4 Science and Biomedical Research Using Human Tissue

وَلَقَدْ كَرَّمْنَا بَنِي آدَمَ وَحَمَلْنَاهُمْ فِي الْبَرِّ وَالْبَحْرِ وَرَزَقْنَاهُم مِّنَ الطَّيِّبَاتِ وَفَضَّلْنَاهُمْ عَلَىٰ كَثِيرٍ مِّمَّنْ خَلَقْنَا تَفْضِيلًا

And indeed We have honoured the Children of Adam, and We have carried them on land and sea, and have provided them with at-tayyibāt (lawful good things), and have preferred them to many of those whom We have created with a marked preferment.”(al-Isrā’:70)

 

Biomedical research using human tissues and stem cells has grown rapidly over the past few decades. The procurement and use of such tissues and cells have caused some controversy globally. The most recent instance was the nationwide protests in the United States against Planned Parenthood for allegedly selling tissues from aborted babies. Such controversies and dubious practices highlight the need for regulation of the biomedical research industry.

With regard to the supervision and monitoring of biomedical research in Singapore, the Ministry of Health has required all government sectors and hospitals to establish ethics committees since 1998.  Each committee reviews the pharmaceutical trials, procedures and other clinical studies involving human subjects.[1] At the national level, the National Medical Ethics Committee was formed primarily to issue guidelines on research involving human subjects. However, this legal infrastructure proved inadequate as advances in biomedical research brought many new issues to the table. In December 2000, the Singapore Cabinet appointed the Bioethics Advisory Committee (BAC) to examine the ethical, legal and social issues that could result from developing biomedical research in Singapore. The establishment of the BAC is very important and timely for Singapore as the country moved towards creating a thriving biomedical industry as part of Singapore’s economic planning. Members of the BAC are appointed for two-year terms. The Committee comprises legal experts, scientists, religious leaders, and academics from various disciplines.[2] Before submitting its findings, the BAC consults various organisations, including religious organizations such as Muis.  A large number of the questions submitted to Muis have been discussed by the Fatwa Committee in which they ascertained their religious positions and the results of these have been returned to the BAC. Since 2002, the Fatwa Committee has published eight reports outlining their policy recommendations for issues such as stem cell research, genetic testing, human-animal hybrid research, donation of human eggs and the use of personal information in biomedical research.[3]

Prior to the consultation by the BAC, the Fatwa Committee received requests for fatwas on issues related to scientific research involving human bodies, tissues and cells as early as the 1970s, such as the issue of post-mortem on cadavers for the purpose of forensic and medical research. Although this was not a cutting-edge procedure compared to today’s scientific research, the fundamentals of the ruling nonetheless outlined the main principles for future concerns in similar issues.

Fatwa Decision 29/8/1972
PERFORMING POST-MOTERM ON CADAVERS FOR RESEARCH

Question:

Is it permissible to perform post-mortem on Muslim cadavers for medical research?

Answer:

The Fatwa Committee could not reach a unanimous decision on whether the bodies of deceased Muslims can be used for medical research.

The Chairman is of the view that this is allowed only in cases of emergency, with the condition that the researcher is an actual medical student who is required to dissect the human body as part of his medical training, and not any lay person who is not undergoing training for medical studies.

The evidence for the opinion is as follows:
Islam commands its followers to seek treatment when ill. The Messenger of Allah (ﷺ) himself sought treatment and instructed his household and companions to seek treatment when ill. The Messenger of Allah (ﷺ) said in a hadīth, which means:

Seek treatment because Allah does not place a disease, except that there is a treatment.”

And he also said:

Allah does not bring down a disease, except that there is a treatment. Some know the treatment (how to treat) and some do not.

Therefore the learning and teaching of medical treatment, is masyrū‘ (permitted by religion) based on evidence from the hadīth and the actions of the Prophet, in addition to evidence from the Qur’an that allows the breaking of fast for the sick so that they may seek treatment and avoid matters that may bring further harm.

Clearly, learning medicine and its related knowledge is beneficial and is thus considered fardu kifayah, which makes it obligatory on some Muslims. Otherwise, everyone would be in sin if it were totally neglected. The same goes for other sciences and disciplines that are needed by the community; there must be Muslims from the ummah who fulfil the fardu kifayah.

Post-mortem and surgery are essential lessons in medical science and should be adequately studied both on theoretical and practical levels so that the student can appropriately and successfully fulfil his task upon completion.

With the aforementioned evidence, it is clear that learning surgery is compulsory (fardu kifayah) upon every community. The same goes for teaching and making full use of the knowledge gained in service of humanity. It is also a fundamental maxim that it is (as-shāri‘) who makes the law – when a matter is compulsory, then its components are also compulsory. For example, when Allah made prayer obligatory, it is obligatory for the one who performs it that his body is also in a state of cleanliness.

Since some Muslims are obligated to learn medicine and serve as doctors, Islam also requires that they study surgery to become surgeons. It is clear therefore that to do so, they need to learn how to dissect. Now, the other issue is the question of the sanctity of the human body, and whether it would be considered an abuse if it is dissected.

A person who does not comprehend this will definitely object to it. But by considering the Islamic legal maxims, we will find that the objective of Islamic law is to “maintain goodness and avoid harm.” That which leads to good is pursued, and that which leads to harm is avoided and strictly prohibited by the religion.

When weighing the benefit of surgery or dissection in medical research in comparison to that which brings benefit as a result of the study– such as upholding truth, helping the wrongly accused from capital charges, convicting a murderer – we will find that research involving surgery and dissection is more beneficial. Some conditions have to be adhered to before such procedures are carried out: mainly that it is allowed only due to ḍarūra (exigency). The procedure must also be done by Muslim doctors in a Muslim country, and not simply conducted by anyone.

