1 the eighth asian bioethics conference march 19-23, 2007, bangkok, thailand

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1 The Eighth Asian Bioethics Conference March 19-23, 2007, Bangkok, Thailand

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Page 1: 1 The Eighth Asian Bioethics Conference March 19-23, 2007, Bangkok, Thailand

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The Eighth Asian Bioethics Conference March 19-23, 2007, Bangkok, Thailand

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Bagher Larijani, Bagher Larijani, MDMDProfessor of Tehran University Professor of Tehran University

of Medical Sciencesof Medical Sciences

Farzaneh Zahedi, MDFarzaneh Zahedi, MD Researcher of Researcher of Tehran University Tehran University

of Medical Sciencesof Medical Sciences

Medical Ethics and History of Medicine Research Centre,Medical Ethics and History of Medicine Research Centre,& Endocrinology and Metabolism Research Centre,& Endocrinology and Metabolism Research Centre,

Tehran University of Medical SciencesTehran University of Medical Sciences

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INTRODUCTION

The discovery of Embryonic The discovery of Embryonic Stem Cells (ESCs ) in the Stem Cells (ESCs ) in the 1980s1980s

suggested suggested therapeutic therapeutic approachesapproaches to chronic, to chronic,

debilitating, and incurable debilitating, and incurable diseases such as Parkinson’s diseases such as Parkinson’s

disease, Alzheimer's, Diabetes disease, Alzheimer's, Diabetes Mellitus, and brain and spinal Mellitus, and brain and spinal

injuries.injuries.

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Using ESCs are surrounded by a Using ESCs are surrounded by a number of number of ethical controversiesethical controversies, ,

the extent of which is partly the extent of which is partly dependent on their source. dependent on their source.

The debate over this subject became The debate over this subject became further complicated in further complicated in 1998 1998 when when researchers were able to researchers were able to isolate isolate human Embryonic Stem Cellshuman Embryonic Stem Cells

(hESCs). (hESCs).

Introduction (cont.)

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Introduction (cont.)Many areas of stem cell research Many areas of stem cell research

and their potential clinical and their potential clinical applications are associated with applications are associated with

controversy; controversy;

therefore there are variedtherefore there are varied socio- socio-cultural, ethical, political, and cultural, ethical, political, and

religious viewpointsreligious viewpoints to be to be considered in discussions about considered in discussions about the production and use of stem the production and use of stem

cells. cells.

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POTENTIAL APPLICATIONS

The most important The most important application of hES cells is application of hES cells is

clinically in clinically in

transplantation transplantation

and regenerative and regenerative medicine.medicine.

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POTENTIAL APPLICATIONSDisorderDisorder Cells transplantedCells transplanted

Alzheimer's disease Nerve cells

Atherosclerosis Endothelial cells

Burns Skin cells

Chronic pain Chromaffin cells

Diabetes Islet cells

Epilepsy Nerve cells

Heart disease Cardiomyocytes

Huntington's disease Nerve cells

Hypocalcemia Parathyroid cells

Hypocholesterolemia Hepatocytes

DisorderDisorder Cells transplantedCells transplanted

Kidney disease Kidney cells

leukemia Hematopoietic cells

Liver disease Hepatocytes

Macular degeneration Retinal cells

Multiple sclerosis Glial cells

Muscular dystrophy Skeletal muscle cells

Osteoarthritis Chrondrocytes

Parkinson's disease Dopaminergic neurons

Rheumatoid arthritis Chrondrocytes

Strokes Nerve cells

Spinal cord injuries Nerve cells

NATURE BIOTECHNOLOGY 1999; 17: 1173

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APPLICATIONS IN RESEARCH

Models of human disease Models of human disease The pharmaceutical researchThe pharmaceutical researchHuman developmental biologyHuman developmental biologyGene therapyGene therapy

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Cell Characteristics in Stem Cell Biology

TermTerm DefinitionDefinition ExampleExample

Totipotent Able to Produce an entire being Blastomeres

Pluripotent

Able to produce all tissues and self-renew indefinitely

Embryonic stem cell

Multipotent

Able to produce many cell types and self-renew over the lifetime of the being and over many subsequent generations if transplanted

Hematopoietic stem cell

Progenitor Able to produce restricted number of cell types and with limited to no capacity of self-renewal

Neural stem cell

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STEM CELL SOURCES

There are various ways in which human There are various ways in which human stem cells might be obtainedstem cells might be obtained::

•Adult Stem Cells•Umbilical Cords •Placenta•Aborted Fetuses•Spare Embryos from IVF Clinics•Cloned Human Embryo

