based on reasons that appeal to the majority of citizens" (Salem 2019, 13).Rawls (1999, 61) recognized public reason in nonliberal societies as part of a broader concept of a society of peoples where there is respect for persons: "If liberal peoples require that all societies be liberal … then decent nonliberal peoples … will be denied a due measure of respect by liberal peoples.This lack of respect may wound the self-respect of decent nonliberal peoples as peoples, as well as their individual members."

A Country's Carbon Footprint Should Factor into Site Selection
MacPherson (2024) raises the important question of "the relationships that exist between bioethics and climate change." They ask specifically whether relatively more responsibility should be assigned in site selection to "wealthy countries that are among the largest producers of greenhouse gas emissions." Relatedly, Salloch (2024) invokes climate justice as a reason not to participate in a Qatar conference, noting that in 2022, Qatar was the number one per-capita emitter of greenhouse gasses.
In response, Hamad Bin Khalifa University, not the Qatar government, is hosting WCB 2024.The university does not determine the country's climate policies and it would be unfair to hold it responsible.The focus of our green principle is the carbon footprint of the conference itself.Do hosts offer hybrid options, accommodations close to the congress venue, and sustainable food options?We reiterate that decarbonizing conferencing is not a zero-sum proposition and can occur through stepwise strategies.The conference should include green themes and bring into conversation people from regions that contribute least and are affected most by climate change.
We agree with MacPherson that bioethics and the environment are entwined.This consideration triggered the IAB Board to direct its Sustainability Working Group to host a panel discussion with IAB members at the 2024 WCB about changing the definition of "bioethics" in IAB's Constitution to include the interrelation between health and the environment.In reply, we take issue with the comparison between LGBTQ + conference participants and Rosa Parks, the legendary "mother" of the American civil rights movement.Parks protested an unjust ordinance requiring blacks to sit at the back of public buses and to relinquish their seats to whites if the bus filled up.Parks was an American citizen, suffering discrimination by her own state, every day of her life, just to travel from point a to point b.That differs fundamentally from a foreigner, electing to travel to another country for a three-day event.A better analogy to Parks would be a Qatari protesting Qatari laws that render their daily existence as an LGBTQ + person illegal.
A further difference is that when Parks was arrested in Montgomery, Alabama in 1955 for refusing to follow a bus driver's order to move to the back of the bus, she lost her job as a seamstress; her husband lost his job as a barber (NAACP n.d.).By contrast, bioethicists' livelihoods are not on the line.
A still further difference is that LGBTQ + conferees have a choice between online and in-person conferencing.Parks had no choice.For these reasons, comparing Parks's courageous action to the situation of LGBTQ + visitors trivializes what Rosa Parks did and the courage it took.Further, even today, not all bioethicists have a choice about participation in conferences.For those unable to pay for traveling to Qatar, or unable to obtain the requisite travel visa, the question is not should I go, but can I go.
Finally, online conferencing is not the proverbial back of the bus.In the wake of the COVID-19 pandemic and worsening climate change, online participation is not only increasingly common (Guetter et al. 2022), but progressive and "climate forward." In 2022, IAB's incoming president (NSJ) conferenced online, delivering her presidential address to the World Congress virtually.The president expressed pride that 2022 was IAB's first hybrid congress, and called the online option "more inclusive, more resilient, and greener" (Jecker 2023, 5).
While we reject the analogy between LGBTQ + people and Rosa Parks, we acknowledge significant impediments facing LGBTQ + people traveling in-person to WCB 2024.In response, we reiterate key points from our original article.First, the human rights of LGBTQ+ Qataris and their local supporters should be considered.Engaging with Qataris can make a positive contribution if it helps empower local people to debate human rights and to determine the best way forward for their society.Second, if restrictions on site selection based on a country's human rights record are applied to any country, they must be applied consistently to all countries and to the full range of human rights abuses.A litmus test that takes human rights seriously would be at odds with the larger goal of fostering dialogue and the free exchange of ideas between people from diverse regions.Third, implementing a human rights requirement raises thorny questions: Who defines the standards a country must meet?Who sits in judgment?
In the final analysis, we support engaging with Qataris while striving for fairness to diverse groups over time.Another approach, championed by Brown and Martinez (2024), is fully virtual conferencing.Blackshaw, Rodger, and Hurst (2024) also favor this option, arguing that all seven of our proposed principles are best realized by eliminating in-person conferencing altogether-a virtual format is fairer to geographically, economically, and culturally diverse groups, because it is more accessible, costs less, avoids visa challenges, and removes safety concerns related to race or gender identity.They add that it reduces barriers for people with dependent family members and people with disabilities.Both commentaries recommend offsetting the loss of physical contact associated with fully online engagement by innovative tools to foster interpersonal contact and access: digital networking; anonymous participation for people facing threats to academic freedom; virtual poster sessions; virtual affinity groups; and virtual mentor-mentee meetings.These ideas hold promise and merit further consideration.Different conference organizers might reasonably elect different strategies based on their commitments and constituents' preferences.