In discussing the issue above, the Fatwa Committee weighed between the two forms of potential harm (mafsada): the mafsada if Muslims were prohibited from performing dissections on a cadaver for the purpose of studying medicine and surgery, thus being deprived of the knowledge of treating sickness, and the mafsada of dissecting a human body.

Based on the maxim “jalb al-maṣālih muqaddam ʿalā dafʿ al-mafsada” (drawing benefit takes precedence over avoiding harm), the Fatwa Committee assesed the benefits that can be gained from the procedure and weighed it against the necessity of avoidance of harm.

The Fatwa Committee opined that examining diseases through surgery could save many lives. It should also be noted that in the opinion of the Fatwa Committee, a post-mortem does not encroach on the sanctity of the deceased. However, the Fatwa Committee cautioned that the procedure should be carried out only on the basis of necessity, in order to avoid any exploitation that can give rise to other ethical issues, such as the sale and trafficking of cadavers. By allowing the operation to be performed on the deceased, the fatwa is similar in its objective to the 1985 fatwa on organ donation on the basis that transplantation can be performed due to exigencies.

When analysed from a contemporary perspective, it can be said that the fatwa reflects a conservative stance. For example, it places a condition that the surgery should be performed only by Muslim doctors in Muslim countries. Such a position was not all too surprising, given several reasons. Among them is that the fatwa was issued in the early years of the formation of the Fatwa Committee and less than a decade since its inception. It therefore shows a preference towards adopting a cautious approach and decisions issued were guided by the opinions of scholars from Islamic countries, particularly the Middle East. This approach changed in subsequent years. For example, the religion of the health provider no longer became a condition in subsequent fatwas related to medical issues such as organ donation.

Human Stem Cell Research

Research involving human tissue not only focused on the cause of diseases, but also on improvements on current health services and explorations in new forms of treatment and research. Among the findings that have paved the way for other forms of research is the use of stem cells in treatment and reproduction of other cells. This secondary area of research is not free from ethical questions either. This is because one of the sources of stem cells – in fact, the one with the greatest pluripotentiality – is from embryos less than five days old. This breakthrough has generated numerous discussions on whether it should be done, and whether the potential benefits outweigh the harm that may arise.

Stem cells are unspecialised cells which are able to renew and reproduce themselves. Under certain conditions, they could also differentiate into specialised cells for specific functions. There are three common types of stem cells, each of which come from three different sources; (1) Embryonic stem cells which come from early human embryos created from in-vitro fertilization; (2) Adult stem cells which are found in certain adult tissues such as the bone marrow and the brain; and (3) Embryonic germ cells which come from developing or cadaveric fetuses.

Sources of human stem cells

Name Acronym Source Pluripotentiality*
Embryonic stem cell ES Embryo aged less than 5 days (blastocysts) High pluripotentiality
Embryonic germ cell EG Aborted foetus in the first trimester Undetermined pluripotentiality
Adult stem cell AS Tissue taken from adult human (blood, bone marrow, cord blood, liver, brain) Low capability pluripotentiality

*Pluripotentiality: the ability to generate into other types of cells[4]

There is great scientific interest in these cells because they could potentially be used to generate specialised cells to replace tissues and organs, treat injuries as well as ameliorate currently incurable conditions such as muscular degeneration, Alzheimer’s disease, multiple sclerosis and spinal cord injuries. Embryonic stem cells, in particular, have the greatest potential. The incidence rates for such medical conditions in Singapore are expected to increase in the future. For example, the rate for dementia is projected to increase from 0.16% in 2005 to 1.09% in 2050.[5] These conditions will become even more prevalent as Singapore’s population ages. Therefore, there is great interest in promoting research that could help combat these diseases.

Prior to the formation of the BAC, there was no comprehensive legal framework in Singapore governing research on human embryos,[6] apart from guidelines for private healthcare institutions embarking on stem cell research. Soon after it was formed, the BAC discussed stem cell research under their Human Stem Cell Research subcommittee. This Committee studied the practices of other countries and developed some recommendations. In November 2001, they conducted a series of consultation sessions in which their findings were shared, and views from 39 professional and religious bodies, including Muis, were sought. This was followed by a number of dialogue sessions. The Fatwa Committee studied their findings as well as the views of contemporary scholars on related technological developments.

Fatwa Decision 22/11/2001
HUMAN STEM CELL RESEARCH

Question:

The Bioethics Advisory Committee (BAC) is of the view that it accepts the use of embryos created from in-vitro fertilisation, which are less than 14 days old, for the purpose of serious research involving stem cells for the benefit of mankind.

Based on scientific research, human embryos, which are less than 14 days old, have no pain or sentience since only at the 14th day does a primitive streak appear and develop into the nervous system.The Fatwa (Legal) Committee was requested to give a fatwa on this issue.

Answer:

Muis had organised a talk on 8 Sep 2001 on Stem Cells and Genome, which was delivered by Assoc Prof Tusqa Too Heng Poon.  The talk was attended by the Muis Council and the Fatwa Committee.

Based on the explanation and research on the issue, the Fatwa Committee is of the view that Islam welcomes academic research on human genome, genetic engineering and other related fields.  However, such research must be utilised for the benefit of mankind in areas like the treatment of illnesses.  The research has to be within the boundaries of principles in Islamic Jurisprudence, which include:

  لا ضرر ولا ضرار
There should not be any harm and nothing should be done to cause harm”

The principle means:-

  • Do not cause harm to one self and to others.
  • Do not do something that will benefit one self but will harm or cause difficulty to others.

