SINGAPORE – With recent advancements in gene-editing technologies, scientists can now modify genes in a faster, lower-cost and more precise manner to prevent or treat fatal or life-altering diseases and keep them from being passed down to future generations, or address infertility.
In the future, parents may also be able to enhance the genetic traits of their unborn baby.
However, Singapore’s Bioethics Advisory Committee (BAC) has concluded in a newly launched report that heritable gene editing is not recommended for clinical research or application in Singapore.
This is due to the unknown long-term effects and the need for full validation of the technology’s safety and efficacy. For instance, unintended edits introduced during genetic modifications may be passed down to future generations, it said
The Ministry of Health has also not approved heritable gene editing for these purposes as there is currently insufficient evidence of its safety.
The BAC recommendation was among those found in an advisory publication on the ethical use of Human Nuclear Genome Editing (HNGE) technologies in biomedical research and clinical applications titled
Ethical, Legal And Social Issues Arising From Human Nuclear Genome Editing
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It was launched during the inaugural Asian Bioethics Network (ABN) Conference, which was jointly organised by the BAC and the Centre for Biomedical Ethics (CBmE) at the National University of Singapore, on Oct 23-24.
BAC was established by the Singapore cabinet in 2000 as an independent national advisory body to examine and develop policy recommendations on the ethical, legal and social issues arising from human biomedical science and research.
Apart from heritable gene editing, HNGE also includes non-heritable gene editing, which is generally allowed in Singapore, and gene editing in embryos or germline cells (cells that form eggs in females and sperm in males) for research, which is strictly regulated here.
The scientific techniques that allow researchers and clinicians to modify one’s deoxyribonucleic acid or DNA by adding, removing, or changing genetic material, include the groundbreaking Crispr-Cas 9 tool.
Chinese scientist He Jiankui shocked the world in 2018 when he revealed that he had used the tool to engineer the birth of the world’s first babies with edited genomes to make the children’s cells resistant to infection by the human immunodeficiency virus (HIV).
At the conference’s opening ceremony, Professor Kenneth Mak, Singapore’s Director-General of Health highlighted the rapid advances in biotechnology and biomedical sciences. He emphasised how developments such as artificial intelligence (AI), precision medicine, gene editing, and innovations that advance human longevity, are bringing us closer to what was once unimaginable – cures for hereditary diseases and extended healthy lifespans.
Yet, they raise complex ethical concerns.
“Precision medicine promises accelerated diagnoses and targeted prevention but also challenges us to manage data disclosure and confidentiality,” he explained, referencing one of the examples.
“Healthcare providers must navigate whether, when, and how to disclose genetic information, especially when variants of uncertain significance may only gain clinical meaning in the future.”
Singapore must adapt approaches to keep pace with evolving technologies, such as the rapidly evolving field of human gene editing, he added.
Citing the example of the 2018 Crispr-modified babies in China as a cautionary tale of the consequence of applying such technologies without adequate safeguards, he said that while the field has the potential to eliminate disease, a lack of due consideration for ethics, can result in harm.
The attempt to reduce susceptibility to HIV had instead introduced a harmful mutation and violated established safety norms, underscoring the need for responsible governance to protect patients and sustain public trust, said Prof Mak.
The conference, held at the Grand Copthorne Waterfront Hotel Singapore, explores some of the most pressing ethical questions confronting modern healthcare, especially those that surround the use of AI in making personalised choices.
Associate Professor Brian D. Earp, director of the Oxford-NUS Centre for Neuroethics and Society within CmBE, explored the concept of having a digital psychological twin, a model that is trained on the values and preferences of the patient.
The question arises: Can such a model understand the patient well enough to make medical decisions on his or her behalf, particularly when the patient is, for instance, in a coma?
Keynote speaker Professor Glenn Cohen, deputy dean and faculty director of the Petrie-Flom Centre for Health Law Policy, Biotechnology and Bioethics, Harvard Law School in the United States said that even training an AI system to schedule appointments can have significant ethical issues.
“How many patients should you schedule in a day? How much overlap should there be?”
The problem is when you try to train an AI system to make a guess about whether a patient will be late or a no-show for instance, you might end up with a situation where those that lack transport or are really burdened by serious illness get the least time with the physician, he said.
In his keynote session, Professor Julian Savulescu, Chen Su Lan Centennial Professor in Medical Ethics and Head of CBmE spoke about how to form ethical policy, giving examples that included which patient to prioritise during a pandemic when there is a ventilator shortage.
At the conference, BAC also released a second publication – a casebook titled “Biomedical Ethics In Singapore: Cases And Commentary.
It consolidates important court rulings related to medico-legal issues, offering healthcare professionals, policymakers and the public a comprehensive reference on how legal principles intersect with medical practice.