It Is Wrong to Create Disadvantages for Any Disadvantaged Group, as Occurred for Queer Bioethicists When the IAB Board Selected a Qatari-Based Host
Hanson (2024) proposes a litmus test requiring "that all likely attendees ought not to feel significantly less comfortable attending the conference and exploring the local city outside the conference than they would in their home country/city." However, this makes the standard relative to one's home country, which is morally arbitrary and may itself be unjust.Hanson also argued that the benefits of conferencing in Qatar "are easily obtainable elsewhere, " yet the bids available were limited and none other than the Qatar-based bid guaranteed free exchange of ideas at the congress venue.Shai (2024) proposes a different litmus test: Conference only in democratic societies, where free speech can be ensured.However, this approach would further isolate bioethicists in nondemocratic societies; for them, conferencing can provide a safe space for collaboration and exchanging ideas.Moreover, in purportedly democratic societies, free speech is increasingly trampled (Jecker et al. 2023).IAB instead requires prospective Congress hosts to "commit to furnishing a Congress venue where bioethics can be debated freely in an atmosphere of mutual respect, " but rejects requiring a host country's government to be democratic, which would exclude nearly 39% of countries (Jecker and Ravitsky 2023, 324).Haidar (2024) recommends "scrutinizing the power dynamics embedded in the representation of marginalized voices" and "challenges scholars to reflect on their own positions of privilege." Savulescu (2024) casts these issues in terms of two contrasting models: missionary versus Socratic bioethics.Savulescu thinks that, "Much of bioethics appears to have become missionary.Structural injustice, human rights, and climate change are all causes motivating people to bring about change." Socratic bioethics hews close to Haidar and Affdal's (2024) notion of self-reflexivity, implying "dialogue … questioning one's own assumptions and beliefs … It is about the search for knowledge, not the presupposition of it." Savulescu (2024) argues, "Engagement is better than disengagement."

Epistemic Inclusion Requires Not Only Expanding the Field of Bioethics, but Reflexive Awareness of Positionality and Privilege
We concur with both analyses and consider their points inherent in our principle of epistemic justice.As others have argued, epistemic justice demands considering the standpoint from which knowledge is being produced and foregrounding marginalized groups who have limited ownership of knowledge production and sensemaking (Pratt and De Vries 2023).

ADDENDA TO THE PROPOSED PRINCIPLES
In addition to these comments, some commentators recommended addenda to our proposed principles.

Fair Bidding and Independent Funding
De Vries and Van Der Graaf (2024) propose two addenda: fair bidding and independent funding.For fair bidding, they endorse Accountability for Reasonableness (Daniels and Sabin 1997), a framework that requires transparency and publicity in site selection criteria.It also requires engaging with an organization's members, especially when site selection is potentially controversial.When societal change is an organization's goal, these authors recommend long-term strategic partnerships with international organizations well placed to enact change.With respect to funding, they advise obtaining independent funding, in lieu of reliance on hosts, in order to facilitate greater participation of underrepresented lowand middle-income countries.
We support these recommendations, while also pointing out that implementing them will not be applicable or achievable for every conference organizer.Since the ethics of international bioethics conferencing is a new concern, it will take time for organizations to formulate, consider, and implement fair bidding and independent funding.Additionally, other proposals in the offing, such as fully virtual conferencing, should be considered.Fully virtual conferencing would alter the fundamentals of conferencing, including who can afford to host and attend.Ozisik, Dellgren, and Emanuel (2024) propose two preconditions as essential requirements that must be met before a site is considered: safety and feasibility.They argue that both apply before other principles are considered, because it defeats the purpose of conferencing if conferees are unsafe or conferencing is unfeasible.

Feasibility and Safety
Feasibility refers to the infrastructure necessary for conferencing.Since feasibility is a pragmatic, not an ethical, requirement, we focus on safety.The authors claim Doha is unsafe for in-person conferencing by LGBTQ + people.While they cite laws making homosexuality illegal and punishable by stoning, they acknowledge, "this penalty has not been imposed in years." More immediately concerning for them, and for us, is Human Rights Watch's World Report 2024 (2024, 514) documenting cases of LGBT people in Qatar who were arbitrarily arrested and treated poorly in detention, including cases of severe and repeated beatings, verbal abuse, and sexual harassment in police custody.Security officers also inflicted verbal abuse, extracted forced confessions, forced detainees to sign pledges that they would "cease immoral activity, " and denied detainees access to legal counsel, family, and medical care.
Targets have included both domestic and international people.We condemn these human rights violations and the immediate threat they represent to LGBTQ + people attending the WCB in person.
Yet focusing only on the safety of visiting bioethicists ignores the serious safety threats LGBTQ + Qataris face daily.What are we, as bioethicists, doing to support them?Keeping our focus on LGBTQ + Qataris, one way to show solidarity is boycotting the WCB.Another is engaging in person with the local community.Admittedly, engaging in person carries risks.Condemning Qatari law or the actions of Qatari security officers is tantamount to criticizing the government, which is illegal and punishable by imprisonment and fines (Human Rights Watch 2024), posing an immediate threat to in-person WCB participants, regardless of sexual orientation.Previously, we expressed concern that refusing to conference in countries with laws against LGBTQ + people left MENA people behind; however, Ozisik, Dellgren, and Emanuel (2024) stress safety, arguing that "Hosting the conference in Qatar is unsafe for LGBTQ + individuals, while hosting elsewhere does not jeopardize the safety of MENA people." Again, the focus is skewed-is it is only about us, that is, our safety, our freedom, our speech as outsiders attending a Qatar-based event?While safety matters, is it necessarily determinative?What about solidarity with LGBTQ + people residing in Qatar?Answering these questions requires considering that safety is a matter of degree.Both conference organizers and participants must set their own safety thresholds.To illustrate, consider another safety worry related to the 2024 WCB.Some individuals expressed concern that the Middle East conflict could escalate and spread, making travel to Doha risky.In 2023, after violence erupted in the Middle East, IAB's Board of Directors (2023) amended its Standard Operating Procedures, adding a protocol for pivoting to an online-only format in emergencies.It directs "each WCB host to prepare for the possibility of an unforeseen emergency that would necessitate making the Congress an online-only event.A final decision to exercise this option will be made by a vote of the four IAB Officers, with the President deciding in the event of a tie." One of us (MG) proposed conditions that would trigger immediate discussions about pivoting to a fully online 2024 Congress, which we agree with: the Middle East conflict becomes a wider, regional conflict; public unrest develops in Qatar, such as widespread demonstrations; safety threats occur targeting Congress hosts, IAB, or FAB (the International Feminist Approaches to Bioethics organization, which is also conferencing in Doha); or Qatar's government bans people from certain countries from entering Qatar.Analogously, if safety threats to LGBTQ + people or their supporters increased, public unrest related to LGBTQ + topics developed, safety threats were made against conference organizers related to LGTQ+ topics, or LGBTQ + people were barred from entering Qatar, this would signal to us greater risk and would prompt us to rethink our assessment.
Our remarks highlight that safety judgments involve pinpointing degrees of magnitude for a given risk under complex, uncertain conditions.Such judgments are open to revision as conditions change or new arguments come to light.Reasonable people set different safety thresholds and may disagree about whether they are likely to be crossed.

Tiered Approach
Ozisik, Dellgren, and Emanuel recommend dividing our seven principles into three tiers: essential; important, but not essential; and supererogatory.They propose essential principles include being antidiscriminatory, leaving no one behind, and free exchange of ideas; important but not essential principles include being international and epistemically just; and supererogatory principles include being green and fair-minded.
We reject the proposal for tiered ranking.First, ranking depends on positionality.For Salloch (2024), the green principle is decisive: "I do not see how my respect for global climate justice would allow me to participate in the Qatar conference, " because climate change is "the most important threat to human health in the middle and long run." For others who suffer the injustice of being silenced or having their testimony deflated, epistemic justice may be indispensable.Second, proponents of a universal hierarchy for international conferencing must justify their rankings by demonstrating they embody a global consensus.The authors make no such effort.Related to this, we note, with regret, that none of the 15 commentaries on our proposal were written by scholars from the MENA region.This is unfortunate, since people outside a region may miss points that seem obvious and compelling to people within the region.

CONCLUSION
In conclusion, our proposed principles for the ethics of international conferencing are provisional.We welcome continued debate, especially from people and regions who have not yet participated.We challenge the bioethics community to think less about the entitlements of bioethicists and more about the needs and vulnerabilities of those bioethicists serve.In the case of international bioethics conferencing, we should think more about the dangers facing people around the globe and how we can help.

Table 1 .
objections and replies.
Note. iAB = international Association of Bioethics; WcB = World congress of Bioethics.It Is