Mr Chairman,
Allow me to congratulate you and your bureau on your successful election to this committee.
2 We are here today to discuss the question of whether to elaborate a convention against the reproductive cloning of human beings, or whether such a convention should be extended to include therapeutic cloning . In this debate, I think it can safely be said that we are all in agreement that human reproductive cloning should not be allowed. Here, we would like to thank the French and German delegations for their important initiative. The second aspect of today's debate involves the question of whether therapeutic cloning should also be banned. The question of therapeutic cloning arises in one of the several facets of human stem cell research, not all of which by the way, are any less controversial.
Mr Chairman,
3 The debate between science, ethics and religion is not a new one. Numerous such examples can be found in the history of science and medicine. For instance, Galileo was persecuted when he provided evidence that the earth was not flat. The breakthrough he achieved represented a revolution in astronomical science. It subsequently opened the doors for many more theories that improved the quality of life for the human race.
4 In the 17th century, when doctors first attempted to transfuse patients with animal blood, it understandably provoked a huge uproar. It was banned in France, England and by the Catholic Church. The idea made a comeback in the 19th century, when an English physician used human blood. After an initial surge in popularity, eminent physicians began denouncing the procedure based on a report that more than half of these transfusions resulted in death. It was only in 1900 that blood types were discovered, and the medical field's confidence in transfusions was renewed, and its usage accepted. More recently, the birth of Louise Brown in 1983 through in-vitro fertilization resulted in an outcry that "monsters" would result. However, time has shown it to be safe and the breakthrough gained widespread acceptance by societies.
The debate
5 The current debate on therapeutic cloning, in many ways, is being conducted on a similar basis. Let us first recall that the objective of the scientific research that is the subject of our present discussion is to find treatments and cures for the illnesses that currently plague mankind. Today, approximately 150 million people suffer from diabetes, and figures indicate that this number may well double by the year 2025. Much of this increase will occur in developing countries and those affected are likely to be in their most productive years. Through human stem cell research, we may one day be able to prevent or cure this and other diseases, including various cancers, Parkinson's, Alzheimer's, heart disease, spinal cord injuries, sickle-cell anaemia and HIV/AIDS etc.
6 The debate we are presently engaged in, to put it into a nutshell, is over which method of scientific research to pursue towards the above lofty ends, and which method we should discard. As mentioned earlier, there are many facets of stem cell research. In layman's terms, they can be divided into that which does not require embryos (as in adult stem cells), and that which necessarily involve embryos (embryonic stem cells and embryonic germ cells). Annexed to this statement is a simple table, setting out the different types of stem cells and their sources. The issue of therapeutic cloning arises in the context of extracting embryonic stem cells.
Embryonic Stem (ES) Cells and Therapeutic Cloning
7 The three widely recognised types of human stem cells are embryonic stem cells ('ES cells'), embryonic germ cells ('EG cells') and adult stem cells ('AS cells'). Generally, ES cells are thought of as being widely "pluripotent" i.e. having the best potential to develop into nearly any cell type, followed in descending order by EG cells and AS cells. There are also important biological differences between ES cells, EG cells and AS cells which impact research. ES cells appear to be the most fundamental and extraordinary of the human stem cells, with the highest research potential.
8 ES cells are derived from 5-day old embryos ("blastocysts"). A blastocyst consists of a mass of cells. In the first 14 days, the cells of the embryo have not yet differentiated into tissues. The 'primitive streak' appears around the 14th day and develops into the nervous system. From the 14th day onwards, the embryo develops other tissues and organs; the foetus then forms from the 8th week of life.
9 Therapeutic cloning refers to the creation of the patient's own human cells by cloning technology . Present methods require the initial formation of an embryo. Potentially, therapeutic cloning is a means of deriving stem cells which are immunologically compatible with the person being treated. As such, the problem of tissue rejection would not occur when these stem cells are transplanted into the patient since it is the patient's own cells. As illustrated in the attached table, there are several other ways of obtaining ES cells, but there are inherent limitations in their medical potential.
10 For instance, many advocate that it is enough to limit the research to the existing cell-lines which can be serially propogated. But this can have negative repercussions. Let me explain : Every person carries some form of genetic mutation, and some recessive genes. Limiting research to a few cell-lines would have the effect of spreading those particular mutations and recessive genes and would be tantamount to allowing widespread propagation of a gene mutation. Moreover, as pointed out by the IPS UN Daily Journal in an article dated 26 August 2002, the 64 stem cell lines that are currently in existence come mainly from white couples, with the remaining from East Asian donors. The IPS article goes on to cite that "It is well-documented that populations in Africa, where modern humans likely originated, are the most genetically diverse in the world......A stem cell policy that does not guarantee a significant percentage of cell lines from various African sub-populations will limit human biodiversity and could limit the effectiveness of drug therapies on those and other populations not adequately represented in the current cell lines. African American health advocates are also concerned about the lack of sample diversity." In the same IPS article, Ms Lorraine Cole, President of the National Black Women's Health Project in Washington D.C. is also quoted as stating that "Embryonic stem cell research has great potential to turn the tide on a variety of diseases and health conditions that disproportionately affect African Americans."
11 There are others who support the use of "surplus embryos" created by IVF in assisted fertility treatments, and are subsequently found to be in excess of fertility need. These "surplus embryos" would otherwise be discarded. The use of "surplus embryos" from IVF treatment could to some extent address the problem outlined above, by introducing "diversification" into the gene pool. But this method still presents us with the problem of immune rejection when these stem cells are transplanted into the patient. This problem of "tissue matching" will not arise on the other hand, in the use of therapeutically cloned cells as the cells are the body's own cells.
Adult stem (AS) cells and Embryonic germ (EG) cells
12 There are also proponents of limiting stem cell research to areas which do not necessarily involve what is considered to be "nascent life" or an embryo with the potential to become a foetus. Adult stem (AS) cells for example, constitute an area of research that does not involve the use of embryos. AS cells are derived from certain adult tissues such as the bone marrow, brain, and blood cells of the umbilical cord at time of birth. There is much ongoing debate as to the use of adult vs embryonic stem cells. Proponents of AS cells favour their use because in their view, there are no ethical dilemmas. But these AS cells are relatively difficult to isolate, to maintain, and to expand in culture. Moreover, AS cells already possess different characteristics, and increasing their numbers without changing their properties has been difficult to achieve.
13 Then there are embryonic germ (EG) cells. These originate from primordial reproductive cells of developing foetuses, and can be derived from aborted foetuses. EG cells are thought to be less "pluripotent" than ES cells, having less potential to develop into other cell types.
Future research
Mr Chairman,
14 Human stem cell research, especially with ES cells, holds the promise for tremendous benefits to mankind in the major areas of treatment and therapy. The complications and limitations that are inherent in any one method of research in themselves also constitute an ethical dilemma. Are we prepared to knowingly persist in one limited and imperfect approach when the potential exists that might allow us to avoid these pitfalls?
15 There is very active ongoing research all over the world to enhance medical care using the principles of therapeutic cloning. It might even be possible eventually to form specific tissues from the patient's own somatic cells without growing an embryo first. Hence there would be no need to destroy the embryo. It is essential that techniques and methods be optimised. For that to occur, there is a need for continued research. We do not think it would be wise to hastily close off such a promising avenue of medical science before we have all had the benefit of properly understanding it. In fact, the UK's CMO Expert Group Report (Aug 2000), stated in recommendation #20 that "Benefits of being able to develop an individual's own cells to create a new source of cells for their own future treatment makes this action ethically justifiable." More recently, in yesterday's The Washington Post, you would have read that the Governor of the State of California plans to sign into law a bill that would promote research on embryonic stem cells including those extracted from therapeutically cloned embryos.
16 Other potential benefits that may be derived from therapeutic cloning is that the patient could have his/her own cells modified before they are generated into stem cells through therapeutic cloning. Why modify? Cells that are deficient in certain proteins (either from the lack of proper genes, or as the patient ages) can be "boosted" to increase their production back to normal. The "boosted" cells will continue to divide, grow and function in the patient's own body. In fact, this possibility has the greatest potential for medical benefit. Such a strategy could be used to prevent immunological tissue rejection to allow for more successful organ transplantation. Immune cells could also be engineered to increase their capabilities, thus preventing cancer development or making the individual resistant to infection, including AIDS.
17 Therapeutically cloned cells could also be used as very sensitive "testers" for drugs to check whether the patient responds successfully or instead develops an adverse reaction to it, before the drug is administered into the patient's body. It is now recognised that different populations have different gene types that result in different reactions to drugs. Being able to check their response before the drugs are used would significantly reduce unnecessary severe drug reactions or even death.
Singapore's Position
Mr Chairman,
18 Singapore is a multi-racial and multi-religious country. We fully recognise that serious ethical issues have to be addressed, and that social norms, theological perspectives and philosophical persuasions all shape the answers given by each society in response to the very difficult questions involved. For this reason, in December 2000, the Government appointed a Bioethics Advisory Committee ('BAC') to examine the ethical, legal and social issues arising from biomedical research and development and to recommend appropriate policies and safeguards.
19 The BAC has conducted an extensive national public consultation process through feedback and dialogue sessions with religious and community groups. It has studied the legislative regimes of various countries and commissioned scientific papers. The fundamental approach that the BAC has taken is to balance two ethical commitments: to protect human life and the rights and welfare of the individual, and to improve human life by curing diseases. On the subject of human reproductive cloning, the BAC has recommended a complete ban. On overall stem cell research, the BAC is of the view that research for now can adequately be pursued using the existing ES cell lines, and if necessary, surplus embryos, and other types of stem cells, without resorting to the creation of new embryos. Nevertheless, ES cell research today is developing at a fast pace, and the scientific evidence on the benefits of therapeutic cloning is emerging day by day. Here, the BAC has recommended strict conditions for the creation of human embryos specifically for research :
(a) where there is strong scientific merit in, and potential medical benefit from such research;
(b) where no acceptable alternative exists, and
(c) on a highly selective, case-by-case basis, with specific approval from a proposed national statutory body.
20 The Singapore Government has accepted the BAC recommendations on 17 July 2002. The recent developments in human stem cell research have raised hopes of discovering cures for debilitating and fatal illnesses that are presently incurable. Allowing this area of research to proceed under strict guidelines and appropriate safeguards may well bring this hope to reality. Singapore is in the process of drafting a comprehensive legislative framework and guidelines. We are also setting up a regulatory mechanism to license, control and monitor all human stem cell research conducted in Singapore.
Conclusion
Mr Chairman,
21 Advances in biomedical science knowledge and technology and their application to the treatment of human diseases are being made at a breathtaking pace. The barriers of biological science have been pushed beyond the perimeters that we have thought existed. The potential of this massive change in treatment possibilities could be as revolutionary as the discovery of penicillin and the use of antibiotics to control infection. It is our duty to decide responsibly and thoughtfully whether this opportunity is made available to humanity for the benefit of future generations, and at the same time not lose our moral dignity.
22 The ethical, legal and social debate arising from biomedical research and development is important and necessary. This has also to be balanced with the great potential for good that responsible research can bring about. We should not snuff out the hope of millions of people who now suffer from incurable diseases that they might one day lead a normal life.
23 Mr Chairman, Singapore fully agrees that human reproductive cloning should be banned. We should act efficaciously on a matter that enjoys unanimous agreement, that is to enact an effective international instrument against the reproductive cloning of human beings. Having said that, even though we may all be in agreement, it is still important to have comprehensive discussions on the issue instead of acting hastily. As for the question of therapeutic cloning, this is something that we believe requires much more deliberation and careful consideration.
Thank you.