Dr. Musa Mohd. Nordin FRCP, FAMM
Consultant Paediatrician & Neonatologist, MALAYSIA
President, Federation of Islamic Medical Associations

Heralded by the revelation of the double helical structure of the DNA molecule in 1953, the 21st century is aptly designated the biotechnology century. The 20th century of physics, which saw the transformation of silicon into computing magic, was embraced with enthusiasm by virtually every household. However, unlike her predecessor, the same cannot be said about the advancements in biomedicine.

These revolutionary procedures in biotechnology has probed the outermost boundaries of what is scientifically possible and acceptable. Micro manipulation at the very earliest stages of human development, at the level of the embryo, single cell and genetic structure is undoubtedly a very delicate and sensitive issue with potentially explosive ethical, social, medico-legal and religious ramifications. Hence, the turbulent and not uncommonly hostile controversies that has since evolved.

The breaking news of the cloning of Dolly the sheep by the technique of somatic cell nuclear transfer in February 1997 unleashed a polarized world view towards the new technologies of human reproductive cloning (1). Eight years post-Dolly, only a few countries have either drafted or enacted laws to bring human genetic and reproductive technology under responsible societal governance. As of November 2003, 77% of countries have not taken action to ban reproductive human cloning. Malaysia is in the final stages of drafting laws to ban the reproductive cloning of human beings.

Apart from a small minority of "rogue cloners" there is an international consensus against the reproductive cloning of human beings. However the opportunity to elaborate an international convention to ban reproductive human cloning was lost when member countries disagreed on the extent of the ban.

Unfortunately, the confusion and disgust at the prospect of cloning and creating babies has been transferred to therapeutic cloning. In therapeutic cloning unlike human reproductive cloning the end point is not cloning a human being. This technology involves the production of human clonal embryos for the purpose of harvesting stem-cells, tissues and organs. This would open the potential of curing a whole host of chronic and debilitating diseases including diabetes mellitus, parkinsonism, myocardial infarction and spinal injuries apart from many other biomedical spin offs.

The source of the totipotent stem cells has however been a source of intense controversy. Stem cells found in umbilical cord blood, bone marrow and aborted fetuses are generally acceptable from the ethical and moral point of view. Though less plastic, scarce and sometimes quite inaccessible, there have been some success stories with the use of these non-embryonic stem cells (adult stem cells).

The use of embryonic stem cells (ESC) is however fraught with highly charged religio-bio-ethical debate. The source of controversy revolves around the various questions about when life becomes a human life; namely :

1. Is an ovum and sperm a person?
2. When do the products of conception become a person?
3. Does a zygote have a full set of human rights?
4. Does the foetus have a soul?

This concept of personhood is neither logical nor empirical. It is based on one’s fundamental assumptions about the nature of the world. It is primarily a religious or quasi-religious concept.

Those who believe that the soul enters the body at conception regards the fertilized ovum as a dignified human person will full human rights. And therefore would not accept the manipulation or destruction of human embryos, even when their proposed goal is good in itself.

The scientific paradigm defines the pre-embryonic stage as the period from fertilization up to the determinant of the primitive streak at the age of 14 days. The pre-embryo is unable to feel pain or pleasure and therefore has no moral status. They may be cryopreserved, discarded or used for research purposes.

The Quran is a book of guidance to invite mankind to the truth and salvation. But nonetheless it contains many "signs" which invites mankind to reflect upon his creation and the world that surrounds him. In various verses, it illustrates lucidly both the physical and spiritual dimensions of man’s creation. In chapter 23, verses 12-14, the Quran says :

"And indeed We created man from a quintessence of clay. Then we placed him as a small quantity of liquid (nutfa) in a safe lodging firmly established. Then we have fashioned the nutfa into something which hangs (alaqa). Then We made alaqa into a chewed lump of flesh (mudgha). And We made the mudgha into bones, and clothed the bones with flesh. And then We brought it forth as another creation. So blessed be God, the best to create"

In another verse the Quran very clearly revealed another phase of man’s being, the process of ensoulment.

"and breathe into him of His spirit" (32:9)

The soul is a metaphysical concept which is fundamental in Islam and it defines a human individual. The majority opinion in Islam accepts the 120th day of pregnancy as the time of ensoulment. Eventhough ensoulment occurs later, the embryo is respected from the onset of fertilization and acquires consideration as a human foetus after implantation.

And based on these fundamental premises, at least four Islamic Fiqh (Jurisprudence) Councils have given permission for the use of surplus embryos from IVF laboratories for ESC research (2,3,4,5). However, it is not permissible at this juncture, to consciously generate pre-embryos either by conventional IVF techniques or somatic cell nuclear transfer (SCNT) for ESC research.

As at November 2003, 6 (3%) countries have allowed therapeutic cloning whilst 30 (16%) have prohibited it. The 6 countries in favour of allowing therapeutic cloning to proceed within stipulated policy guidelines are China, Singapore, Belgium, UK, Cuba and USA (6).

The Federal Embryo Protection Law (1990) of Germany prohibits both reproductive and therapeutic cloning. This represents the spectrum of countries with "relatively restrictive" laws related to reproductive technologies. Others include Austria, the Scandinavian countries, Ireland, Italy, Netherlands, Spain and Switzerland

The other end of the spectrum is represented by the United Kingdom’s Human Fertilisation and Embryology Act (1990) and Human Reproductive Cloning Act (2001) and Singapore’s Bioethics Advisory Committee (BAC) Report on "Ethical, Legal and Social Issues in Human Stem Cell Research, Reproductive and Therapeutic Cloning" which was approved by the government on 18 July 2002. The UK and Singapore "more permissive" regulations allows the generation of embryos by both IVF and SCNT technologies if there is a demonstrable and exceptional need which cannot be met by the use of surplus embryos.

The "in-between" policies are demonstrated by the Canadian’s new Assisted Human Reproduction Act (2004) and Australia’s Research Involving Embryos Act (2003). They both allow the utilization of surplus IVF embryos for research but prohibit the creation of human embryos for research and SCNT for research and reproduction. The current thinking in our Malaysian National Committee on Human Cloning seems to favour this line of thought and legal framework; which also resonates well with the fatwa (edict) issued by the three jurisprudence councils in Jeddah, USA and Jordan.

Previously it was thought that it would be extremely difficult to develop comprehensive policies to govern human genetic and reproductive technologies. Despite the earlier skepticism, various countries have now shown that it is possible to break the policy deadlock and draft legislation to regulate these new technologies of human genetic modification. Despite their different political and social experiences, some of the national policies thus available have exhibited a remarkable sharing of core principles; namely :

1. they affirm technologies with a real chance of preventing or curing disease
2. they ban technologies which could harm children or open the door to free market eugenics
3. they ensure research involving embryos is tightly regulated
4. they establish publicly accountable means to review policies & make new ones
5. they pose no risk for reproductive rights

Probably one of the most far reaching thoughts on this highly controversial issue of ESC research has been that propounded by Sheikh Dr. Yusuf Al-Qardawi, a highly respected and contemporary Muslim scholar who related in his concluding remarks after a lengthy juristic deliberation the following position (7) :

"If it becomes possible through research to clone organs such as the heart, liver, kidneys or others which may benefit those who are in dire need of them; then this is permitted by religion and the researcher or scientist will receive the reward from Allah. This is because the research will confer benefit on humanity without loss to others or infringing upon them. Therapeutic cloning with this noble research pursuit is permissible and it is encouraged. In fact, in some circumstances, it may become mandatory to enhance this research in accordance with the need and man’s research capability and accountability."

Islamic medical bioethics is firmly grounded on the fundamental tenets of the Islamic Shariah ( Divine Law ). The close collaboration between the scholars of jurisprudence and the scientific and medical fraternity has enabled her to keep abreast of the plethora of advancing biotechnologies.

Despite the wide ranging bio-religio-ethical problems and dilemmas posed by these emerging biotechnologies, Islamic medical bioethics, has provided a "middle of the road" approach moderating between the extremes of conservatism and liberalism. This it does without impeding the genuine and responsible quest for new knowledge and breakthroughs in new research frontiers. It has provided a legal framework for responsible societal governance of human genetic and reproductive technologies and banned all forms of free market eugenics.

REFERENCES

1. Recommendations of the 9th Fiqh-Medical Seminar; Islamic Organisation of Medical Sciences
2. Aly A. Mishal. Cloning and advances in molecular biotechnology. FIMA Year Book 2002, pp 38.
3. The Council of Islamic Fiqh Academy of the Muslim World League. 2003; 17th session in Makkah, 13-17 December.
4. Fiqh Council of North America, International Institute of Islamic Thought, Graduate School of Islamic and Social Sciences, Islamic Institute news release August 27, 2001.
5. National Fiqh Council of Malaysia. MFK No. 66. February 22, 2005
6. National Policies Governing New technologies of Human genetic Modification. : A preliminary Survey. Center for Genetics and Society. 2003.
7. Yusuf Al-Qardawi. Hadyul Islam Fatawi Mu’athirah. Darul Qalam Kuwait 2001. Translated Gema Insani Press, October 2002.