HEAL Committee Meeting
Notices of Meeting include information about the subject matter to be examined by the committee and date, time and place of the meeting, as well as a list of any witnesses scheduled to appear. The Evidence is the edited and revised transcript of what is said before a committee. The Minutes of Proceedings are the official record of the business conducted by the committee at a sitting.
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37th PARLIAMENT, 2nd SESSION
Standing Committee on Health
EVIDENCE
CONTENTS
Tuesday, November 19, 2002
| ¿ | 0910 |
 |
The Chair (Ms. Bonnie Brown (Oakville, Lib.)) |
|
Mr. Paul Szabo (Mississauga South, Lib.) |
|
The Chair |
|
Mr. Paul Szabo |
|
The Chair |
|
Mr. Paul Szabo |
|
The Chair |
|
Mr. James Lunney (Nanaimo—Alberni, Canadian Alliance) |
|
The Chair |
|
Mr. Rob Merrifield (Yellowhead, Canadian Alliance) |
|
The Chair |
|
Mr. Rob Merrifield |
|
The Chair |
|
Mr. John Bryden (Ancaster—Dundas—Flamborough—Aldershot, Lib.) |
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The Chair |
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Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ) |
| ¿ | 0915 |
|
The Chair |
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Ms. Carolyn Bennett (St. Paul's, Lib.) |
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The Chair |
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Mr. James Lunney |
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The Chair |
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Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP) |
| ¿ | 0920 |
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The Chair |
|
Ms. Judy Wasylycia-Leis |
|
The Chair |
|
Ms. Judy Wasylycia-Leis |
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The Chair |
|
Mr. Joe McGuire (Egmont, Lib.) |
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The Chair |
|
Ms. Carolyn Bennett |
|
The Chair |
|
Mr. Paul Szabo |
|
The Chair |
|
Mr. Paul Szabo |
| ¿ | 0925 |
|
The Chair |
|
Mr. John Bryden |
|
The Chair |
|
Mr. Réal Ménard |
|
The Chair |
|
Mr. Rob Merrifield |
| ¿ | 0930 |
|
The Chair |
|
Mr. Réal Ménard |
|
The Chair |
|
Mr. Rob Merrifield |
|
The Chair |
|
Ms. Judy Wasylycia-Leis |
|
The Chair |
|
Mr. Rob Merrifield |
|
The Chair |
|
Ms. Carol Skelton (Saskatoon—Rosetown—Biggar, Canadian Alliance) |
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The Chair |
|
Ms. Carolyn Bennett |
|
The Chair |
| ¿ | 0935 |
|
Ms. Carolyn Bennett |
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The Chair |
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Ms. Carol Skelton |
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Mr. Rob Merrifield |
|
The Chair |
|
Mr. Rob Merrifield |
|
The Chair |
|
Ms. Carolyn Bennett |
|
Ms. Carol Skelton |
|
Mr. Rob Merrifield |
|
Ms. Carolyn Bennett |
|
The Chair |
|
Ms. Yolande Thibeault (Saint-Lambert, Lib.) |
|
The Chair |
|
Ms. Yolande Thibeault |
|
The Chair |
|
Ms. Yolande Thibeault |
|
Mr. Réal Ménard |
|
The Chair |
|
Mr. Rob Merrifield |
|
The Chair |
|
Mr. Rob Merrifield |
|
The Chair |
|
Ms. Carolyn Bennett |
|
The Chair |
|
Ms. Carolyn Bennett |
|
The Chair |
|
Ms. Carolyn Bennett |
|
The Chair |
| ¿ | 0940 |
|
Mr. Rob Merrifield |
|
The Chair |
|
Mr. Paul Szabo |
|
The Chair |
|
Mr. Paul Szabo |
|
The Chair |
|
Mr. Rob Merrifield |
|
Mr. Paul Szabo |
|
The Chair |
|
Mr. Paul Szabo |
|
The Chair |
|
Mr. Paul Szabo |
|
The Chair |
|
Mr. Paul Szabo |
|
The Chair |
|
Mr. Réal Ménard |
|
The Chair |
|
The Chair |
|
Mr. Réal Ménard |
|
The Chair |
| ¿ | 0945 |
|
Ms. Carolyn Bennett |
|
The Chair |
|
Ms. Carolyn Bennett |
|
The Chair |
|
Mr. Paul Szabo |
|
The Chair |
|
Mr. Paul Szabo |
|
The Chair |
|
Mr. Paul Szabo |
|
The Chair |
|
Mr. Ian Shugart (Assistant Deputy Minister, Health Policy and Communications Branch, Department of Health) |
| ¿ | 0950 |
| ¿ | 0955 |
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The Chair |
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Mr. Rob Merrifield |
| À | 1000 |
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Mr. Ian Shugart |
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Mr. Rob Merrifield |
|
Mr. Ian Shugart |
|
Mr. Rob Merrifield |
|
Mr. Ian Shugart |
|
Mr. Rob Merrifield |
|
Mr. Ian Shugart |
| À | 1005 |
|
Mr. Rob Merrifield |
|
Mr. Ian Shugart |
|
Mr. Rob Merrifield |
|
Mr. Ian Shugart |
|
Mr. Rob Merrifield |
|
Mr. Ian Shugart |
|
Mr. Rob Merrifield |
|
Mr. Ian Shugart |
|
Mr. Rob Merrifield |
|
Mr. Glenn Rivard (Senior Legal Counsel, Department of Justice) |
|
Mr. Rob Merrifield |
|
Mr. Glenn Rivard |
| À | 1010 |
|
Mr. Rob Merrifield |
|
The Chair |
|
Mr. Réal Ménard |
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Mr. Glenn Rivard |
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Mr. Réal Ménard |
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Mr. Glenn Rivard |
| À | 1015 |
|
Mr. Réal Ménard |
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Mr. Ian Shugart |
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Mr. Réal Ménard |
|
Mr. Ian Shugart |
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Mr. Réal Ménard |
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Mr. Ian Shugart |
|
Mr. Réal Ménard |
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The Chair |
|
Mr. Paul Szabo |
| À | 1020 |
|
Mr. Ian Shugart |
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Mr. Paul Szabo |
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Mr. Ian Shugart |
|
Mr. Paul Szabo |
|
Mr. Ian Shugart |
|
Mr. Paul Szabo |
|
Mr. Ian Shugart |
|
Mr. Glenn Rivard |
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Mr. Paul Szabo |
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The Vice-Chair (Mr. Réal Ménard) |
| À | 1025 |
|
Mr. Paul Szabo |
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The Vice-Chair (Mr. Réal Ménard) |
|
Mr. Paul Szabo |
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The Vice-Chair (Mr. Réal Ménard) |
|
Mr. Paul Szabo |
|
The Vice-Chair (Mr. Réal Ménard) |
|
Mr. Paul Szabo |
|
The Vice-Chair (Mr. Réal Ménard) |
|
|
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Mr. James Lunney |
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The Vice-Chair (Mr. Réal Ménard) |
|
Mr. James Lunney |
|
Mr. Ian Shugart |
| À | 1030 |
|
The Vice-Chair (Mr. Réal Ménard) |
|
Mr. Rob Merrifield |
|
Mr. Ian Shugart |
|
Mr. Rob Merrifield |
|
Mr. Ian Shugart |
|
Ms. Francine Manseau (Senior Policy Analyst, Health Policy and Communications Branch, Special Projects Division, Department of Health) |
|
Mr. Rob Merrifield |
|
Ms. Francine Manseau |
|
Mr. Rob Merrifield |
|
Ms. Francine Manseau |
|
Mr. Ian Shugart |
| À | 1035 |
|
Mr. Rob Merrifield |
|
Mr. Ian Shugart |
|
Mr. Rob Merrifield |
|
Mr. Ian Shugart |
|
Mr. Rob Merrifield |
|
The Vice-Chair (Mr. Réal Ménard) |
|
Mr. Rob Merrifield |
|
Ms. Francine Manseau |
|
Mr. Ian Shugart |
|
Mr. Rob Merrifield |
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The Vice-Chair (Mr. Réal Ménard) |
|
Mr. Ian Shugart |
|
The Vice-Chair (Mr. Réal Ménard) |
|
Mr. Paul Szabo |
|
Mr. Ian Shugart |
|
Mr. Paul Szabo |
|
Mr. Ian Shugart |
|
Mr. Paul Szabo |
|
Mr. Ian Shugart |
| À | 1040 |
|
Mr. Paul Szabo |
|
Mr. Ian Shugart |
|
Mr. Paul Szabo |
|
Mr. Ian Shugart |
|
Mr. Paul Szabo |
|
Mr. Ian Shugart |
|
Mr. Paul Szabo |
|
Mr. Ian Shugart |
|
Mr. Paul Szabo |
|
Mr. Ian Shugart |
|
The Vice-Chair (Mr. Réal Ménard) |
|
Ms. Francine Manseau |
|
The Vice-Chair (Mr. Réal Ménard) |
|
Mr. James Lunney |
|
Mr. Glenn Rivard |
| À | 1045 |
|
Mr. James Lunney |
|
Mr. Ian Shugart |
|
Mr. James Lunney |
|
Mr. Ian Shugart |
|
Mr. James Lunney |
|
Mr. Ian Shugart |
|
Mr. James Lunney |
|
Mr. Ian Shugart |
|
Mr. James Lunney |
|
Mr. Ian Shugart |
|
Mr. James Lunney |
|
Mr. Ian Shugart |
|
Mr. James Lunney |
| À | 1050 |
|
Mr. Ian Shugart |
|
The Chair |
|
The Chair |
|
Ms. Mary Lou Cranston (Director, Catholic Health Association of Canada) |
| Á | 1100 |
|
The Chair |
|
Ms. Mary Lou Cranston |
| Á | 1105 |
|
The Chair |
|
Mr. Mike Hogeterp (Research and Communications Coordinator, Christian Reformed Church in North America) |
| Á | 1110 |
|
The Chair |
|
Dr. Bridget Campion (Member of the Board of Directors, Catholic Organization for Life and Family) |
| Á | 1115 |
|
The Chair |
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Ms. Diane Watts (Researcher, REAL Women of Canada) |
| Á | 1120 |
|
The Chair |
|
Mr. Rob Merrifield |
| Á | 1125 |
|
Ms. Diane Watts |
|
Mr. Rob Merrifield |
|
Dr. Bridget Campion |
|
Ms. Mary Lou Cranston |
|
Mr. Rob Merrifield |
| Á | 1130 |
|
Ms. Mary Lou Cranston |
|
Mr. Mike Hogeterp |
|
Mr. Rob Merrifield |
| Á | 1135 |
|
Most Reverend Terence Prendergast (Chair, Catholic Organization for Life and Family) |
|
Dr. Bridget Campion |
|
The Chair |
|
Mr. Réal Ménard |
|
Dr. Bridget Campion |
| Á | 1140 |
|
Mr. Réal Ménard |
|
Dr. Bridget Campion |
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The Chair |
|
Mr. James Lunney |
| Á | 1145 |
|
Ms. Mary Lou Cranston |
|
Ms. Diane Watts |
|
Mr. James Lunney |
|
Ms. Mary Lou Cranston |
|
Dr. Bridget Campion |
|
Ms. Diane Watts |
| Á | 1150 |
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The Chair |
|
Mr. Jeannot Castonguay (Madawaska—Restigouche, Lib.) |
|
Most Rev. Terence Prendergast |
|
Mr. Jeannot Castonguay |
|
Most Rev. Terence Prendergast |
|
Mr. Jeannot Castonguay |
|
Most Rev. Terence Prendergast |
|
Mr. Jeannot Castonguay |
| Á | 1155 |
|
Ms. Mary Lou Cranston |
|
Ms. Diane Watts |
|
Mr. Jeannot Castonguay |
|
Ms. Mary Lou Cranston |
|
The Chair |
|
Ms. Judy Wasylycia-Leis |
| Â | 1200 |
|
Dr. Bridget Campion |
|
The Chair |
|
Dr. Bridget Campion |
|
The Chair |
| Â | 1205 |
|
Dr. Bridget Campion |
|
Ms. Judy Wasylycia-Leis |
|
Ms. Mary Lou Cranston |
|
The Chair |
|
Ms. Diane Watts |
|
The Chair |
|
Ms. Mary Lou Cranston |
|
Dr. Bridget Campion |
|
Ms. Diane Watts |
|
The Chair |
| Â | 1210 |
|
Ms. Diane Watts |
|
The Chair |
|
Ms. Mary Lou Cranston |
|
The Chair |
|
Ms. Mary Lou Cranston |
|
The Chair |
|
Dr. Bridget Campion |
|
The Chair |
|
Dr. Bridget Campion |
|
The Chair |
|
The Chair |
|
Dr. Bridget Campion |
|
The Chair |
|
Dr. Bridget Campion |
| Â | 1215 |
|
Ms. Mary Lou Cranston |
|
The Chair |
|
Mr. James Lunney |
|
The Chair |
|
Mr. James Lunney |
|
The Chair |
|
Mr. Rob Merrifield |
|
Dr. Bridget Campion |
|
Mr. Rob Merrifield |
|
Dr. Bridget Campion |
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Mr. Rob Merrifield |
|
Ms. Mary Lou Cranston |
|
Mr. Rob Merrifield |
|
Ms. Diane Watts |
|
Mr. Rob Merrifield |
|
The Chair |
|
The Chair |
|
Mr. Réal Ménard |
|
The Chair |
|
Dr. Ronald Worton (Scientific Director, Stem Cell Network) |
| ¹ | 1545 |
|
Mr. Paul Szabo |
|
Dr. Ronald Worton |
| ¹ | 1550 |
| ¹ | 1555 |
|
The Chair |
|
Mr. Michael Wosnick (Acting Executive Director, National Cancer Institute of Canada) |
| º | 1600 |
|
The Chair |
|
Mr. Ron Forbes (President and Chief Executive Officer, Juvenile Diabetes Research Foundation of Canada) |
| º | 1605 |
|
The Chair |
| º | 1610 |
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Professor Françoise Baylis (Department of Bioethics, Dalhousie University) |
| º | 1615 |
| º | 1620 |
|
The Chair |
|
Prof. Françoise Baylis |
|
The Chair |
|
Prof. Françoise Baylis |
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The Chair |
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Mr. Paul Szabo |
|
Prof. Françoise Baylis |
|
Mr. Paul Szabo |
|
The Chair |
|
Mr. James Lunney |
|
The Chair |
|
Mr. Rob Merrifield |
| º | 1625 |
|
Prof. Françoise Baylis |
|
Mr. Rob Merrifield |
|
Prof. Françoise Baylis |
|
Mr. Rob Merrifield |
|
Prof. Françoise Baylis |
| º | 1630 |
|
Mr. Rob Merrifield |
|
The Chair |
|
Mr. Rob Merrifield |
|
Mr. Ron Forbes |
|
Mr. Rob Merrifield |
|
Dr. Ronald Worton |
|
Mr. Rob Merrifield |
|
Dr. Ronald Worton |
|
Mr. Rob Merrifield |
|
Dr. Ronald Worton |
|
Mr. Rob Merrifield |
|
Dr. Ronald Worton |
|
Mr. Rob Merrifield |
|
Dr. Ronald Worton |
| º | 1635 |
|
The Chair |
|
Ms. Yolande Thibeault |
|
Ms. Françoise Baylis |
| º | 1640 |
|
Ms. Yolande Thibeault |
|
Ms. Françoise Baylis |
|
Ms. Yolande Thibeault |
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Mr. Michael Wosnick |
|
Ms. Yolande Thibeault |
|
The Chair |
|
Mr. James Lunney |
| º | 1645 |
|
Dr. Ronald Worton |
| º | 1650 |
|
Mr. James Lunney |
|
The Chair |
|
Mr. James Lunney |
|
Dr. Ronald Worton |
|
Mr. James Lunney |
|
Dr. Ronald Worton |
|
Mr. James Lunney |
|
The Chair |
|
Mr. James Lunney |
|
The Chair |
|
Ms. Carolyn Bennett |
|
Dr. Ronald Worton |
| º | 1655 |
|
Ms. Carolyn Bennett |
|
Dr. Ronald Worton |
|
Ms. Carolyn Bennett |
|
Dr. Ronald Worton |
|
Ms. Carolyn Bennett |
|
Dr. Ronald Worton |
| » | 1700 |
|
Ms. Carolyn Bennett |
|
Dr. Ronald Worton |
|
Ms. Carolyn Bennett |
|
Dr. Ronald Worton |
|
Ms. Carolyn Bennett |
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Prof. Françoise Baylis |
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The Chair |
|
Mr. Paul Szabo |
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Dr. Ronald Worton |
|
Mr. Paul Szabo |
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Dr. Ronald Worton |
|
Mr. Paul Szabo |
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Prof. Françoise Baylis |
|
Mr. Paul Szabo |
|
Prof. Françoise Baylis |
| » | 1705 |
|
Mr. Paul Szabo |
|
Prof. Françoise Baylis |
|
Mr. Paul Szabo |
|
Prof. Françoise Baylis |
|
Mr. Paul Szabo |
|
Prof. Françoise Baylis |
|
Mr. Paul Szabo |
|
Prof. Françoise Baylis |
|
Mr. Paul Szabo |
|
Prof. Françoise Baylis |
|
Mr. Paul Szabo |
|
Prof. Françoise Baylis |
|
Mr. Paul Szabo |
|
Prof. Françoise Baylis |
|
Mr. Paul Szabo |
|
Prof. Françoise Baylis |
|
Mr. Paul Szabo |
|
Prof. Françoise Baylis |
|
Mr. Paul Szabo |
|
Prof. Françoise Baylis |
|
Mr. Paul Szabo |
|
Prof. Françoise Baylis |
|
Dr. Ronald Worton |
| » | 1710 |
|
Mr. Paul Szabo |
|
Prof. Françoise Baylis |
|
Mr. Paul Szabo |
|
Mr. Ron Forbes |
|
Mr. Paul Szabo |
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Dr. Ronald Worton |
|
Mr. Paul Szabo |
| » | 1715 |
|
The Chair |
|
Mr. Rob Merrifield |
|
The Chair |
|
Dr. Ronald Worton |
|
Mr. Rob Merrifield |
|
Dr. Ronald Worton |
|
Mr. Rob Merrifield |
|
Dr. Ronald Worton |
|
Mr. Rob Merrifield |
|
Dr. Ronald Worton |
|
Mr. Rob Merrifield |
|
Prof. Françoise Baylis |
| » | 1720 |
|
Mr. Rob Merrifield |
|
The Chair |
|
Mr. Rob Merrifield |
|
The Chair |
|
Prof. Françoise Baylis |
|
The Chair |
|
Prof. Françoise Baylis |
|
The Chair |
|
Prof. Françoise Baylis |
|
The Chair |
|
Prof. Françoise Baylis |
|
The Chair |
|
Prof. Françoise Baylis |
|
The Chair |
| » | 1725 |
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Prof. Françoise Baylis |
|
The Chair |
|
Dr. Ronald Worton |
|
The Chair |
|
Dr. Ronald Worton |
|
The Chair |
|
Dr. Ronald Worton |
|
The Chair |
| » | 1730 |
|
Dr. Ronald Worton |
|
The Chair |
|
Dr. Ronald Worton |
|
The Chair |
|
Dr. Ronald Worton |
|
The Chair |
|
Dr. Ronald Worton |
|
The Chair |
|
Dr. Ronald Worton |
|
The Chair |
|
Dr. Ronald Worton |
|
The Chair |
|
Dr. Ronald Worton |
|
The Chair |
|
Dr. Ronald Worton |
|
The Chair |
|
Mr. Rob Merrifield |
|
The Chair |
|
Mr. Rob Merrifield |
|
The Chair |
|
Mr. Rob Merrifield |
| » | 1735 |
|
The Chair |
|
Mr. Rob Merrifield |
|
The Chair |
|
Mr. James Lunney |
|
Prof. Françoise Baylis |
|
Mr. James Lunney |
|
Dr. Ronald Worton |
|
Mr. James Lunney |
|
Dr. Ronald Worton |
|
Mr. James Lunney |
|
Dr. Ronald Worton |
|
Mr. James Lunney |
|
Dr. Ronald Worton |
|
Mr. James Lunney |
| » | 1740 |
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Dr. Ronald Worton |
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The Chair |
|
Mr. Rob Merrifield |
|
Dr. Ronald Worton |
|
Mr. Rob Merrifield |
| » | 1745 |
|
Dr. Ronald Worton |
|
The Chair |
CANADA
Standing Committee on Health |
|
l |
|
l |
|
EVIDENCE
Tuesday, November 19, 2002
[Recorded by Electronic Apparatus]
¿ 
(0910)
[English]
The Chair (Ms. Bonnie Brown (Oakville, Lib.)): The meeting is now called to order. I welcome everybody back from the break. Some people have been kind enough to come to fill our numbers this morning, so thank you very much.
You have a notice of motion that talks about business of the committee, and the first business of the committee is to expand our budget so we can hear all these witnesses.
On your agenda there's a motion,
| That the proposed supplementary budget in the amount of $83,000, for the purpose of hearing witnesses on Bill C-13, be adopted and that the Chair present the said budget to the Budget Sub-committee of the Liaison Committee. |
Would somebody like to move that? I shouldn't move it, being the chair.
Madame Thibeault moves that.
Are there any questions on that budget? I can explain that it is the clerk's best guess as to how much it will cost to bring the witnesses on the list that you have submitted.
Mr. Paul Szabo (Mississauga South, Lib.): Madam Chair, with regard to the witnesses, does that presume that all the witnesses that were requested by members will be heard?
The Chair: No, there is no such presumption. We have some people who say they can come in the new year, or can come on December 20, and so on. So we have to discuss that at another time.
This is his best guess, at least to get a balanced picture.
Mr. Paul Szabo: So we don't know how many witnesses this covers.
The Chair: No, there's no detail attached to this number other than the fact that the clerk has worked it out as best he can, considering flights from Vancouver and teleconferencing.
Mr. Paul Szabo: Can this be changed in the future?
The Chair: Yes, we can always go for more money, but in order to get started, we need this.
Are there any other questions?
Mr. James Lunney (Nanaimo—Alberni, Canadian Alliance): Is it going to be enough?
The Chair: Well, if somebody would like to amend it and raise the number, I would accept such an amendment.
Mr. Merrifield.
Mr. Rob Merrifield (Yellowhead, Canadian Alliance): I'm not sure if it's enough or not; I think the point is, we don't see what this really is going to give us. Whether it's going to be enough of the witnesses or not, we have no way of judging.
I suppose if it's an initial amount to get started, that would be fine and let's start with that, but we may need more. I think with that understanding we should proceed.
The Chair: Are there any other questions or comments?
(Motion agreed to)
The Chair: There's a second motion, from Mr. Merrifield, essentially that immediately upon the release of the Romanow report, we have four meetings to discuss it. That would be in another week or so.
Mr. Merrifield will be speaking to his own motion.
Mr. Rob Merrifield: I've brought this forward because I see where we're at in health care right now, which is at a bit of a crossroads, and we are the Standing Committee on Health, not the standing committee on reproductive technologies, as important as that is.
We talked about this a little bit at the last meeting. I think Judy had brought it forward, suggesting that perhaps we should take a couple of weeks, or whatever it's going to take, to do a bit of a review of the recommendations from the Romanow report so that we can give our input to the minister and to this government as they're dialoguing prior to the first ministers conference early in the new year. If we wait until after the break and we fail to do this before Christmas, we've missed any opportunity for any kind of input.
I believe it is absolutely imperative for us, as the Standing Committee on Health, to be able to take a look at what the recommendations are, to give some sort of indication as to whether we agree with some of them or disagree with them strongly, depending on how they come out.
We already have the one report, the Kirby report. We know now that Mr. Romanow is going to report on the 28th of the month, so we know the exact date. It's something that I think we should consider very seriously because of the critical point that health care is at in this country right now.
The Chair: Thank you, Mr. Merrifield.
I'll now stop and ask the media to leave. They've had about five minutes. The program they're preparing for will be on, I think, Thursday evening. You might want to see yourselves.
Mr. Bryden.
Mr. John Bryden (Ancaster—Dundas—Flamborough—Aldershot, Lib.): I just want to make an observation. I'm very keen on the debates on the Romanow report when that comes down. I have a particular interest in the transparency and accountability provisions that I'm hoping are going to be a part of the report.
So I am certainly looking personally for some sort of forum where I can participate in the debate on the Romanow report. But as I'm only an occasional, and indeed rare, member of this committee--I come not very often--I'm not sure of the scheduling of the committee and how it might conflict with the committee's other business. Perhaps I can suggest, in passing, if there's no other way of doing it, that this committee hold evening meetings or extra meetings in order to hear the Romanow report. I would certainly be willing and could easily come to this committee if it held evening meetings to hear that report, whereas during the day it is a bit more difficult for me.
The Chair: Mr. Ménard.
[Translation]
Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): Madam Chair, I think it is premature to vote now on holding four meetings on the Romanow Report. I think we should wait at least until we have seen what the report says. If it were to advocate a significant increase in transfers and all the premiers responded positively, and cabinet agreed to go in that direction, that would not prevent the minister from coming to speak to us for an hour or two. However, would we need to hold four meetings to declare that there is a consensus on this?
We are not going to redo the work of the Romanow Commission. We have a great deal of work ahead of us, and many other concerns. Personally, I would like the motion to be tabled, and once the report has been made public, we would come back to this matter. If the Romanow Report is very controversial and we need clarification, we might need to hold three or four meetings. However, I do not think the committee can make a decision about that now, because we do not know what the report will say.
¿ (0915)
[English]
The Chair: Dr. Bennett.
Ms. Carolyn Bennett (St. Paul's, Lib.): I'm just wondering if there are other ways to achieve the goal of Mr. Merrifield's motion, as Réal has said. I think it would be very important that, before the first ministers meeting and before the budget, this committee look at our ability to support what we hope will be some unstoppable momentum to actually see a different way of doing business when those first ministers meet in January.
I am wondering whether a subcommittee could meet in the evenings or maybe even on December 3 or December 10, on a Monday, doing a full-day round table. We could get everybody heard and see if we could come up with a report or a letter to the minister or a letter to the first ministers or our pre-budget support for what's in Romanow or something. Out of one day-long meeting, we might be able to achieve this and then not get in the way of the work this committee is already doing. So whether it's a subcommittee or whether it's a big round table, I think we can...
I think there are serious time constraints, in terms of our response to Romanow, to be the most effective in terms of that first ministers meeting and in terms of the budget. We could do a full study on health reform or on other things at some other time, if people want, but I would like to see some ability to not stop the important work of the subcommittee on this bill, but also to achieve the goals of Mr. Merrifield's motion.
The Chair: Dr. Lunney.
Mr. James Lunney: Thank you, Madam Chair.
The Romanow commission has spent 15 million taxpayers' dollars over the last 18 months. Canadians are really anticipating that this is going to have an impact on the future of health care. The minister has indicated that she intends to act quickly on the recommendations. I think it is a proper, responsible role of this committee to take a brief period of time to investigate this quickly, in order to have some significant impact, hopefully, if we're going to have any influence at all on the minister's response and on having any meaningful impact to the government before such action is taken. So I would suggest that it is certainly in the interest of Canadians that this committee pause to at least consider the recommendations of the Romanow commission.