 الضرر يزال
Harm should be avoided

The principle means:-

  • Harm, when is sure to occur, should be avoided whether before or after it occurs.

POSITION OF EMBRYO IN ISLAMIC LAW

 

What is Islam’s view on the fertilisation of an embryo within or outside the womb?

The Fatwa Committee is of the view that Islam does not place any judgement on an embryo which is not fully formed.  An embryo is only considered as a human life after it is 4 months old as, in Islam, it is believed that a soul is introduced into the embryo when it is four months old.  This is the view of most jurists based on the hadīth (tradition) narrated by Abdullah bin Mas‘ūd:

‏إن أحدكم يجمع خلقه في بطن أمه أربعين يوما ثم يكون في ذلك ‏ ‏علقة ‏ ‏مثل ذلك ثم يكون في ذلك ‏ ‏مضغة ‏ ‏مثل ذلك ثم يرسل الملك فينفخ فيه الروح ويؤمر بأربع كلمات بكتب رزقه وأجله وعمله وشقي أو سعيد

 “Verily the creation of each one of you is brought together in his mother’s belly for forty days in the form of seed, then he is a clot of blood for a like period, then a morsel of flesh for a like period, then there is sent to him the angel who blows the breath of life into him and who is commanded about four matters: to write down his means of livelihood, his life span, his actions, and whether miserable or fortunate…”-narrated by Bukhari and Muslim.

Thus, an embryo below four months, whether within or outside the womb, is considered a living thing undergoing the growth process.  However, it is not yet considered as the beginning of human life with the presence of a soul.

Past and present jurists have given a similar view.  Among them is Dr Muhammad Sulaiman Al-Asyqar who is of the view that no judgement will be pronounced or placed on an embryo which is not formed or is not in a woman’s womb:  He explains:

 Islamic law does not place any form of judgment on an embryo which is not formed.  Verily, I have indeed explained in detail my opinion during my forum discussion on birth.  In that forum, a decision had been made that Islamic law does not place any judgment on a woman’s fertilised egg except after it is in the womb. There is no judgment on it before it is in the womb.

A similar opinion was also given by the Darul Ifta’ of Saudi Arabia, where, for as long as there is no soul in an embryo, the sperm and the egg are judged to be living things adapting to their specific conditions.  They are considered as components of the fertilization process. They have not reached the stage of a complete human being.  The following is the text from the fatwa of Darul Ifta’:

 If it is destined that the sperm and a woman’s egg do not die, both will live adapting to their respective conditions as they were created. With Allah’s will and predestination, both will fuse.  At that point, an embryo will be formed.  The embryo will live according to its growth and development following the defined stages.  When a soul is introduced, a human life will be created based on the will of Allah, who is the Subtle one and the All-Knowing.

In relation to this, the Fatwa Committee rules that the opinion of the BAC to use stem cells from embryos below 14 days old for the purpose of research that will benefit mankind is allowed in Islam. This is with the condition that is is not misused for the purpose of human reproductive cloning, which would result in the contamination of progeny and loss of human dignity.

In the Fatwa Committee’s view, this issue needs to be addressed from both religious and legal aspects. The Fatwa Committee needs to answer related ethical questions, such as whether a stem cell attains the status of personhood, which requires it to be protected like a complete human being, and thus not to be used for research purposes. This is then related to whether such research is permitted in Islam, and the prerequisite guidelines and ethical limitations that should be observed.

Status of Personhood

The status of a foetus whether it is considered a full person is an issue that has still not been conclusively resolved from the Islamic viewpoint. The status of a foetus whether it is considered a full person is an issue that has still not been conclusively resolved from the Islamic viewpoint. Apart from references in the Qur’an and hadīth to the various stages of embryology, there are no clear criteria in the Muslim sources that determine when the foetus should be considered a human being and is endowed with the same rights as a newborn.[7] While the ‘ulamā do not dispute the biological development of life and the sanctity and dignity of the foetus, they disagree on the stage at which a foetus cannot be tampered with, or have its existence threatened (which is discussed through the concept of dhimma ṣāliha).[8] Therefore, differences of opinion exist on moments of fertilisation, the insertion of the soul, the possibility of life, and the rights of personhood which is granted only to newborns whose life is definite outside the womb.

By way of definition, a foetus is confined (istijān) in the mother’s womb until birth,[9] and thus does not have the personhood status that results in the full protection of human rights. This view is expressed in the Ḥanafī school of law. This changes after the foetus is born when it begins to acquire related rights such as protection of life, lineage, inheritance and others.[10] This also forms the basis for the Ḥanafī view that if the foetus endangers the life of the mother (whose existence is definite), it can be aborted no matter how late the stage it is in.[11] However, such an understanding of the human foetus could and have resulted in abuses, such as abortions which are not due to any medical emergency, or done to avoid poverty as evident in population control measures.[12]

In its response to the ethical dimension of the foetus’ personhood, the Fatwa Committee differentiates between two types of foetuses; a foetus that was fertilised and developed inside the mother’s womb, and a foetus that was fertilised outside the mother’s womb and remained externally, i.e. not implanted in the mother’s womb.

In a fatwa ruling on aborting a foetus that is inside the mother’s womb, the Fatwa Committee recognised that this foetus is accorded the status of personhood as early as the moment of conception. Therefore, abortion is not allowed no matter how early, except in medical emergencies when the mother’s life is in danger if she continues with the pregnancy. Although the Fatwa Committee interpreted the hadīth (which describes the stages of foetal development) narrated by ʿAbdullāh ibn Masʿūd above that the status of personhood is granted on the one hundred and twentieth day, it is more disposed to the interpretation that personhood could occur within one month.[13] This preference takes into consideration the sanctity of life that has been bestowed on a fertilised embryo and the fact that the stages of human development have already begun from the moment of conception. Meanwhile, the egg and sperm that are fertilised in-vitro and implanted into the womb at a later stage would remain, in essence, as separated cells without any element of soul nor personhood. This means that it is not subject to the ordinary rights of protection.

Despite the Fatwa Committee’s opinion above on embryos fertilised externally, it should also be noted that the Fatwa Committee, on ethical considerations, has set a limit of 14 days for the manipulation of stem cell for research. This is because studies have shown that embryos have the potential to sense pain due to the onset of nerve pulses after 14 days. In this case, it is clear that the Fatwa Committee takes into account scientific developments in establishing the criteria for determining the status of personhood. In addition, the Fatwa Committee also stressed that the use of stem cells is limited to research that benefit mankind. It also placed ethical conditions that stem cells cannot be abused, whether for human cloning, contaminating lineage, or whatever may cause harm to mankind, in reference to the maxim which prohibits the removal of harm with another type of harm, which forms a core principle in Islamic ethics.

The BAC had also received feedback through its consultations on the issue of the personhood of embryos. It had outlined three main views on the subject of stem cell research. One camp treats embryos as mere cells and do not object to any form of research on them. A second camp accepts that a human embryo is more than a collection of cells and should be accorded some protection and respect but is uncertain about how this should be done. A third camp accords the human embryo with the status of a person and considers the creation and destruction of an embryo for research purposes wrong and unethical.

The final recommendation by the BAC adopts a moderate view that such embryos hold a special status, one that is different from the rights of a living person. Pursuant to this, they recommended the use of stem cells in research under stringent conditions. They also published a set of recommendations related to research involving human tissue in general in 2002. Their recommendations include the following:

  1. Enforcing informed consent on donors of human tissue, allowing only the use of tissues which had been gifted for this research and not to accept or give any form of payment,
  2. Allowing the donor to decide how the tissue can be used,
  3. Restricting institutions which carry out each research and safeguarding the personal information of donors to licensed statutory bodies,
  4. Initiating professional and public dialogue on the matter.[14]

A subsequent publication in 2004 refined the recommendations in the 2002 report. In particular, it sought to monitor future research by suggesting that all proposed research programs should be reviewed by an independent board licensed by the Health Sciences Authority (HSA).

Cloning

The question of the permissibility of cloning was also studied by the BAC. Cloning is a process where a genetically identical copy of an animal or human being is produced. With the advent of in-vitro fertilization, concerns arose that the technology could potentially be applied in a socially undesirable way. This includes choosing a baby’s gender and skewing the population sex balance, “designing” babies with desired intelligence and physical traits, and hiring wombs to carry and birth such babies in an attempt to create a “super-race.” [15]

The fears were not about the sanctity of traditional nuclear families but the act of genetically tinkering and ‘creating’ new human beings. In other words, with the success of in-vitro fertilisation, many felt that cloning would not be far behind. This proved to be true, as in-vitro methods paved the way for the transfer of nuclei of humans and animal cells, a key step that enabled cloning.

Therapeutic Cloning

Therapeutic cloning is a related technology that does not involve the creation of a genetically identical human or animal. Instead, it uses the somatic cell nuclear transfer process to create new cells that are genetically identical to donor cells. This means that these new cells could be used to treat diseases. Unlike transplanted donor cells, the body is unlikely to reject these new cells as they are genetically identical.  Therapeutic cloning is thus more likely to succeed than stem cell transplants. Furthermore, cells created from cloning have the added advantage of being pluripotent, which means that it could give rise to all cells in the body except the embryo.

However, therapeutic cloning also gave rise to some ethical problems. For example, this process involves many attempts to create a viable egg as the egg with an infused somatic nucleus often has poor stability. At the same time, the embryo created through this method is usually destroyed after stem cells are extracted. For groups that consider an embryo as a human life and has rights to life and dignity, the destruction of the embryo is unacceptable. For groups that consider an embryo as a human life and has rights to life and dignity, the destruction of the embryo is unacceptable.

At both international and local levels, these issues were a matter of some concern. The United Nations Education, Scientific and Cultural Organization (UNESCO) issued several guidelines in 2001 for countries that wish to develop research in this area. It recommends that any country that permits research involving the use of embryos should also come up with a regulatory framework and construct controls to prevent the unethical use of embryos. However, UNESCO stopped short of specifying the controls and standards that it considers to be ethical since it was mindful of the diversity of opinions on this matter.[16]

As part of its consultation process on the issue of cloning, the BAC sought the views of Muis on the various types of cloning. In determining the ruling, the Fatwa Committee studied the risks and wide-ranging impact of such scientific technologies. This includes the potential benefit of allowing it for therapeutic use as it could lead to other advancements in patient care such as growing replacement organs and conceiving twins. In determining the Muslim law regarding cloning, the Fatwa Committee’s consideration needs to carefully balance between the potential benefits and possible harm at both individual and community levels. It is similar to allowing controversial procedures such as stem cell research on the basis that it has the potential to bring great benefits in the future.

Fatwa Decision 15/2/2000
CLONING

Question:

What is the opinion of the Fatwa Committee on cloning, especially on the matters related to the issues below:

a. The process of determining the sex of the child.
b. The process of creating identical twins.
c. The process of giving birth to twins using DNA from only the father or mother, without the DNA of the spouse, although the child is implanted in the mother’s womb.
d. The process of producing human organs for the purpose of

  • Medical research and
  • Replacing the organs of needy patients

Answer:

After deliberating and examining the content of the lecture on cloning that was previously organised by Muis, the Fatwa Committee is made aware of several forms of genetic cloning that can be conducted to produce babies that have the same characteristics, or for medical purposes. The Fatwa Committee is of the opinion that the fiqh ruling on them varies according to the different intents and processes taken. As described in the question above, cloning could be carried out for the following purposes:

First: Cloning for the purpose of determining the gender of the child.

This form of cloning is contradictory to religious ethics from two perspectives:

i. The knowledge of the womb is a matter for Allah. None on God’s creation knows it. Allah says in surah ar-Ra’d:

اللَّهُ يَعْلَمُ مَا تَحْمِلُ كُلُّ أُنثَىٰ وَمَا تَغِيضُ الْأَرْحَامُ وَمَا تَزْدَادُ ۖوَكُلُّ شَيْءٍ عِندَهُ بِمِقْدَارٍ
Allah knows what every female bears and by how much the wombs fall short (of their time or number) or exceed. Everything with Him is in (due) proportion”. (ar- Ra‘d: 8)

ii. Any claim that humans have the power to determine the gender of the foetus is considered to be interfering with the affairs of Allah the Omniscient and the All-Wise; His Wisdom has determined everything for the foetus. In fact, this is one of the evidence for the existence of Allah and His power. Allah says in surah as-Shūrā:

 لِّلَّهِ مُلْكُ السَّمَاوَاتِ وَالْأَرْضِ ۚ يَخْلُقُ مَا يَشَاءُ ۚ يَهَبُ لِمَن يَشَاءُ إِنَاثًا وَيَهَبُ لِمَن يَشَاءُ الذُّكُورَ

To Allah belongs the kingdom of the heavens and the earth. He creates what He wills. He bestows female (offspring) upon whom He wills, and bestows male (offspring) upon whom He wills” (as-Shūrā: 49)

However, as the contemporary scholar Shaikh Yūsuf al-Qaraḍāwī: mentioned in the first volume of his book “Fatawa Mu’asharah”, we can interpret Allah’s knowledge of the womb as ‘tafsili’ (detailed) knowledge which covers the particulars of the womb, such as whether the foetus will live or die, be bright or dull, weak or strong, happy or suffering, and so on. Whereas man is only able to know whether the foetus is male or female.

If we consider this interpretation, then gender selection of the foetus is not excluded from the will of Allah because man is only carrying out His will. The Fatwa Committee is of the opinion that gender selection through this process is allowed only in an emergency because the process is merely an attempt to satisfy the human desire that is included in Allah’s will; man proposes, Allah disposes. The process is allowed only if there is no syubhah (uncertainty) in the Sharīʿa. It is, therefore, better and safer in this case to refrain from engaging in such a selection and follow Allah’s will and predestination.

Second: Cloning for the purpose of fulfilling the desire to have identical twins. This process is done by splitting the embryonic cells into two (for twins), four (for quadruplets), eight (for octuplets), and so on. Then the embryo is implanted into the mother’s womb to be born as identical twins. The Committee believes that in principle, this process is allowed because it does not contaminate the lineage. In this case, man proposes, God disposes.

Third: Cloning for the purpose of giving birth to a baby, by using only the DNA of the father or the mother, and not the combination of both (as it would have been by fertilising the father’s sperm with the mother’s egg). Each egg that undergoes fertilisation contains 46 chromosomes, 23 from the father and 23 from the mother. This cloning process, therefore, aims to produce children that inherit 100% of the DNA of the father or the mother. This is done by removing the DNA (46 chromosomes) from the fertile egg. Then they are replaced with 46 new chromosomal DNA extracted from the mother (if the couple wants their child to inherit her mother’s genes). This new DNA is inherited through the mother from the grandparents of the new egg. The egg – with the new maternal DNA – is inserted back into the mother’s womb. When born, the child will be 100% similar to the mother as the genes were inherited totally from the mother. This can also be conducted on virgin women, or in other words, she can get pregnant without marrying or without husband-wife intercourse.

The Fatwa Committee is of the opinion that this cloning process involves elements of syubhah (uncertainty) because the baby’s genes are not the result of the genes of both the mother and father, but instead comes from the mother only, which in turn was inherited from the baby’s grandparents. Regarding lineage, the baby is a syubhah because she/he is like the mother’s twin. As Muslims are commanded to avoid syubhah, this form of cloning is prohibited for Muslims. It is especially prohibited on women who are not married.

Fourth: Cloning for the purpose of producing organs of the human body, either for the purpose of medical research or replacing damaged organs. Although scientists are still in the early research and experimental stages, it may be a reality in the future. If the project is successful, a person suffering from heart or kidney disease will not face problems in obtaining replacement organs as it can be produced from his DNA. Moreover, since these organs originate from his DNA, it will not face transplant rejection. The Fatwa Committee is of the opinion that this form of cloning is permissible because it brings benefit without violating any religious rules. However, it should be noted that this cannot be done for commercial reasons.

The Fatwa Committee would also like to note that the Muslim community should not be confused and worry if there is a conflict between Allah’s law, the Islamic faith, and scientific discoveries. Indeed, all knowledge comes from Allah and it is exposed to man for their benefit, to be used for good – or as guidance – and not to be abused for harm. Discoveries such as these should further strengthen our faith because it reinforces the verses of the Qur’an on Allah’s creations, such as the creations of Prophet Adam and Prophet Jesus (peace be upon them).

Fatwa Analysis

In its position issued above, the Fatwa Committee has prohibited cloning for gender selection except in an emergency, as well as the production of a clone of either parent, especially for unmarried women. The Fatwa Committee highlighted that technological innovation should not affect Muslim faith in Allah s.w.t since knowledge itself comes form Him, the All-knowing. The Fatwa Committee also considered the ethical concerns of each type of cloning, distinguishing the forms and purposes of different type of cloning techniques. Such specificity shows that the Fatwa Committee understands the differences between the processes which lead to a more meaningful deliberation.[17] In evaluating and developing appropriate answers to the questions above, the Fatwa Committee relied on a number of principles, (1) maqāṣid al-sharīʿa, (2) fiqh al-ma’āl, and (3) fiqh iftirāḍī.

For example, the Fatwa Committee’s decision to prohibit the third type of cloning using DNA from only the mother underscores the need to preserve the maqāṣid al-sharīʿa in protecting lineage. By stating that a baby created solely from the mother’s DNA is “syubhah because she/he is like the mother’s twin”, the Fatwa Committee also implied that for the pregnancy to be valid in Sharīʿa, the foetus must be formed from two types of genes; man and woman. This ultimately ensures that the traditional family – the union between a husband and wife – remains preserved in Islam. For this reason too, the Fatwa Committee prohibited such procedures if it were conducted on an unmarried woman. This symbolises the principles of fiqh al-ma’āl by considering the long-term social impact should the third type of cloning be allowed.[18] At the same time, the Fatwa Committee also considered the future potential of this procedure by utilising the concept of fiqh taqdīrī (also known as fiqh al-tawaqquʿ and fiqh iftirāḍī).[19]a concept more commonly used by scholars in the Ḥanafī school of thought.[20] This is apparent from the text of the fatwa: “Although scientists are still at the early experimental stages, it may be a reality in the future.”

The Underlying Principles on the Permissibility of Therapeutic Cloning

The Fatwa Committee’s decision to prohibit the cloning of a complete human means that cloning parts of the human body for therapeutic purposes is excluded from the general prohibition, and by extension, can be permitted. However, it is safeguarded by certain conditions. For example, it should only be used for the person whose cells it originates from. This is to fulfill its main objective of minimising rejection of donated organs by replacing it with a cloned organ that is fully compatible. In addition, the Fatwa Committee placed a clear prohibition on the the trade of cloned body parts. This is intended to guard against potential abuse, such as the exploitation of the poor, and the commodification of human cells and tissue by those who are deemed to have attractive physical features.

Based on the concept of qiyās al-aulā,[21]it could be surmised from this decision that cloning body parts and attaching them to form a complete human being is also prohibited, all the more cloning multiple people would be so. This clearly runs contrary to maqāṣid al-sharīʿa that preserves clear lineage, familial ties, and human dignity.

Between Playing God and Preserving God-Granted Knowledge

The issue of cloning is also intricately linked to the Islamic theological creed. For example, the Fatwa Committee questioned whether man is playing God through the act of cloning. This concern is not unique to Islam. In their discourse on religious ethics, Christian thinkers view cloning with suspicion and great caution. They often emphasise their concern that cloning is akin to playing God, especially in imitating the process of human creation and manipulating human stem cells and the nucleus.[22] In the first part of the aforementioned fatwa, the Fatwa Committee recognises that cloning to select gender is seen as a violation of ethics on human creation as outlined in the Qur’an. From this ethical viewpoint, what takes place in the womb is the affair of Allah s.w.t and no creature has knowledge of it. Thus, any claims of human having the power to dictate the sex of the foetus is considered to be interfering in God’s affairs. In elaborating this, the Fatwa Committee quoted the view of the contemporary Muslim jurist Shaikh Yūsuf al-Qaradāwī that God’s knowledge of the womb is tafsīlī (i.e. detailed) that covers the fate of the foetus, whether it will survive, and various other attributes such as its intelligence, happiness or suffering, whereas man could only have access to the gender of the foetus with scientific progress. On this basis, the Fatwa Committee allows gender selection of the foetus with the condition that it should be free from any syubhah and ambiguity. On this basis, the Fatwa Committee allows gender selection of the foetus with the condition that it should be free from any syubhah and ambiguity. The Fatwa Committee however, stated that it is “better and safer in this case to refrain from engaging in such practice and to follow Allah’s will and predestination.”

The Fatwa Committee did not directly address the question of man playing God, but opined instead that these are dubious matters that are best avoided. Nonetheless, it did not expound on the concept of syubhah in this instance. For example, does the syubhah here prohibits cloning? The cautious approach adopted by the Fatwa Committee serves as an indication that they are more inclined to prohibit cloning, or allow it only in extreme necessity and in controlled conditions. However, this view is unlike that expressed by the former Mufti of Egypt Dr. Naṣr Farīd Wāsil who disapproves of cloning and believes that the government should protect its citizens from its dangers.[23] The Fatwa Committee also did not address the implications of allowing gender selection. For example, couples or individuals could end up selecting preferred attributes that changes the genome, further resulting in the creation of a “super race.” Although the Fatwa Committee took steps in including ethical considerations and restrictions, there is still room to further develop these ethical considerations.

Following its opinion that cloning for gender selection is not in conflict with religious ethics, the Fatwa Committee then allowed the manipulation of cells fertilised outside the womb, which are then split into multiple cells, and later developed into a foetus in the womb. The two processes are similar to genetic engineering; by cloning and creating life from human or animal DNA for the purpose of having progeny.

Genetic Testing

Genetic testing is a contentious issue because the technology enables individuals to find out whether their genes predispose them towards certain medical conditions. Examples of genetically inherited conditions include blood disorder thalassemia, Down Syndrome, Alzheimer’s disease and dementia. A major breakthrough occurred in the new millennium with the Human Genome Project, which mapped the sequence of human genomes for the first time.[24] By 2005, the technology had progressed enough for successful testing of embryos to determine if it was free of gene mutations linked to Alzheimer’s and to screen for gender even before the embryo is implanted into a mother’s womb.[25] Do-it-yourself medical testing kits also became available over the Internet, promising to reveal an individual’s ideal diet, how to exercise and which diseases they are likely to have.[26]

The repercussions of genetic testing go beyond individual patients. With advancements in technology, sections of the public became concerned that public knowledge of their genetic make-up might result in discriminatory practices by employers or insurers. A survey among the British public in 1998 indicated that 51 per cent were unwilling to take a genetic test and less than 20 per cent was willing to share their genetic information with insurers.[27] These worries are not unfounded. As early as 1983, a few companies in the United States used genetic testing to determine who are more susceptible to occupational diseases. Some 59 more companies expressed an interest in doing so.[28] However, the United States Equal Employment Opportunity Commission (EEOC) later took some employers to court for carrying out genetic testing on their workers.[29] British life insurers are allowed to charge higher premiums or refuse cover to those born with genes that could lead to serious illnesses later in life.[30] While an individual could choose not to be tested, he could not withhold the results if he was tested. The United Kingdom was the first country in the world to do so, with the Netherlands, Norway and France objecting to such a move.[31] These debates around the world highlighted the potential impact of genetic testing on the general public.

In Singapore, the BAC recommended that genetic testing be done only with informed consent from the patients and that it should be followed with a post-test counselling.[32] Parents are only allowed to screen their unborn babies for serious genetic diseases such as thalassemia, preferably so that preventive treatment could be carried out. Genetic testing to choose the gender of a baby is not permitted.[33] Employers and insurers should not be allowed access to the data without the consent of the patient himself. Public feedback indicated that Singaporeans, in general, agree with the BAC’s proposals. Click here for future issues in Bioethics.

Conclusion

Based on the decisions of the Fatwa Committee on scientific research and the biomedical use of human tissues, some principles in Islamic legal and ethical thought can be outlined:

  1. Necessity dictates that any research in this area contribute to the preservation of maqāṣid al-sharīʿa, and brings people closer to it, instead of away from it.
  2. The maṣlaḥa that may be achieved from any research in this area outweighs any harm and prevents the occurrence of greater harm.
  3. The need to apply the concept of fiqh iftirāḍī on an informed but hypothetical basis and latest research trends, and not to wait until the research has begun before issuing religious and ethical guidelines.
  4. The need to preserve the knowledge granted by Allah s.w.t. together with ethical guidelines. Although caution is necessary so that research does not violate ethical limits, it should not necessarily hamper efforts to develop further research. Researchers need to strike a balance between the potential of ideas for scientific discovery and the risk of harm to nature and human beings.
  5. The determination of full personhood. In this matter, the Fatwa Committee distinguishes between an embryo fertilised in the womb and one that is fertilised externally. In the former, the foetus is granted the position of full personhood from the moment of fertilisation, and thus its growth cannot be tampered with, unless the mother faces harm. On the other hand, if an embryo is fertilised outside the womb and was not implanted in the mother’s womb, the Fatwa Committee allows it to be manipulated solely for human medical purposes, provided that it does not exceed 14 days.

The principles above should continue to be reviewed and improved as research and biomedical science develop, especially in places such as Singapore with its emphasis on such research activities. This means that the religious leadership and jurists have to continue develop a framework that is suitable to guide further research from religious and ethical aspects. The guidelines and positions should not only contribute to the development of religious thought, but also inform conversations on global ethics.


  1. "Genetic Testing: How (not) to play God," The New Paper, April 2001, 6.
  2. The details of the Committee can be obtained in the preface of each bioethics committee report. The report is available online at: http://www.bioethics-singapore.org/index/publications/reports.html.
  3. Ibid.
  4. Ariff Bongso, “Human Embryonic Stem Cells – Science & Ethics”, in Ethical, Legal and Social Issues in Human Stem Cell Research, Reproductive and Therapeutic Cloning, Bioethics Advisory Committee Singapore (2002).
  5. “Dementia in the Asia Pacific Region: Statistical Appendix,” for Asia Pacific Members of Alzheimer's Disease International, Access Economics PTY (2006), 24. Accessed on November 11, 2015. http://www.scribd.com/doc/118025112/About-Dementia-Statistics-AsiaPacificEpidemicSept06-Statistical-Appendix#scribd
  6. Human embryo refers to the first eight weeks after fertilisation, after which it is described as a foetus. Stanley J Ulijaszek et al, The Cambridge Encyclopedia of Human Growth and Development (Cambridge: Cambridge University Press, 1998), 161.
  7. Abdulaziz Sachedina, Islamic Biomedical Ethics Principles and Application (Oxford: Oxford University Press, 2009), 125.
  8. In the chapter “Crime against foetus”, ʿAbd al-Rahmān al-Jazīrī, “Kitāb al-Ḥudūd,” in Kitāb al-Fiqh ʿalā al-Madhāhib al-Arbaʿa (Beirut: Dār al-Kutub al-ʿArabia, 1972), Vol. 5, 372-75, explains the detailed rulings and legal comparison of the status of the foetus and acts that could be deemed as crime against it.
  9. This is as defined in Lisān al-ʿArab and other dictionaries such as al-Ṭāhir ʾAhmad al-Zāwī, Mukhtār al-Qāmūs: Murattab ʿalā Ṭarīqāt Mukhtār wa al-Ṣiḥḥa wa al-Misbāḥ al-Munīr (Riyadh, Saudi Arabia: Dar Alam al-Kutub, 1998); and al-Muʿjam al-Wajīz Majmaʿ al-Lugha al-ʿArabiyya (Cairo: al-Majma’, 1980).
  10. Muhammad Amīn Ibn ʿĀbidīn, Hāshia al-Radd al-Mukhtār fī al-Sharḥ al-Tanwīr al-Abṣār fī al-Fiqh al-Mazhab al-Imām Abī Ḥanīfa al-Nuʿmān (Cairo: Maṭbaʿa Muṣṭafā al-Bābī al-Halabī, 1966), Vol. 6, 587; Zain al-Dīn Ibn Nujaym, al-Baḥr al-Rāʾiq: Sharḥ Kanz al-Daqāʾiq (Cairo: al- Maṭbaʿa al-ʿIlmiyya, 1983),vol. 8 839.
  11. Al-Mausūʿa al-Fiqhiyya al-Islāmiyya (Cairo: al-Majlis al-Aʿlā li Shuʾūn al-Islāmiyya, 1953) Vol. 3, 159-179.
  12. Al-Mausūʿa al-Fiqhiyya al-Islāmiyya Vol. 3, 159-179. Also see the declaration made in the International Conference on Population and Development (ICPD), September 5-13, 1994, Cairo, Egypt.
  13. Ṣaḥīḥ Muslim, no. 2643 (Cairo: Dār Ihyāʾ al-Kutub al-ʿArabia, 1955), 2036.
  14. The report and recommendation can be found online at http://www.bioethics-singapore.org/index/publications/reports/173-human-tissue-research.html
  15. See “Sambutan girang-bimbang terhadap kemunculan bayi tabung uji pertama [Celebration and worry over the first test tube baby],” Berita Harian, August 1978; “Cubaan Hitler cipta generasi terbaik [Hitler’s attempt to create the best generation],” Berita Harian, October 1978 and “2800 bayi lahir di bawah ujian Hitler cipta bangsa terbaik [2800 babies born in Hitler’s experiment to create the best race],” Berita Harian, October 1978.
  16. Alexander McCall Smith dan Michel Revel, The Use of Embryonic Stem Cells in Therapeutic Research,” United Nations Education, Scientific and Cultural Organization (UNESCO), (2001).
  17. Sachedina, Islamic Biomedical Ethics, 203.
  18. The term fiqh al-maʾāl was known or used by classical ulama such as Imam al-Shāṭibī (d. 790H) in his treatise al-Muwāfaqāt with the phrase Iʿtibār al-maʾāl  or al-naẓar fī maʾālāt al-afʿāl. The word fiqh means understanding, thinking and analysing, and is a perfect match for the word al-Maʾāl which means result or something that will arise in the future. Therefore, a mujtahid must understand, think, and analyse a matter that has long-term consequences, and whether they bring goodness (maṣlaḥa) or harm (mafsada).
  19. For further details on the concepts of fiqh iftirāḍī or fiqh tawaqquʿ, see transcript of discussion with Shaikh Abdullah bin Bayyah at http://www.aljazeera.net/programs/religionandlife/2009/4/14/%D9%81%D9 % 82% D9% 87-% D8% A7% D9% 84% D8% AA% D9% 88% D9% 82% D8% B9 (accessed on 15 September 2015)
  20. See: http://www.ahlalhdeeth.com/vb/showthread.php?t=36943 for a discussion on the opinions surrounding cases of fiqh iftirāḍī.
  21. Qiyās Aulā is a qiyās in which its reason necessitates the existence of a dependent (mulḥaq) ruling, and is conditional on a stronger ruling based on the original case (mulḥaq bih). For example, the comparison between physically harming one’s parents and saying “ugh” to them, as mentioned in the Qur’an: وَقَضَىٰ رَبُّكَ أَلَّا تَعْبُدُوا إِلَّا إِيَّاهُ وَبِالْوَالِدَيْنِ إِحْسَانًا ۚ إِمَّا يَبْلُغَنَّ عِندَكَ الْكِبَرَ أَحَدُهُمَا أَوْ كِلَاهُمَا فَلَا تَقُل لَّهُمَا أُفٍّ وَلَا تَنْهَرْهُمَا وَقُل لَّهُمَا قَوْلًا كَرِيمًا And your Lord has commanded that you shall not serve (any) but Him, and goodness to your parents. If either or both of them reach old age with you, say not to them (so much as) "Ugh" nor chide them, and speak to them a generous word.” (surah al-ʾIsrāʾ:23)
  22. Eugene C. Newman, “Biblical Reasoning against Human Cloning,” in Chalcedon Foundation, accessed on 8 September 2015, http://chalcedon.edu/research/articles/biblical-reasoning-against-human-cloning-part-i/
  23. Istinsākh Bayna al-Islām wa al-Masīḥiyya (Beirut: Dār al-Fikr al-Lubnānī, 1999), 305.
  24. “Genome Mapped,” Today, April 2003, 3 ; “Genome Map 60 days away,” The Straits Times, March 2000, 8.
  25. “Allow genetic tests for serious cases,” The Straits Times, April 2005, 2.
  26. “Do-it-yourself kit? It's not that simple,” The Straits Times, April 2005, 4.
  27. “Insurance: British 'no' to genetic testing,” The Straits Times, July 1998, 3.
  28. “Genetic testing on workers,” The Business Times, May 1983, 5.
  29. “Genetic testing lands employer in court,” The Straits Times, February 2001, 9.
  30. “British life insurers can use genetic tests,” The Straits Times, October 2000, 6.
  31. “British life insurers,” The Straits Times, October 2000.
  32. “Panel sets out guidelines for genetic testing,” The Business Times, April 2005, 9.
  33. “Allow genetic tests for serious cases,” The Straits Times,April 2005, 2.

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