Tag Archives: legal

Organs and Chimeras

January 2017 Pulse

The shortage of transplantable organs is a public health crisis globally. In the United States, for example, 120,000 people are on the waiting list. It is estimated that 35 percent of all deaths in the U.S. can be prevented by organ transplantation.

In Singapore, the average waiting time for a kidney transplant is still 9 to 10 years, despite changes in the law to enlarge the donor pool.

In an effort to solve this global shortage of transplantable organs U.S. research centres are conducting studies on chimeras, trying to grow human tissues in animal hosts, with the aim of creating kidneys, livers and hearts for transplant.

Scientists are proceeding with such studies despite the fact that the National Institute of Health has clearly stated that it will not support chimera research until greater clarity is achieved concerning its ethical, legal and social implications.

Chimeras are currently used in many different studies. For example, the potential of human pluripotent cells in vivo is analysed by microinjecting these cells in a mouse embryo. The aetiologies of metabolic diseases in the ageing population are studied by creating ‘humanised’ mice to which cells from the liver and pancreas of human donors have been introduced.

In Singapore, human and bovine genes are combined to create cytoplasmic hybrid embryos that are purportedly 99% human. These hybrid embryos are used in embryonic stem cell research.

The National Council of Churches in Singapore has made a robust response to this initiative (See http://nccs.org.sg/2010/12/04/human-animal-combinations-for-biomedical-research/).

There are serious ethical issues associated with research involving human-animal chimeras. They include the violation of human dignity, the question of the moral status of the chimeric creature, the risk of creating humanised animals, the violation of the order of nature, and the many uncertainties accompanying such research.

These concerns notwithstanding, the advances in cutting-edge technologies such as stem-cell biology and gene-edition have made the incredible advances in chimera research possible.

For example, scientists can change the DNA of a mammal through genetic engineering, making it incapable to forming a specific tissue. Human stem cells are then added to the animal in the hope that a particular tissue, for example a human kidney, can form in the host animal.

However, for a number of technical reasons scientists are still unable to create a viable human organ in an animal host at this point.

One of the most challenging obstacles to their success is what has been described as the xenogenic barrier. The host animal – for example, a pig – and the human organ that it is supposed to incubate are two different species, making the viability of the chimeric creature itself problematic.

Scientists working on human-animal chimeras have long theorised that the closer the species are to each other, the higher the chance the chimera has of surviving. So, if the human-bovine chimera is not viable, perhaps a primate can be used to host the human organ.

We must ask how far we are willing to go to create transplantable human organs to save lives. If primates prove to be equally unsuitable hosts, what’s next?

Taking the discussion to the extreme, will we consider using people in permanent vegetative state but who are otherwise in relatively stable condition as possible hosts? What about people who are suffering from senile dementia? Can they also be used to incubate organs for transplantation?

Many bioethicists see the importance of imagining a fictional dystopia to address the possible future scenarios presented by the trajectories of current medical and technological capabilities that would enable them to anticipate ethical and social issues that might arise.

This brings us to a fundamental question in bioethics, one that is sometimes unfortunately muted if not silenced by the thick rhetoric in support of the technological imperative and biomedical triumphalism.

The question is: Without in any way trivialising the suffering of people with organ failure, is it society’s duty to save their lives at all cost? Or are there larger moral considerations that should govern our actions?

Bioethicists – both Christian and secular alike – have argued that although saving the lives of people with organ failure is important, it should not be achieved at all cost. They believe that there are other more important moral and social considerations. That is why killing a healthy individual to procure his or her organs and the trading of human organs are both unethical and illegal and should never be countenanced.

With the unprecedented advancements in stem-cell research and gene-editing technology, we must carefully reflect on where the line should be drawn as we work towards enlarging the organ pool.

In the midst of the bio-tech hype we must remind ourselves that in our noblest attempts to ameliorate suffering and cure diseases, we must never allow ourselves to pursue strategies that would in the long run distort our moral sensibilities and dehumanise our society.


Roland Chia (suit)_Large
Dr Roland Chia is Chew Hock Hin Professor of Christian Doctrine at Trinity Theological College and Theological and Research Advisor for the Ethos Institute for Public Christianity.

The State

What should be the Christian perspective on the secular State?