The Chair: Ms. Wasylycia-Leis.
Ms. Judy Wasylycia-Leis (Winnipeg North Centre, NDP): Thank you, Madam Chairperson.
I appreciate the motion before us. It's very consistent with the suggestion I made two weeks ago at our initial committee meeting. I think it reflects the belief some of us have that this committee must be involved in discussions around the future of health care and must be part of the post-Romanow period.
I think, as Carolyn has said, there's a window here that will be lost if we don't have a means to discuss the issues, as a committee, before the House recesses.
Romanow is reporting, we believe, on Thursday, November 28. The motion is suggesting we use our Tuesday and Thursday meetings of the following week, and then the Tuesday and Thursday meetings of the week thereafter. It brings us to the break for the holiday season. To me, it's reasonable, given the significance of this report and the fact that we're talking about the highest possible priority of Canadians right now.
I don't have a problem with the motion. My preference would be for the committee to devote the four sessions to a discussion of Romanow, with a view to developing some recommendations or to provide guidance in a written form to the government, leading up to the first ministers meeting to be held in January and in time for preparations for the budget that we expect comes down in February. I support the motion.
If this motion should lose, as a committee I think we have to agree to come back to it in another form. The suggestions have been made for evening meetings. The suggestion has been made for a subcommittee. I think we should revisit those ideas. It would be a fallback position for us. It shouldn't be the first position though.
I think if you're dealing with something as major as the Romanow commission, it should be all of us in our regular time slots working at trying to understand the significance of his report, the controversies around it, and what we think we could recommend for the government.
If we cannot agree today, then I would suggest we at least agree to meet on the first meeting after Romanow releases his report. It would be December 3.
¿ (0920)
The Chair: Excuse me, but we have a specific motion in front of us. If there are to be further variations on it, this would either have to be amended or they would have to be presented with the 48 hours' notice.
I understand you're thinking out loud; it's fine.
Ms. Judy Wasylycia-Leis: I'm trying to make sure.
The Chair: I can't accommodate all these variations in the list of motions this morning.
Ms. Judy Wasylycia-Leis: Fair enough, Madam Chair.
We have some constructive suggestions on the table for pursuing a common objective; one is for evening meetings, one is for a subcommittee. I wouldn't want to lose the ideas in the event this motion fails. I would like to see committee members support this motion. However, I think we have to find a way as a committee, on a collegial basis, to make sure we have a plan for the post-Romanow period.
The Chair: Mr. McGuire is next, then Mr. Bryden. I think it will be four speakers on either side.
Mr. Joe McGuire (Egmont, Lib.): Briefly, Madam Chair, I know you've been dealing with Bill C-13 for quite a long time. To take another recess from it, I think, would be doing an injustice to all the work you've been doing over the past few years.
I think if there's any accommodation for this motion, it should be outside regular committee hours. You can deal with Bill C-13, get it done, put it to bed, and get it back into the House.
The Chair: This is the voice of an experienced committee chair.
Ms. Carolyn Bennett: Can we go to the table and have the Library of Parliament come up with three alternatives for dealing with Romanow?
The Chair: We can move to table, but it is a motion that stands alone.
Mr. Bryden.
Mr. John Bryden: Mr. Szabo can go first.
The Chair: Okay.
Mr. Szabo.
Mr. Paul Szabo: Thank you, Madam Chairman.
It appears there's certainly a consensus. It's an obvious consensus with regard to the importance of Romanow and the relevance of Romanow.
The Chair: Mr. Szabo, I'll decide if there's a consensus or not.
Mr. Paul Szabo: Sure. Canadians decide; I guess that was the consensus.
I want to comment that the health committee has earned a great deal of respect for the work it's done. That earned respect is because it keeps its eye on the issues. For instance, the report that was done on the draft legislation was one of the best reports I've ever seen a committee do, and it was on an all-party, non-partisan basis. It was quite an excellent report.
Now that I've said that, Madam Chair, my colleague here, Mr. McGuire, made some comment with regard to Bill C-13. The committee is hearing witnesses now, and we're going to deal further with the timeline for the balance of the committee's consideration. Whether Bill C-13 moves out of committee before we break or a week or two after we come back does not have material implication to the legislative timeline. It's not significant, it's not a point at which you might anticipate prorogation, and therefore there's no significant legislative milestone missed if it doesn't get out of committee.
Bill C-13 should happen naturally as the committee wants to deal with it, and that has yet to be worked out by the committee. I don't think we should say for convenience's sake or arbitrarily that Bill C-13 has to be done just because it has been around for a long time. That's not a good enough reason.
Mr. Ménard raises an important point with regard to the fact we don't know what Romanow is going to say. We certainly have heard an awful lot of anecdotal input, etc. It may very well be that when Romanow comes out, there's nothing new and there are no problems, etc. In that case, I suspect that the committee will want to deal with it on a tighter timeline than might be anticipated now.
One of the things I do know, Madam Chair, is that if the job is going to be done properly, it should be anticipated. I think Judy has a good suggestion, that the first thing after Romanow comes down, the committee should meet. In the meantime, the committee clerk has a responsibility to anticipate and prepare for having good meetings on the Romanow report. The committee is the master of its own work. Should the committee, for instance, adopt this motion, it's subject to further revision down the road when it comes up.
I'm just suggesting that this is not going to be fatal. To adopt this motion is probably useful to signal to the clerk and to everybody else that this committee intends to have reasonable consideration in the time available after Romanow comes down. First of all, the intent is to make a representation to the government, to the minister; second, to send signals with regard to budgetary implications, anything to do with the budget. Health care is definitely in the budget. The only thing that isn't there is the number.
As to the budgetary implications, the dollar figure isn't there but will be subject to some discussion. Equally important is the distribution of that dollar figure among the various aspects of health care. The committee will have an opportunity to look at that and should take that opportunity prior to the break because budgetary matters will be established well before we come back after the break.
Certainly, with regard to a signal to Canadians and to the first ministers, we should reaffirm that this committee sees health as the number one issue in Canada and that this committee intends not only to provide this input on an interim basis but to work more fully at the appropriate time on the implementation of reform of health care.
¿ (0925)
The Chair: Mr. Bryden.
Mr. John Bryden: Madam Chair, I note that the motion does not preclude having evening meetings. It does not preclude the chair, at her discretion, deciding to have one meeting on Romanow and three evening meetings. It does preclude a subcommittee and other variations, but it seems to me that the motion is very reasonable. I would be making representations to the chairman to have evening meetings even if she decided to have one or two daily sessions.
The Chair: Mr. Ménard.
[Translation]
Mr. Réal Ménard: Madam Chair, could we suggest an amendment? Would the mover of the motion be prepared to entertain an amendment to the main motion? Notice is not required, but I would like to check whether the mover would be inclined to accept an amendment.
[English]
The Chair: I'll ask the mover if he'd accept an amendment.
Mr. Rob Merrifield: What's in the amendment?
Some hon. members: Oh, oh!
¿ (0930)
The Chair: Mr. Ménard.
[Translation]
Mr. Réal Ménard: The amendment would read as follows, Madam Chair: “That the committee demonstrate its commitment to the future of our universal health care system by devoting part of its deliberations to this subject at its next meeting following the tabling of the report”.
Let us provide for a discussion; in this way, immediately after the Romanow Report comes down, we could spend part of our next meeting discussing it. That would be a guarantee: we will discuss it, as Judy has requested, but we would not be forced to spend four meetings on the report without even knowing what it contains.
[English]
The Chair: Mr. Merrifield, we have an amendment on the floor.
Mr. Rob Merrifield: Yes. Just speaking to the amendment, we can dance around this issue if we like and we can shove it off to evening meetings if we like, but I don't think that's doing justice to the intensity of the problem and the issue at hand. For us to go through a full day of sitting--we're starting at 9 a.m. today and we go right through until 5:30 p.m. with witnesses, and that could well continue into the first two weeks in December--and then to take on, as a committee, the intensity of discussion on Romanow and his very exciting report, I would suggest, would not do it justice and would send the wrong message from this committee. I don't think we can physically do it and do it justice. That's number one.
For us to take a two-week period--the first two weeks of December--and deal with the Romanow report is I think very valid and appropriate, and certainly does not interfere in a significant way at all with the piece of legislation we're dealing with right now.
When it comes to the amendment, to put one meeting aside for it and then shove it off to something else, I find is inappropriate. I don't think it's in the best interests of the material at hand that we have to deal with, nor the issue.
The Chair: Perhaps I may suggest, Mr. Ménard, that it wouldn't take much of an amendment to say “for at least one meeting” at the end. So “for no less than four meetings” could be just changed to “for at least one meeting”. Is that what you're suggesting, even if it's a full day?
Mr. Réal Ménard: Oui.
The Chair: Okay.
I'm going to call the amendment right now, because we have witnesses waiting and we have three more motions to do.
Ms. Judy Wasylycia-Leis: On a point of order, simply to be clear, my suggestion for the first meeting after the Romanow report was not to present that as one meeting to discuss the Romanow report per se and to make recommendations; it was for us as a committee to discuss how we will handle the Romanow report and whether we need three meetings, or whether we need a subcommittee, or whether we need a steering committee.
I want to be clear that I can't support the amendment if the intention is to perhaps limit our discussion.
The Chair: I said at least one meeting. I think that implies there would be some discussion as to how we're going to handle it.
It's pretty clear. He's suggesting at least one meeting, that could stretch into more, and Mr. Merrifield's motion, if this amendment fails, is suggesting four meetings. So calling the amendment--
Mr. Rob Merrifield: On a point of order, I asked what the amendment was. I guess it's not...I wouldn't accept it as an amendment.
The Chair: You don't accept it as an amendment.
Mr. Rob Merrifield: No.
The Chair: Okay.
I think we're ready to call the question.
Ms. Carol Skelton (Saskatoon—Rosetown—Biggar, Canadian Alliance): May I ask, is this the main vote?
The Chair: Yes.
Ms. Carol Skelton: I'd like a recorded vote on this, please.
The Chair: Okay.
Four meetings for the Romanow report is the essence of the question.
Ms. Carolyn Bennett: It's too linear to do it in this way. This may not be the best way.
(Motion agreed to: yeas 7; nays 5—See Minutes of Proceedings)
The Chair: Moving on to the next motion, it is for four meetings again on the Kirby report. Do you wish to debate it, or do you just wish to vote?
¿ (0935)
Ms. Carolyn Bennett: Vote.
The Chair: Do you want a recorded vote, Ms. Skelton?
Ms. Carol Skelton: Yes, please.
Mr. Rob Merrifield: Madam Chair, may I speak on the motion, just quickly?
The intent is that this is essentially the same issue as Romanow, in terms of dealing with it.
The Chair: We know, but is there some separate point about Kirby that you wish to make?
Mr. Rob Merrifield: Yes, but I would suggest that since the past motion passed, we should incorporate the discussion on Kirby within our discussion on Romanow, which I'm sure will happen at any rate.
The Chair: Are you pulling this motion, then? It suggests an extra four meetings. If this passes, we have to have eight meetings on these two reports.
Ms. Carolyn Bennett: Why would we have four meetings on Kirby?
Ms. Carol Skelton: We should be discussing it.
Mr. Rob Merrifield: Let's let it go.
Ms. Carolyn Bennett: This is not the way to plan a committee. This is appalling.
The Chair: Excuse me, but we have to deal with the motions that are duly before us.
Ms. Yolande Thibeault (Saint-Lambert, Lib.): On a point of order, Madam Chair, am I to understand that Mr. Merrifield is withdrawing his motion?
The Chair: No.
Ms. Yolande Thibeault: Then I would like to address it, if I may.
The Chair: Go ahead, Madame Thibeault.
[Translation]
Ms. Yolande Thibeault: Madam Chair, we are a committee of the House of Commons. The House of Commons has asked us to study Bill C-13 at this time. As far as the Kirby Report goes, with all due respect for Mr. Kirby, his team and the senators, I think we should start by dealing with the matters referred to us by the House of Commons. We could get to the Kirby Report later, once we have done what is necessary to deal with Bill C-13.
Mr. Réal Ménard: Madam Chair, I would like to remind our colleagues from the Canadian Alliance that senators are not elected, and that we are.
[English]
The Chair: Are there any other comments on this motion? Mr. Merrifield.
Mr. Rob Merrifield: Just to be clear, I would be open to an amendment suggesting that we incorporate the meetings with Kirby into those two weeks in December, because the other one doesn't say they have to be regular meetings necessarily. If that would satisfy everyone in dealing with it, that's fine, because we have already decided we're going to deal with Romanow. So if we're going to deal with essentially the same issues for the first two weeks of December, then I certainly would be open to that. I think that was the intent.
The Chair: But you didn't amend your first motion to say that, and now we have four meetings dedicated to Romanow.
Mr. Rob Merrifield: That's right, and that's why I said that—to clarify it and to perhaps garner some support. I'd certainly be open to an amendment to that effect.
The Chair: Dr. Bennett.
Ms. Carolyn Bennett: I don't think we can plan the work of a committee in linear motions, yes or no. I think we should strike a steering committee, we should plan the work of this committee properly, and then let's get on with it and do it by consensus and in a collaborative way. In having sequential motions that we have to say yes or no to and to not vote on the amendment, this is hopeless.
Could we actually get on with this? Let's get on with the hearing today. Let's strike a steering committee, plan the work of the committee, and get on with working in a collaborative fashion so that we don't have to vote down....
The Chair: Are you making a motion to table this one?
Ms. Carolyn Bennett: I'm making a motion to strike a steering committee to plan the work of this committee.
The Chair: There's a motion on the floor, Dr. Bennett. We have to follow parliamentary procedure.
Ms. Carolyn Bennett: Then let's call for the question on this one.
(Motion negatived—See Minutes of Proceedings)
The Chair: Thank you.
We have one last motion:
| That the Committee call on the Health Minister to be available for questioning for a minimum of 2 hours during her next appearance at committee. |
I think Mr. Merrifield is responding to the fact that the minister has come to us before, and I think she has been averaging about an hour and a quarter to an hour and a half. He just wants to ensure that he has two hours for this meeting with the minister. In other words, I would send a letter requesting that she set aside that time.
Is that correct, Mr. Merrifield?
¿ (0940)
Mr. Rob Merrifield: You're sort of right, although I think you're a little generous when you say we've had an hour and a half for the minister. We've seen the minister come to this committee in times past and have seen much less time than that when we've scheduled a two-hour meeting. That is very frustrating for the opposition. On the government side, you may have access to the minister any time you like. On the opposition side, however, we have a very difficult time in sitting the minister down and discussing very important issues that we have, and very important questions. In times past, we've been limited in the amount of questions that we could have, and that was very frustrating for our side.
We just want to be very clear that the minister has not spoken on this piece of legislation before the committee. We need to have a fair hearing with the minister when she comes, and that's the intent of the motion.
The Chair: I think the intent of the motion is clear.
Mr. Paul Szabo: Madam Chair?
The Chair: It's pretty simple, Mr. Szabo. Could we not just move to vote?
Mr. Paul Szabo: This motion says the minister is to be called, but it's not clear to me what the purpose is. Is it with regard to Romanow or Bill C-13?
The Chair: He's trying to leave that open, I think. He's saying it's to be at the next meeting of the committee. I think he's trying to establish a two-hour precedent. That's what he's probably trying to do.
Mr. Rob Merrifield: If I could address that, when the minister is here, we should have an open dialogue. If it goes into something else—
Mr. Paul Szabo: I understand that, but all the ministers say they only have 45 minutes to an hour.
Madam Chair, I understand that the minister was requested to appear with regard to Bill C-13?
The Chair: Yes, she is on the list.
Mr. Paul Szabo: But this is not specifically dealing with Bill C-13. It's for some purpose, whatever the purpose of that meeting is. Whenever she can come, it will be for general purposes. Is that the intent?
The Chair: No, there is nothing in the motion. It's only what's in the motion. He said it would be at the next meeting. It could be about Bill C-13, but Mr. Merrifield is suggesting that if the minister is here for as long as two hours, it could become a little more wide-ranging.
Mr. Paul Szabo: Madam Chair, I'm sorry, but if the minister is going to be asked to appear at the next meeting of the committee—
The Chair: No, it's not the next meeting. It's at the next meeting when she will be here.
Mr. Paul Szabo: Well, whenever. But if she's going to be asked to come to a meeting, it probably would be useful to tell her what the purpose of the meeting is.
The Chair: Mr. Ménard.
[Translation]
Mr. Réal Ménard: Madam Chair, there is a constitutional convention with which I'm sure Mr. Szabo is familiar. Personally, I will be supporting the motion. Ministers appear before this committee rarely, and when they do appear, they do not answer our questions. When the minister appears before the committee, committee members have the prerogative to question her about all sorts of activities related to her department. We do not need to limit our questions to one topic.
So, we will decide on the questions we want to ask her, and it is not asking too much to think that there will be a general discussion, in keeping with ministerial responsibility. That is just fine. There are so many things we could talk about. She can be an endearing woman, but she avoids questions. This must stop.
[English]
The Chair: Thank you.
(Motion agreed to)
The Chair: We have now dealt with the motions before us today.
Mr. Ménard.
[Translation]
Mr. Réal Ménard: Do you think we could have consent to establish a steering committee? I know that we are supposed to give 24 hours' notice of a motion, but with the consent of the committee, we could set up a steering committee made up of yourself, the two vice-chairs and the parliamentary secretary. I think it is important that we have a steering committee.
[English]
The Chair: I'm very aware of the fact that we have witnesses who have now been waiting 15 minutes to begin. We did deal with four motions. I'm hoping that the committee will agree that we move forward with the agenda as presented.
Some of the members might like to get together and discuss the possibility of Dr. Bennett's suggestion earlier of some other kind of planning mechanism, such as a steering committee. In actual fact, I prefer not to go into it now, because we have witnesses waiting. There is a period this afternoon, between the morning session and the afternoon session, that would allow time to put forward a motion for consideration for Thursday.
Mr. Réal Ménard: D'accord.
The Chair: In terms of the committee having a plan or not having a plan, the committee had a plan. The plan was imposed upon us by the referral from the House of Commons to study Bill C-13. As chair, I feel it's my first responsibility to get back to the House as clearly, and as well, and as quickly as possible with our response to their assignment.
As Madame Thibeault has wisely pointed out, we are a creature of the House. Even though we control our own business, this is not a committee formed to study a matter, this is a committee that can study matters when it has time, but in other times it is a legislative committee, a standing committee of the legislature. That's why I felt we had a plan and we didn't need a planning meeting. We had a bill, and according to the Standing Orders that's the usual, bills take precedence over anything else you might wish to do.
The committee has chosen to go a different route this morning, to inject four meetings on the Romanow report. That is the will of the committee, so it will be done.
¿ (0945)
Ms. Carolyn Bennett: Madam Chair, could I ask the Library of Parliament to perhaps suggest a work plan for Romanow.
The Chair: To handle it.
Ms. Carolyn Bennett: Yes, to handle it, whether that's a round table or whether that's the equivalent of four meetings all running together. In terms of what would be eight hours on Romanow, is there a more coherent, productive way of going about this, in a one-day meeting for eight hours, 9 a.m. to 5 p.m.? Or is there a way we could do this such that they think we could get a better result or have a more full round-table kind of discussion? I would like the library to give us a little menu of choices.
The Chair: I will ask them to do so. After any motion passes, I meet with the researchers and the clerk to discuss the fallout of the motion and how it might be handled. I think the regular members of this committee will acknowledge that I have tried to be as democratic as possible and not make choices myself, but rather present things to them. If you'd been here last year, Dr. Bennett, you would know that this would have automatically happened.
Ms. Carolyn Bennett: I've just never been on a committee without a steering committee, actually.
The Chair: Yes.
Could we ask the witnesses to come forward now. I apologize for keeping you waiting.
Mr. Paul Szabo: Madam Chair, could you advise the committee on when there will be a discussion with regard to witness planning for Bill C-13?
The Chair: I'm hoping maybe tomorrow afternoon. It's just that today is pretty full, Mr. Szabo. Tomorrow afternoon looks a little freer.
Mr. Paul Szabo: I know that members were asked to submit, but I don't think the information with regard to the suggestions that other members have made was circulated to members of the committee. I'm not sure if that might be helpful for them to anticipate that discussion and maybe have some input. I think you had made a comment that some people weren't available until January, and--
The Chair: I have not had that report from the clerk yet. He worked all last week trying to contact these people. I was not able to come until last evening, so I am seeing him for the first time this morning. We will try to meet after this meeting so I can get that information. I don't have it, so you don't have it.
Mr. Paul Szabo: So would it be possible for the committee members to receive at least a list of the people who have been suggested for witnesses so that they could be aware of what others are thinking?
The Chair: Yes, we can do that.
Mr. Paul Szabo: Thank you.
The Chair: I welcome, from the Department of Health, the assistant deputy minister on health policy and communications, Ian Shugart, and Francine Manseau, the senior policy analyst. Glenn Rivard will explain numbers to us if such needs arise.
Mr. Shugart.
Mr. Ian Shugart (Assistant Deputy Minister, Health Policy and Communications Branch, Department of Health): Thank you, Madam Chair. It's a pleasure to be here again.
My suggestion, if it would be acceptable to the committee, is to make a brief introductory statement that deals with two issues: specific developments in science over the summer months since we last met and how that, in our view, relates to Bill C-13, and then secondly and briefly, developments in terms of federal-provincial relations and again how Bill C-13 relates to that issue. Then we're in your hands for questions.
As we would expect, the AHR field continues to be at the forefront of science. Having observed the developments in the scientific field since we last met, we have not changed our view that the balance set out in Bill C-13 is still appropriate. If anything, the developments seem to indicate the importance of having a regulatory framework in place in Canada.
The highest-profile scientific developments have occurred in the area of stem cell research. There have been a number of studies published involving both adult and embryonic stem cells, and none were more prominent than the two that were published at the end of June in Nature magazine. The findings have generated a considerable degree of interest in the scientific community.
The first paper by a research group, headed by Catherine Verfaillie at the University of Minnesota, reported success in isolating extremely versatile cells from the bone marrow of adult mice. These are adult stem cells. They possessed a high degree of self-renewal, and when injected into a mouse embryo, they were able to differentiate into different cell types. These findings were significant because they demonstrated a higher degree of plasticity in adult stem cells than was previously thought to be the case.
The second paper was published by a group at the NIH that was headed by Ron McKay. It demonstrated that mouse embryonic stem cells, when differentiated into neural cells, could alleviate the symptoms of Parkinson's disease in rats. This was an important proof of principle--not categorical proof but a proof of principle--showing the potential therapeutic effectiveness of differentiated embryonic stem cells.
Nature subsequently published an editorial that concluded that these papers demonstrate both the exciting potential of stem cell research and the many unanswered questions that remain. Advances in one stream of stem cell research inform and assist research in the other stream, and it works in both directions. Fundamentally, the dynamism, the interaction, between these two streams of research, embryonic and adult stem cells, will serve to advance overall knowledge about stem cells and their potential therapeutic effectiveness.
Many questions obviously remain, such as the stability of stem cells in culture, whether the cells behave the same in all cases in the human body as they do in the laboratory. That question of whether in vivo works the same way as in vitro is a fundamental and common line of inquiry in research, not just in this field but really in any field.
In short, it's still very early in the scientific community's understanding of these different types of stem cells. Researchers in both streams would conclude, in the main, that much further research is required. I know you're going to be hearing from the scientific community, and I'm sure they will be able to elaborate on this.
The second development in science over the summer months is related to egg freezing.
¿ (0950)
¿ (0955)
[Translation]
At the time we were very interested in research on stem cells, the possibility of freezing eggs took centre stage in October 2002, after the announcement of the birth in the United Kingdom of a baby conceived from a frozen egg.
There is no information about the number of babies that have been produced using this technique. Some say that there are about 30, while others think there are closer to 100 throughout the world.
As the committee knows, freezing eggs, unlike freezing sperm, is a very technical and difficult procedure. For the time being, the success rate is very low.
[English]
Most experts consider the technique of egg freezing to be experimental at present. Little data exists on whether an AHR procedure using previously frozen eggs is safe for the children born from that technique or for the woman undergoing it. Again, much more research is needed before this could become accepted clinical practice.
How does Bill C-13 relate to this? It would establish a regulatory regime in which this type of procedure could take place only in the context of clinical trials, at least at this time. This would ensure that untested medical procedures do not become common medical practice without adequate scientific data supporting their safety. Without Bill C-13 there will continue to be little separation, at least little formal and assured separation, between experimental procedures and clinical practice in the area of AHR.
That concludes my comments on the scientific developments. Very briefly, I'll provide an overview of the relationship of this bill to what's been going on with the provinces and territories.
Bill C-13 sets a consistent, solid, minimum standard for health and safety protection across Canada in assisted human reproduction. However, as we've discussed before, there are opportunities under the bill for provinces and territories to develop their own legislation, regulations, and guidelines as long as they meet or exceed the standards set by Bill C-13. We do not believe there are any major conflicts between Bill C-13 and existing provincial or territorial legislation that affects the AHR sector.
[Translation]
In addition, we can take steps to ensure that the measures will be combined in a productive manner.
I would like to draw the committee's attention to a number of useful measures contained in Bill C-13.
First of all, subclause 65(2) gives the federal government the power to incorporate into the regulations existing policies, standards or regulations regarding assisted human reproduction.
Therefore, it would be possible to incorporate existing provincial requirements and policies under this clause provided they meet the basic requirements of Bill C-13 as regards health and safety. Any decision of this type must be made by means of a regulation that would be reviewed by Parliament.
Second, clause 68 gives the federal government the power to enter into equivalency agreements with provinces or territories wishing to establish their own regulations. However, before such an agreement may be entered into, the provincial and territorial proposals will have to provide at least the same level of protection as Bill C-13 in the area of health and safety.
[English]
Finally, clause 58 allows the agency to enter into an agreement with a department or agency of a province with respect to enforcement. We will consult with the provinces and territories. We have consistently at federal-provincial meetings kept provinces and territories apprised and will consult with them as we develop the regulations for Bill C-13. Furthermore, we will be vigilant not to regulate in areas of provincial jurisdiction, particularly the practice of medicine, and we repeat that commitment to the committee.
The committee will also remember the bill provides for a provincial or territorial deputy minister of health to be named, to attend meetings of the board, and to speak to any matter before the board in the same way the federal deputy minister of health can do.
Should you wish, we can provide you with more specific details regarding the linkage between Bill C-13 and provincial legislation.
Those were the two issues we wanted to update the committee on, Madam Chair, and we're in your hands for questions.
The Chair: Thank you.
Mr. Merrifield.
Mr. Rob Merrifield: Thank you for coming in and sharing this.
First of all, my attention is directed to what has transpired over the summer and to some of the exciting things that have gone on. I'm intrigued by and read about with great interest the idea of freezing eggs. We talked about this last year. When we looked at the draft legislation, we brought witnesses in from Australia, I think it was, who said they had worked on the practice of freezing eggs and that it would be perhaps a year or two further along before that was perfected to some degree. To see that now 30 to 100 children, which is what I think you said, have perhaps been born from frozen eggs indicates to me there is significant advancement in that as an area of science.
I was struck--though I'm not exactly sure what you were saying--when you suggested that it may be of greater risk to the woman. Could you clarify exactly what you were talking about there.
À (1000)
Mr. Ian Shugart: And to the child potentially born from that technique. I can ask Francine to make some comments if you'd like to explore further the precise thinking behind that risk.
Let me just be clear, Mr. Merrifield. These are estimates. In fact, we don't know the extent of the procedure. Certainly, this was noteworthy in the United Kingdom, because to this point the technique has been conducted exclusively under the rubric of clinical trials, which would be the appropriate way of beginning to test a technique like this, so that the data can be monitored very quickly and it doesn't prematurely enter mainstream clinical practice.
Mr. Rob Merrifield: But what's the risk to the mother? I don't understand.
Mr. Ian Shugart: Francine, do you want to comment on that...
The concern about freezing the egg--without being a technical expert--is that the egg, which is a far more complex pre-organism than sperm, could undergo cellular change in subtle, unknown ways.
Mr. Rob Merrifield: Similar to a frozen embryo.
Mr. Ian Shugart: Yes. It's a more sophisticated biological material. On implantation and over the course of the pregnancy, those changes may have effects that could bear out in the pregnancy. Of course, for the child it's a little more obvious.
Mr. Rob Merrifield: Maybe the question could be better answered by a scientist or someone in that field.
Mr. Ian Shugart: I think so, yes. I wouldn't want to go beyond that answer.
À (1005)
Mr. Rob Merrifield: That's fair enough.
It is really exciting to see where the bone marrow experiment has gone, suggesting that the stem cells from bone marrow would be much more elastic, which is the word I think you used. That, of course, was always the argument over the embryonic stem cells being so much more plastic. But there's a two-edged sword there: they're so plastic that you can't control them, and yet they can turn into any other organ in the body. I see this experiment now taking stem cells from the bone marrow and turning those into the same thing we thought the embryonic stem cell was only capable of doing and how that changes the thinking. In fact, in some of the articles I read this summer they suggested that some scientists would have to rethink their drive for going after the embryonic stem cells because of this. Actually, they are so much more beneficial because they are adult stem cells, which are much easier to get, as well as not having the rejection potential.
In light of that I go back to my great discomfort about this piece of legislation. It talks about going for the embryonic stem cells if it is deemed necessary, but “necessary” is not defined in the legislation. I wonder if in light of that you are still comfortable with the word “necessary”. And I'd like you to explain to me what is meant by that word.
Mr. Ian Shugart: Let me begin by reiterating that the scientific community itself is enormously excited by these developments. To the extent that those working with adult stem cells would say that there are unanswered questions in their own inquiries to this stage, scientists working with embryonic stem cells in the other stream would argue that in fact there are equally profound unanswered questions about embryonic stem cells. In short--this isn't a categorical statement--in the main both would acknowledge that we're a very long way from testing the therapeutic application of either stream.
If there is a trend, and you would want to check this against the scientists you will hear from, there's a sense that there is less competition between the two streams and more reliance on what is happening in the other stream to sense where this is really going.
On the question of necessity, the language that the United Kingdom uses, for example, and has had some experience with is very similar to what is proposed in the bill.
The answer to your question is that from the point of view of the legislation, we are still comfortable with the concept of necessity and how the wording that supports that is crafted.
Mr. Rob Merrifield: I know the chair is going to cut me off pretty soon, so I want to get a quick one in here.
The Chair: You're lucky; we didn't turn the clock on. We're a bit rusty.
Mr. Rob Merrifield: Oh, well, then I should have let you continue.
My issue is exactly that. The United Kingdom is using that same wording, yet the United Kingdom has now moved to therapeutic cloning and to developing embryos solely for the purpose of research. You can see the slide there under that kind of terminology. Is that the intent of where we're going in Canada with this piece of legislation? If it isn't, why would we use the same wording?
Mr. Ian Shugart: I think you're attributing the direction that has been taken in the U.K. to the wording of the bill. In fact, as I understand it, in policy terms the U.K. starts from a different point. They have decided in policy terms, and in their regulatory framework, explicitly to allow therapeutic cloning, but we have not.
Mr. Rob Merrifield: Could we not nip this here?
Mr. Ian Shugart: No, because the bill doesn't allow for it.
Mr. Rob Merrifield: Well, not right now. That's why we're examining the bill. Our problem here, in this committee... We worked very hard on the draft piece of legislation and put forward the wording that no other biological material could be used. You softened that down to say “necessary”. Well, “necessary” can be determined as anything.
Mr. Ian Shugart: Our only concern with the language was to get into a situation where a scientist is required, in effect, to prove a negative, to prove what cannot be proved. Therefore it would rule it out, not on the basis of the intent of showing scientific necessity, but simply because of the proving of a negative; it cannot be done.
The point I was trying to make is that the U.K. has arrived at that point because they decided explicitly to go to that point. We have decided in the provisions of the bill not to go to that point at this time. If the bill were changed in the future, then yes, we could go there, but it wouldn't be the fault of the language in the “necessary” clause that would get us there. It would be a policy direction by parliamentarians to go there.
Mr. Rob Merrifield: It wouldn't really be by parliamentarians under this. It would be the regulatory body, moving forward, that would allow it. Would that not be true?
Mr. Glenn Rivard (Senior Legal Counsel, Department of Justice): Paragraph 5(1)(a) of the bill explicitly prohibits the creation of any human clone or its transplantation into a woman.
Mr. Rob Merrifield: That's right, but we're not talking about that. It's reproductive cloning we're talking about, right?
Mr. Glenn Rivard: No, that is any sort of clone. The definition of a clone is quite broad in the legislation. It's not possible to create a clone without breaking this bill, assuming it's adopted.
As Mr. Shugart has indicated, the provision in subclause 40(2) only applies to the type of research that is allowed under the bill, but if a line of research or activity is prohibited, such as cloning, then it's prohibited, and subclause 40(2) is simply inapplicable to it. It cannot happen.
À (1010)
Mr. Rob Merrifield: Are you talking about therapeutic--
The Chair: Excuse me, Mr. Merrifield. That's your last answer.
Mr. Ménard.
[Translation]
Mr. Réal Ménard: Thank you.
As you know, I am particularly interested in all the provisions affecting relations with the provinces and the establishment of the regulatory agency. Have you seen a letter from the Quebec Minister of Health in which he outlines his opposition to the bill and lists the aspects of it that are incompatible with some 20 pieces of Quebec legislation?
This afternoon, I will be tabling the letter from Minister Legault for my colleagues. I had it sent to the parliamentary secretary to the minister. Some 20 statutes are involved, including the Quebec Civil Code and the Privacy Act, as well as the guidelines of the Quebec Health Research Fund. If the regulatory agency were established, there would be serious incompatibility between these Quebec statutes and the bill. What is your response to that?
[English]
Mr. Glenn Rivard: Thank you.
We have examined in depth the laws of Quebec that would be applicable to this area. Of course, it's not at all unusual in any area that there would be both federal and provincial laws that are applicable.
[Translation]
We have looked at the Quebec Civil Code, the Health and Social Services Act, the Charter of Human Rights and Freedoms, and a number of other pieces of legislation.
[English]
There is no incompatibility between Quebec legislation that touches on these issues and federal legislation. It is quite possible for anyone in Quebec to comply with both pieces of legislation. In addition, there is, as Mr. Shugart indicated, the ability to tailor our regulations so that they take into account whatever standards or provisions exist in a particular province.
[Translation]
Mr. Réal Ménard: How can you say that when the Quebec government, the cabinet, and the legislative counsel of the Quebec government have reviewed the bill thoroughly, with examples, and found many incompatibilities—some minor and some major? For example, in the Civil Code, there is no provision for surrogate mothers and nothing about payment. There are provisions in this bill that are not compatible with that.
With respect to privacy, although this is not mandatory, as you know, a person may consent to having information released later in connection with the national registry that will be established for donors and individuals who have used reproductive technology. Under the Quebec Civil Code and the Privacy Act, there is no situation in which such information may be released. I do not know how you can be so sure about the incompatibilities, but there are two choices: either the Quebec government did a poor job, and I cannot imagine that from this government, or else you are quite complacent or naive, which I cannot imagine from experienced individuals like yourselves. However, the fact is that the Quebec government has sent an official letter to the federal Health Minister. She has not yet replied, even though the letter was sent in June. So apparently there are some incompatibilities.
Excuse me, I'm going to correct what I said. Two weeks ago, there had still not been a reply; if there has been one since then, I would apologize to the parliamentary secretary. So there has been a reply, but let us say that it was not a premature pregnancy, but that it was something more like a caesarian section, in my opinion.
You had to use the forceps to deliver that answer, but let us get back to our gestation.
[English]
Mr. Glenn Rivard: With respect to surrogacy, the law of Quebec is essentially that any agreement entered into between a commissioning couple and a surrogate mother is unenforceable in the courts. There is nothing in Bill C-13 that would change that. The bill has no provision that relates in any way to surrogacy contracts. If a contract is unenforceable in a province, it will remain unenforceable.
The most the bill does is authorize somebody to make very limited reimbursements to a surrogate mother. That is independent of whether there is an agreement between them, and it does not allow the surrogate to in effect use that authority as a basis for arguing that the contract is enforceable. It has nothing to do with whether there is an agreement between the two parties involved. The contracts in Quebec will remain unenforceable. There is nothing in the bill that affects that.
À (1015)
[Translation]
Mr. Réal Ménard: I have one final question. First of all, so as not to take up too much of the committee's time, I would like to do the following: sit down with you and Ms. Manseau to review these statutes individually—there are about 20 of them—and if you demonstrate to me that there is no incompatibility, we will table on Tuesday—and I am saying that for the chair and the parliamentary secretary—a motion in the House to split the bill. I have every hope that the minister, with her customary politeness, will comply with my request. However, in politics, one is sometimes disappointed, as you know.
That said, my last question is about stem cells. You say that there have been some technological advances. However, have things advanced to the point that research on stem cells has become less necessary in the case of the major degenerative diseases? Could we say that to the young people who came to see us about muscular distrophy and juvenile diabetes, and who I think will be back this afternoon or tomorrow? Can we say that things have advanced so much that this type of research may not be necessary to achieve the objective of improving the outlook for these individuals? Or do you rather think that we will still have to obtain stem cells, that there will always be researchers who will want to have ministerial authorization to destroy embryos, because, ultimately, this is something that has to be done in order to improve the lives of human beings?
Mr. Ian Shugart: Mr. Ménard, I think the conclusion at the moment is that stem cells are very promising for therapeutic applications, but it is too soon to say with certainty that this promise in the therapeutic field will be fulfilled.
Mr. Réal Ménard: But research is essential.
Mr. Ian Shugart: Research is essential if we want to explore this area.
Mr. Réal Ménard: Those opposed to using stem cells because it involves destroying embryos say that this is no longer necessary now, because adult cells can be used to achieve the same results. You are saying that that is not quite true and that there are still some research protocols that may involve the destruction of embryos in order to obtain stem cells, and that could ultimately produce some interesting results for major degenerative diseases.
Mr. Ian Shugart: I imagine the committee would like to check with some scientists to see how they would answer your question, but we say that from what the scientists tell us, the two avenues of exploration are essential at this stage to inform each other and to provide us with the facts, concepts and experiences that will show what the future holds for research of this type.
Mr. Réal Ménard: Thank you.
[English]
The Chair: Thank you, Mr. Ménard.
Mr. Szabo.
Mr. Paul Szabo: Thank you, Madam Chair.
Mr. Shugart, you had made a statement that there was no conflict between Bill C-13 and the provincial equivalents. I suspect that may be true, but Bill C-13 in itself, without all the regs that are necessary, is actually only about half a bill; you really don't know what this bill is all about. Have you compared it with the provincial legislation or guidelines that are in place while presuming certain regulations, and are those regulations, for instance, the CIHR guidelines and regs?
À (1020)
Mr. Ian Shugart: We have compared with provincial law the policy intent of the bill. As you know, Mr. Szabo, we have not drafted the regulations, and won't until Parliament authorizes that to occur. What we have indicated, though, is that, starting with the essential guideline or the starting point that we must not depart from federal jurisdiction, either in the bill or the regulations that follow, we will hold to that approach throughout the process of developing the regulations.
Let me just briefly add that we've committed to working with provinces in the development of the regulations, so that if they say: “Wait a minute, that particular proposed regulation is contrary to something we have on the books”, we will know that. They will have every opportunity to identify it, and we will sort it out with them.
Mr. Paul Szabo: Okay. I asked that question.... Specifically, my prompting has to do with the issue of informed consent, and I'm very interested in pre-existing embryos--i.e., prior to this act coming into force.
The CIHR guidelines are very explicit in terms of the consents even before the donation of gametes. I'm wondering whether in your looking at what the provinces are doing now--maybe Mr. Rivard can comment from a legal aspect--they would or would not have the equivalent of what the CIHR was suggesting concerning informed consent and such specific requirements as declaration of conflict of interest, sign-off promising no participation in future commercialization of your gametes, etc.
Mr. Ian Shugart: Do you know the answer to that, Glenn, at the moment?
Our intent would certainly be to draft regulations in the area of informed consent that would apply to donation of gametes for research purposes, as you know. To us it doesn't matter whether provinces have on the books regulations or not. We would, in those areas affecting the practice in clinics or in research institutions, be working with the provinces on that.
Mr. Paul Szabo: Would it be safe to assume that the conditions for acceptance of pre-existing embryos would be equivalent to the criteria that would be applicable to new donations--
Mr. Ian Shugart: Would there be retroactivity? Yes.
Mr. Paul Szabo: —as opposed to a transitional fast-track, or whatever, or we don't need that part, if it requires signing off on no participation in future commercialization of your gametes? If that's not in place on pre-existing, but is in place for new donations, once it gets royal assent and the agency is operating, would that pre-existing embryo be eligible for research?
Mr. Ian Shugart: In effect, you're asking about retroactivity.
Mr. Paul Szabo: Exactly.
Mr. Ian Shugart: Glenn.
Mr. Glenn Rivard: The requirements around the use of the embryo have no limitation, with respect to when that embryo was created. So after the law comes into effect, if there is a desire to make use of an embryo, the requirements under the act and the associated regulations will have to be met, even if that embryo itself was created prior to the act coming into effect.
Mr. Paul Szabo: I'm taking from your response that the CIHR guidelines will not be adopted. Because they do require, prior to donation, specifically... in addition to--
[Translation]
The Vice-Chair (Mr. Réal Ménard): Excuse me, Mr. Szabo, but your time is almost up. The answer will have to be short, because the chair should always be guided by concern for equity.
À (1025)
[English]
Mr. Paul Szabo: If I may, I'll move on to another question.
[Translation]
The Vice-Chair (Mr. Réal Ménard): Quickly, please. We could come back to you on the second round.
[English]
Mr. Paul Szabo: Dr. Ronald Wharton appeared before the committee and stated--and this, I believe, was during--
[Translation]
The Vice-Chair (Mr. Réal Ménard): Your time is up, Mr. Szabo. We will come back to you, if that is all right, because the floor now goes to...
[English]
Mr. Paul Szabo: He stated that, from a scientific point of view, definitions were either incorrect or problematic.
[Translation]
The Vice-Chair (Mr. Réal Ménard): You are defying the chair, Mr. Szabo. I cannot imagine that. Your time is up. It is now Mr. Lunney's turn. We will come back to you on the second round.
[English]
Mr. Paul Szabo: Okay.
[Translation]
The Vice-Chair (Mr. Réal Ménard): We will put your name on the list.
He had 5 minutes and 30 seconds: he is from the opposition. The chair calls for calm on the part of the new members of the committee.
Mr. Lunney, you have the floor.
Mr. James Lunney: Thank you, Mr. Chairman.
The Vice-Chair (Mr. Réal Ménard): For the time being, I am the chair.
[English]
Mr. James Lunney: Back to Mr. Shugart here, indeed the committee will be looking forward to discussing the advances in science over the summer with the scientists, as they appear. But I want to refer back. You made a comment that both streams--adult stem cells versus embryonic--seem to be far from testing the therapeutic possibilities, if I understood that correctly. In reality, it seems that only one stream is far from testing the therapeutic possibilities, and that is embryonic, because the great advances over the summer have, by and large, been in the adult realm, with the exception you mentioned there.
For example, the news just yesterday reported on injecting immature skeletal cells into scar tissue after heart attacks, producing beating cells, and the tremendous potential in that. Hopefully that will replace open-heart replacements.
Another example is multiple myeloma. I ran into a patient just last summer in Toronto who had experienced extraction of adult cells from his own body. They then killed his immune system, because of the multiple myeloma--this is a very serious cancer--and injected those stem cells into him. He's walking around doing very well at this time. Of course, multiple myeloma, multiple sclerosis, and other conditions have done very well...and the woman with cord blood.
You mentioned the use of embryonic cells for Parkinson's in rats. It was a very limited study, in terms of time, and the problem of immune rejection has yet to be overcome. I'm not sure the study you referred to showed whether the embryonic cells were going to avoid the problem of rejection.
I just want to ask you to clarify that. Is there something you're aware of on the embryonic side? Is it not clear that the adult cells have made tremendous advances over the summer, in terms of usefulness?
Mr. Ian Shugart: The point, Mr. Lunney, is that what was very exciting to the research community on the adult stem cells stream was the demonstration of much greater plasticity, the capability of the cells to differentiate into different specific kinds of cells, than was previously thought. That was a very important development because that had previously been the biggest theoretical knock against adult stem cells. That objection was to some extent refuted by the demonstration that these were actually more plastic than had previously been thought.
I won't try to pretend to present a departmental view on the science; that's not our role. The issue is whether the provisions of the bill, as they relate to developments in science, are still appropriate from a policy and a legislative point of view.
The first step for both lines of inquiry is the capability of differentiation of these cells, regardless of their origin. That's what is being worked out now, and that's what some of the developments over the summer relate to.
The second step, of course, is proof of the principle that any of these stem cells, differentiated, can have the kind of life, first of all in culture in the laboratory, that allow them to work in the body to reverse cellular damage, replace cells, to operate as the new cells are supposed to operate. I think it would be fair to say that you would want to verify this with others.
Much of the scientific debate is still in the nature of differentiation. There is still a huge amount that has to be done in testing the survivability, the viability, the actual working of these differentiated cells in the ultimate host, which would be the human patient. In other words, can these cells do what they are ultimately supposed to do in the body?
There are issues of rejection, immuno-suppression, and all of those kinds of things, where one type of cell may have an advantage or it may not, but both categories of cells still have a considerable distance to go before they can prove even basic viability in a therapeutic context.
À (1030)
[Translation]
The Vice-Chair (Mr. Réal Ménard): Excuse me, but the time is up. Five minutes and 30 seconds have gone by and we still have two more speakers to hear from before we move to our next witnesses. I have Mr. Merrifield and Mr. Szabo on my list. Normally, we should be hearing from the next witnesses now. Do you want a second round for the departmental officials or should we move immediately to our next group of witnesses?
Mr. Merrifield.
[English]
Mr. Rob Merrifield: Thank you very much.
Getting back to your issue on provincial equivalency, I'm quite fascinated by that. I think the wording you used was “as long as it meets the same degree of protection”. I understand Quebec has legislation--whether it's in place or not I'm not 100% sure--prohibiting embryonic stem cell research. Which one would supersede, this piece of legislation that would allow it, or Quebec's that would prohibit it? I don't understand how the degree of protection would qualify in that instance. I don't know how to interpret that. Can you explain?
Mr. Ian Shugart: I'll ask Francine to provide an answer on that specific question.
I only want to reiterate that the basic premise here is that the federal government has proposed legislation that we are very confident, given its limit and scope, is within the legislative competence of the federal Parliament. It's basic that whatever is on the books in provincial and territorial law is within the competence of the provinces, and this bill is within the competence of the federal government.
It is frequently the case that both orders of government will legislate in the same field, and the scope of those two areas of legislation will abut each other and come together. One has to be very careful then about the interface, so that on the margin you don't cross the line into provincial jurisdiction.
Mr. Rob Merrifield: They're saying that within the actual laboratories it's provincial jurisdiction. They're saying they will not allow embryonic stem cell research in Quebec, whereas this would allow it. My question is, which would supersede?
Mr. Ian Shugart: I think there's an issue of fact that we should be clear on.
Ms. Francine Manseau (Senior Policy Analyst, Health Policy and Communications Branch, Special Projects Division, Department of Health): I don't know which legislation you are referring to.
Mr. Rob Merrifield: I'm not sure if it's legislation, as I said earlier.
Ms. Francine Manseau: I don't think there is.
Mr. Rob Merrifield: I do know it's the intent. There were some reports that there would be no embryonic stem cell research in Quebec.
Ms. Francine Manseau: Certainly the provincial health research funding agency in Quebec, le Fonds de la recherche en santé du Québec, has adopted the CIHR guidelines for research on embryos. It is allowed. Maybe it's not happening right now, but they have adopted the same guidelines.
Mr. Ian Shugart: I think there was some misinterpretation in the media on adopting the CIHR guidelines that contain limits on embryonic stem cell research. It was interpreted that the Fonds de la recherche en santé du Québec was not allowing embryonic stem cell research. We've checked. They do in principle allow it, subject to the CIHR guidelines.
À (1035)
Mr. Rob Merrifield: Let's not argue about the facts. Let's argue about the principle of it.
If a province came along and said they would not allow embryonic stem cell research within their laboratories, which would supersede?
Mr. Ian Shugart: Ultimately, given the constitutional division of powers, it would be the federal law in this area that would supersede the provincial legislation, if there were a conflict and if the nature of the conflict was on the basic question of jurisdiction.
In other words, there's no requirement that a province and the federal Parliament have to see things in the same way. When they don't, then one reverts effectively to constitutional law to see which order of government has the jurisdictional competence and which law would supersede the other.
Mr. Rob Merrifield: I think this one would end up in court, I'm sure of it, if that's what would happen. You're going into provincial jurisdiction, which has the authority to deal with whatever happens within laboratories, rather than this piece of legislation.
Mr. Ian Shugart: Mr. Merrifield, given that this is done under the criminal law power and that one of the purposes of the criminal law is, in the language of the law, to prevent a public evil, in this case, our view is this would not be within provincial jurisdiction. In other words, activities can occur in a particular venue, but they may still be subject to the federal criminal law power.
Mr. Rob Merrifield: We'll probably be pursuing this one further.
[Translation]
The Vice-Chair (Mr. Réal Ménard): One final question.
[English]
Mr. Rob Merrifield: I have one more quick question.
Is embryonic stem cell research being done today on the imported stem cell lines from the United States?
Ms. Francine Manseau: We don't know the answer for sure. You'd have to ask the researchers. There are no tools right now to ensure you know exactly what is going on everywhere.
Mr. Ian Shugart: Can we take it as notice and get back to the committee? It's a good question.
Mr. Rob Merrifield: We know we've imported them. We've had witnesses here saying it has happened.
[Translation]
The Vice-Chair (Mr. Réal Ménard): Will you reply to all committee members in writing?
Mr. Ian Shugart: If you wish.
The Vice-Chair (Mr. Réal Ménard): Fine.
It is now Mr. Szabo's turn. And then we will have Mr. Lunney for a final five-minute period, so that we do not get too far behind for our next witnesses. If we could try to keep to 10 minutes each, that would be ideal.
[English]
Mr. Paul Szabo: Thank you.
I have five questions. I'll keep the questions short, and hopefully the answers will be as short as possible.
Mr. Shugart, you said the success rate of freezing eggs is extremely low. What number would you apply to “extremely low”?
Mr. Ian Shugart: We don't know because there's very little data on this.
Mr. Paul Szabo: Okay.
Dr. Françoise Baylis wrote an article in a gynecological magazine. It was reported in the papers. It concluded, bottom line, that only about 2% of cryogenically frozen embryos would be able to produce stem cells that were of a quality necessary for meaningful research.
Do you think 2% is extremely low?
Mr. Ian Shugart: Do you mean from the point of view of desirability or verifying the facts?
I'm sorry, I don't know.
Mr. Paul Szabo: The stem cell network is doing a survey of clinics to determine how many are actually out there. If it only turns out that 2% of embryos would be resold for research purposes and there are only 500 existing in Canada, are we going through all this? My question to you is how come Health Canada didn't determine what the availability or the possibility of availability of embryos was before this legislation was drafted? It seems as if we have to reverse it.
Mr. Ian Shugart: No, I think we're putting in place a legal and regulatory environment building on a long trail of public discussion on the issue. We've known that there are huge gaps, Mr. Szabo, in our knowledge, and one of the advantages of putting in place this framework would be to generate the knowledge so in future we will know.
À (1040)
Mr. Paul Szabo: The tri-council policy statement covers education and training use of embryos as well as research. Does this legislation address the use of embryos for education and training purposes, and should it?
Mr. Ian Shugart: I'm not sure what we mean by education, apart from the research context.
Mr. Paul Szabo: Could you look at the tri-council policy statement, because I can only presume that the policy statement is going to be pre-empted or superseded by the legislation.
Mr. Ian Shugart: It would be subject to the legislation, yes.
Mr. Paul Szabo: But they include education and training.
Mr. Ian Shugart: Well, we'll have to explore what that means. I'm not sure what that means apart from a research context.
Mr. Paul Szabo: Definitions, you know what I'm asking about. Why isn't there a moratorium on embryonic stem cell research until this act is in place? As you know, the CIHR has basically said no funding until April 2003. Once we hit that, does that mean that before this legislation gets royal assent and all the regulations and agencies are in place, embryonic stem cell research is going to happen in spite of the legislation?
Mr. Ian Shugart: Unless Parliament authorizes something, we don't have the authority to impose any moratorium other than the legislative and regulatory environment included in the act.
Mr. Paul Szabo: Finally, I'd like to address the CIHR guidelines. I don't know what their status is in the spectrum of things. In a regulatory vacuum they're the only thing they have to work with, and people have been looking to those. Obviously, a lot of work was done, but they have some tremendously specific things. I'd really like a response, since the regulations are not going to be known to us and it looks as if most of this stuff is going to be buried in the regulations, as to whether or not it is the intent to emulate at least, if not the specific guidelines, the spirit of those guidelines with regard to the application of the legislation.
The last thing is, I would just simply ask while he's considering that if the clerk or the researcher could communicate with Mr. Shugart to get copies of the Verfaillie papers you refer to, the NIH paper, and also the Nature editorial and have them circulated to members. It sounds as if all members should apprise themselves of that information.
Mr. Ian Shugart: There is consistency between the guidelines and the provisions of the bill, and the CIHR themselves have made it clear that they did that work in the absence of the legislation and that when Parliament declared itself on the legislation, they would be acting in terms of their policy and procedures accordingly in the spirit of what Parliament had asked.
Francine, do you want to comment on the CIHR guidelines?
[Translation]
The Vice-Chair (Mr. Réal Ménard): I would like Ms. Manseau to reply briefly, and then we will go to Mr. Lunney.
[English]
Ms. Francine Manseau: What I would add is that in the process of developing regulations as a task, we'd be looking at what exists right now in terms of standard guidelines that would apply to what we're trying to do and looking at those to see how they are meeting the requirements we have. So certainly we'll be looking at the CIHR guidelines with that view and trying to see how much of them could be then referred to. As you know, there is the possibility of legislation referencing standard guidelines that already exist.
[Translation]
The Vice-Chair (Mr. Réal Ménard): Mr. Lunney will now have five minutes.
[English]
Mr. James Lunney: Merci.
I'm just picking up on Mr. Szabo's comments on the freezing of ova. As far as being safer is concerned, for women it would certainly be far safer when they used ova because you can extract one ovum without having to hyperstimulate a woman with those caustic drugs to force or to hyperstimulate her to produce multiple ova for fertilization. It would certainly...for the whole issue of having to commercialize or make an informed decision to commit one of these embryos for commercialization for who knows how long...that part of that embryo might continue for commercial purposes.
Just leaving that comment, I want to ask a specific question about the bill in its present state. Does it allow the import and export of human embryos? Could you refer me to the section, perhaps?
Mr. Glenn Rivard: There is an authority that pertains to importing and exporting. Subclause 10(3) deals with several things, including importing or exporting in vitro embryos for any purpose. So there is an authority to regulate that practice.
À (1045)
Mr. James Lunney: How do we really propose to regulate that?
Mr. Ian Shugart: The enforcement would be the same as occurs currently with respect to the health and safety regulations—the regulation of semen, for example. The bill's authorities in this regard deal first of all with licensing of the clinics. The licences relate to the health and safety obligations. Second, there's provision for inspection. It would include audits, which would presumably extend to the financial dealings of clinics. So the source of any imported biological materials would be transparent to inspectors, and so on.
Mr. James Lunney: So are we advocating sending inspectors and auditors to foreign countries or third world countries—the Philippines, or African countries—if they're a source of products coming into Canada?
Mr. Ian Shugart: The first point of enforcement of acceptable safety standard for biological materials held by clinics is at the level of the clinic. There would be safety standards established in the regulations. If the clinic could not demonstrate that the standards are being adhered to, then a licence could be withheld, or those materials impounded, or—
Mr. James Lunney: Excuse me. With all due respect, are you referring to the clinics in Canada or elsewhere?
Mr. Ian Shugart: Yes, in Canada.
Mr. James Lunney: Okay. So how can a clinic ensure the standards of something outside the country?
Mr. Ian Shugart: If they couldn't, then they would not be used. In other words, the agency would have the authority on health and safety grounds to prevent the use of biological materials whose safety could not be assured by the relevant clinic.
Mr. James Lunney: Suppose we're importing products from an African country, where there is lots of AIDS, and so on. How are we going to assure safety for Canadians?
Mr. Ian Shugart: The agency would certainly adopt the normal standards of risk management—which would be to be informed about the source of these materials. If they were deemed to be high risk—which your example certainly would be....the point is that the safety standard or threshold would be there on the books in regulations.
Simply because material may be imported, it does not follow that it necessarily must be used. The agency would have adequate powers to require that such materials not be used, if it could not be demonstrated that they were acceptable.
Mr. James Lunney: Okay, to take another line on this, one of the things we're very concerned about in committee is that some people would try to create designer children—sperm from Robert Redford and an egg from some model to create a super kid. What assurance can we have that if an embryo is being created outside the country, an industry won't develop in a third world country or in another part of the world where this does take place, with huge sums of money being sent for an embryo to be imported into Canada?
Mr. Ian Shugart: Again, the financial records and dealings of the clinic are accessible to the agency, and are reviewable. The proposed law quite clearly prevents this kind of commercial transaction by clinics.
Whatever occurs offshore, of course, is another matter. But the dealings of the clinics themselves are subject to scrutiny by the agency. The clinic cannot function without a licence that covers the whole range of provisions of the bill.
Mr. James Lunney: Mr. Shugart, just a final question. Do you really have confidence that we can regulate or control what goes on outside our borders in this matter?
À (1050)
Mr. Ian Shugart: I think, Mr. Lunney, that was my point.
In both the legislative provisions and in the inspection and licensing powers of the agency, we can regulate what occurs in Canadian clinics. Even external dealings by these clinics will show up in things like the inspection of stocks or inventory of biological materials. If the dealings of the clinics are not transparent—if there's a discrepancy between what's on the books or what's in their financial records and dealings and what's in the warehouse—then the licences will not be granted. In the same way that customs laws and other police activities are enforced—including linkages with the outside jurisdictions—these things can be enforced, and become transparent to the inspectors working with the agency. So, yes, we are confident that it can be regulated.
The Chair: Thank you, Mr. Lunney.
Thank you to our witnesses. On behalf of the committee, I thank you for coming and giving us this update based upon federal-provincial relations and the latest scientific breakthroughs. Thank you very much.
I now invite the next panel to come forward and take their places: Ms. Cranston, Mr. Neutel, Mr. Hogeterp, and Most Reverend Bishop Prendergast.
À (1051)
À (1056)
The Chair: Good morning, and welcome to our meeting. We'll reconvene and begin with our first witness on the agenda, Mary Lou Cranston, director of the Catholic Health Association of Canada.
Ms. Cranston.
Ms. Mary Lou Cranston (Director, Catholic Health Association of Canada): Thank you, Madam Chair.
I'd like to thank you for the opportunity to once again present a response to the legislation respecting assisted human reproduction. Given the short notice for this hearing--I just found out on Wednesday that I was coming--I'm unable to provide a translation of my speaking notes, but a written brief will be submitted to the clerk this afternoon.
My presentation will focus on four points. First of all is the need for explicit identification of the foundational ethical values and principles that can give focus to the bill, give justification for the designation of prohibited and controlled activities, and give guidance for the proposed assisted human reproduction agency of Canada.
While I acknowledge the very real challenge to get universal agreement on all ethical issues in law and policy in society, I believe some ethical values and principles are of such a foundational nature that government cannot forsake its responsibility to enshrine them in law and policy for the good of society.
It is commendable that Bill C-13 adopts the health committee's recommendation that there be a statutory declaration identifying foundational ethical values and principles. The bill, for example, identifies free and informed consent as a fundamental condition in clause 2, paragraph (d). This is a foundational principle, and it is important that it is identified. But as I pointed out in my presentation to this committee last year, consent alone does not guarantee ethical justification.
There is yet another foundational principle that I believe should be expressly identified in this statutory declaration: to use the words of this section, it is “the protection and promotion of human health, safety, dignity and rights”, as listed in clause 2, paragraph (a)--but I would say not just of the human but of the embryo.
I say “expressly identified” because the bill does implicitly suggest that the embryo has a certain ethical status. The bill recognizes, for instance, a distinction between human reproductive material and the embryo. Secondly, the bill places an emphasis on the non-commercialization of human gametes, as for example in subclauses 7(1) to 7(4), suggesting that this human reproductive material and the embryo have an ethical status beyond simply being material things.
Thirdly, the bill suggests the need for regulation of the disposal of human reproductive material and embryos, in clause 54.
In other words, Bill C-13 does guarantee increased protection of the unborn, of human reproductive material, and of the embryo. The bill does suggest an implicit respect for the health, safety, dignity, and rights associated with the various dimensions of the transmission of human life. Why then does the bill shy away from explicitly articulating this intuitive ethical sense? Why then does the bill not articulate a clear statement on the promotion and protection of the health, safety, dignity, and rights of the human embryo?
It is unfortunate that the bill does not include the health committee's recommendation that the declaration include a principle acknowledging that persons with disabilities can lead a full life. This is important, for example, in light of the statement around prohibiting any procedure that would increase the probability that an embryo will be of a particular sex--a prohibition that has an “except” clause: “except to prevent, diagnose or treat a sex-linked disorder or disease”.
This is an “except” clause that substantially weakens, if not totally nullifies, the stated prohibited activity described in subclause 5(1), paragraph (e). This prohibited activity can, as stated in the bill, be a real affront to if not a threat to the very existence of persons with disabilities. It needs to be understood in the context of a clearly articulated ethical principle.
The second point I wanted to talk about links with what we've been listening to the last hour here. Having appeared before the standing health committee last November, I know that the question of the use of embryos for stem cell research has been discussed very seriously, and I would suggest agonized over very intensely.
Á (1100)
Recommendation 14 represented an attempt to protect the embryo by making research on it a last resort. It is clear that Bill C-13 wants to protect human life at all stages of its development, while it also wants to give hope to those who are living with serious diseases who could be helped with various stem cell therapies.
One of the arguments for the use of embryos for stem cell research has been that there is not an alternative that would offer equivalent potential for developing tissue for therapeutic uses, as we've just been listening to. However, since the health committee met last June, ongoing research is showing that stem cells found in adult tissues can be transformed into virtually all types of human body cells.
Dr. Alan Bernstein, president of the Canadian Institutes of Health Research and a world authority on stem cells, in a National Post article from June 2002 claims that research is showing that adult stem cells are as plastic as embryonic cells, a discovery, as the title of the article suggests, that could increase pressure to stop using embryos.
There is increased medical and scientific evidence that adult stem cells are a viable option for stem cell therapy. The use of in vitro embryos even, in accordance with regulations and the licence--for example, 10.(20)--still begs the foundational ethical question. I believe it warrants repeating that many Canadians believe that research on human embryos and the use of embryonic stem cells should not only be controlled, but should be prohibited. From the perspective of looking at foundational ethical principles, any activity that does not promote and protect the health, safety, dignity, and rights of the embryo must be prohibited and not merely controlled by means of regulations and licensing.
Three, a comment on prohibited and controlled activities.
The Chair: Ms. Cranston, you're at seven minutes now. Could you move a little more quickly, please, and make a few more points.
Ms. Mary Lou Cranston: Yes, I can read faster.
It is noted that both the standing health committee and Bill C-13 have retained the category of prohibited activities that are subject to criminal law and reclassifiable only through the process of legislative review. As stated by the committee, this outright statutory ban signals more clearly that certain activities are unsafe. I think that's a good thing.
I'll quit on that one, because I want to finish by talking about the role of the assisted human reproduction agency of Canada. The objectives of the agency we know; they're listed. They present a formidable task. One need but consider paragraph 65, with 26 areas that need regulation.
The Canadian public needs to be assured that these regulations are consistent with the values of Canadians and that they establish strong national standards. To this end, it is extremely important, first, that the bill in the statutory declaration clearly provide the foundational ethical framework needed to realize the objectives of the agency.
Secondly, the bill must state that the membership of the board of directors of the agency must reflect a range of backgrounds and disciplines relevant to the agency's objectives. Given the complexity of the issues involved, explicit identification of the need for ethics expertise at this level should be included in the bill.
I'll simply conclude by saying I think it's been a long journey since the establishment of the royal commission in 1989. I commend the government's leadership and resolve in taking the steps forward. It does affirm many fundamental norms, values, principles, but it would be my hope that the issues raised in this presentation be sincerely considered in its final form.
Thank you.
Á (1105)
The Chair: Thank you, Ms. Cranston.
Now we'll have the representatives from the Christian Reform Church, Ms. Neutel and Mr. Hogeterp. You're going to share your time, I understand.
Mr. Mike Hogeterp (Research and Communications Coordinator, Christian Reformed Church in North America): I'll be presenting.
Thank you, Madame Chair and committee members, for the opportunity to appear with you today. I'm Mike Hogeterp of the committee for contact with the government, of the Christian Reformed Church, a denomination with approximately 240 churches and 80,000 members here in Canada. With me is Dr. Ineke Neutel, of our assisted reproduction task force.
We've prepared a brief concerning Bill C-13. Unfortunately. it is not available in French. Some of you may have seen an e-version yesterday. We do have copies available for you today.
Bill C-13 is an important piece of legislation, and we're pleased that it has been reintroduced. We hope that your deliberations concerning it will lead to a strong, ethical, and regulatory framework that protects the God-given gifts of health, life, and dignity of Canadian women, children, infertile couples, and families.
We've drawn together a task force of experts in our efforts to understand these issues. It includes medical researchers and ethicists, people who have experienced infertility, a person with juvenile diabetes in his family, theologians, and a family counsellor. We've struggled profoundly to understand the ethical and life issues surrounding assisted human reproduction and hope that our recommendations are helpful to you.
Assisted human reproduction is one area in which scientific achievement has surpassed ethical deliberations. Ethics serve the common good by inserting concerns for sustainable safety and public moral consensus into the drive to scientific discovery. There is, of course, no single ethical position on these issues, and we've noted this within society and within the churches themselves. So we believe the agency proposed in Bill C-13 should be structured to maximize opportunities for ethical dialogue. This will serve the common good by contributing to a broader consensus on these difficult issues. Careful and prudent reflection and urgent humanitarian concern are essential elements of such dialogue.
Dialogue must take place within the agency board and its advisory panels. Specifically, it can be promoted in board selection criteria that require both technical and ethical expertise concerning assisted human reproduction.
The stated non-commercialization goals of the agency are a critical matter of ethics that will be upheld in strong conflict-of-interest guidelines for board membership. So we've suggested appropriate amendments to the membership criteria included in clause 26.
We're also convinced that ethical dialogue within the agency will be promoted by the input of specific stakeholders in the advisory panels that are proposed in clause 33.
A public agency must be clearly accountable to Parliament--which is the public representative, of course--in all dimensions of its work. Clause 74 implies that the agency will submit an annual report to Parliament under the requirements of the Financial Administration Act. The work of this agency will be ethically complex, so we believe it should specifically address its progress in meeting the objectives in Bill C-13's clause 22 in these annual reports. Clause 22 requires the agency to promote health, safety, dignity, and rights, and to foster the application of ethical principles in assisted human reproduction.
Full transparency and public accountability of the agency is, again, a matter of ethics. As it stands now, clause 25 permits the minister to issue policy directives to the agency without parliamentary consideration. In the interest of transparency, then, we call on you to suggest amendments to clause 25 that require parliamentary consideration of these directives, which in some cases will have profound significance for agency operations.
Finally, with respect to embryonic stem cell research, we've noted a lack of consensus on the life status of human embryos. We understand the potential of stem cell research but are deeply concerned about methods resulting in the destruction of human embryos. Consequently, we believe a temporary prohibition should be placed on embryonic stem cell research, and at the same time that appropriate funding be channeled to adult stem cell research. This will serve the common good by allowing needed pause to develop a consensus on ethical practices regarding the embryonic life form. It will also empower Canadian adult stem cell researchers to become innovative international leaders in their field.
Bill C-13 has incredible potential to enhance the life and health of Canadians who have been touched by assisted human reproduction. We've appreciated the careful work of your committee in the past, and wish you God's blessing in your continuing deliberations on this bill.
A more comprehensive discussion of our recommendations is available in our brief.
Thank you for your attention and time.
Á (1110)
The Chair: Thank you, Mr. Hogeterp.
I'll ask the clerk to take that off your website and circulate it to the committee.
We'll move on to the Catholic Organization for Life and Family. We're honoured to have Archbishop Prendergast with us, but I understand that he's just here to maybe answer questions afterwards, and the presentation will be made by Bridget Campion, who is on the board of directors.
Dr. Bridget Campion (Member of the Board of Directors, Catholic Organization for Life and Family): Yes, that's right. Thank you very much.
The Catholic Organization for Life and Family is an organization jointly founded by the Canadian Conference of Catholic Bishops and the Knights of Columbus. It consists of a multidisciplinary group of specialists in bioethics, health care, law, and education.
The first thing we have to say is that there is much in Bill C-13 that is positive. There is much that we can support, such as the prohibitions concerning animal-human hybrids; the ban on commercial surrogacy; the prohibition on the marketing of embryos and gametes; and the intention to prohibit cloning for the purposes of reproduction or research. We also welcome the fact that one of the objectives of the new agency is to foster the application of ethical principles.
This morning we will be focusing on one compelling issue, the one that is most important to us. That is, the need to protect human life at all of its stages. Our major concern is that Bill C-13 does not adequately protect the human embryo. We will also speak briefly to what this might mean to Canadians.
We are pleased to see that Bill C-13 has established its guiding principles in the statutory declaration. Principles are usually understood as a set of guiding or foundational statements, but they also have a great deal to do with identity. They convey something of who we are as a society insofar as they express our values. They also shape us as a society as we mould our practices to reflect our principles.
In the statutory declaration, the principles express Canada's commitment to preserving human dignity and rights, even as we pursue technologies and knowledge. They convey our sensitivity to the needs of, and the burdens placed on, members of our community affected by the technology. The principles demonstrate our belief in the importance of personal autonomy as it is expressed through the practice of informed consent. It is clear in the principles, and their prominent placement in the bill, that we are a society interested in pursuing what is good and what is just.
There is, however, a major ommission in the principles as they are written: nothing is said about the rights and dignity of the human embryo. While it is true that women and men are affected by the human reproductive technologies, we cannot escape the fact that the very embryos created by these technologies are affected by them.
With the Catholic tradition, we believe that human life starts at conception. While we do not know the precise moment that ensoulment occurs, we err on the side of personhood, treating the human being as a person from conception onwards. At the heart of it, we simply do not know how a human being could be other than a human person. Put another way, the term “human embryo” is simply descriptive of a stage of life in the existence of a human being, a life stage that is part of the personal history of everyone here. This is how we all began.
We ask you to change the principles in the statutory declaration in such a way that they include protecting the dignity of human beings who happen to be at the embryonic stage, according them the protection we would provide for all vulnerable members of our community. This would include the protection of their dignity, keeping them from undue harm and exploitation.
The beginning of this is already present in the bill in the recognition that embryonic humans are distinct from ova and sperm, and are not to be classified as reproductive material; that they are not to be the subject of commercial transactions; that special care must be taken in attending to the well-being of children born through the application of these technologies.
We would go further and suggest that we must recognize in the statutory declaration and in the legislation that humans in the embryonic stage, no matter how they came into existence, must be protected in the same manner as their vulnerable counterparts at any life stage. We recommend that research on embryos, as well as any treatment that is not for their benefit, be prohibited. While we realize that this will preclude embryonic stem cell research, in which so many hopes have been invested, we are convinced that adult stem cell research, which is showing remarkable promise, can still go forward and has every potential to fulfill those hopes. We could thereby signal to the world, in a global arena, influenced by strong commercial interests in the area of reproductive technologies, that Canada is committed to honouring, protecting, and including everyone in the human family.
Thank you.
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The Chair: Thank you very much, Ms. Campion.
Our next witness is from REAL Women of Canada, and her name is Diane Watts.
Ms. Watts.
Ms. Diane Watts (Researcher, REAL Women of Canada): Thank you very much for inviting us to appear before the health committee.
Our national organization, REAL Women of Canada, which was federally incorporated in 1983, is concerned about this legislation because of the broad impact new technologies have on societal values and the family.
Although the bill provides for the establishment of a government-appointed agency that will give advice to the Minister of Health, issue licences to researchers, and monitor the procedures, the real power of the bill, according to the act, lies with the minister herself. According to this bill, the Minister of Health has the ultimate discretion and jurisdiction to permit medical research on human beings in the embryonic stage of life.
In clause 5, the bill lists the technologies that are to be prohibited in Canada, including one type of cloning. There are apparently a dozen different types of cloning not covered in this bill and not prohibited.
The bill prohibits the generation of an in vitro human embryo for purposes “other than creating a human being or improving or providing instruction in assisted reproduction procedures”. The words “improving or providing instruction in assisted reproduction procedures” are so vague that they are open to interpretation to include any and every research possible on the human embryo. In short, this provision does not provide protection for human embryos and will permit their use for unrestricted research purposes.
Further, clause 10 lists the procedures to be controlled by way of a licence. Subclause 10(1) states that no one may create an embryo by manipulation or by treating human reproductive material—that is, gametes, sperm, or ovum—unless he has a licence. That is, a researcher may “alter” and “manipulate” and “treat” human reproductive material to create a human embryo, providing he has a licence to do so.
Clause 65 lists the regulations that may be made under the act, but paragraph 65(z) is the real shocker, as it is this provision that gives the minister true power. Clause 65 provides that “controlled activities” such as manipulating and making use of a human embryo, whether in vitro or not, may be exempted from the act by way of the regulations. That is, clause 65 allows any controlled activity, such as artificially generating human embryos, exporting or importing them, destroying them, transferring them, or combining animal species with human life for “improving and providing” research, without restriction on such procedures, solely at the discretion of the minister.
Clause 66 requires that the Minister of Health “shall lay the proposed regulation before each House of Parliament”. The latter, then, may make recommendations as to the proposed legislation, but, significantly, there is no requirement that Parliament actually approve such a regulation before it is put into effect. Even if Parliament should reject outright a proposed regulation by the minister, there is no requirement that the minister proceed in accordance with the wishes of Parliament. Instead, under clause 66 of the bill, the minister may proceed with the regulation regardless of Parliament's views. In short, under this bill, the Minister of Health has enormous power to circumscribe the act and authorize any experimentation on human offspring during their embryonic stage.
Why bother passing this legislation if the minister can do an end run around its licensed provisions? The legislation is meaningless, because, as we wrote in our newsletter in rather strong language, it is a sham and a fraud, which provides minimal protection against medical research on the human entity, which is the embryo.
The Minister of Health quite literally has power over life and death under this legislation. In a free and democratic society, we believe no minister should have such power. We have asked our members and supporters to strenuously object to the provisions of Bill C-13, the Assisted Human Reproduction Act, provisions that place such unreasonable power in the hands of the Minister of Health and provide no protection for human progeny during their embryonic stage.
Paragraph 2(a) proclaims “the protection and promotion of human health, safety, dignity and rights”, but further sections erode this goodwill by opening the door to human experimentation on vulnerable human life. Because of the many loopholes and other problems with the bill and the enormous harm it could cause, REAL Women recommends at least a three-year moratorium on embryo stem cell research. Our preference would be the prohibition of all research on the human embryo. We would also like other forms of cloning addressed, and not merely one kind, namely somatic cell nuclear transfer.
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We have two major observations and recommendations. We are deeply concerned about the power over life and death given to the Minister of Health to license just about any manipulation and destruction of human life at the embryonic stage of existence. We would insist that the health minister be obliged to follow the decision of Parliament and not have absolute power to circumvent the act.
There are many other inadequacies in the act as well, such as the name of the bill, for example. As with previous proposed legislation, the name of the act gives the appearance that it deals with assisted human reproduction. The name continues to mislead because it does not encompass the entire intention and content of the act, which includes research not only on human reproduction, but also research that is scientific experimentation with a view to treating diseases. A more comprehensive title would have been more accurate.
We're disappointed that the recommendations of the House of Commons Standing Committee on Health were ignored, and specifically the recommendation that the embryo stem cell research provision be strengthened.
There are many problems with this bill, such as its vague definitions and omissions, in that many of the new medical technologies are not included. When they're not included, they're not prohibited. For example, the bill is supposed to ban cloning of human beings, but it does not prohibit all techniques of human cloning, including embryo splitting, human germ-line cell cloning, non-chromosomal DNA cloning, and human chimeras.
There is no definition given for the term “human being”, a term used throughout the bill.
The legislation continues to refer to the donor of an embryo in the singular. One can speak of a gamete donor in the singular, but the human embryo has two parents, a mother and a father, whether anonymous or known. Therefore, there are always two donors involved when dealing with a human embryo. The language reveals a denial of this reality and a surprising lack of accuracy.
The definition of “valid consent” is highly unsatisfactory because of incomplete knowledge concerning the actual research to which the donated human embryo will be subject in the future. At present, the interests of the would-be parents, the donors, and scientists, appear to have priority over that of the embryonic offspring, who in many cases is regarded as an end product or consumer item to satisfy the needs of others.
The embryonic progeny is the human being most affected by the research. Obviously, human embryos cannot give consent to research procedures, and a substituted consent by the parent donors of gametes is not an adequate response to this difficulty. The embryo has rights and is not owned by others. All children at all stages of development are gifts, and adults are merely their stewards, guarding and guiding them. For this reason alone, all research on human embryos must be prohibited. We all want to help eliminate diseases, but we do not need human victims to end human suffering. A two-tiered classification of human beings is scientifically unsound, and we believe rather dangerous.
Thank you very much.
The Chair: Thank you, Ms. Watts.
We'll proceed to the question period, and we'll begin with Mr. Merrifield.
Mr. Rob Merrifield: I want to thank you for coming in, because I know it's difficult. We have a panel of five or six witnesses. To try to get all of the information and to try to give you all a proper hearing is difficult. I have three subjects I'd like to throw out and get your input on.
If you're boiling the issue down, there are some people who see the embryo as merely life at its very beginning, which is just a grouping of cells. Other people see it as the beginning of human life. I hear you loudly and clearly suggesting that it's human life at its beginning.
One of the things that struck me over the summer—and I read the article about what was happening in the United States not in the summer but, I think, this fall—was the strong attempt in the American legislation to not call this an “embryo”. I think we get wound up in the terminology because it doesn't truly reflect what we're trying to say. I think it comes from the advisory committee to Mr. Bush, but I believe the Americans are looking at or are suggesting that the embryo not be called an “embryo”—which can lend itself to this fuzzy language—but that it actually be referred to as the “human subject”. Might that kind of terminology reflect your wishes more accurately in this piece of legislation?
Á (1125)
Ms. Diane Watts: It would certainly be an improvement. The bill refers to the embryo as a human embryo, but throughout the bill and throughout many of the presentations here, we heard people talking about the embryo, the embryo, the embryo. Well, there are a lot of embryos. We're talking about a human embryo. We're not complaining about research on a bovine embryo or a fowl embryo. We're talking about a human embryo.
This is the controversy. When the bill doesn't specify that in every section, in every clause, it's very misleading and it can lead us to the dehumanization of a human being. It's not just a potential human being and it's not just the beginning of human life; it is human life. We tend to lose that concept. I shouldn't say the scientists do more than others, but the proper use of language would remind us that we're dealing with a human being with parents, grandparents, brothers and sisters.
Mr. Rob Merrifield: The other thing that sort of clarifies this in my mind, or actually accentuates the problem, is the article we saw on national TV, about a month ago, with a patient being cured of leukemia from umbilical cord stem cells. After having a child, they took the umbilical cord. The preamble to that news article was embryonic stem cells and how the people of Canada would support embryonic stem cells. Then it led right into the cure coming from the umbilical cord.
If you were a lay person walking on the street, you would be wondering what the problem is with embryonic stem cells. Look at this, they just take the umbilical cord, they take the stem cells, and away they go. It's a very complex issue, and that's why I think it becomes very important that we get the terminology clear.
Is that what you're finding in your churches or in people you're dealing with? Are people clear on the issues? Do they understand the issues well enough? Are you finding the confusion that comes to us as committee members sometimes?
Dr. Bridget Campion: I think you're absolutely right. For the public, there's a tremendous amount of confusion. When we start to talk about showing the distinction between embryonic stem cells and stem cells taken from umbilical cord blood, those are two distinctly different sources of stem cells.
As well, it would seem that stem cells that come from embryos are somehow magical, that they can do anything. Well, I'm sure that in your hearings you have heard that if we start to work with stem cells from embryos, we run into difficulties that parallel what happens with transplantation. If you're using a stem cell from another body, you must then ensure that your body will receive it and never reject it. So it is not as straightforward as perhaps the media would have us believe.
Ms. Mary Lou Cranston: I just want to say the same thing. I think this all the time. I think people are not just confused; I think they're overwhelmed and it's all too big for them.
Mr. Rob Merrifield: Don't feel bad about that. We had a row of witnesses that had just been introduced to this subject today, and they're not here any more. That gives you a rough idea of how complex the issue really is.
Are there any other comments on that?
The other thing that I think Diane Watts had mentioned is the power of the minister under this piece of legislation. I am as alarmed as she is. It is alarming, and it's something we were told as we went through the draft piece of legislation. How are we going to make this regulatory body truly accountable to the people of Canada? How are we going to do that in a way that this whole subject area doesn't get driven solely by science rather than by every interest that is out there?
As a committee, we put forward in our recommendations how to structure the regulatory body, which was to have the wisest people of the land sit as judges and have statutory standing of the interest groups before that. That wasn't what came out in the piece of legislation. Actually, it's now to have different interests sit around the boardroom table, vying for power within the committee.
Which way would you recommend as the way you would prefer to see your interests at the regulatory body or on the regulatory body?
Á (1130)
Ms. Mary Lou Cranston: One of my comments, one of the things I didn't say when I started becoming a motor mouth at the end, was precisely that. It shocked me, first of all, how much is left for regulations later. It's phenomenal when you really look at it. Even in terms of structure of the bill, after clause 20, or clauses 20 to 68 or 69, or wherever, they are kind of over there somewhere. That's why I focus, first of all, on the foundation of ethical principles, because I think there has to be a foundation out of which this body, this agency, is working.
Also, one of the things I didn't say at the end is that I do believe, in clause 65 or wherever they talk about the constitution of this agency and the board and the 13 people, we specifically need an ethicist there. I really do. It can't simply be, as you say, interests. What's happening has to be very clearly thought out, because it's scary, and it's scary that you keep getting these “except” clauses and everything. No matter what you say, you then get a bracket, according to the regulations and the licensing.
I think I've said enough. It really does scare me.
Mr. Mike Hogeterp: If I could quote from one of our recommendations on this topic, we suggested that clause 26 be amended such that the membership of the board of directors must, so far as possible, reflect a range of backgrounds and disciplines relevant to the agency's technical and ethical objectives.
So rather than inserting specific interests and maybe clogging up the work of the agency within the board, if we have people gifted in the technical aspects and the ethical points of view, we'll have a board that's well suited to regulating these things. Specific interests can well be heard at the advisory panels that are to advise the board, of course, and we certainly would like to see faith communities, disabled folks.... Why not have Michael J. Fox and Suzanne Scorsone sitting in on an advisory panel such as that and trying to find consensus on these incredibly perplexing issues?
Mr. Rob Merrifield: That sounds like a fight to me. My bet would be on Suzanne.
Yes, it is absolutely amazing. I think one of the things that a couple of you had mentioned was the idea of a donor being both male and female, and that authorization for the use of a gamete needs to be received from both, and that's not in the piece of legislation at the present time. I'm not sure if it's an oversight or if it's a definition, but when you get into some of the definitions in this legislation, you really start to become quite concerned.
Diane Watts, I think you mentioned as well that the 12 or so different types of cloning are not mentioned. When you get into say the area of therapeutic cloning, many of the scientists are starting to fuzzy the wording of therapeutic cloning. They're calling it nuclear transfers, and somatic cell transfers, and on and on. You have a real problem when you start looking at the definitions.
I know Diane had mentioned that. Is that the concern of the rest of you? Is it something you're comfortable with or not?
Á (1135)
Most Reverend Terence Prendergast (Chair, Catholic Organization for Life and Family): Quite clearly, we have to have the right principles in there, including definitions, and when you're lacking those things, you have problems that are going to arise later on.
I think the greater amount that can be done at the early stage, at the legislation stage, the better. That's of course in keeping with the follow-up, which is that there be an ethicist involved in the decision-making or regulations and interpretation.
Dr. Bridget Campion: Just as one last comment, when you start denying humanity of human life or a human being at a particular stage, that's when you run into difficulty. The same processes take place generally with animal research, and actually, many of the techniques are derived from animal research on the embryonic stage, and even at the stage before the zygote is formed. There is no difficulty with that, other than when you're denying the humanity of a human being and you're ending up experimenting on a human being. That's really the problem.
The Chair: Thank you, Mr. Merrifield.
We'll go to Mr. Ménard.
[Translation]
Mr. Réal Ménard: Thank you, Madam Chair. Your testimony reminds us how different this bill is from the others; it deals with our values, our ethics and even how we see the world.
I had a political science professor who told us that members of Parliament have to be careful: one's moral principles tend to erode with time, and one person's morals are not necessarily the same as the next person's. As you know, under the Canadian Constitution, there is no state religion, so we cannot use that criterion as a basis. That said, people can have their own personal convictions, and maybe we will have a chance sometime to talk about that. But the chair will not allow such a discussion here.
The question is whether we, as legislators, should allow a certain type of research that is not only quite tightly regulated but also subject to ministerial authorization. Under our system, I agree that the minister needs to give his or her consent, given that ministers are elected, that there is ministerial responsibility involved and that ministers can be called to account during question period. I would like to hear your opinion on a question I asked the officials this morning. This afternoon, people will be coming to talk to us about juvenile diabetes and other degenerative diseases. If I was sure that research on mature cells would improve the human condition—I am referring to that part of philosophy called ontology—I can assure that I would not agree to research on embryonic stem cells. Unfortunately, as things stand, research into embryonic stem cells is inevitable. Certain witnesses have reminded us that in the 1950s, the church and some other people were opposed to research on insulin. Imagine how different things would be for diabetics if legislators had let that opposition stop things. You hold the view that life begins as soon as an embryo is formed; I would like you to give me, in addition to that principle, a good reason that we as legislators should express all the reservations you have raised about embryonic stem cell research. Is it not our job, as legislators, to concern ourselves with the human condition and be somewhat visionary? What Ms. Watts said is important to me as well.
[English]
Dr. Bridget Campion: First, research on human subjects is not new. We undertake research on human beings every day. Because of atrocities in the past--and those atrocities are not limited to the Nazi regime--we are very careful in setting up guidelines for research on human subjects.
When I look at the history of this, in the past, vulnerable groups without advocates were initially targeted to provide human subjects for research, not simply Jewish concentration camp inmates. Think of Tuskegee and poor, illiterate, rural African-American men. Think of Willowbrook, a state-run school, where children with profound handicaps became subjects of studies around meningitis and hepatitis. They were injected, deliberately, with those viruses.
I'm very optimistic because our trend has been to take a look at human populations and recognize that they are part of the human community, and we cannot simply subject them, without consent, to interventions that would put them in undue harm. That would be torturous.
It seems to me that the last of the human populations to be embraced by us is--
Á (1140)
[Translation]
Mr. Réal Ménard: Excuse me, but your comparison seems to me to lack rigour: you are playing fast and loose with history. After all, for this type of research, gamete donors will have to give their consent. Of course, we are talking about informed, written consent. Individuals have the right to authorize research. No research on embryonic stem cells will take place without donor consent, you can concur in that. You also say that the unborn child should give its consent. In our legal tradition, unborn children do not have any legal status; the Supreme Court made that ruling, and no one around this table can change it in any way. In short, your comparison is not a rigorous one.
[English]
Dr. Bridget Campion: I have two things to say about that. First of all, given the atrocities in the past, we have been very careful with our research guidelines to ensure that we protect vulnerable populations in a special way so that in many cases substitute consent is not sufficient to enroll some vulnerable human populations into research studies. That's the first thing to say.
The second thing to say is that it may be very clear to some people around the table that the human embryo simply does not have full status in the human community. I would argue that in 1943 there were people who felt that Jews did not have full status in the human community. I would argue that in the south, in 1932, there were some people who would argue that illiterate, poor, rural, African-American men did not have full status in the human community. I would also argue that in 1963 there were people who argued that children with profound handicaps were not full members of the human community.
Now, I don't expect to change anybody's mind about the human embryo this morning, but what I would say is that I am optimistic in the way our understanding of what it is to be human has been constantly expanding and that we have become more and more inclusive. I would also say that I'm very optimistic because our understanding of the value of creation, of the created order, has also been expanding. I would say that even if you decide that the human embryo is not a full member of the human community, I do not see how we can exclude the human embryo from the beauty of creation.
The Chair: Thank you, Mr. Ménard.
We'll go on to Mr. Lunney.
Mr. James Lunney: Thank you, Madame Chair.
I want to go back to a common thread in all your presentations, and that was reviewing the advances in stem cell research over the past few months. One of you quoted the National Post and Dr. Bernstein that adult cells are as flexible as embryonic stem cells, and anther mentioned a needed pause on the embryonic side to allow us to develop the tremendous potential we're seeing in adult stem cells. Other witnesses who we've heard this morning have come up with references to legislation in other jurisdictions, in England and in the United States.
Some would say thank God, perhaps, that we're dealing with this at this time in history in Canada, because science has now provided answers, if we have eyes to see it, that we didn't have a year ago or five years ago in terms of options.
Of course, we know that scientists said or the community felt that we had to have...there was a lot of talk about what embryonic cells could do and would do and how flexible they were and therefore we needed them for juvenile diabetes and Parkinson's and Alzheimer's, etc.
Some of you didn't, because of limitations of time, have time to expand on that, but would you say there's consensus in the communities that you represent, for those who have time to examine the issue and understand it, that in fact we should be calling for the brakes on going the way of embryonic stem cells and pushing forward for Canada to expand all options and perhaps lead the world in adult stem cell research?
Á (1145)
Ms. Mary Lou Cranston: I know that I did a presentation actually that Rob Merrifield saw, and it's fascinating how many different areas they're using adult cells in. And even, which is something I'm interested in, they can use our fat now as stem cells. I figure I have a good store.
But basically what I'm seeing without being facetious is that there is a lot of interest all across for using adult cells. The more we see that, I think it would be really wonderful if we could stand up and say let's really push that, let's pull back on the embryonic and be leaders in it, because there is no question it is a new area--we all know that--in terms of research.
Ms. Diane Watts: It is very encouraging to see the results of adult cell research. Why go to an area shown to be problematic? There was great hope a couple of years ago. This is how things go when the media are covering things and the political process is involved. You get all these great hopes for embryonic stem cell research, and all of a sudden you get these terrible letdowns when the results are not as expected. This goes on all the time. But the results for adult stem cell research are much more encouraging than for embryonic stem cell research.
We're better off not going into an extremely controversial area, and going to something that has proven itself to be more productive and hopeful in treating disease--or more hopeful, so far. I think we have to look at the facts already. What has been cured, what has been healed, what has been changed? We seem to be great on promises, but the results aren't here yet for embryonic stem cell research.
Mr. James Lunney: I have just one more question. Can informed consent really take place if definitions are not accurate or are missing? Examples are omitted definitions of human being, person, human mosaic, and cloning; and inaccurate definitions of clone, embryo, gene, genome, and chimera
What do you see as the implications of having inaccurate definitions when dealing with consent or informed consent? Would anyone like to take that on?
Ms. Mary Lou Cranston: It's one thing to have it in a bill in the definitions, but that's not really where the consent is going to happen. It's going to happen in the clinics, or wherever. Informed consent is a real issue to me. All of us, whether we want to or not, give the information we think will be helpful for where we want to go. We say we can be really generic, but we can't.
I'm also concerned about it in the bill. It's like you give it once and it's gone, but you have no idea what's happening all the way through with the rest of it. So that's one of my concerns.
Dr. Bridget Campion: To add to that, as we know, we try to regulate research very strictly, to make sure we protect the dignity of the human subject. On the other side, we have therapy. Those are the interventions undertaken to help particular individuals.
In between research and therapy is something called innovative therapy. It is untested therapy. It's meant to benefit the individual, but as therapy it's not subject to research guidelines. So my fear is that we will find people possibly undertaking something called innovative therapy, rather than research.
Ms. Diane Watts: A further point we mention in our brief is that the embryo is not owned by others, like you can own the animal embryo, as a farmer or a pharmaceutical company doing the research. We're stepping on dangerous ground when we assume the human embryo is owned by the parents and can be given, can be even sold--well, we prohibit that--and anyone can consent for that human being. We were all at the embryonic stage at one point in our lives. Would we have wanted scientists to consent for whatever--or maybe even our parents, if they were unsure about the terminology?
It's all very confusing for everyone because it covers so many fields. How much more confusing is it for parents involved in the emotional situation of wanting a cure for a sibling, or whatever?
Á (1150)
The Chair: Thank you, Dr. Lunney.
Dr. Castonguay.
[Translation]
Mr. Jeannot Castonguay (Madawaska—Restigouche, Lib.): Thank you.
I would like to know your position on the assisted reproduction techniques that are being used today to create embryos. Do you agree or not with the assisted procreation techniques being used today?
[English]
Most Rev. Terence Prendergast: We would take a position in the Roman Catholic faith community that certain assisted reproduction technologies are not moral. We understand that they do take place and that couples as a matter of fact make use of them. We would have an ethical view against those things which perhaps others may not share.
Nonetheless, if you would ask explicitly on those assisted reproduction technologies, we would have some difficulties with the moral separation of the union of the husband and wife in marital union; so we would have some difficulties on those as well. They are not, I don't think, the primary issues we're talking about here, but they would pose a difficulty for us as well.
[Translation]
Mr. Jeannot Castonguay: I appreciate your answer, and perhaps others would also like to respond to the question.
You know as well as I do that today, when we want to help couples using assisted reproduction techniques, it involves creating embryos, which results at some point in a surplus of embryos. This is where the question arises. What do we do with these embryos that the couple do not need for themselves? There are various options. One option that has to be considered is to use the embryos for research.
I understand your position and I respect it, but I would like to see if there are other positions here. That is part of the debate. In your opinion, what should be done with the embryos that have been created for reproductive purposes but are surplus to couples' needs?
[English]
Most Rev. Terence Prendergast: I think there's an extension of our issue; that is, that once these embryos exist, we need to respect the dignity of those embryos and their right to life and the fact that they are potential human subjects—they are human beings—and so on. We treat that in our own paper here. We recognize that some of these embryos come in in ways that perhaps we would have difficulty with; nonetheless, once they do exist, there is a protection that is needed for their dignity and their status.
[Translation]
Mr. Jeannot Castonguay: What should be done with these embryos? Should they be kept frozen indefinitely? Should they be given to another couple? Should we allow their use in research? That is the issue. We cannot deny the existence of these embryos. What should be done with them? That is my question.
[English]
Most Rev. Terence Prendergast: The primary one is that we don't want them to be killed; we don't want them to die. That's really what you have to do in using embryonic stem cells for research: you kill the embryo. We're opposed to that. In terms of other, lesser evils, obviously there has to be a development or a difference of opinion on those things, but nonetheless we think the fundamental principle is to respect the life.
[Translation]
Mr. Jeannot Castonguay: Given that the embryo cannot speak, should its parents be able to speak on its behalf and say what they would like to have happen so that the embryo can contribute to society? It is a bit like parents whose son is brain dead: the son is a human being and unfortunately cannot speak, and the parents are the ones who authorize the use of his organs to help the human race. Is that unacceptable, given that the parents of these embryos have participated in their creation?
That is what this debate is really all about. I would like to hear your comments.
Á (1155)
[English]
Ms. Mary Lou Cranston: I'm not going to speak from a church position, but from my own heart right now, okay?
First of all, once we have them created--which is what I hear you saying--we're between a rock and a hard place, in a sense. If we cannot find a way to implant them--and to implant them simply for the sake of implanting them probably is also questionable--then what do we do with them?
My first answer a couple of years ago, when I was asked publicly, was basically that we bury them, return them to the earth. Now, I don't know why I said that--because I was caught between the rock and the hard place, if you're really honest.
I hear people arguing what you're saying: “If I am allowed to give different organs and tissues when my child dies, is there a comparable reality there?” I'm not answering it; I'm simply saying I recognize your question. It's a real struggle, and I just want to be honest. In my own personal position I see the struggle; I really do.
Ms. Diane Watts: Why are there reminders that we're dealing with a human being? What we're trying to do is to prevent more and more situations where we have these human beings and have to decide what do we do with them. This is why we suggest alternatives to embryo stem cell research.
The more science progresses, the more we will have the capacity to keep these human beings alive in unusual or unnatural circumstances other than the mother's womb, which is the traditional and proper location for an unborn child. By saying such and such a thing should be prohibited, this is one of the things we're trying to prevent, so that we—and more and more Canadians—don't run into situations that you're describing.
So prevent first before saying “What will we do with them now?”
[Translation]
Mr. Jeannot Castonguay: Yes, but we cannot deny the reality; these embryos exist. As a society, we have accepted these assisted reproductive techniques and embryos have been created. They are there today and will be there tomorrow.
I find this very difficult. Once an embryo is created in a Petri dish, it has the potential to become a human being, as long as it is implanted in a uterus. Right now, that is one of the necessary conditions: a sperm and an egg have to be present, but a uterus is also needed. We have not yet managed to grow a human being outside the womb. I do not have the answer. Like you, I am looking for it.
[English]
Ms. Mary Lou Cranston: May I make just one more comment?
I think this goes back to what we said earlier. When it comes to creating too many embryos—which is one of the issues we have when we go to fertility clinics—I think it is because people are not given good information when they go to the clinics. So they don't get good consent.
A part of our problem, too, is the commercialization of the clinics—especially in the United States. If clinics are vying with each other, they have to have good success rates. They have good success rates by creating a maximum number of embryos, so you can choose the best ones, etc.
It becomes extremely complex. As an ethicist I've dealt with couples who are caught between that rock and a hard place. Almost to a couple, they'll say, “If we had really realized this question way back then, when we were this young couple just dying to have kids, we wouldn't be here.” A lot of it is education and information, etc.
The Chair: Thank you, Dr. Castonguay.
Mrs. Wasylycia-Leis.
Ms. Judy Wasylycia-Leis: Just pursuing the discussion about commercialization, we have various differences among us in terms of understanding the status of the embryo and the question of embryonic stem cell research. But leaving that aside for a minute, I think there are some commonalties that we need to work on. One has to do with commercialization, and whether or not... My view is that it should be an accepted principle in all aspects of reproductive health. But I know that it can run into some difficulties in terms of some families who are desperate to have a child and see no other option but to purchase or to trade in eggs and sperm, and so on. I'd like your understanding of how you'd handle the idea of non-commercialization as a principle.
Then the other area goes back to the question of people with disabilities, which I think Bridget mentioned. I missed all of the presentations, so whoever is the expert on that I'd like you to tell us if... We did some pretty good work on the draft bill to try to ensure language and understanding that would respect people of all backgrounds and honour the diversity of our population. I'm not sure that the present bill captures that essence. I guess what I would like from you is some help with wording to ensure that we actually protect in all aspects of the legislation—including the preamble—the diversity of Canadians, and the interests of people with disabilities.
 (1200)
Dr. Bridget Campion: Let me start with your first point about non-commercialization. I think social justice is a huge component here. We've been very much focused on the status of the human embryo, but there's a huge social justice component to this. When we start to talk about commercialization, there is room for exploitation. We know, certainly, about the desperation of the couples who wish to have a child; and there's the desperation usually of the women who wish to pay the rent.
If we work by analogy, we could take a look at organ so-called “donation”. The Globe and Mail a couple of days ago reported on a fellow who has purchased a kidney from his housekeeper. The idea of that story was not to say “here's a great idea”; it was scandalous.
Informed consent comes into this. Certainly among the components of informed consent is not simply getting the information, not simply being able to have the competence to deal with it, but voluntariness. If we have vulnerable people, how voluntary is their consent? How voluntary is a woman's consent to say “Well, yes! Gee, I'd like to make $16,000 carrying a baby to term; I need the money”? So there is a huge social justice component to it as well.
When we get into assisted human reproduction, who benefits from it? I think about teenagers who are sniffing solvents in Whitedog. I used to live in St. Jamestown in Toronto. Assisted reproduction means nothing there, and we are spending millions of dollars on it. If we are so very concerned about resource allocation rationing, what are we saying to the rest of the world, where there are orphans in Africa taking care of their siblings?
There's this huge component we haven't even taken a look at in what is really elitist medicine.
The Chair: Thank you, Dr. Campion. In previous meetings and in previous thinking we have thought about all those things.
Dr. Bridget Campion: Thank you so much. I am so glad to hear that. Thank you.
The Chair: Yes, we have. We have tried to talk about the exploitation of the weak in order to accommodate the desires of the wealthy; we have talked about the superabundance of children--in Canada even, and around the world--who need parenting; and we have talked about whose desires are being fulfilled by all this and whether they deserve, as probably less than 2% of our population, all this structure and superstructure when in fact there are other people who really need them.
We have talked about all that, and I can't remember if we actually put it into words in our report, but in fact the social justice idea, the economic exploitation idea--all those things we have explored at length prior to writing our report.
 (1205)
Dr. Bridget Campion: Thank you so much. I appreciate that. Thank you.
Ms. Judy Wasylycia-Leis: Would it be possible to get an answer on the question pertaining to people with disabilities, or did you already address that before I arrived?
Ms. Mary Lou Cranston: I actually just made reference to it because I noticed it was in the preamble at the beginning--or whatever you call it--that there was a principle on it. Then there is the clause there on pre-implantation diagnosis, basically in terms of sex-related diseases, etc.
I guess I felt when I read it that what happens to it is because it has that “except” clause in it and there are so many exceptions, it again is going to make the disabled person say, “Well, gee, if that technology had been around I wouldn't have been here, because they would have weeded me out already.” That was my concern.
Therefore, I think one of the foundational principles has to be that none of this has anything to do with saying some people are more worthy of living than other people. My big premise would be, because so much is in the realm of agencies and ministers and regulations and licences, that those foundational principles have to be very solid. That's why I want to bring that back up there.
Ms. Judy Wasylycia-Leis: Thank you.
The Chair: Does Madam Thibeault want to get in here, or Mrs. Skelton?
I'm really hoping that Mrs. Watts will put out another newsletter where she can maybe say something about this bill, other than it is a sham and a fraud.
I understand your point completely, where we try to set up all these structures at the beginning of the bill, and then say the minister can exempt certain things. That does seem like a lot of power for one person.
Ms. Diane Watts: According to our legal analysis of the bill, she can do just about anything she wants. She does have the power over life and death; she's not the only one, but in this case she does. So this bill isn't going to solve a lot of the confusion and difficulties. It's going to multiply them.
The Chair: I think you can have faith in members of the committee, who will probably have something to say about that when it's time to present amendments.
Ms. Diane Watts: Thank you.
The Chair: We talked for a minute about informed consent. The committee, in preparing its report, thought we didn't even like that term, because of the implication that consent meant saying yes. So while you're trying to expose a potential donor or client to the choices, if you say you need their informed consent, the implication is they're probably going to say yes.
We had decided to move forward with the term “informed choice”, which leaves the option for a yes or no more clearly in place. Do you think we should pursue that, as we go about perhaps amending this bill?
Ms. Cranston.
Ms. Mary Lou Cranston: I guess my first response is that informed consent is kind of a technical term we, as ethicists, use in this content. But I think your comment is fair. That is a good idea. Consent, as we say it, is yes.
There's another thing connected to it, in terms of choice. In our field as ethicists, we'd be careful when it came to consenting to doing research on children--full stop--therefore embryos. So I think there's another area there.
But in terms of your actual question, I like the idea of choice.
The Chair: Ms. Campion.
Dr. Bridget Campion: I would agree that seems to be the way the terminology is evolving.
You're talking about informed choice, and I just have a question of my colleague here. I think of informed choice as a practice rather than a principle. So rather than the principle of informed choice, I would talk about the practice of informed choice, and use the practice based upon a principle; and that is the principle of respect for patient autonomy, or the principle of personal autonomy.
The Chair: Ms. Watts.
Ms. Diane Watts: I think I would prefer--just offhand--a more neutral term like option or decision.
The Chair: The problem is that the options described might all be sort of headed in the same direction. I see what you mean about options, but there's always the option to say no.
 (1210)
Ms. Diane Watts: That's what we want.
The Chair: In any case, maybe we're splitting hairs here.
Ms. Cranston talked about the need for an ethicist on the 13-member board. We have actually gone beyond that as a committee, because we think a lot of boards have ethicists who bring forward the ethical point of view on the subject that is on the table, but in the end the board votes, and often the ethicist's point of view is lost.
After the board has made a decision, essentially against the ethical position, because it was democratic, the ethicist then becomes the defendant of the board's position. He or she is part of the group. Do you see what I mean? Don't you think that's problematic?
Have you ever been on a board that has not taken your advice on a certain issue, and then been asked to go to the press conference to defend that as the resident ethicist?
Ms. Mary Lou Cranston: They know me well enough to know I won't defend it. But I hear your position; there's the same parallel. Who pays the ethicist in the health care facility? That's the same question.
The Chair: Exactly. We went into all that, which is why we recommended that the board of directors of this agency not be people who were connected to the field. In other words, if you had a board of thirteen, and eight of them were from the scientific community, representing different areas of expertise, and you had a couple of lawyers, two ethicists, and two consumers, it seems to me the scientific viewpoint would always prevail. What if the consumers wanted more of this activity because they were part of the infertile community? They would vote with the scientists.
So we suggested--
Ms. Mary Lou Cranston: Wouldn't you hope that there was some kind of intellectual integrity such that if we're all basically listening to each other, we can all learn? I would hope it doesn't end up that we all sit here and discuss, but scientists keep their scientist hats when they vote, etc. Hopefully we are going to learn from each other. These ethicists could be the gnat, at least, or the burr under the saddle, or whatever.
The Chair: What we were thinking of was more a group of people who are not specialists in those fields, but people who have expertise more like that of a judicial panel, with some religious components so that a variety of religions are represented by people who are used to making tough decisions. The scientists, the infertile community, and the people with interests specific to pursuing their careers or advancing the development of their families, would have to present to those people who have no interest at all. But the bill, as you pointed out, came back with the more traditional model. I'm trying to ask for your guidance on whether we as a committee should fight harder to get the model of board that we wanted in the first place, and get rid of this 13-member thing that has the various interests represented on it.
Ms. Campion.
Dr. Bridget Campion: I also work as an ethicist, and the first thing to be said is that anytime you get a lawyer on the committee, it is the legal position that will prevail. People are very interested in what the law says. The law has very definite answers, and people find a great deal of comfort in that.
The second thing to be said is that I think the Canadian Bioethics Society has written out guidelines about the role of an ethicist. Ethicists are not necessarily spokespersons, and they're not even meant to be watchdogs.
The principles that you have set out in statutory declaration are very important.
The Chair: We didn't write the bill, Dr. Campion.
Dr. Bridget Campion: Okay, but what I mean to say is that—
The Chair: We don't even like parts of it.
Voices: Oh, oh!
The Chair: We wrote a report. Did you read our report?
Dr. Bridget Campion: Yes, I did. But what I'm saying is that, generally speaking, the ethics and ethical framework will usually be established ahead of time. The ethicist then works within that framework to make sure there is a consistency.
It's taking a teleological approach. It's the same way that people work with mission statements or vision statements to understand this particular moral community and to try to keep it on track that way.
The Chair: If we had one ethicist on this board, he or she would be expected to vote when the vote was put.
Dr. Bridget Campion: Yes, and that happens on hospital ethics committees all the time. You work through it. You try to understand what this moral community is about, and then try to keep it consistent that way.
Do you think that's fair to say?
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Ms. Mary Lou Cranston: Yes, and that's why I talked about integrity. It's a lot about the credibility of everybody speaking and how much we're going to listen to each other.
The Chair: Mr. Lunney had a comment, only he doesn't need responses. We'll then end with Mr. Merrifield.
Mr. James Lunney: It's a quick one on that point.
With integrity, unfortunately, if industry is represented and big dollars are at stake, integrity often goes out the window. Excuse me for saying so, but...
Just to come back to Dr. Castonguay's conundrum about what to do with the leftover ones, I think your first instinct, Mary Lou Cranston—to return to the earth—is a practical concept. First of all, if ova come through freezing, we won't have to worry about leftover ones because there won't be leftover ones.
Secondly, of course, the adult stem cells seem to be having all the promise to deliver all we need, so perhaps we can avoid it that way.
Finally, any couple seeking reproductive assistance surely has been trying naturally to accomplish this end anyway. In many cases, conception does occur but implantation doesn't. For a vast majority of them, they have already had multiple miscarriages, as it were, or very tiny fertilized ova that have never been implanted.
I would just throw out... well, I'm not supposed to, because it's just a comment.
Voices: Oh, oh!
The Chair: Be quick.
Mr. James Lunney: In going back to the earth, as you said, they would simply follow the path of many others. If they're not used for the purpose for which they were created artificially, then perhaps they would be allowed to go the way they would otherwise have gone, as any fertilized egg that simply had not been implanted would. Would you agree with that generally?
A witness: Yes.
The Chair: Thank you, Dr. Lunney.
Mr. Merrifield, for the final round. We're actually a couple of minutes past.
Mr. Rob Merrifield: I have one quick question.
Coming back to Dr. Castonguay's dilemma and the dilemma in this bill, what do we do with the supposed leftover embryos from in vitro fertilization? Somebody just sitting back and looking at it might say if they're going to be destroyed, why don't you get some good out of them before you do it? That almost sounds logical, doesn't it?
From an ethicist's point of view--and that's why we have this panel here--my problem becomes the following. If through this legislation we allow ourselves to let the end justify the means and we destroy human life for the purpose of research, knowing that in the thawing process 95% or more will die and will never reach the achieved goal of research, and moving down the road five years, ten years, or whatever it takes, would it not be more ethical to develop them solely for the purpose of research, where they wouldn't die and you would get them fresh prior to the freezing process? Would it be more ethical once you've gone to the place where you're prepared to allow the end to justify the means?
Dr. Bridget Campion: Let me talk about research for a moment. When a person agrees to be involved in research, that person is undertaking an act of charity. That person is agreeing to do something that is not going to benefit her. We ought to treat that person as really giving us a great gift.
Generally speaking, we do not use human beings as a means to an end.
Mr. Rob Merrifield: I realize that, but we are about to go there under this legislation. That's my fear. The United Kingdom has gone there. Now they say let's develop them solely for the purpose of research. You might think this is hypothetical. It isn't; it's reality.
Dr. Bridget Campion: We shouldn't do that.
Mr. Rob Merrifield: That's where ethics comes in.
Ms. Mary Lou Cranston: I agree. Don't go there.
Mr. Rob Merrifield: We're going there under this piece of legislation. That's my point.
Ms. Diane Watts: The consequences will be horrendous. We can't even imagine what the consequences are going to be.
Mr. Rob Merrifield: Thank you.
The Chair: On behalf of the committee, thank you very much for coming. You have helped remind us of some of the thinking we did at the outset of this process, and we're very grateful. I have tremendous faith that Ms. Watts is going to find some good things to say about the process in her next newsletter.
Thank you to the members. I will see you this afternoon.
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¹ (1541)
The Chair: Good afternoon, ladies and gentlemen. It's my pleasure to welcome you to the second session of this meeting of the health committee. I would like to welcome representatives from the Stem Cell Network, the National Cancer Institute, the Juvenile Diabetes Research Foundation, and Dalhousie University. We'll begin with Dr. Ronald Worton of the Stem Cell Network.
Excuse me, I forgot one thing. Mr. Ménard wants to give us a notice of motion. He's going to read that motion. It will come up for voting on Thursday.
Go ahead, Mr. Ménard. Just read your motion, please.
[Translation]
Mr. Réal Ménard: I move that the Standing Senate Committee create a steering committee composed of the chair, the two vice-chairs, a representative of the Canadian Alliance, the NDP and the Conservative Party. The steering committee would be responsible for planning future business and expediting routine business.
It seems to me that this motion is fair, but we can amend it on Thursday if there is any debate.
[English]
The Chair: Thank you.
Sorry, Dr. Worton. Please, go ahead.
Dr. Ronald Worton (Scientific Director, Stem Cell Network): First, thank you. I want to thank the committee for the opportunity to provide some scientific input, particularly on the issue of stem cell research as it relates to Bill C-13.
I do speak to you today as the scientific director of the Stem Cell Network. This is one of Canada's network of centres of excellence. Members of the network now include over 65 of Canada's best stem cell scientists, engineers, clinical researchers and, indeed, social scientists. Their collective knowledge and experience makes Canada one of the top countries in the world to investigate the power of stem cells for both regeneration and repair of tissues that are damaged by disease.
My comments today are focused on a review of a couple of the key scientific findings in the last year or so, because I knew you would be interested in that, and on the scientific interpretation of these new studies as they pertain to the need for research with embryonic stem cells. I do not attempt to address any other parts of the act that deal with assisted reproduction.
In summary, overall I do, of course, support Bill C-13, as I did its draft form earlier, particularly as it pertains to stem cell research and potential stem cell therapy. I'm pleased to see that the revised legislation retained that portion of the legislation that allowed derivation of embryonic stem cells from embryos generated by in vitro fertilization, but not used for human reproduction. I cannot emphasize enough how important this is for the future of stem cell research. If Canada is to play a major role in the development of stem cell therapy, this provision must be retained. I'd like to just address why. I think that's really an important issue.
Why do we need embryonic and stem cell research? It is critical for the committee to understand the value of working with stem cells.
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Mr. Paul Szabo: Embryonic and stem cell?
Dr. Ronald Worton: Embryonic and adult stem cells, my apologies.
It is particularly important because I've read quite a bit lately from those who are opposed to embryonic stem cell research arguing that there are cells in the adult body, adult stem cells, that have the same potential or similar potential, and that their use eliminates the need to work with embryonic stem cells.
It is true that there is good evidence for a class of cells in adult tissues that appear to have many of the properties of embryonic stem cells. The two key properties are the ability to divide and generate new stem cells without limit--that is, if you like, immortality--and the ability to become specialized or differentiate into cell types characteristic of many different tissues and organs. So there are adult stem cells that can do this.
Over the last five years, in fact, there have been close to 50 publications on this topic, but a majority, especially in the early days, primarily 1998 through 2001, were somewhat inconclusive, and in some cases, repeat studies failed to support those original conclusions. So what I want to focus on in the next couple of minutes is the work in the last two years that, in fact, is more convincing, particularly the work of Catherine Verfaillie. I understand that others have already quoted her work, and I think it's fair to say that this is probably about the best work in the field and that we should pay close attention to her and to her work.
She is from the Stem Cell Institute at the University of Minnesota medical school. The paper was published in Nature within this past year and found that rare cells in bone marrow behaved very much like embryonic stem cells, very encouraging work. They were found to have extensive capacity for cell division, and with an appropriate stimulus, these cells would transform themselves into cells characteristic of bone, cartilage, muscle, and even brain.
There are two aspects of this study that set it apart from some of the earlier work that I have suggested was less conclusive. First, Catherine's lab began the experiment with a single mouse stem cell--and I emphasize that all of this is done in mouse; it would have to be repeated in humans. They started with a single mouse stem cell in a culture dish, and after many doublings by cell division, they found differentiation into these various cell types. This proved that the various cell types that were generated came from a single cell, and this is really important. It was lacking in some of the earlier evidence.
Second, they tested the plasticity in vivo, or if you like, in the body, by injecting a single mouse adult stem cell into a developing mouse embryo, and found that this one cell ultimately contributed to the cell population in a variety of tissues. So this is sort of the ultimate in vivo test, and it makes it look very much like an embryonic stem cell. So with that, why would we still need to do research work with embryonic stem cells?
In preparing this presentation, we consulted heavily with Dr. Verfaillie. We know she is being quoted around the world, and she has been very vocal about this. So we've spoken with her. Particularly, we did not want to misrepresent her work in front of this committee, or its implications.
Despite the excitement around her results, she has, as we have in Canada, consistently advocated that there are still compelling reasons not to stop research, or indeed, not to prevent research with embryonic stem cells. I'd like to enumerate these. Six of the seven that I'm going to enumerate are contained in a review article by Catherine.
One, embryonic stem cells are immortal, being able to undergo continuous cell division for years in cell culture, whereas the vast majority of adult stem cells that have been tested extensively to date die out after a few cell divisions. This new work from Dr. Verfaillie, her new cells, may be an exception, but as she says, they haven't been tested for a long enough time to be sure that they're immortal.
Two, to date the efficiency of adult stem cell differentiation is really quite low in comparison with some of the embryonic stem cell lines, and the differentiation pattern is less predictable and less controlled. We expect that one day it will in fact be just as predictable and just as well controlled with adult stem cells, but to get there we need to understand those controls, and to do that, we need to be able to work with both cell types in order to understand what those control mechanisms are at the molecular level.
Such control is really essential, if you think about it. We have to be able to control how the cells differentiate. If we're going to treat a Parkinson's disease patient--and that's one of the two or three diseases that's held up as probably the first to be treated--by putting stem cells into the brain, we have to be absolutely sure that those cells are going make neurons, or brain cells, and that they're not going to differentiate abnormally and make bone, muscle or blood in that location. The same goes for every stem cell therapy that you can think of. Control is really the key.
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The third point is that adult stem cells from the patient will not be usable to treat a genetic disease such as muscular dystrophy, which is my own field, because all cells in the body have the same genetic defect. We'd have to correct the defect if we were going to use the patient's own cells. That's likely to be feasible in the future, but we're just saying let's not rule out the use of other stem cells from other sources, such as embryonic cells, until we're confident that we're going to be able to make that genetic correction.
Fourth, adult stem cells from the patient would not be usable to treat an acute disorder such as a damaged cardiac muscle following a heart attack. That is, if you have a heart attack and you're taken into hospital there's no time to collect stem cells from your bone marrow or other places in order to treat your damaged heart. We would have to use existing cell lines that are already in culture and already ready for use as a therapeutic tool.
Fifth, while embryonic stem cells have been proven to differentiate into virtually every tissue, the best data on adult stem cells indicates they are limited in the cell types. Even in the latest experiments from Catherine Verfaillie's lab, which is, I would argue, the best to date, they were unable to get the cells to form cardiac muscle, for example. And they tried hard. They tried for two years to get these cells to make cardiac muscle, yet embryonic stem cells from a similar mouse almost make cardiac muscle better than any other tissue. So there are some differences there that we need to take into account. And of course cardiac treatment is one of the biggest potential implications down the road.
Six, the disease most likely to benefit from stem cell therapy, besides Parkinson's, is diabetes. Stem cells are being studied to see if they can make pancreatic islet cells, which are the cells that make insulin in the body. Therapy with such cells would eliminate the need for insulin injections in diabetics and would avoid a whole host of complications, including blindness and severe kidney disease. There have been several newspaper articles about people being much better after they have been treated with islets by the group in Edmonton, but the islets are not available in large enough supply. In the future they're going to have to be made from stem cells if there's going to be enough supply.
However, having said that, to date embryonic stem cells have been shown, in two major papers within the last year, and another one that was just brought to my attention this morning, to make islets--this is from embryonic stem cells--but to date those same groups have not been able to make islets with adult stem cells. This is not to say that it won't happen in the future, but it hasn't been available yet.
Finally, a very general comment is that the most likely scenario according to most of the scientists I've talked to, and including Catherine Verfaillie, is that no one cell type will be the magic bullet for all types of therapy. One cell source might provide a good yield of neurons for Parkinson's disease treatment, while an entirely different cell source might be the ideal for diabetes; therefore it would be premature to eliminate research on one of the most versatile cell sources to date, and that is the embryonic stem cells.
I want to end by quoting Dr. Verfaillie, because she summarizes what I just said in her own words. This is in a review article that we received a copy of a few days ago. And we have her permission to make it available to the committee, if you would like to have it. This is a quote from Catherine:
“No investigator currently knows which cell, adult or embryonic, will ultimately be the best cell for clinical use and treatment of a particular disease. Therefore, any decision now regarding the funding or legality of adult vs. embryonic stem cell research would be premature and harmful to both the scientific process and to the patients who will benefit from treatments developed as a result of the research.”
So that was Catherine's comment.
And if I may, I would like to make one plea at the end for flexibility. I am concerned about the inflexibility of law. I support, for sure, the need for research within an ethical and legal framework that reflects the values of a majority of Canadians. I agree that the proposed assisted human reproduction agency will facilitate this, but I'm increasingly concerned about the inflexibility of the proposed legislation to take into account a changing scientific and social environment.
A case in point is a sticky one, and that is the ban on therapeutic cloning, a procedure that we can probably do without for the next three or four years, as we do research with other cell lines, but whose importance may in fact become compelling if cells of embryonic origin do turn out to be the best for a variety of diseases.
It would be important to maintain flexibility so that if scientific evidence suggests that this is the best way to save lives, and if public opinion supports research and eventually therapy by this approach, which a recent public opinion poll suggests they do, then the government will not be locked in forever to a situation in which important and necessary research is a criminal offence.
So I'm urging flexibility, and that not only the committee but members of Parliament keep in mind the need for flexibility. Already countries that are quite properly criminalizing reproductive cloning are now looking at the possibility of permitting research into therapeutic cloning under licence, and this includes the United Kingdom. Even in the United States the issue is stil being actively debated. So I just want you to keep that in mind and to maintain a position that will be flexible.
Thank you.
¹ (1555)
The Chair: Thank you, Dr. Worton.
We'll move on now to Michael Wosnick, from the National Cancer Institute.
Mr. Michael Wosnick (Acting Executive Director, National Cancer Institute of Canada): Thank you very much.
The National Cancer Institute of Canada, more informally known as the NCIC, very much appreciates the opportunity for me to participate in the committee's deliberations. Clearly, opening constructive dialogue will benefit all Canadians. My comments will be a little more general than Ron's and will be centred on some potential cancer applications.
Let me just tell you a bit about the NCIC. We have been the largest single funder of cancer research in this country for many years. NCIC's mission is to undertake and support cancer research and related programs in Canada that will lead to a reduction in incidence, morbidity, and mortality with cancer. We accomplish this mission via two very important partners, the Canadian Cancer Society and the Terry Fox Foundation, from whom we receive about 75% and 25% of our funds respectively. More importantly, through these partners we are very accountable to the people of Canada overall, and that's an accountability we take very seriously indeed.
It's in the spirit of that accountability that the NCIC welcomes those clauses of Bill C-13 that deal with human embryonic stem cell research. NCIC is particularly pleased that under the proposed legislation all stem cell research undertaken in Canada would be carried out in a responsible, ethical, and fully accountable manner. This is of absolute and paramount importance to us. We do believe stem cell research offers great promise in advancing our knowledge of cancer, a disease that, as every one of you knows, takes the lives of many of us, more than 65,000 Canadians each year.
You've all no doubt heard about the explosion of knowledge in the cancer field over the last, say, 20 years. For the first time scientists indeed have some understanding of many of the subtle cellular mechanisms that can go wrong and can contribute to the development and the progression of cancer. But there are many gaps left to fill if we're going to continue making the progress that will affect the health and lives of our fellow Canadians. Stem cell research provides one such avenue. I'd like to give a few examples that may illustrate the point.
It doesn't take us very long to realize that cancer cells have a lot of properties in common with stem cells, especially the ability to renew themselves. The study of stem cells compared with cancer cells may therefore lead to a better understanding of why cancer cells survive so well in spite of aggressive treatment to the contrary, and this should enable us to better develop strategies for circumventing this property.
The ability of stem cells to develop and to differentiate into a variety of other specialized cells, tissues, or even organs provides additional examples of the values of such research in the cancer field. It's well known that most cancer treatments have very harmful effects on normal tissues. The use of stem cell therapy and bone marrow transplantation, for example, can restore the immune and blood-forming systems after a patient receives high dose chemotherapy.
Embryonic stem cells could play similar roles in other forms of cancer as well. For example, they could be used to restore liver or brain functions following aggressive radiation or chemotherapy treatments. They may be useful in helping to regenerate tissues or even organs that have been damaged or removed during cancer surgery. Stem cells might be useful in gene therapy approaches, many of which currently fail because the introduced genes just don't spread themselves widely enough to be effective. Introducing those genes into stem cells might better achieve the widespread and lasting functionality we want to see. Alternatively, engineering stem cells that are resistant to chemotherapeutic assault may well enable patients to withstand the toxicity of cancer treatment, a feature we unfortunately all recognize too well.
In short, improved treatment of cancer is a key area in which human stem cell research can make huge inroads in the fight against cancer. These improved treatments may not only mean that patients suffer less and experience fewer side effects, but eventually, we would hope that increasing numbers would survive the disease altogether.
I'd like to talk for a few seconds about the provisions for the national registry, to go on record as saying that the NCIC strongly supports the creation of a national registry of human embryonic stem cell lines, given that such a registry will not only facilitate research, but minimize the need to generate new cell lines, which, of course, should decrease the need for donation of large numbers of embryos.
º (1600)
In conclusion, let me remind the committee that Canada has a celebrated history in stem cell research, dating back over 40 years to the seminal publications of Jim Till, Ernest McCulloch, and their colleagues at the Ontario Cancer Institute. Their ground-breaking research on stem cells and the blood-forming system led to the modern era of stem cell research. The National Cancer Institute of Canada believes we are on the very brink of truly understanding the vast potential these Canadian researchers first described for the rest of the world. Continued research into these areas will be the only way to unlock those promises for the future good of all Canadians and of everyone.
Thank you for the opportunity to address the committee.
The Chair: Thank you, Dr. Wosnick.
We move now to the Juvenile Diabetes Research Foundation, and the spokesperson will be the president, Ron Forbes.
Mr. Ron Forbes (President and Chief Executive Officer, Juvenile Diabetes Research Foundation of Canada): Good afternoon.
With me at the table is Elaine Flis, manager of government relations, and Robert Hindle, the chairman of our board.
JDRF thanks the committee for the opportunity to appear before you to share our views on Bill C-13. JDRF also thanks all committee members for their careful and balanced deliberations on this very important piece of legislation. We support the overriding principles within Bill C-13, but we're concerned with some provisions of the bill that require further discussion prior to implementation.
The next ten years hold tremendous growth potential for groundbreaking cures, as research advances are happening at an incredibly fast rate. From the research perspective, JDRF supports the three-year review of the administration of this legislation and recommends that clause 70 of the proposed legislation remain as stated.
JDRF also believes it is crucial to have the correct composition and representation on the Assisted Human Reproduction Agency of Canada and the proposed board of directors. Thus, JDRF recommends that clause 26 strongly reflect the fact that it is important to have not only appropriate representation from the scientific community, but also appropriate and adequate representation from patient advocacy groups. As stated in the proposed legislation, it is also important that the individuals are chosen based on their expertise, diversity of knowledge, and commitment to the implementation of the intentions of the legislation.
JDRF also questions the definition of the word necessary that is used within this bill. Subclause 40(2) states that a licence is to be issued “only if the Agency is satisfied that the use is necessary for the purpose of the proposed research”, although there's no definition of “necessary”. After careful consideration and extensive consultation, it is deemed appropriate that if the composition of the Assisted Human Reproduction Agency is correct, the appropriate skills and backgrounds will be represented in order to adequately define “necessary”.
JDRF understands the requirement outlined in the bill for the creation of a separate agency specific to this all-encompassing legislation, but we're concerned that the proposed Assisted Human Reproduction Agency of Canada may duplicate existing work of the CRHR as it pertains to human pluripotent stem cell research. A national stem cell oversight committee is being established within the CRHR to review government-funded stem cell research proposals. JDRF recommends that the agency and this committee work closely on all aspects of the stem cell research issue, so that there is consistency, without any duplication, on this crucial aspect of research. JDRF, therefore, recommends that the national stem cell oversight committee and the CRHR jointly deal with all applications for human pluripotent stem cell research requiring a licence.
The use of human reproductive materials for research is also of great interest to JDRF, for a variety of reasons. The Edmonton protocol is a set of procedures for islet transplantation that has been hailed as a historic breakthrough to kill diabetes. There are still several problems researchers are working to address with this procedure. Among these is that the current supply of donor pancreases is far below the need. Finding a solution through stem cell research could potentially solve the supply problem. The Juvenile Diabetes Research Foundation supports the use of embryonic stem cells for research purposes. So we recommend that clause 10 of the legislation, dealing with embryonic stem cell research, remain as stated in the current legislation and not be amended, that this type of research be conducted in accordance with regulations and a licence.
JDRF also opposes a permanent ban on somatic cell nuclear transfer, commonly referred to as therapeutic cloning. Instead, JDRF proposes that the government ensure that all research adheres to appropriate scientific and ethical guidelines.
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There is a difference between reproductive cloning and therapeutic cloning. The promise of therapeutic cloning is that the patient's body would not see the transplanted cells as foreign, and so would not reject them. Reproductive cloning is the use of cloning technology to create an embryo for implantation into a woman's uterus to create a child. JDRF strongly opposes reproductive cloning.
JDRF opposes the banning of therapeutic cloning and recommends a regulated and licensed framework limited to conditions in which there is strong justification for research, so that the research cannot otherwise be performed. JDRF argues that it is too early to put permanent legislative restrictions on this type of research without knowing its full potential. An Ipsos-Reid poll conducted in October this year showed that 61% of Canadians support therapeutic cloning and that 76% of those polled support embryonic stem cell research. These results are consistent across the country and across identified political affiliations.
Canada is a world leader in diabetes research. There are no timelines to scientific breakthroughs or medical cures. They can happen any time in any place. By restricting research in Canada, we may potentially slow down the cure for many devastating diseases and the suffering of millions of people worldwide. We respectfully request that the committee carefully consider the recommendations we've put before you today. We believe our recommendations will ensure and protect the necessary opportunities for research in Canada.
Thank you for your time and consideration.
The Chair: Thank you, Mr. Forbes.
It's now my pleasure to welcome back Dr. Baylis from Dalhousie University. We enjoyed your interventions in the first round and we look forward to hearing what you have to say about the bill as it's now being considered.
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Professor Françoise Baylis (Department of Bioethics, Dalhousie University): Thank you very much for the invitation to come back. It's always a pleasure--and I might get invited again.
I'm going to stick to a written text, but I will be very happy to engage in what I hope will be an interesting conversation afterwards.
At the outset I'd like to acknowledge publicly that I'm a member of the governing council of the Canadian Institutes of Health Research, and prior to this I was a member of the CIHR ad hoc working group on stem cell research that drafted the CIHR guidelines. I am also a researcher, now funded by the Stem Cell Network to do research in the area of ethics on the sources of stem cells. These affiliations notwithstanding, I want to state very clearly that I am here today speaking as an independent academic, as a professor of bioethics and philosophy at Dalhousie University.
In the brief time available to me I want to draw your attention to five issues regarding human embryonic stem cell research I believe require your attention.
The first concerns a need for a consistent perspective on the ethics of human embryo research. Human embryo research has been explicitly permitted in Canada since 1987. Since then embryos not used for reproductive purposes have been used for all kinds of research, from the development of contraceptives to infertility treatments. Indeed, were such research not permitted, we would not have assisted reproduction in this country and there would be no need for this piece of legislation you are working on.
In my view there has been unwarranted and, I would argue, disproportionate attention to embryonic stem cell research in the discussion of this bill, which is actually about assisted human reproduction. The practice of IVF involves the destruction of embryos and it relies on ongoing embryo research to improve techniques. As with any other area of health care, once we make a commitment to provide a health intervention, we make a commitment to continue research to improve that health intervention. If human embryos can be destroyed for research on IVF to treat infertility, why can they not be destroyed for stem cell research to treat a range of health conditions that afflict fertile and infertile people alike?
Let me be clear, it is right and important that there should be discussion and debate about the ethics of human embryo research. This is an important topic. My only point is that there should be a consistent approach to the moral question about the ethics of human embryo research. The moral status of the human embryo, about which we may or may not agree, should not depend on the purpose for which it was created or destroyed. Whatever position is adopted on the acceptability or not of embryo research, the position should be consistent for infertility treatment, for stem cell treatment, or for any other treatment we might later wish to develop.
The second thing I'd like to draw to your attention concerns the consent issue. The legislation as currently worded stipulates that written consent must be obtained from the embryo donor before making use of an embryo--this is clause 8. You'll not be surprised to know I would support a commitment to getting informed consent. Consent is to be detailed, however, we're told, in the regulations as per paragraphs 65(1)(a) and (b). The legislation as currently drafted does not specify who the embryo donor is, and so we can't know from whom consent must be obtained. As I have argued elsewhere, this omission is irresponsible. One of the fundamental principles of Bill C-13 is free and informed consent. I quote from the bill:
| The Parliament of Canada recognizes and declares that the principle of free and informed consent must be promoted and applied as a fundamental condition to the use of human reproductive technologies. |
In my view, it is difficult to reconcile this commitment to the principle of free and informed consent with the subsequent failure to clearly define in legislation from whom such consent should be obtained and how the consent process should function.
So the question is, who should provide consent? Will the law require consent to embryo research only from the gamete providers, as is currently required in the tri-council policy statement? Alternatively, will the law require consent to embryo research from both the gamete providers and those with the reproductive project for whom the embryos were originally created, as per the CIHR stem cell guidelines? There are two sets of guidelines, two different rules. The bill has to answer this question, but it tells us to wait for the regulations. Another possibility is that perhaps somebody else is to be the embryo donor, a clinic, a company. It seems to me it's absolutely crucial that the embryo donor be defined in the legislation and that this not be left to the regulations.
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My second point about consent is, how should the consent function? Minimum disclosure requirements should be included in the legislation as part of the consent process. This is not to say all the details need be here, but in my view, embryo providers should understand the nature and purpose of the research, and they specifically should know and understand that the research will involve the destruction of the human embryo. They should also know there will be no financial benefit from any future commercialization and no personal benefit in respect of dispositional authority. I think this is a critical issue if we want to attend to the risk of coercion in the context of consent.
Finally, the embryo provider should be told of any perceived, potential, or actual conflicts of interest. In addition to the above, I would argue that there's room to speak to the details of the timing of consent and the right to withdraw before the embryos are used. These too, in my view, should be included in the legislation. They are too important to be left to the regulations. I would draw your attention to schedule three of the U.K.'s Human Fertilization and Embryology Act, where these issues are addressed.
My third point has to do with the issue of policy-making in the absence of data, and I gather there's been some conversation about that today. Bill C-13 limits the acceptable sources of embryos for research to in vitro embryos originally created for reproductive purposes, sometimes referred to as spare embryos. Using only spare embryos to derive embryonic stem cells appears to represent a compromise, if you will, between the demands of science to create research embryos and the concerns of those opposed to intentional embryo destruction. Widespread acceptance of this compromise, however, may rest on the assumption that the number of spare embryos available and eligible for research will be sufficient for future research needs. This assumption may be seriously flawed, however.
At present there are no accurate data on the total number of human embryos stored in Canadian IVF clinics. No one knows how many frozen embryos have been donated or are likely to be donated for research under the conditions required in Bill C-13. There are questions about the merits and limitations of restricting embryo research to spare embryos, but these cannot be critically assessed without the relevant empirical information, which is to say, I can't comment on whether the provisions are good or bad, because facts are missing.
I tried to address this problem in an article published earlier this year in the Journal of Obstetrics and Gynecology, and I've brought copies with me if anyone would like to have a copy. Based on the information I had from a fertility centre at the Ottawa Civic Hospital site, I estimated that there might be 500 frozen embryos currently available for research in Canada. For the sake of argument--and it could be a false assumption--I assumed that half of these embryos would be used for stem cell research, the assumption being that the others would be used for other kinds of research, such as I've already alluded to. I then go on to point out that only half of these embryos, now 125 embryos, would be expected to survive the freeze-thaw process and go on to divide. Of these 125 embryos approximately 9 would be expected to generate stem cell lines. Most importantly, some, but not all, of these cell lines would satisfy the criteria for human embryonic stem cell lines and be available for select stem cell research projects.
Whether that's a good number or a bad number in part depends on what is the objective, and that's the critical value question that needs to be addressed. I would ask you, will the policy actually provide embryos for research? We currently do not know enough about embryo storage and donation practices in Canada, something that hopefully will be redressed with this piece of legislation, such that one would be in a position to have information on the basis of which to make wise choices.
The next point has to do with embryo banking. Since human embryo research is permitted in the legislation under certain conditions, and since the number of embryos potentially available for research is limited, in my view, there's reason to consider the benefits and limitations of establishing a virtual or actual human embryo bank to direct researchers to materials available for research in conformity with the existing rules. As access to embryos for research could then be controlled, it would be possible to introduce mechanisms to ensure that the embryos, potentially a scarce resource, go to the best projects with the best chance of success, so that scarce resources are not wasted.
º (1620)
Lastly, I'd like to address the issue of overlap between the CIHR stem cell oversight committee and the Assisted Human Reproduction Agency. The CIHR stem cell oversight committee has a mandate to review all human stem cell research and will be operational, perhaps with an amended mandate, regardless of whether Bill C-13 or a version thereof is enacted.
If this legislation were to fail—something I desperately hope does not happen—the CIHR guidelines on the stem cell oversight committee would be authoritative in all matters concerning stem cell research. In the alternative, if the legislation is enacted, clearly the law will supersede the CIHR guidelines where there is overlap concerning embryonic stem cell research.
With regard to the specific role of the stem cell oversight committee, in the short term embryonic stem cell researchers will be faced with uncertainty. Will they need to obtain an embryo research licence before or after scientific peer review, before or after local review by the research ethics board, or before or after national review by the CIHR stem cell oversight committee or some other national research ethics review body? With respect, the issue here is not so much a duplication as it is one of coordination, because the bill is going to be fundamentally different in that it will capture privately funded research, something the CIHR guidelines cannot do.
In conclusion, I want to urge you again to consider the following in your ongoing deliberations: first, the need for a consistent perspective on the ethics of human embryo research; second, the need to improve the consent provision in the bill by defining “embryo donor”, stipulating minimum disclosure requirements and detailing the process of obtaining and withdrawing consent; third, the need for facts regarding the number of frozen spare human embryos potentially available for research; fourth, the need potentially to establish a virtual or actual research embryo bank; and finally, fifth, the need to attend carefully to the relationship between the Assisted Human Reproduction Agency and the CIHR stem cell oversight committee.
Thank you for your attention.
The Chair: Thank you, Dr. Baylis.
Prof. Françoise Baylis: If I can, I would just say again that I have brought copies of the article from the Journal of Obstetrics and Gynecology. I have also brought with me two offprints of an article that will be appearing hopefully in the next couple of weeks. One of them addresses the issue of donor consent and who the donor might, should, or could be. The other one is, I hope, a careful analysis of the issues of difference with respect to both structure and substance between the CIHR guidelines and this bill.
I've brought copies of all of those articles if anyone is interested.
The Chair: Thank you. The clerk will receive those and have them copied and distributed.
Prof. Françoise Baylis: There are copies here.
The Chair: Oh, you brought copies? Thank you.
Mr. Paul Szabo: We received the notes from the other witnesses. I guess we don't have notes from Dr. Baylis. I wonder if we could maybe borrow her copy, make copies, and then return her original.
Prof. Françoise Baylis: I brought one copy that you can have.
Mr. Paul Szabo: Oh, okay.
The Chair: We can't distribute it until it's translated. That copy will have to go to the clerk.
Mr. James Lunney: Can I have it with unanimous consent?
The Chair: No, not with the Bloc not present. Dr. Baylis will give it to the clerk. He will then take care of it and we will get it after that.
Thank you very much.
We'll now enter the question-and-answer period, and we'll begin with Mr. Merrifield.
Mr. Rob Merrifield: I'm in a bit of a dilemma, just like this bill, but mine's not quite so critical. We have five great witnesses before us. I think we should have had an hour and a half to two hours for each one, because there's so much here that I would like to ask and so much that it is very important for us to know as we look at this piece of legislation. But I want to start with Françoise Baylis, just because her presentation is fresh in our minds. We've just had her presentation but we don't have her notes.
You have laid out five proposals, five things we should look at. The first one is that we be consistent in how we treat the embryos. I take from that suggestion that, if we're using them for other research, we should be using them for stem cell research. That's what I understand you to be saying. If that's the case and that's your view, then I have a difficult time understanding why it's so important that we understand where they come from; that we have consent; that we know how they're being utilized as far as the numbers in the freezers now are concerned; how come banking is so important; and how come it's so important for the CIHR whether or not it overlaps this piece of legislation. If we've already gone there, if that's our view, I don't understand the logic in that.
So I'm wondering if you could just elaborate a little bit. Maybe I've missed something.
º (1625)
Prof. Françoise Baylis: I'm actually making a number of points. The first point is really just the point of logic: that whichever way you choose to go, you should do the same thing. If you wish to allow it for in vitro purposes to continue to do research, you would need to have a principled reason to draw a distinction. One principled reason would be to look at the moral status of the developing human embryo, which is what most people do when they raise concerns about the intentional destruction of the embryo.
My point is that this argument doesn't work differently depending on the goal or objective. You would have to have a different reason for saying we can do this kind of research, but not that kind of research. Your answer cannot be that the moral status of the embryo is such that it would be wrong to destroy it. If that's a good argument, it has to apply to both areas of research.
It was really just a point of logic, but you could bring other arguments forward. You just couldn't bring that one without applying it in the same way to both kinds of research.
In response to the second question, I would just say there are many things that we can do, but we can do them well or we can do them poorly. In that sense, I think it's important that we look at some of the things I've detailed. For example, I spoke quite clearly here about the issue of consent, but I would do that irrespective of whether it was to be used for stem cell research or in vitro fertilization research. Consent is critically important. So the parameters become a function of the goal.
Mr. Rob Merrifield: Would it be fair for me to assess it, then, as being that the four below your first one are very important because of your concern with the ethics and the way we treat the embryo? The first is that we be consistent in that throughout, however we intend to use the embryo, and perhaps we have been negligent in the way we've treated it up to this point in the research that we've allowed.
Prof. Françoise Baylis: One could draw that conclusion from the perspective that I'm bringing forward, which is just about consistency. If you don't think it should be used for stem cell research because this committee and Parliament and the public believe its moral status is such that it should not be used for that kind of research, the argument necessarily means it should also not be used for in vitro fertilization, and you should therefore not be putting forward this bill.
Mr. Rob Merrifield: I understand your consistency argument, and I agree with your consistency argument. I was just trying to get exactly to where you're going with it, and where we're going.
You've done a little bit of research on this, and you've suggested that there are 500 embryos right now. Is that your best guess, or are you pretty certain of that? Last year, we had numbers between 100,000 to 200,000. That was the number that we had from witnesses who came to committee and said that perhaps that's how many are there. I'm just not sure. There's a radical difference in the numbers.
Prof. Françoise Baylis: I'd like to explain to you how I got that number and let you be the judge of the quality of the information.
I will stand by the answer--because it's quite true--that nobody knows from a strictly knowledge point of view. How did I come up with the number 500? I asked a number of different clinics to provide me with information on how many embryos they had in storage and how many of those embryos they explicitly had a consent for such that they could be eligible for research use.
I did not get answers from some clinics. I got answers from other clinics. Most of the clinics that responded were unable to provide me with information that was usable because of the way in which the information was collected. In the end, I elected to use the information from only one clinic, the Ottawa clinic.
I used that information for two reasons. First, it was very clear, and there were solid numbers. As well, theirs is actually one of the larger clinics in Canada. They do approximately 10% of the IVF cycles. So I took their numbers, multiplied by ten, and then said--very clearly--that 500 could be wrong. And it could be wrong for multiple reasons. Some of the other clinics that also do freezing have not been around for as long as the Ottawa clinic. Some of the other clinics that also do freezing may not do it as well as the Ottawa clinic. Some of the other clinics that do this freezing may be better at getting consents, or not. There are many factors that make the 500 a very slippery number.
So I would never defend it as a solid number, but I would say that in the absence of data, it was a reasonable way to proceed in order to illustrate in a very concrete way what we might be talking about.
º (1630)
Mr. Rob Merrifield: Fair enough. It's your best estimate, and I can accept it as that. I think we all can. It just seems to me, though, that with only a very limited number of clinics in Canada it would be a very simple thing to get a number. Nonetheless, I accept your 500 number.
My time is a problem, but--
The Chair: You have four minutes and ten seconds.
Mr. Rob Merrifield: Okay. Tight leash here.
To Ron Forbes, and perhaps Ronald Worton and Michael Wosnick can add some insight, all through your presentation you mentioned the need for ethical guidelines when we deal with embryos. We talk about doing research into stem cells because of the potential of developing islets. I was actually just at the Edmonton Protocol facility and had a tour through the CIHR lab there. It's a very exciting piece of work, and we should be very proud of what the Edmonton Protocol is doing; nonetheless, it has very little to do with embryonic stem cell research at the present time.
Now, if, as Mr. Worton and Mr. Wosnick have said, triggering the embryo or triggering the stem cell into growing into whatever we want it to is the most ticklish and difficult part about the research, then I fail to understand why we'd say we want it to come from the embryo rather than the adult stem cell, and why the drive for the embryonic when the embryonic is the most difficult to trigger. That's what we've seen, and what witnesses have said.
So I just don't understand the logic behind your insistence in driving for the embryonic, if that's where you're at.
Mr. Ron Forbes: We're not insisting that it's embryonic. We're suggesting that all fields of research should be followed, adult stem cells and embryonic stem cells, because we haven't scientific proof in either case that what we're looking for we're going to get. We believe that if we follow all the various sources, chances are we will find something.
Mr. Rob Merrifield: Perhaps the scientists can help us with the triggering, and why--
Dr. Ronald Worton: I can address both questions, actually. Your comment that the Edmonton Protocol, as exciting as it is, has nothing to do with embryonic stem cells, or ES cells, is not true. I tried to make the point that the greatest problem with the Edmonton Protocol is that tens of thousands of people need to receive islets for treatment when there are only potentially hundreds of sources of material. Therefore, deriving new islets from stem cells is critically important.
Mr. Rob Merrifield: Then maybe I got that wrong. Are you saying that the islets are derived from stem cells now?
Dr. Ronald Worton: No. The islets now are derived from people who have recently died, from cadavers, and they're extracted.
Mr. Rob Merrifield: Absolutely. I don't think we're wrong about the issue.
Dr. Ronald Worton: But the hope is.... A large part of the research of the Stem Cell Network, supported by the Juvenile Diabetes Foundation, is to see whether islets, or something that functions like an islet, can be created from stem cells. If they can, it will solve the supply problem.
Mr. Rob Merrifield: Okay. Now, on triggering, why would the embryonic be easier than the adult?
Dr. Ronald Worton: I didn't say anything about triggering, so I'm not sure where that came from.
On embryonic versus adult stem cells, we're not pushing for any kind of exclusivity or even emphasis on embryonic stem cells. In fact, in our Stem Cell Network, even if this bill passes and we get clearance from the CIHR guidelines, and so on, to work with embryonic stem cells, we will be working with only one of several different cell types
My guess is we'll never do more than 20% of our research on embryonic stem cells, because there are so many other things to do. We just don't want to exclude embryonic stem cells from the research, because we think we will be able to learn some things from them.
It's a bit ironic that we want to see adult stem cells be the cells of choice for therapy a few years from now, but we really believe that to be able to utilize those adult stem cells to their maximum potential, we need to know the differences at the molecular level between adult and embryonic stem cells, so we can exploit them.
Mr. Rob Merrifield: I understand what you're saying. But I don't understand why you can't get that research from animal embryos to prove that. I also don't understand why we can't get it from the human embryonic stem cell lines we've imported from the United States.
Can you explain why we have to go further before we can do that research?
Dr. Ronald Worton: The total number of stem cell lines available worldwide that actually work, differentiate, and behave nicely in culture is nowhere near the 63 or 65 that were originally described a year and a half ago.
Biological variation is really an important factor in all of this. We know that even within the mouse there are a few embryonic cell lines that are used for various purposes. An embryonic stem cell line derived from one strain of mouse is good for certain things, but doesn't work at all for others; a different line is better for other things. So this is just biological variation.
Similarly, we already know that if you prepare 20 human embryonic stem cell lines, they're all going to behave slightly differently. They're going to differentiate more favourably in one direction than another.
So we're just asking for flexibility to make sure we don't reduce our supply of materials that could turn out to be the most important.
º (1635)
The Chair: Thank you, Mr. Merrifield.
Madame Thibeault.
[Translation]
Ms. Yolande Thibeault: Thank you, Madam Chair.
To begin with, I would like to talk about a problem that has caused some concern here in the committee. In its report to Health Canada, the committee recommended to the Minister of Health that the bill specify that applicants would need to demonstrate that the research could not be done with any other biological material.
We are talking, of course, about embryo stem cell research. In the bill that came back to us, the wording has been changed. It says that research can be authorized "only if the Agency is satisfied that the use is necessary for the purpose of the proposed research." These two interpretations are different, which I find somewhat troubling. I know that some of my colleagues are concerned about this as well. In your opinion, has the committee's recommendation been properly reflected in the bill? Could someone, perhaps Ms. Baylis, respond to that question?
Ms. Françoise Baylis: I think that in either case it will be a matter of interpretation. It will be up to the agency and, given the way the agency will be structured, it will have the task of deciding whether a researcher can obtain a licence to carry out research. In any case, I think that playing with the wording will not move us closer to your objective or goal; it will really depend on the committee and how it works.
º (1640)
Ms. Yolande Thibeault: So this interpretation is not of concern to you.
Ms. Françoise Baylis: Well, I think I understand the committee's thinking or what it wanted. I believe that there is a real problem on the scientific side when people are asked to prove the impossible. In order to be able to go ahead, I would have to prove to you that there is no other way I could do what I want to do. You are asking the impossible of me, I would say. This has no direct connection with stem cells; it could apply to any type of research. Since this is such a big problem, the committee will have to sit down and think about these issues in order to decide how it will choose to interpret the evidence that has been requested so as to be able to say yes or no to a researcher. That is why I do not think that the wording will help us. I understand the spirit of it, but the result depends on the people and their desire to really understand the objective or the intention.
Ms. Yolande Thibeault: Thank you very much, Ms. Baylis. You have definitely reassured me.
Dr. Wosnick, you state in the last paragraph on page 3 of your presentation that:
| Human embryonic stem cells could play a similar role in other forms of cancer, for example they could be used to restore liver or brain function following aggressive radiation or chemotherapy treatments. |
You talk about embryonic stem cells. Has any research been done with adult stem cells? Have there been any results? Or has anything been tried along those lines?
[English]
Mr. Michael Wosnick: The real point I was trying to make in that example was not so much to suggest embryonic versus adult. It's really more to suggest, as my colleagues have said already, that we don't want to limit the possibilities at this point.
In the field of cancer research, people think it's very difficult to kill cancer cells; in fact, it's not difficult to kill cancer cells at all. What's difficult is to kill cancer cells selectively so that you don't do collateral damage to healthy tissue and to healthy organs. It's easy to do surgery and cut tumours out. It's difficult to not take healthy tissue and to make sure you have everything, Selectivity is always a problem.
One of the areas, therefore, that stem cell research allows us to think about involves ways to navigate around that problem by being able to now generate a cell type, a tissue, perhaps a whole organ. If something has been surgically removed, if something has been damaged by radiation therapy, if tissues have been damaged by chemotherapy, then it allows us new therapeutic opportunities to regenerate healthy tissues and healthy organs.
I was not making, in that sense, a specific point about embryonic stem cells versus adult ones. But we know at this time that the ability of embryonic stem cells to do that full sort of regeneration, if you will, or to have the greatest degree of output is certainly documented much better than for adult cells. I think it would be fair to say, and I don't think anyone here would disagree, we would hope that in the future adult cells indeed could be found to substitute fully for what we know embryonic cells can do now.
[Translation]
Ms. Yolande Thibeault: Thank you very much, Dr. Wosnick.
[English]
The Chair: Thank you, Madame Thibeault.
Mr. Lunney.
Mr. James Lunney: Thank you, Madam Chair.
Well, I'll go over to Dr. Worton on the stem cells. When Freda Miller came out with skin-based cells that she was able to differentiate into various other cells, the headlines were “Researchers Find Gold”.
Dr. Worton, you admitted today again that you see the best therapeutic advantages with adult cells, and you did previously at committee as well when you were here. That of course is the gold standard: if we can take autologous cells, we avoid all the rejection and so on.
I just want to pick up the point here about immortality of embryonic stem cells. You state here the possibility of being able to undergo continuous cell division for years in cell culture.
I think it's rather disingenuous to suggest that these cells are in fact immortal because they might survive for a few years in a culture. There certainly is evidence that even after a number of years they begin to deteriorate. We've heard other scientists suggest that.
Of course, as stem cells they were on their way to becoming a full-grown human being, which takes roughly 18 to 20 years anyway. That's a normal course of events and certainly nothing near immortality.
Just going on, having made that point, we've had other researchers suggest here that the beautiful aspect of the autologous cells when they're injected back into the body is that they have a propensity to become like the cells they find in their environment.
Let's take that over to the third point here, where you mention a genetic disease like muscular dystrophy. We know, frankly, there are very few true Mendelian genetic diseases. We might add to muscular dystrophy diseases like Huntington's chorea, or Down syndrome or achondroplasia. These perhaps are diseases that are not likely to ever respond to stem cell therapy, and so perhaps should not even be included as an example. If they were, perhaps cord blood would be a solution, because it seems to have less specificity.
Going on with points four and five--I have to just make references, because my time is very limited, and I'll leave you to respond--you deal with cardiac tissue; you claim that there so far have not been successful cardiac cell lines. In point four you mention time, and in the next point you say they haven't differentiated into cardiac cells.
But a study in the paper just the other day talked about immature skeletal muscle cells that were injected into cardiac tissues successfully and developed beating cells. So on the factor of time, even into fibrous tissue in an infarct that's already somewhat into the fibrous stage there seems to be some successful infiltration of active cardiac cells.
The sixth point here, involving pancreatic islet cells, concerns a very specific and small-target tissue; it's one I haven't got an answer for, but I would suggest one is perhaps just waiting around the corner to be discovered.
So I want to suggest that those are rather interesting arguments, but I think it's certainly--to repeat that word--disingenuous to suggest that any of these cells are immortal. In fact, wouldn't you agree, if the gold standard is likely to be found for application to the patients in adult cells, that a moratorium on embryonic cells while we focus our attention on these wonderful progressive advances that are being made in the adult stem cell range would be a more reasonable way to go?
º (1645)
Dr. Ronald Worton: Thank you.
Those are all good questions.
Let me start with your reference to Freda Miller and her skin stem cells. Yes, those cells do grow for fairly lengthy times in culture. They haven't stopped growing yet, so we don't know how long they're capable of growing, but Freda Miller's are a good case in point. These are skin cells that, to her amazement, were able to make cells that looked like and functioned like neurons, so they might have some specific applications in the brain.
They didn't do nearly as well at making muscle or cartilage or bone or some other tissues, the point being that certain cell lines seem to do certain things well, but other cell lines do something else well--and let's not limit the choice.
Freda will tell you that it's terribly exciting to be working with these skin cells. She hopes they're going to be useful in Parkinson's disease one day, but she herself would never advocate.... She stood in one of the committee rooms here and said quite clearly she thought it was still important to continue the work with embryonic stem cells because there might be some lessons to learn from them--not because they might be the ultimate treatment some day, but because we might learn something from them in studying them that will allow us to create the ultimate treatment. That's just a point about Freda.
As for immortality, probably I shouldn't have used the word “immortality” in there. It's a word other people have used quite frequently, and Catherine Verfaillie used it in her arguments, so I picked up on it. But we do need cell lines that will grow for very long periods in culture, because otherwise we'll be having to constantly replenish them from new material, and we don't want to have to do that.
On the other hand, many adult cells, whether they be adult bone marrow stem cells that have traditionally been used in bone marrow transplantation or other kinds of skin cells, typically will grow for about 60 doublings and then die.
º (1650)
Mr. James Lunney: Can I jump in with a quick comment?
The Chair: Yes.
Mr. James Lunney: The point of the autologous transplant is, if you had up to 60 doublings and they go back into the body, they don't need to be cultured for a long time outside the body. There's a continuous supply, for most people, within the body.
Dr. Ronald Worton: Sure.
Mr. James Lunney: They would be injected back into the body quickly and, hopefully, find their target area quickly. Is that not true?
Dr. Ronald Worton: Agreed. Yes, there is no problem.
You said there are a few genetic diseases. There are probably few that are relatively well known to the general public. There are, in fact, over 4,000 genetic diseases. Most of them are not terribly common, although cystic fibrosis is one in 2,000. It's pretty common. Muscular dystrophy is one in 3,000 males. It's only one kind of muscular dystrophy.
When you add up all of the genetic diseases, while individually the diseases are fairly rare, collectively they're a big problem. Some of the therapies that would apply to one genetic disease might well apply to another one as well. Correcting the genetic defect in a genetic disorder is, in fact, very important and not a trivial part of the whole stem cell effort.
With regard to cardiac disease, there have been experiments done on mice and, recently, on humans. Some have put bone marrow into the heart and seen some effect. Some have put skeletal muscle into the heart and had some effect.
Almost all of them are what sometimes are referred to as “shotgun experiments” where you shoot and look. You take cells out of the bone marrow and squirt them into the heart. You look to see if this seems to have an effect after two, three, or five weeks and the answer is, yes, there's some effect.
We heard some presentations last winter. Deliberately, we set up a task force and workshop to look at this. We heard people talking about putting in bone marrow. We were frankly quite worried that the number of cells needed to be put in to have some kind of an effect might, in the long term, do more harm than good. I think we need exquisite procedures to put in the minimum number of cells under appropriate control so they will make exactly the right amount and kind of muscle. To do so, we don't yet know what cell type will be the best.
My own research institute here in Ottawa has recently published the isolation and characterization of cardiac stem cells from the heart. There are two other groups in the world who have found similar things. Those may be the best, but again, we're not saying we have to use embryonic stem cells in order to cure heart disease. I'm saying let's not block the use of embryonic stem cells. We might learn something from them.
Finally on the islets, you mentioned a small and specific target tissue. In fact, diabetes is one of the most common and serious disorders in Canada and the western world. It's growing at a phenomenal rate. Ron can probably give you better statistics than I. It's terribly important.
Mr. James Lunney: It's small, certainly in terms of the size of the target tissue, the islets themselves.
Dr. Ronald Worton: The target tissue is small. So far, as far as I'm aware, there is no real success in taking adult cells of any particular type. People are trying to work with the ducts in the pancreas to see if they will transform into islets and so on. It might turn out to be really good.
The best published data, to date, happens to use embryonic stem cells in the mouse. It has shown they do indeed make islet cells. At least we know embryonic cells are capable of making islet-like cells that will produce insulin. The others, we don't know about.
Mr. James Lunney: Could you make another comment very briefly?
The Chair: No, Dr. Lunney. It's someone else's turn.
Mr. James Lunney: It's a quick comment. Okay.
The Chair: Dr. Bennett.
Ms. Carolyn Bennett: Thanks very much.
I have been concerned over the last while that people's comments have been used out of context, including Dr. Baylis, Dr. Bernstein, and Dr. Miller. Of the people on the ground on this issue of stem cell research in this country, can you tell us if there's anyone who thinks we should abandon embryonic stem cell research in favour of moving on to adult stem cells?
Dr. Ronald Worton: I have not. I'm in touch with virtually all of the stem cell researchers in Canada on a fairly regular basis. We've discussed the topics at considerable length. There is not a scientist in the Stem Cell Network who would make the argument that we should abandon embryonic stem cell research for any reason.
I'm also in fairly close touch with many of the key players in the United States, Catherine being one of them. There are many others. Although I haven't attended some of the more recent meetings in the United States, other members of the network have and bring feedback.
There is a general consensus at scientific meetings among scientists. This is mostly coming from people who, in fact, don't work on embryonic stem cells; they work on adult stem cells. Uniformly, they do not want to stop or block the research on embryonic stem cells. They think there are valuable lessons to be learned from the research.
º (1655)
Ms. Carolyn Bennett: Thank you.
In your last point on therapeutic cloning, Dr. Worton, could you help the committee a little with what that actually is? I think the language is fairly misleading. Basically we don't like cloning. Whatever is therapeutic about it, we're not sure. Could you explain what is really meant by therapeutic cloning and if there's some better language for it so that we could avoid that language forever?
Dr. Ronald Worton: Yes, I'd be delighted to.
In fact, when I heard Ron Forbes' presentation, I was thinking he defined it much better than I could have. I'll try to paraphrase what he said.
Therapeutic cloning is an awkward word. It's not an accurate description, and we should all stop using it. The only reason I use it is that it has become in such common usage. This committee, I think, has been familiar with that term for more than a year now.
Therapeutic cloning is really nuclear transfer. So if we want to treat--let me use myself as the patient--a disorder in me, and we need stem cells that have my genetic constitution, we can take bone marrow or skin or some other tissue, isolate a nucleus from one of the cells that contains all of my genetic information, and put that into an enucleated fertilized egg. You take the nucleus out of the egg that's been fertilized, put the nucleus from my cell in it, and then let it grow for a few doublings so that it will create the stage called “blastula”, where you get stem cells from.
If it will grow to that stage in the form of blastula, then on the inner cell mass are the embryonic stem cells. Those embryonic stem cells now will be identical genetically to me, not to the original fertilized egg. Therefore, when those stem cells are grown up and used for treatment in my body, they will not be rejected. In other words, they behave, in that sense, like an adult stem cell that's taken from me. That's the big advantage. That's why people would like to leave open this option to be able to do that.
The same procedure, of course, is used in cloning an individual, except that before it gets to the blastula stage it is implanted back into the womb and allowed to grow to create an individual.
I, like Ron Forbes and I suspect everyone around this table, am opposed to the cloning of individuals because of the numerous problems associated with it. Also, I think it's not something that has any medical imperative.
Ms. Carolyn Bennett: In banning reproductive cloning, there's an extra step where legislation can take place in terms of banning the reproductive nature of this. Right?
Dr. Ronald Worton: If you ban reproductive cloning and not the therapeutic cloning--
Ms. Carolyn Bennett: You have already banned that so-called next step of implantation.
Dr. Ronald Worton: I would interpret it that way.
» (1700)
Ms. Carolyn Bennett: In terms of internationally, what are the cautionary tales and what is being considered legislatively around the world?
Dr. Ronald Worton: The use of nuclear transfer to create embryos for the purpose of obtaining stem cells is allowed, certainly, in Great Britain. It's allowed in Singapore. It's being discussed currently in the United States. A number of my colleagues have been involved in discussions with the government about this. There have been members of Congress and in the Senate in the United States who have supported this. It hasn't been decided there yet.
In terms of legislation, therapeutic cloning has been allowed in Israel, Japan, and the United Kingdom. It is under discussion in the United States. It is not allowed in a number of other countries, including Germany and France. Canada is down for a “no”, but I guess that's really not certain yet.
This refers to the CIHR guidelines in Canada. It's still being debated in a number of places, and it is allowed in some places and not in others.
Ms. Carolyn Bennett: Are you saying that it could be handled in the regulations rather than in the law?
Dr. Ronald Worton: That was my preference. In fact, if it could be handled in regulations, I think most scientists would agree that for right now we can put it on the shelf and let it lie, and see how the research plays out in animals and other studies. For certain it would be easier if it were going to become a very important tool for therapeutic purposes. It would be much easier to deal with it through regulation and a regulatory body than it would be by changing a law that had already been made.
Ms. Carolyn Bennett: Does Dr. Baylis have a comment from the ethical perspective on this?
Prof. Françoise Baylis: With respect, I disagree. I wrote an editorial for the Globe and Mail in July on this issue of cloning and, in fact, was supportive of the legislation as it is currently drafted, which would preclude both types of somatic cell nuclear transfer. Part of the reason for that is my belief that it is not needed now, and I think Dr. Worton said as much. Part of it is also because I'm quite skeptical about the likelihood of our health care system being able to support the cost of autologous stem cell therapies.
I think if we are able to move in that direction, we will not be doing this on a one-to-one basis for patients. I personally don't believe our health care system will be able to support that. Furthermore, I am on record as saying, having had my law students do the research for me, that there is a little bit of a misunderstanding about what has to be the case with respect to changing legislation. My understanding, based on the research done by my colleagues, is that if you didn't sleep it could be done in 24 days, which is actually less now than would be required to change the regulations, which is 60 days.
Therefore, I think there's a fair bit of misunderstanding about how inflexible the legislation is or needs to be. I think if we look at legislation as being a statement about who we are as a people in Canada and what we believe in, and it's a statement of our values, at the present time I'm very comfortable with the legislation as it's drafted, and as things change, I'm also comfortable for this country and this committee and this Parliament to revisit the issue. But I don't think it's needed now. I don't think we're moving toward autologous transplants in the stem cell context in any immediate future. If we get there later on, then we should have a debate about it again.
The Chair: Thank you, Dr. Bennett.
Mr. Szabo.
Mr. Paul Szabo: Dr. Worton, is the difference between cloning and therapeutic cloning the fact that you stop the process and extract the m-cells and kill the embryo?
Dr. Ronald Worton: Yes.
Mr. Paul Szabo: Thank you.
The Stem Cell Network has been engaged to do a survey of fertility clinics to determine the population of embryos. Can you tell the committee how long this is going to take?
Dr. Ronald Worton: The survey you're referring to, I believe, is the one being undertaken by Dr. Baylis, and it would--
Mr. Paul Szabo: But she's here from Dalhousie today and you're a representative of the Stem Cell Network.
Prof. Françoise Baylis: I'm happy to speak on behalf of my research as an academic. I think it's important to understand that research has yet to be funded. It's a research proposal. That research proposal has been submitted for funding to two different organizations. It has been submitted for funding to Associated Medical Services, which is a not-for-profit research funding organization in the area of bioethics. It is also going to be submitted on January 9 for funding through the stem cell research. So, in part, how quickly that research proceeds will be a function of getting approval both from our local research ethics board and then getting the appropriate funding to move forward.
Mr. Paul Szabo: Who is going to determine what number of embryos is enough to sustain meaningful research?
Prof. Françoise Baylis: I don't know that anybody has the authority or the wisdom to make that decision at this point in time. I think our project is designed to get as close as we can to an accurate understanding of what are the practices currently in place in Canada, what embryos are currently frozen, and which subset of those might be eligible for research.
On the basis of that, we then hope to move forward, because the empirical research for me in this context is really simply a means to an end. It's in order to be able to do other research that I think is important. We want to use that data to ask questions around the issue of the merits or limitations of developing an embryo bank.
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Mr. Paul Szabo: Am I correct that if your assumptions on the availability and deliverability of useful stem cell alliances is correct, you've concluded that something less than nine embryos in Canada would ultimately yield usable stem cell ones?
Prof. Françoise Baylis: No. That's not quite what I'm saying. I'm saying two different things. First of all I'm saying if we assume that there are 500 embryos and we assume that that number--
Mr. Paul Szabo: It's 500, 250, 125, 9 and something less than 9.
Prof. Françoise Baylis: Right. But I think what's really important, and I think I tried to outline that in the article, is that when you do any kind of analysis of that kind you have an obligation to point out the weaknesses in the reasoning.
Mr. Paul Szabo: The hypothesis is that if all your assumptions were correct, it would be less than--
Prof. Françoise Baylis: Right, but another part I haven't articulated that is in the article actually speaks to today versus tomorrow versus next week versus a year from now. And I think you cannot underestimate. It can go in either direction; that's the point I'd like the committee to understand. It could grow phenomenally from 500 to 5,000 if people all of a sudden were persuaded, through the media or whatever, that this was a very good use of their excess embryos. Alternatively, it could go in the opposite direction if people made fewer embryos in the first place.
Mr. Paul Szabo: You made a statement that embryonic stem cell research has been permitted in Canada since 1997 by the tri-council policy.
Prof. Françoise Baylis: Since 1987, by the MRC guidelines first. Those were changed in 1998 to the tri-council policy statement.
Mr. Paul Szabo: This permission is permission of the research community itself to do things. It's not the permission of any legislation or jurisdictional authority, such as a parliament or a government.
Prof. Françoise Baylis: That's absolutely correct, and that is a concern I've brought to the committee before.
Mr. Paul Szabo: We have this legislative vacuum that we're trying to fill.
Prof. Françoise Baylis: That's correct.
Mr. Paul Szabo: If this legislation passes, and I think it will and will get royal assent, and we'll eventually get all the other details done, will this supersede or negate all of the tri-council policy statements?
Prof. Françoise Baylis: It will override anything in the tri-council policy statement and in the CIHR guidelines where there's overlap, and that's absolutely critical for you to understand.
Mr. Paul Szabo: Okay.
What about education and training?
Prof. Françoise Baylis: I'm not sure what you mean.
Mr. Paul Szabo: The tri-council policy statement says embryos can be used for training and educating doctors in the utilization of embryos for transplanting purposes, etc.
Prof. Françoise Baylis: Unless this piece of legislation says it's illegal, that will continue to be the case.
Mr. Paul Szabo: Should this legislation, then, not only address research using embryos, but also specifically permit, under certain conditions, education and training use of embryos?
Prof. Françoise Baylis: I think what needs to be appreciated here is that you've got two problems layered onto this. This bill really is about treatment, and what you're doing is scooping up a very little piece of research. By scooping up such a tiny piece of research, you're actually introducing all kinds of potential areas of conflict. The legislation, unless it says yes or no, won't change the status quo. If it says yes or no, it has the potential to change the status quo.
Mr. Paul Szabo: Okay.
You stated that nobody knows if we have enough embryos for medical research, and I had to think about that one for a while. The CIHR went through a massive process of developing guidelines for the research on embryos, now we've gone through draft legislation, etc., and here we are today having gone from Bill C-56 to Bill C-13. Isn't it strange that we would have all this work and not know whether or not there are enough embryos to even do any research?
Prof. Françoise Baylis: I have offered my services repeatedly to the federal and provincial governments to get that information. Nobody appears to have been interested until now.
Dr. Ronald Worton: I wanted to make a comment that's highly relevant to the numbers of embryos. In the Stem Cell Network we're very aware that if we're going to use this embryonic material to create cell lines, we should do it responsibly and in the best possible way. So we have been developing an approach by which we would make sure the research is done not everywhere in Canada and not by every scientist who wants to do it, but only by a small number. We will insist on certain standards of excellence.
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Mr. Paul Szabo: Dr. Baylis, with regard to informed consent, CIHR has very detailed criteria for this, right back to before donation of the gametes. Is it your view that those criteria should be incorporated in the legislation?
Prof. Françoise Baylis: I would be thrilled, given that I wrote them.
Mr. Paul Szabo: Thank you.
Now I would like to deal with the Juvenile Diabetes Research Foundation. You sent a very nice package to all MPs, I believe, last April. Your covering letter refers to isolating stem cells that could be used to develop pancreatic studies. It says:
| Moreover, these cells could be engineered in such a way that people who receive them might not need highly toxic immunosuppressive drugs, which prevent the body from rejecting “foreign” tissue--currently a major obstacle to successful islet transplantation. |
Based on your testimony, is it fair to say that what you're telling us here is that stem cells can help us, that we might be able to develop islets for transplantation, but this so-called engineering is actually therapeutic cloning that you're talking about?
Mr. Ron Forbes: Yes.
Mr. Paul Szabo: Thank you. That's all I wanted to know.
Dr. Worton, what's necessary? It's really going to come down to that.
Quite frankly, I think Dr. Baylis, Dr. Worton, and the other witnesses this morning have really helped to make me believe that recommendation 14 to the draft legislation is unworkable because it puts the onus on researchers to prove the not provable. When they dealt with the draft legislation, the spirit of the health committee was to suggest a compromise on embryonic stem cells. Instead of saying “Ban them, you can't do it” or leaving it wide open, it was to give everybody a little hook and to suggest that it should be not permitted unless it was a last resort. So if the provisions of the legislation were to state that a licence could not be issued for embryonic stem cell research if it was known by the agency that there was another biological material--say, an adult stem cell or some other way--to achieve the same research objective, would that cause you some grief in terms of amplifying “necessary”?
Dr. Ronald Worton: That would not, the way you stated it. I think the difficulty we had with the wording from this committee last December was that it didn't ask the researcher to show that the research was necessary to achieve the result. It asked the researcher to show that the research couldn't be done with some other tissue. You can never prove that, and I was trying to think of an analogy while I was sitting here. It's like saying, do you need a soccer ball to play soccer, and you do, but could you play soccer with a golf ball? Yes, but it wouldn't be as good. It wouldn't be the same game. So that's the point.
Mr. Paul Szabo: Madam Chairman, it has to do with therapeutic cloning. I am of the belief that there is a strong interest in the research community to allow therapeutic cloning because the anti-rejection problem is going to be solved. It means that you don't have to have an invasive procedure to get analogous cells, etc. You have a beautiful stream and supply and all you have to do is keep taking the DNA out of this egg, from your calf, throw it in here, and now I can help you with all kinds of things. It makes so much sense.
In fact, on May 16, 2001, one week after Bill C-56--now Bill C-13--was introduced, Dr. Bernstein, the president of the CIHR, appeared on the money market television program announcing that he was going to work to change the legislation to get the therapeutic cloning permitted because of the commercialization benefits of the treatment.
Now, I've heard this from so many people. There's more to this, and I hope we're going to see Dr. Timothy Caulfield, who has some information on what happens in the research community about commercialization. The CIHR guideline says, dear donors, sign off, and no matter what we do with your gametes, you cannot participate in any commercial benefit. What it doesn't say is, by the way, we're going to use it for commercial purposes and we are going to benefit.
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The Chair: Excuse me, Mr. Szabo. You're at 12 minutes instead of 5 minutes. I'm sorry you're going to have to ask these people afterwards. We're moving to Mr. Merrifield.
Mr. Rob Merrifield: If you would like to answer that one, I'll let it.
The Chair: Okay, it's in your time then.
Dr. Ronald Worton: On the question about commercialization, I think stem cell research is like any other research. It's like research on drugs, on compounds, on ways of preventing disease. I have no commercial interest whatsoever. Most of my colleagues in the Stem Cell Network have absolutely zero commercial interest or possibility of commercial interest from the work they do. We get paid to be scientists and we do our work.
That's not to say that some of the work done in Canada won't be commercialized; it has to be commercialized, because that's the only way you can bring the product to the people. We could do research in our academic labs for years and years. If we didn't allow it to be commercialized by somebody, it would never become a bona fide service or product to benefit people. Commercialization is the process by which you take it from the academic lab to something that is deliverable and of benefit.
Mr. Rob Merrifield: One of the things we looked at in the first draft piece of legislation that we felt should be in here--in fact, we made a recommendation--concerns the whole idea of the patentability of human life. It's not in this legislation. People say it shouldn't be in the health area; it belongs more in industry. But it is absolutely imperative, if we're going to put a stop on commercialization, that we put something in this piece of legislation on accountability.
Dr. Ronald Worton: But why do you want to put a stop on commercialization?
Mr. Rob Merrifield: No, on the commodification of human life; let's maybe put it that way, if you're going to look at it that way.
Dr. Ronald Worton: Yes, but I think if somebody--
Mr. Rob Merrifield: And that's what patentability is all about. If you're not going to want to patent it.... Why would you want to patent it if you're not going to try to make money from it?
Dr. Ronald Worton: Sure, but let me give you an example. If somebody in Canada developed a stem cell line--adult or embryonic; it doesn't matter--and it happened to be really good and happened to be very good at producing islet cells for diabetes treatment, in order to make it into a product that clinics around the country and around the world could buy, it needs to be commercialized. A drug company might want to commercialize it and make it available, but they're not going to do it unless they have the patent, because they need that patent protection to allow them to invest the hundreds of millions of dollars that might be required to make it a commercial product. Patenting is a necessary part of commercialization.
Mr. Rob Merrifield: Yes, patenting the process is fair enough. Patenting the actual human gene or the human stem cell is a different thing, and that's what we're talking about here. It's sort of like the question, do you patent a star or do you patent the telescope looking for it? That's a whole issue that we talked about here, and we felt we should be saying something with regard to that in here.
What you just commented on, from a scientist's perspective, is interesting.
Is there anyone else? Maybe Françoise Baylis would like to add something.
Prof. Françoise Baylis: I have a couple of comments. With respect to the issue of commercialization and the fact that the issue of consent is in the CIHR stem cell guidelines, the reason for it being there is actually just about telling people the truth, because in fact they ought to know the way the world is constructed right now. The fact of the matter is that there are cases that have been decided around those issues. The most important one that people refer to is an American case, Moore v. the Regents of the University of California, where universities, researchers, everybody but the patient, has made money from the cell line.
First of all, it was just a matter of honesty. People, when they participate in something, should understand the consequences. That is why this is there: it's to let people understand that they will not benefit, because of the current world we live in.
The second thing to say is that there is a concern about moving towards paying people, because it's not so simple to say, well, if everybody else can make money from this, so ought the patient as well, partly because of the concerns of subtle coercion; that in fact, you then end up going to people who might need this as a source of income. So the issue of remuneration becomes a very complicated issue.
I do think, however, the issue of remuneration can be separated from the broader issue around commercialization. I noticed that the statement about patenting human life had been removed. I actually was disappointed to see that had happened, especially in the current context where this a case before the Supreme Court of Canada on the patentability of the Harvard onco-mouse, and a decision there will be made with respect to the patenting of higher life forms.
Again, however, it's a complicated issue because of agreements we have signed with other partners. Europe, Japan, and the United States all allow for patenting in this area; therefore, it's in the context of agreements we've signed that we find ourselves, I would argue, in some sense less independent as a nation than we might be in terms of pursuing our own goals and values. I would encourage you to reconsider and debate this issue of patenting higher life forms, especially the human.
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Mr. Rob Merrifield: Thank you.
I'm sure as we move forward in the 21st century this will become a major issue and we should try to nip it in the bud at this stage.
How much time do I have?
The Chair: None. You've had five minutes and twenty seconds. You're finished, but I'll carry on, if you don't mind.
Mr. Rob Merrifield: One question? It'll last a long time.
The Chair: Dr. Baylis, your response involved “the world in which we live”, and yet your examples were the world in which our American cousins live. Some of us have as our main goal in being here not living in that world and not letting that world change our world, but instead having the courage, through our legislation, to state Canadian values and those kinds of things. Then you went on the say we have signed certain international agreements on this sort of thing. Which agreements are those?
Prof. Françoise Baylis: They are complicated agreements with the World Trade Organization, etc., and the Canadian Biotechnology Advisory Committee has been looking into this issue and would have all that information available in a context that would be much more accurate than anything I could provide.
The Chair: We did have something a few years ago they were trying to get started there that would put together some rules on intellectual property, and Canada decided not to go ahead with that. As a matter of fact, it became derailed even at the international body. I'm sure they still have plans to do that, but as far as I understand, we have not signed anything that has to do with this international property business, as far as trade is concerned.
Prof. Françoise Baylis: As I said, I'm not the best person to speak to that accurately. I do know there have been a number of negotiations, and they were certainly a major part of the discussions while I was a member of the Canadian Biotechnology Advisory Committee. I have not been a member of that organization now for over a year.
The Chair: Certainly, our trade people here, like trade people all around the world, would be pushing the idea that we can't put our own rules in because--
Prof. Françoise Baylis: I'm not advocating that.
The Chair: I know you're not. I'm just saying it's possible that the Biotechnology Advisory Committee is also being advised by the trade officials, who have one perspective. It seems to me that in some cases this committee, which is interested in the health of Canadians and maintaining a set of ethical principles on this very hot topic we're dealing with now, might be the last bastion.
Prof. Françoise Baylis: The thing I would draw to your attention is the comment I made earlier about what the health care system can support. Many of you will be quite aware of how the issue of patenting is already playing out in respect of the availability of certain kinds of diagnostic and other interventions for Canadians. Especially if you think this is an area of health care you'd like to see develop so that we can offer treatments to Canadians in the context of a universally accessible, equal-access, one-tiered health care system, you need to worry about the issue of patenting higher life forms.
The Chair: Such was the case between B.C. and Oregon on some treatment out there, where a woman was denied or something--I've just forgotten the details.
Prof. Françoise Baylis: I was actually thinking of the contemporary debates to do with Myriad Genetics and its patents on the BRCA1 and BRCA2, different provinces going in different directions, and different countries also making decisions about whether or not they're going to respect those patents. The net result is that if it costs too much, the system can't afford to pay for it, and then people don't have access to interventions that might be helpful to them.
The Chair: Do those high prices not have to do with the fact that a pharmaceutical company has grabbed hold of the process or the material? It was a pharmaceutical company, I believe, that prevented a certain procedure from being done in B.C.
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Prof. Françoise Baylis: Yes, you're right, in that the ownership of many of those patents is in the private domain. There again you're looking at a broader issue, which is the reality that the type of research going forward in the current context--and this would be true in the area of stem cells--is extremely expensive. Public funds are insufficient, by and large, to fund that kind of research, so you are looking for partnerships with a number of different kinds of organizations, charitable organizations, pharmaceutical companies, etc. You may well be aware that there is ongoing concern and debate about the nature of these partnerships and the kind of trouble people can end up in with regard to contracts that do or don't get signed and things that do or don't get negotiated away.
The Chair: Certainly, the star of private-public partnerships that rose in the 1980s and continued to rise in the 1990s, it seems to me, has crashed with things like, in Ontario, hydro and the Walkerton water case. All those different things suggest that the public role, which was being diminished over those two decades, is becoming more and more important, particularly with regard to things like health and safety.
I'll go to Dr. Worton, because he suggested that you must have these pharmaceutical companies. If, in fact, a scientist in your lab discovered a process that was going to help mankind solve a problem, with the World Wide Web we have today, why is it that we need a pharmaceutical company? Why can that process not be shared as wisdom has been shared in the scientific community over the ages? Why is it that a pharmaceutical company has to grab that knowledge and patent it?
Dr. Ronald Worton: It really depends on the size and nature of the investment required to bring it to the marketplace, so to speak. Patenting doesn't prevent me from putting all my results on the World Wide Web. In fact, one of the tenets of patenting is that you must do that; you must make available in the patent process all the details of your procedure or your article, whatever it is you're patenting, so that anybody in the world can do it. The patent protects the commercialization. So any academic lab in the world can work on a patented gene; they can do whatever experiments they want.
The value of patenting is where a molecule is discovered that seems to regulate stem cell growth, for example, and a huge amount of research is required to bring that to marketplace, to purify this protein, to study it, to modify it, to make it better, whatever. If that amount of money is measured in the hundreds of millions of dollars, as the drug companies will tell you it is, no drug company is going to invest $100 million unless they can be sure they're the only ones who are going to be able to sell that product for the next 15 or 16 years afterwards.
The Chair: I understand all that talk, because it applies in exactly the same way to other kinds of chemical pharmaceutical products.
Dr. Ronald Worton: Exactly.
The Chair: But now people like Freda Miller and others and you are working in your labs to try to come to solutions for physical health problems. Is your lab funded at the present time by a pharmaceutical company?
Dr. Ronald Worton: No.
The Chair: Is Dr. Freda Miller's?
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Dr. Ronald Worton: Hers is funded not by a pharmaceutical company, but by a small biotech company in Canada.
The Chair: But a private sector company?
Dr. Ronald Worton: Yes, in part. She's funded by CIHR as well and by the network.
The Chair: It seems to me, as soon as we allow private sector companies to form these partnerships and get in on the ground floor of these discoveries, that's when we all of a sudden have to patent things, and then we allow those companies that essentially own the patents to decide how much money will be charged for the treatment. Presidents of pharmaceutical companies have told me that the prices they charge are what the market will bear; in other words, as high as the market will bear. It has little or nothing to do with anything that preceded it and little or nothing to do with the price of producing the drug. I don't want that kind of ethic to come in and start applying to this kind of potential treatment.
Dr. Ronald Worton: If you're asking me whether I disapprove of drug company prices, I do think that's a problem. There's a good case in point with the breast cancer genes we've just been talking about. The Province of Ontario has decided not to pay the exorbitant prices Myriad Genetics wants to charge for doing a breast cancer test. Not only do I support the Province of Ontario in that, but I have talked to people in the provincial ministry, I've given them my views, and I've agreed to sit on a committee to look at this. I think we have to fight that overcharging. However, we still have to recognize that if you want the treatment to be available, somehow you have to support the industry that's going to make it available. If we don't do that, you simply won't have the product.
The Chair: But you are doing work in your lab without private sector investment?
Dr. Ronald Worton: Well, I'm so much involved in research administration now, the amount of work I do in my lab is pretty small.
The Chair: What about your other researchers? I thought you were talking about your whole lab. I'm sure they're doing a lot of hard work.
Dr. Ronald Worton: Within our institute the vast majority of the work is being done with peer-reviewed funding from granting agencies, not from companies. But I'll give you a good example.
Some basic research done in one of our labs by Dr. John Bell discovered a virus that happens to kill cancer cells very efficiently, but it doesn't kill normal cells. Subsequently, over the last five years, he's worked out some of the details of why that happens. You'll realize that a virus that kills cancer cells and not normal cells could be a very valuable treatment, but to develop that virus as a drug that could be given to people, you have to first modify it so it doesn't have any of its viral characteristics. He estimates that the amount of money that would be required to make this commercially available to cancer patients is measured in the tens, if not hundreds, of millions of dollars.
The Chair: Okay, but is that virus connected to human reproductive material?
Dr. Ronald Worton: No, I'm giving an example here of why you need to commercialize it.
The Chair: I understand the example. It's biotechnology and it is a virus and it attacks cancer cells. But what we're talking about here is the similar process you're going to describe about bringing that to commercialization. Should it or should it not apply to human reproductive material? I'm trying to put the case that we should put some kind of a parameter around that particular function and say no. I think there is work being done in a variety of labs that is funded by government and non-profit organizations that could keep that kind of work out of that commercial market, and I think that's what a lot of us are interested in doing.
Dr. Ronald Worton: I guess the only point I would like to make is that it would not be good to put in place regulations or legislation that would allow the academic labs to bring something to fruition--for example, a stem cell of some type--that really could be valuable in a certain disease but the cost of bringing it to the marketplace would be prohibitive for an academic lab, and then disallow--
The Chair: Why do you have to bring it to the marketplace? If you share the information on the process, why could other labs not do the same thing so that it would become available across the country?
Dr. Ronald Worton: It will, but academic labs are not set up to provide materials for therapy. Even if I wanted to, I couldn't in my lab grow stem cells and inject them into a person. They would have to be grown in special lab facilities, with special protections, with all of the various tests done to show they don't bear this or that virus. I couldn't, in my academic lab, produce materials that would be acceptable to the Canadian authorities or to the FDA in the U.S. for use in a person. It would be prohibitively expensive for me to do that.
I can do the mouse experiments just fine, because if I make a mistake or the material is contaminated and the mouse dies, it's not so serious.
Mr. Rob Merrifield: Excuse me--
The Chair: Yes, go ahead.
Mr. Rob Merrifield: --in the absence of our chair, I'd say you've used your time.
Some hon. members: Oh, oh!
The Chair: Yes. I think Mr. Merrifield--
Mr. Rob Merrifield: We're here until about 5:30 p.m., is that right?
The Chair: We're supposed to be, so we're a bit over. But I think Mr. Lunney wanted to make a statement.
Go ahead, Mr. Lunney, and then we'll come back to Mr. Merrifield.
Mr. Rob Merrifield: I'd like to submit a comment. To be honest, I don't think this is fair to the witnesses and I don't think it's fair to the committee. They're such expert witnesses and the questions are intense and we have more. I honestly feel that we very well should have them back again in the future to spend some more time. I think they're very valuable to have before us.
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The Chair: You're talking process now and we're into substance.
Mr. Rob Merrifield: No, but I'm talking at the end of the meeting and you usually make that comment that we may have them back again.
The Chair: Well, we may have to, but seeing that this is the third time some of them have been here, I don't think.... I think if it's the first round, and maybe even the second round....
Mr. Lunney, go ahead.
Mr. James Lunney: The questions are getting better every time.
Prof. