As the return to daily activities progresses, the topics of fundamental bioethics and clinical bioethics are once again becoming very relevant. This especially with regard to the dilemmas at the beginning of human life and those that we inherited from the pandemic as evident, such as the need and urgency of having global governance systems that allow for a fair and equitable distribution of resources for health care worldwide.

This issue presents two articles related to bioethical dilemmas at the beginning of life, particularly with assisted reproductive techniques, and two articles on the subject of global governance in health. Likewise, a novel article is presented that recovers the bioethical principles in the practice of ophthalmology and emphasizes, once again, how these are necessary in all medical specialties. The reviews presented in this issue, on the one hand, address the ethical questions on the “safe” use of drugs and, on the other, the link between the human goods necessary for a happy life and their relationship with bioethics.

The first article, by Dr. Aberdeen, is a documentary research on relevant cases and factors recorded in the literature since 2021 on the donation and transplantation of cadaveric uteruses in order to satisfy the desire of some women to become mothers. Thus, from anthropological, medical and sociological reflection, the author reflects on the motivations and consequences of such donation in a modern society.

A controversial point proposed by the author is the fact that uterus donation is not considered as a therapeutic procedure since uteruses are not essential organs for the survival of the person and their transplantation may entail risks that outweigh the benefits. Other considerations also appear, such as the possible objectification and commercialization of uteruses and of the women who decide to donate them upon their death, the impact it has on the recipient and on the generation of a life, as well as the lack of an international registry, that provides information on standards of transplant protocols for this organ.

These and other bioethical questions arise from the possibility of these donations.

The second article —by Drs. Gómez, Salazar, Salazar T. and Babun—, addresses the issue of global governance, which has caused serious doubts and attempts to put it into practice, especially in this post-pandemic era.

It proposes that governance is a horizontal system of management based on co-responsibility between government and institutions that generates new spaces for joint decision-making.

The authors recover two fundamental characteristics of governance: it is analytical in its description of relationships between actors and processes and it is normative insofar as it dictates guidelines on the implementation of certain values in decision-making processes. Despite these characteristics, the authors admit that, there are other factors such as social, cultural and geographical conditions that also affect the implementation of governance strategies.

The foregoing must be considered especially concerning health governance. It will be crucial to identify and understand the value that both the government and society give to health and life care and the priority given to the rest of the social demands.

To make this possible —the authors mention— the who has indicated certain criteria that measure policies for good governance in the health sector but, beyond these points, the authors also propose incorporating ethics and its principles in health institutions, specifically in Latin America.

The third article presented here, by Dr. Lílian Santos, takes up the topic of global governance in issues such as access to health care resources and access to new technologies that can also help to improve the health of individuals and populations.

Using the example of how a million doses of COVID-19 vaccine were destroyed in Nigeria because they were close to their expiration date. Also the example of how the “Lumen” is used to personalize styles and habits of care and health promotion but with very few possibilities of universal access. The author highlights the need for a system of governance that regulates actions, relationships and dynamics regarding health goods so that they have a wider coverage and are produced, distributed and applied based on ethical and bioethical principles that guarantee international coverage in the improvement of human health.

This governance, the author warns, must take place at the regional and local levels as well as in the international arena to ensure that technologies and the progress of science are not and should not be the property of a few but of all humanity and, therefore, are always available to all.

Such governance cannot, according to Ms. Santos, be only prohibitive, but must also and above all be proactive and incorporate in its proposals ethical principles such as inclusion, precaution and prevention, justice, social justice, transparency, non-discrimination, respect for all people, solidarity and global justice in health, to mention a few.

Finally, a central contribution of this article is the link that the author establishes between these governance principles and human rights. The principles of governance are derived from human rights, which are the backbone of global governance in health.

The fourth article by Maroun Badr in this issue returns to the bioethical problem of assisted reproductive techniques, but does so on the basis of a well-reasoned critique of the changes in the French bioethics law —proposed in 2019 and endorsed in 2021— which opens up the possibility of offering assisted reproductive techniques (ART) to couples consisting of a man and a woman, two women or a single woman. This, for the author, opens the debate on whether art should be a matter of equity and justice to be offered to all people. In his argument, the author argues that this is wrong based on three considerations: a) right reason, b) legitimate authority and c) the common good.

With respect to the first, the author rescues the natural tendency that sustains the natural inclination to human sexuality, which obliges the arts to respect the forms and means that fulfill the purpose of the marital act, which is both unitive and procreative. With this, the author warns against the risks of reducing procreation to a merely technical and utilitarian act.

Regarding the second argument, the author notes that although the obligation of the state authority is to watch over the common good, especially of the most fragile and vulnerable, the modification is not fulfilling this task insofar as it leaves the embryo unprotected as a person subject to rights.

Finally, regarding the third argument, it must be said that the author appeals to Ulpian's notion of justice to separate what is the legitimate desire to have a child from the disordered desire to believe that it is a right to have one, something that ends up reifying the embryo.

A fifth article by Drs. Martínez, Arellano, et al. and presented in this fourth issue offers an analysis of the importance of bioethical principles and professional ethics in the practice of medicine, specifically in the specialty of ophthalmology, based on the narration of a clinical case seen from the multidisciplinary analysis of bioethics. The article emphasizes the importance of illuminating the medical lex artis with these principles for the good of the patient and the physician.

To conclude, the first review that is presented revives the ethical and bioethical debate on the “safe” consumption of drugs in authorized rooms based on what was thrown in a document on the subject reported by the European Center for monitoring drugs and addictions. Here arguments are provided to support the existence of authorized rooms for drug consumption whose purpose is the prevention of diseases and overdoses, as well as the reduction of mortality by ensuring properly sterilized instruments and assisted by health professionals.

The author of the review recommends accompanying these arguments with more measurements on the real effectiveness of disease and death prevention as well as the social, economic and environmental implications of these rooms in those countries where they have already been implemented.

Finally, the review by Dr. Karina Ordóñez describes Dr. Gómez-Lobo's proposal in his book Bioethics and human goods, where he takes up the first proposal on the goods that lead a person to a happy life based on Aristotelian ethics and brings them to the field of bioethics. The argumentative lucidity stands out in this work, making it an unmissable reading for bioethicists, recommends the author of the review.