Perhaps the best place to begin one’s reflection on what might be called a Christian theology of the state is Romans 13:1-7. Paul begins with a categorical injunction that ‘everyone must submit himself to the governing authorities’. The reason offered for this bold injunction is equally startling: ‘for there is no authority except that which God has established’ (Rom 13:1). The first thing to be said, therefore, about the Christian conception of the state is that the secular state is established by God. This implies that God is sovereign over the state, however powerful the latter may be. Commenting on this passage, C.E.B. Cranfield writes: ‘it is God that sets up (and overthrows) rulers, and … no one actually exercises ruling authority unless God has, at least for the time being, set him up’.

Romans 13 tell us further that God has set up the state for a purpose. The ruler is God’s servant, and the primary purpose of the state is to punish the wrongdoer and to commend those who do the right thing (Rom 13:3-4). Put differently, the state is responsible for creating a legal system that would enable, and indeed encourage human flourishing. Without the state and the justice it is tasked to implement, all forms of creative cultural activities would not be possible. The state is given the right to wield the sword in order to bring about law, order and peace to human society (Rom 13:4). As long as the state carries out its duty in ensuring that justice and peace prevail in human society, it is God’s servant because it is fulfilling the divine will. Dietrich Bonhoeffer puts it this way: ‘The mission of government consists in serving the dominion of Christ on earth by the exercise of the worldly power of the sword which is given to it, and to it alone, in deputyship for God’. Romans 13 urge everyone to submit to such a servant state, because in doing so they are submitting to God himself.

Christians have the duty to pray for those in government so that they will fulfil the task that God has given to them. In 1 Timothy 2:1-2 Paul writes: ‘I urge, then, first of all, that requests, prayers, intercession and thanksgiving be made for everyone – for kings and all those in authority, that they may live peaceful and quiet lives in all godliness’. The Swiss German theologian, Karl Barth is surely right when he said that prayer is the Church’s most important service to the state. In praying for the state, the Church hopes that it will always be faithful to the task that God has entrusted to it. In addition, Christians are commanded to submit themselves to the authority of the state that seeks to do the will of God by promoting justice and peace: ‘Submit yourselves for the Lord’s sake to every authority instituted among men: whether to the king, as the supreme authority, or to governors, who are set by him to punish those who do right’ (1 Peter 2:13-14).  Civil obedience is part of Christian discipleship.

It is, however, absolutely crucial to point out that the Christian’s submission to the state is never unconditional or unqualified. The state, it must be remembered, is a creature that belongs to this world. As such it is a fallen creature. The reading of Romans 13:1-7 must therefore always be accompanied by a ‘nevertheless’. The state that is obedient to the will of God can become the idolatrous state that tries to usurp the place of God. The servant state of Romans 13 can become the totalitarian and demonic state of Revelation13. The injunction for the Church to pray for the state and for rulers serves as a clear warning of this possibility. It is precisely because the state is a fallen creature that can easily lose its way that the Church is asked to pray for it.

How then should Christians respond to the idolatrous and totalitarian state that is no longer concerned for justice and human welfare? Are Christians still required to submit to such a state? The concept of civil disobedience has a long history in the Christian Church dating back to the early martyrs of the early centuries. Civil disobedience is implied by the great medieval theologian, Thomas Aquinas, who taught that ‘if the emperor order one thing and God another, it is God who is to be obeyed’. The implicit allusion to civil disobedience in this statement is made explicit in a later section in his dogmatic work, Summa Theologiae in which he wrote: ‘when a regime holds its power not by right but by usurpation, or commands what is wrong, subjects have no duty to obey’. When confronted with the demonic state, civil disobedience becomes part of Christian discipleship.

This means that while Christians can indeed be patriotic, their patriotism can never be undiscerning or unqualified. Christians can never chant the mantra, ‘My Country, Right or Wrong!’, which expresses a naïve but dangerous sentimentalism regarding the state. Such idealism is not confined to totalitarian or Marxist accounts, but is found even in modern democracy. The proper attitude of the Christian to the secular state can be best expressed by the concept critical patriotism. As the term suggests critical patriotism implies that while the patriotism of the Christian is authentic and sincere, it is never undiscerning and triumphalistic. It implies that what is right or wrong is not determined by the state, but by a higher power. It further implies that the state is not infallible and thus never above criticism. Critical patriotism is in fact the truest and most earnest form of patriotism because it wishes and hopes that the state would be what it is meant to be, what God intends it to be: the servant state which stands on the side of justice and peace.


Dr Roland Chia


Dr Roland Chia is Chew Hock Hin Professor of Christian Doctrine at Trinity Theological College and Theological and Research Advisor of the Ethos Institute for Public Christianity. 
This article was first published in The Bible Speaks Today (August 2013).

Morality, Democracy and Marriage

September 2015 Pulse

On 24 May 2015, the citizens of Ireland voted to legalise same-sex marriage, making the predominantly Roman Catholic country the first in the world to do so by popular vote. 1,201,607 or 61% of the voters said ‘Yes’ to same-sex marriage in a landmark referendum, while 734,300 voted against.

Ireland’s political leaders of every stripe were united in welcoming the decision. Prime Minister Edna Kenny said that the vote ‘disclosed who we are – a generous, compassionate, bold and joyful people.’ Deputy Prime Minister Joan Burton agreed and called it a ‘magical, moving moment’, while Sinn Fein leader Gerry Adams said that it was ‘a huge day for equality.’

The Irish referendum has much to teach us about religion, culture, morality and public opinion.

But the one important lesson that stands out is that this incident makes clear that, despite its obvious merits, the democratic process does not guarantee that morality will be upheld and that democracy in and by itself is unable to provide a clear moral compass for society.

One glaringly obvious weakness of the democratic process and indeed of democracy itself is that it is premised on opinions. Voters may feel that they are in control because of their active participation in a process that allows them to determine the outcome by choosing from an array of options and viewpoints. But in reality, it is those who set the agendas – sometimes by reducing complex issues to simplistic sound bites – that are in control.

In a sense, voting is akin to the capitalist economic system that is often allied to democracy. The producers dictate the agenda, and the consumers are simply taken up in choosing from the different opinions available in the competitive marketplace of ideas.

In addition, the sloganeering that sometimes accompanies the democratic process often obscures and obfuscates important issues even as it impedes rational deliberation on these issues.

For example, supporters of same-sex marriage portray themselves as passionate and uncompromising champions of equality. Same-sex marriage is all about equality, they emphatically declare. It is about allowing two people who love each other to enter into this union called marriage regardless of their sex or gender.

The traditional view of marriage, they insist, violates the principle of equality because it discriminates against same-sex couples who wish to get married. They therefore often compare laws against same-sex marriage with antimiscegenation laws that support the unjust system of white supremacy by prohibiting interracial marriage.

But the analogy to antimiscegenation, and with it the appeal to equality, fails on a fundamental point. Antimiscegenation has to do with whom one is allowed to marry, and not with what marriage is essentially about. The issue with same-sex marriage, however, concerns the essential meaning of marriage.

Put differently, antimiscegenation laws are not put in place to change the fundamental definition of marriage. They are there in order to prevent the possibility of a genuine interracial marriage from being realised or recognised.

The same-sex marriage debate is different. By insisting that same-sex couples should be allowed to marry, the proponents of same-sex marriage are not simply expanding the pool of people eligible to marry; they are redefining marriage itself.

In using the analogy of antimiscegenation, supporters of same-sex marriage are in fact implying that race and sex are equally relevant to the essence of marriage.

This assertion is simply false! Race is never relevant to the intrinsic nature of marriage. Sex, however, always is.

In addition, if equality is the only basis for determining who can marry whom, then proponents of same-sex marriage must also support open, temporary, polygynous, polyandrous, polyamorous and incestuous unions as long as they are between or among consenting adults who love each other.

Rational argument and sound judgement are sometimes submerged under the loud sloganeering, aggressive lobbying and charged emotions that many times accompany the so-called democratic process.

For the Christian, marriage is not a social or legal construct. It is a special covenantal relationship between a man and a woman instituted by God (Genesis 2:22-24). In this union called marriage, the man and the woman are permanently and exclusively committed to one another.

Marriage provides the proper relational context for the man and the woman who have become ‘one flesh’ to bear and rear children. It is not only a union that makes procreation possible, but it also provides the natural social order for children to be raised and nurtured.

The structure of marriage is so basic that it is found universally across cultures and religious traditions. As Robert George has rightly pointed out, ‘the demands of our common human nature have shaped (however imperfectly) all of our religious traditions to recognise this natural institution.’

If this is indeed the case, the question that must be put to modern societies is whether the meaning and structure of marriage can be radically revised by a ballot box? Or, to put the question differently and more generically, can morality be democratized?

The answer must surely be ‘No’. The Christian understanding of human sinfulness suggests that morality must be based on more impeccable foundations than the fleeting views of the majority. Human sexuality, marriage and the structure of the family must be established on the design and purposes of the Creator.

As Robert Kraynak has so perceptively put it in his intriguing and provocative book, Christian Faith and Modern Democracy: ‘We must face the disturbing dilemma that modern liberal democracy needs God, but God is not as liberal or as democratic as we would like Him to be.’


Dr Roland Chia


Dr Roland Chia is Chew Hock Hin Professor of Christian Doctrine at Trinity Theological College and Theological and Research Advisor of the Ethos Institute for Public Christianity.

A Good Death?

May 2015 Feature Article

Many reasons are being offered to support making euthanasia (meaning “good death”) and assisted suicide legal. Some arise from sensitivity to the suffering of terminally ill patients, who desire to end their sufferings by speeding up their death through medical intervention. On the surface, it seems the most compassionate action that society can take to allow this. However, there are serious problems that require careful consideration.

Firstly, there is the question of suicide. In assisted suicide, the patient voluntarily takes his life. Hence the term “suicide” is used, as it was by Singapore’s Minister of Health in 2008. In many societies, including Singapore, suicide is an offence. While social values may be changing, suicide is still prohibited by the law, and for good reasons. The underlying logic, whether legally, socially or religiously expressed, is that the right to life cannot be extrapolated to the right to die. Life is sacred and one does not have the freedom to take one’s own life, no matter what the extenuating circumstances might be. This was echoed in 2002 by the European Court of Human Rights in its interpretation of Article 2 of the European Convention of Human Rights.

Proponents of euthanasia argue that patients have the absolute right to exercise autonomy. Even so, can a patient make a free and voluntary decision? In the first place, he depends on information regarding diagnosis and prognosis given to him by doctors whose knowledge is not perfect. Chief Justice Sundaresh Menon, in his lecture to the Singapore Medical Association in 2013, rightly cited the case of Singapore lawyer Suzanne Chin who was diagnosed with brain stem death. Her husband was advised by doctors to “pull the plug” but against all odds she recovered completely and is well.

When doctors are involved in the decision making, there is potential conflict of interest. Patients may also depend on information from the internet which may be misleading. In addition, patients may make their decisions in a state of depression, and if treated, studies show that they may think differently. There is also potential pressure on the patient from family and care-givers, and society at large.

Secondly, there is the problem of murder. Physicians are asked to be involved in euthanasia and assisted suicide, an involvement that would contravene the nature, identity and ethics of the medical profession. For more than 2000 years, physicians have held to the principles of the Hippocratic Oath: the goal of medicine is to heal, care, and bring relief. Harming patients or killing them is strongly prohibited. The World Medical Association has, over the years, repeatedly stated that euthanasia and physician-assisted suicide are unethical and contrary to the practice of medicine. In its most recent statement in 2013, it reiterates the call for “physicians to refrain from participating in euthanasia, even if national law allows it or decriminalizes it under certain conditions.” The doctor-patient relationship which is based on trust would be adversely affected if physician-assisted suicide is allowed.

The medical profession will be under pressure to attend to patients who want assisted suicide. Though the involvement of doctors is voluntary, there is no guarantee that it will be strictly so, especially if there is pressure from superiors or from one’s institution. Dr Christoph Hufeland, Goethe’s doctor, articulated it well in 1806: “The physician should and may do nothing else but preserve life. Whether it is valuable or not, that is none of his business. If he once permits such considerations to influence his actions, the doctor will become the most dangerous man in the state.”

Some argue that the practice of euthanasia can be well-regulated to prevent abuse. But actual experience proves otherwise. Sundaresh Menon notes: “These concerns are not to be dismissed as patently fanciful. One study shows that whereas legal restrictions and safeguards have been enacted wherever euthanasia or assisted suicide has been legalised, these have been ‘regularly ignored and transgressed’ often without prosecution…”

Thirdly, allowing euthanasia and assisted suicide would have negative social consequences. There would be a widening of its application.

In Belgium, legislation was passed in early 2014 to extend euthanasia to children who can request for it if they are “in great pain” and no treatment is available. Not only is this open to abuse (for studies show that many doctors have been practising euthanasia without following the rules), but it will be a door to many more applications. In the Netherlands, one need not be terminally ill to be euthanized. That one cannot have a “livable life” is ground enough, as the Groningen Protocol (which allows infant euthanasia) shows.

Recently, a court in Belgium granted the request by a prisoner for assisted suicide. He is imprisoned for murder and rape and has pleaded to be put to death because of mental anguish caused by his violent impulses. It is significant that he is not suffering from terminal illness or physical pain but from mental anguish. Will this open the flood gates to those who are in a similar situation?

Terminally ill patients would not be able to escape pressure, either imposed by others or by themselves, to seek death and not trouble their loved ones and care givers or incur significant medical costs. In the longer term, legalising euthanasia would shape our society and affect the way we look at ourselves, and how we care for the vulnerable. It has been noted, for example, that hospices are not as well developed in the Netherlands (where euthanasia is legal) as in other European nations. A social mindset that has a “cure or kill” solution would have inadequate space to explore the responsibility to care for the dying and to help them die with dignity. It would affect private and public conscience and alter our society where utilitarianism will dominate and social responsibilities will diminish.

Some use pragmatic economic reasons to argue for euthanasia. However, economic concerns should not be used to support euthanasia. Patients’ lives should not be shortened simply because they occupy hospital beds or it costs money to care for them. We cannot reduce the value of human life to dollars and cents. If we do, we reduce human dignity and value and will think likewise about those who are considered a “burden” to society.

How, then, can we care for the dying? How can we help people dying painfully and feeling that their continuing suffering is pointless and meaningless? The solution of offering euthanasia or physician-assisted suicide has many serious moral and practical problems, a situation where the medicine offered is worse than the malady. A study in Holland showed that in 10% of euthanasia and 30% of assisted suicide, untoward complications arose. They included patients who recovered from an induced coma, vomiting and fits, and technical problems with administering the lethal substance.

Our response to such patients should be one of compassion. There are two points that will help us enable people in such situations to receive compassion and care and die with dignity, without resorting to solutions that will end up with patients taking their own lives or physicians being asked to terminate their lives. It is humane to want to do something to help someone who is suffering. However, euthanasia and assisted suicide are not as humane as they may seem. Pope John Paul II observed that in reality, “what might seem logical and humane, when looked at more closely seem to be senseless and inhumane”.

We should not seek to eliminate the sufferings of a person by eliminating him. There are better and more humane and ethical ways.

Firstly, we have the Advanced Medical Directive. This allows people to express their wish that should they be terminally ill, that “heroic” but futile medicine be excluded in their treatment so that their lives are not artificially and needlessly prolonged. This is different from speeding up death through suicide or homicide. It is a decision that can be rationally and carefully taken before the storm of pain and suffering that may mark terminal illness and cloud judgement.

Secondly, palliative medicine is being significantly improved and offers dying patients relief of pain and compassionate care that enables them to travel the last stage of their lives with dignity and in the company of caregivers. As a society, we should promote palliative medicine and find ways to care for the dying, thus emphasising the dignity of persons and a society that takes responsibility to care not only for the living but also the dying.

Palliative medicine must be mainlined to become part of the normal course of health care. As a medical science and art it must be further developed and offered to all who are dying, so that they can die comfortably and in dignity as recipients of compassionate care.

As a society, we should promote palliative medicine and find ways to care for the dying, thus emphasising the dignity of persons and a society that takes responsibility to care not only for the living but also the dying.


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Bishop Emeritus Dr Robert Solomon served as Bishop of The Methodist Church in Singapore from 2000-2012. He had served previously as a medical doctor, church pastor, principal of Trinity Theological College and president of the National Council of Churches of Singapore. Dr Solomon has degrees in medicine, theology, intercultural studies, and a PhD in pastoral theology from the University of Edinburgh. He has contributed many articles to books, theological dictionaries and journals and authored 20 books, including ‘The Race’, ‘The Conscience’, ‘The Enduring Word’, ‘The Virtuous Life’, ‘The Sermon of Jesus’ and ‘Apprenticed to Jesus’. He now has an active itinerant ministry of preaching and teaching in Singapore and abroad.