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EMBRYONIC STEM CELL Embryonic stem (ES) cells are derived from Embryonic stem (ES) cells are derived from

the inner cell mass of a the inner cell mass of a blastocystblastocyst. . The blastocyst forms at approximately 4 or 5 The blastocyst forms at approximately 4 or 5

days after fertilization and contains from 64 days after fertilization and contains from 64 to several hundred cells organized in an to several hundred cells organized in an outer shell, the outer shell, the trophectodermtrophectoderm, and a , and a collection of polarized inner cells termed the collection of polarized inner cells termed the inner cell massinner cell mass (ICM). (ICM).

J Clin Invest, Vol.114, No.9, 2004, pp. 1184-1186

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PLURIPOTENCY

Stem cells retain the ability to differentiate into Stem cells retain the ability to differentiate into cells and tissues from all cells and tissues from all 3 germ layers3 germ layers

(endoderm, mesoderm, and ectoderm). (endoderm, mesoderm, and ectoderm).

But, these cells But, these cells cannot form the othercannot form the other

‘ ‘extra- embryonic’ tissuesextra- embryonic’ tissues necessary for necessary for complete development, complete development, such as such as placentaplacenta and and

membranesmembranes, therefore , therefore

they cannot give rise to a complete new they cannot give rise to a complete new individualindividual..

•Human Reproduction, Vol.18, No.4, 2003, pp. 672-682•The Journal of Urology, Vol.170, 2003, pp. 2453-2458

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hES cells are pluripotenthES cells are pluripotent

Source: NIH 2001: Stem Cells: Scientific Progress and Future Research Directions

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Disadvantages of ESCs

Cancer and TumorsCancer and Tumors : the potential : the potential of introducing cancer into patients of introducing cancer into patients because of rapid growth of because of rapid growth of embryonic stem cells embryonic stem cells

Tissue Tissue RejectionRejection Genetic AbnormalitiesGenetic Abnormalities Hundreds of thousands to millions Hundreds of thousands to millions

of stem cell lines would be required of stem cell lines would be required to treat the majority of patientsto treat the majority of patients

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CLONING

An alternative method An alternative method of deriving human of deriving human

ESCs is ESCs is somatic cell somatic cell nuclear transfernuclear transfer

(SCNT), or (SCNT), or cloningcloning . .

Dolly 1997-2003

SCNT across species is an important challenge.

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Removing the maternal nucleus

before nuclear transfer

Nuclear transfer embryo about to be

activated(Roslin Institute http://www.roslin.ac.uk)

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ADVANTAGES OF CLONING

No rejection, “Perfect match”No rejection, “Perfect match”Stem cells produced by Stem cells produced by therapeutic therapeutic cloningcloning are are genetically similargenetically similar to the to the cells of the individual who donated the cells of the individual who donated the nucleus, and thus avoid problems of nucleus, and thus avoid problems of rejectionrejection. .

•The Journal of Clinical Investing , Vol.14, No.10, 2004, pp. 1364-1370•Journal of Medicine and philosophy, Vol.27, No.3, 2002. pp. 297-317 •The New England Journal of Medicine, Vol.346, No.20, 2002, pp. 1576-1579

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DISADVANTAGES OF CLONING

Not Enough Human Eggs Not Enough Human Eggs Cloning damages DNA Cloning damages DNA

Further Further improvements in SCNTimprovements in SCNT protocols and in vitro culture protocols and in vitro culture systems are needed systems are needed before before

contemplating the usecontemplating the use of this of this technique for cell therapy.technique for cell therapy.

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ADULT STEM CELLS

Stem cells have been identified in Stem cells have been identified in adult tissuesadult tissues.. Examples include the brain, skeletal muscle, Examples include the brain, skeletal muscle, bone marrow and umbilical cord blood, bone marrow and umbilical cord blood, although the heart, by contrast, contains no stem although the heart, by contrast, contains no stem cells after birth. cells after birth.

It is becoming increasingly evident that adult It is becoming increasingly evident that adult stem cells can show considerably stem cells can show considerably more more plasticityplasticity and could be and could be more versatilemore versatile than than previously believed. previously believed. • Cell prolif, Vol.37, 2004, pp. 23-34• Proc Natl Acad Sci USA, Vol.100, 2003, pp.

1191-7

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Advantages/Disadvantages

Stem CellStem Cell CostCost Tissue Tissue rejectiorejectionn

Ethical Ethical ProblemProblemss

Works Works for for genetic genetic diseasesdiseases

Human Human EmbryosEmbryos

Low (Low (??))(IVF (IVF leftoversleftovers))

YesYesUnique Unique human human embryosembryos

YesYes

Human Human ClonesClones HighHigh NoneNone

Cloned Cloned human human embryosembryos

NoNo

AdultAdultAutologoAutologousus

LowLow NoneNone NoneNone NoNo

AdultAdultDonatedDonated LowLow YesYes NoneNone YesYes

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KEY ETHICAL ISSUES

Moral status of human embryo The creation of embryos only for research purposes Exploitation of women to obtain oocytes and

commercialization of human eggs Resource Allocation Justice: Equitable distribution of the benefits is also

important. Conflicts of Interests: financial interest of researchers Patenting of stem cell lines Animal/human hybrids …

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MAIN ETHICAL ISSUE

Moral status of human embryoMoral status of human embryo: : The embryo is unavoidably destroyed The embryo is unavoidably destroyed during the process of ESCs harvesting. during the process of ESCs harvesting.

When does “human life” begin?When does “human life” begin?

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Humanity of the Unborn

The Moral status of human embryo The Moral status of human embryo

is major ethical issue in conducting this is major ethical issue in conducting this research. To create new cell lines, it is research. To create new cell lines, it is necessary to destroy preimplantation necessary to destroy preimplantation

blastocysts. blastocysts.

The question is The question is

whether the destruction of human embryos whether the destruction of human embryos amounts to the amounts to the killing of human beingskilling of human beings..

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The Status of the EmbryoThe Status of the Embryo

Does the blastocyst have the same rights (e.g., the right to life, to thrive, not to be harmed, etc.) as human beings?

If the blastocyst has the same rights as a human being, then to derive stem cells from it means that a human being must be killed.

Is it ethical to fertilize embryo merely for stem cell harvesting?

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Views about the Moral Status of the Embryo

The Pro-Life ViewThe Pro-Life View: An early embryo has the same : An early embryo has the same right to life as a normal adult human being.right to life as a normal adult human being. The The embryo is a ‘person’ and because of the embryo is a ‘person’ and because of the potential of the embryo to develop into a potential of the embryo to develop into a person, it ought to be considered as a person, it ought to be considered as a person. person.

The Pro-Choice ViewThe Pro-Choice View: An early embryo has no : An early embryo has no moral status whatsoever.moral status whatsoever. The embryo (and even the fetus) as a The embryo (and even the fetus) as a ‘non-person’‘non-person’ ought not to be attributed ought not to be attributed any moral status at all. any moral status at all.

There is a There is a spectrum of opinionsspectrum of opinions between between these extremes. these extremes.

Human Reproduction, Vol.18, No.4, 2003,pp. 672-682

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The Status of the Embryo (cont.)

One moral argument is that human One moral argument is that human ‘‘personhoodpersonhood’ begins at ’ begins at conceptionconception, ,

or –as in cloning– at the genetic or –as in cloning– at the genetic beginning.beginning.

Based on this argument, the Based on this argument, the destruction of embryos for research destruction of embryos for research

cannot be justified.cannot be justified.

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The Status of the Embryo (cont.) It is necessary to consider that viewing the It is necessary to consider that viewing the

embryo as a person rules out not only stem-cell embryo as a person rules out not only stem-cell research, but all research, but all fertility treatmentsfertility treatments that that involve the creation and discarding of excess involve the creation and discarding of excess embryos. However, defenders of in vitro embryos. However, defenders of in vitro fertilization point out that embryo loss in fertilization point out that embryo loss in assisted reproduction is less frequent than in assisted reproduction is less frequent than in natural pregnancynatural pregnancy, in which more than half , in which more than half of all fertilized eggs either fail to implant or are of all fertilized eggs either fail to implant or are otherwise lost.otherwise lost.

New Engl J of Med, Vol.346, No.20, 2002, pp. 1579-82

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The Status of the Embryo (cont.)A different moral argument underlines that A different moral argument underlines that embryos do deserve protection and a certain embryos do deserve protection and a certain respect, but not to the same extent as fully respect, but not to the same extent as fully

developed babies. developed babies.

From this viewpoint, the moral status of From this viewpoint, the moral status of embryos embryos gradually increasesgradually increases with their with their

development. Once they are born, they are development. Once they are born, they are entitled to enjoy full rights as human beings. entitled to enjoy full rights as human beings.

Therefore, destruction of embryos can be Therefore, destruction of embryos can be justified to provide a treatment for patientsjustified to provide a treatment for patients..

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The Status of the Embryo (cont.)

A third type of moral argument points A third type of moral argument points out that out that certain milestonescertain milestones exist exist

in embryonic development that in embryonic development that change the status of embryos. change the status of embryos.

For example:For example: Ensoulment Ensoulment The primitive streak The primitive streak

development at day 14, before development at day 14, before three germ layers appear three germ layers appear

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Recent advances in scientific research and Recent advances in scientific research and technological sophistication have raised totally technological sophistication have raised totally new possibilities of deciding about birth and new possibilities of deciding about birth and deathdeath. Different religions, faiths, and customs . Different religions, faiths, and customs have different views on these issues have different views on these issues

The sacred writings and teachings of different religions contain

a wealth of teachings about the

key moments of life; its beginning and its end.

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OVERALL CONSENSUS

All religions believe that usage All religions believe that usage of adult, placental, and umbilical of adult, placental, and umbilical stem cells is acceptable.stem cells is acceptable.

Controversy lies with idea of Controversy lies with idea of using using embryonic stem embryonic stem cellscells and and where life where life

beginsbegins..

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•What is an Embryo ?What is an Embryo ?•When does life begin ? When does life begin ? •At what point do rights apply?

•Is there any agreement on these questions?

Religious Questions

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Moral Status of Human Embryo

There is There is no consensusno consensus on the morality of on the morality of the embryo, even within particular the embryo, even within particular religious traditions.religious traditions.

There is substantial debate regarding at There is substantial debate regarding at which specific stage dignity is conferredwhich specific stage dignity is conferred in development (conception, primitive in development (conception, primitive streak development, implantation, streak development, implantation, ensoulment or birth)ensoulment or birth)

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CHRISTIANITY

Life begins at Life begins at conceptionconceptionKilling embryo any time after Killing embryo any time after

conception is conception is equivalent to killingequivalent to killing a a human beinghuman being

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Christianity (cont.) Although RomanAlthough Roman CatholicismCatholicism officially officially

opposes human embryonic stem cell opposes human embryonic stem cell researchresearch, some Roman catholic moral , some Roman catholic moral theologians endorse it. theologians endorse it.

ProtestantsProtestants have a wide range of views. have a wide range of views. OrthodoxOrthodox Church firmly reject any and all Church firmly reject any and all

manipulation of human embryos for research manipulation of human embryos for research purposes as inherently immoral and a purposes as inherently immoral and a fundamental violation of human life.fundamental violation of human life.

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JUDAISM A A fetus is not seen as being an ensouled fetus is not seen as being an ensouled

personperson. Not only are the first forty days of . Not only are the first forty days of conception considered 'like water' but also conception considered 'like water' but also even in the last trimestereven in the last trimester, the fetus has a , the fetus has a lesser moral status.lesser moral status.

A number of Jewish thinkers hold that the A number of Jewish thinkers hold that the extracorporeal embryo, in the Petri dish or extracorporeal embryo, in the Petri dish or cry preserved, does not have standing in cry preserved, does not have standing in Jewish law and that it is Jewish law and that it is justifiable to go justifiable to go forward with embryonic stem cell forward with embryonic stem cell researchresearch..

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EASTERN RELIGIONS BuddhismBuddhism

Controversial on embryonic stem cell researchControversial on embryonic stem cell research AdvocatesAdvocates::

-- Central virtues of knowledge and compassion Central virtues of knowledge and compassion -- Want to alleviate human suffering Want to alleviate human suffering

OpponentsOpponents::- - First precept of Buddhism: prohibits causing death First precept of Buddhism: prohibits causing death or injury to living creatures or injury to living creatures - Ahimsa- Ahimsa- non harming- non harming- Life begins at conception; karmic identity of - Life begins at conception; karmic identity of recently deceased individualrecently deceased individual- No enduring soul- No enduring soul

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ISLAMISLAM

In opinion of most Muslim jurists, In opinion of most Muslim jurists,

stem cell and cloning research, as great stem cell and cloning research, as great scientific events, would have scientific events, would have advantages advantages

andand limitations limitations. . Due to majority of Muslim reference Due to majority of Muslim reference

decrees, according to decrees, according to inevitable inevitable consequencesconsequences of of reproductive cloningreproductive cloning, it , it is is prohibitedprohibited. .

Transplantation Proceedings, Vol.36, No.10, 2005, pp. 3188-3189

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According to Islamic beliefs, the fetus According to Islamic beliefs, the fetus undergoes a undergoes a series of transformationsseries of transformations

beginning as an organism and beginning as an organism and becoming a human being. The fetus becoming a human being. The fetus

culminates in becoming a full human culminates in becoming a full human being when being when it is “ensouled” at 120 daysit is “ensouled” at 120 days (the end of the fourth month) from the (the end of the fourth month) from the

moment of conception.moment of conception.

ISLAMISLAM

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Holy Holy QuranQuran (chapter (chapter 2323/verses /verses 12-1412-14) ) describes the describes the development of an embryodevelopment of an embryo

into a full human personinto a full human person: : ""We created Man of an extraction of clay, then We created Man of an extraction of clay, then we set him, a drop in a safe lodging, then We we set him, a drop in a safe lodging, then We

created of the drop a clot, then We created of the created of the drop a clot, then We created of the clot a tissue, then We created of the tissue bones, clot a tissue, then We created of the tissue bones,

then we covered the bones in flesh; then we covered the bones in flesh; thereafter thereafter We produced it as another creatureWe produced it as another creature. So blessed . So blessed

be God, the Best of creators (khaliqin)!be God, the Best of creators (khaliqin)!" "

ISLAMISLAM

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Nevertheless, the Nevertheless, the rights of the child begin rights of the child begin prior to her/his birthprior to her/his birth. Given the Islamic . Given the Islamic teachings, the embryo, teachings, the embryo, even in the first even in the first

days of its existencedays of its existence, has the right to live , has the right to live and no one has the right to kill it; but the and no one has the right to kill it; but the

punishment of fetus eradication in the punishment of fetus eradication in the pre-ensoulment stages will be much less pre-ensoulment stages will be much less

than abortion after ensoulment.than abortion after ensoulment.

ISLAMISLAM

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It is obvious that because of the It is obvious that because of the

potential therapeutic benefitspotential therapeutic benefits of the of the

procedure of stem cell research and procedure of stem cell research and

cloning, destruction of the blastocyst cloning, destruction of the blastocyst

and research into human ESCs should and research into human ESCs should

be be justifiedjustified according to according to the majority the majority

of Muslim scholarsof Muslim scholars. .

ISLAMISLAM

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The conference was organized in CasablancaThe conference was organized in Casablanca . . A A consensus was reached that: consensus was reached that:

““Cloning does not bring into question any Islamic belief Cloning does not bring into question any Islamic belief in any wayin any way. Allah is the Creator of the universe but He . Allah is the Creator of the universe but He has established the has established the system of cause-and-effectsystem of cause-and-effect in this in this

world. Sowing a seed in the ground is the cause but only world. Sowing a seed in the ground is the cause but only Allah produces the effect from it in the form of a plant. Allah produces the effect from it in the form of a plant. Similarly Similarly cloning is a cause and only through Allah's cloning is a cause and only through Allah's

Will it can produce the effectWill it can produce the effect. Just as the person sowing . Just as the person sowing the seed is not the creator of the resulting plant, so the the seed is not the creator of the resulting plant, so the cloning technician is not the creator of the resulting cloning technician is not the creator of the resulting

animal. Allah alone is the Creator and animal. Allah alone is the Creator and all creation takes all creation takes place solely through His Willplace solely through His Will..""

The Islamic Fiqh Council (1997)The Islamic Fiqh Council (1997)

Human Cloning: comments by political groups, religious authorities.http://www.religioustolerance.org/clo_reac.htm

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Most attendees concluded that Most attendees concluded that reproductive cloning is permissible reproductive cloning is permissible

for plants and animals, but not for plants and animals, but not humans. "humans. "The extension of cloning The extension of cloning

to human beings would create to human beings would create extremely complex and intractable extremely complex and intractable

social and moral problems.social and moral problems." "

ISLAMISLAM

Human Cloning: comments by political groups, religious authorities.http://www.religioustolerance.org/clo_reac.htm

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ISLAMISLAM

Currently, stem cell research and cloning Currently, stem cell research and cloning for for therapeutic purposestherapeutic purposes is is permissiblepermissible with full consideration and all possible with full consideration and all possible

precautions precautions in pre-ensoulment stagesin pre-ensoulment stages of of fetus development. fetus development.

This is the consensus of Sunni and Shia This is the consensus of Sunni and Shia Muslims; but only a minority of Sunni Muslims; but only a minority of Sunni

scholars are against it.scholars are against it.Transplantation Proceedings, Vol.36, No.10, 2004, pp. 3188-3189Blood Cells, Molecules, and Diseases, Vol.32, 2004, pp. 100-105

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A brief review of A brief review of Islamic perspectivesIslamic perspectives about reproductive and therapeutic about reproductive and therapeutic

cloning and stem cell research has been cloning and stem cell research has been published in 2004.published in 2004.

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NATIONAL LAW

Considerable differences exist Considerable differences exist between countries in the between countries in the

regulation of stem cell researchregulation of stem cell research and nuclear transfer to produce and nuclear transfer to produce

human embryo. human embryo.

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Reproductive cloningReproductive cloning

is is prohibitedprohibited in in IranIran, however, , however,

embryonic stem cell researchembryonic stem cell research

has been has been approvedapproved by the by the religious authorities and some religious authorities and some

projects have started.projects have started.

Office of the Supreme Leader, Ref # M/8/239001, February 5, 2003

NATIONAL LAW

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Iran was the 10th country in the world to produce, culture and freeze hES cells (The nine previous countries were Sweden, Japan, the United States, Australia, Britain, India, South Korea, and Singapore).

Stem Cell Research & Cloning

Iranian scientists have established 6 human ESs lines since 2004.

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In addition, researchers at the Royan Institute were witness to the birth of the first cloned sheepfirst cloned sheep born in Iran in 2006.

Stem Cell Research & Cloning

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An An emphasis on ethicsemphasis on ethics has has

been also voiced by medical been also voiced by medical

and religious authorities in Iran and religious authorities in Iran

in recent decade.in recent decade.

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Compiling the Specific National Ethical Guidelines for Biomedical Research

The Guidelines were compiled as a common project The Guidelines were compiled as a common project by the “Medical Ethics Research Center” and the by the “Medical Ethics Research Center” and the “Endocrinology and metabolism research center” “Endocrinology and metabolism research center” of Tehran University of Medical sciences (of Tehran University of Medical sciences (2005-2005-

20062006). This project supported by “Deputy of ). This project supported by “Deputy of research and technology of the Ministry of Healthresearch and technology of the Ministry of Health

.”.”

The primary draft was reviewed by some The primary draft was reviewed by some law, ethics, medical and religious law, ethics, medical and religious

expertsexperts..

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Compiling the Specific National Ethical Guidelines…(Cont.)

The Guidelines were The Guidelines were developed developed to observe to observe

ethical rules in researchethical rules in research and to protect research and to protect research participants all over the participants all over the

country.country.

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The Specific National Ethical Guidelines for Biomedical Research

1.1. Ethical Guidelines for Clinical TrialEthical Guidelines for Clinical Trial

2.2. Ethical Guidelines for Research on MinorsEthical Guidelines for Research on Minors

3.3. Ethical Guidelines for Genetic ResearchEthical Guidelines for Genetic Research

4.4. Ethical Guidelines for Gamete and Embryo Ethical Guidelines for Gamete and Embryo ResearchResearch

5.5. Ethical Guidelines for Transplantation ResearchEthical Guidelines for Transplantation Research

6.6. Ethical Guidelines for Research on AnimalsEthical Guidelines for Research on Animals

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ReligionReligion has an inevitable has an inevitable

influence on many medical influence on many medical

ethics ethics decision-makingsdecision-makings and and

legislationslegislations..

CONCLUSION

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Conclusion (cont.)

No consensusNo consensus exists among religious exists among religious traditions (or secular moral traditions) traditions (or secular moral traditions) about the about the moral status of the embryomoral status of the embryo..

An An ethical public policyethical public policy in our in our pluralistic world has to pluralistic world has to respect diverse respect diverse

fundamental beliefsfundamental beliefs..

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Conclusion (cont.)

Cooperation of scientists, ethicists, Cooperation of scientists, ethicists, jurisprudents and lawyers is essential jurisprudents and lawyers is essential

for for establishing a wellestablishing a well--controlled controlled systemsystem and appropriate ethical and and appropriate ethical and

scientific scientific supervisionsupervision of the research of the research programs at national, regionprograms at national, regional and al and

international levelsinternational levels..

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Conclusion (cont.)

Guidelines and protocols ought to be Guidelines and protocols ought to be established in order to established in order to allow allow

scientists to pursue new medical scientists to pursue new medical advancesadvances while maintaining the while maintaining the

highest ethical standardshighest ethical standards in the use in the use of human embryosof human embryos. .

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Conclusion (cont.)

Public educationPublic education about the about the ethical and policy issues ethical and policy issues

raised by stem cell research raised by stem cell research and its application is and its application is

necessary.necessary.

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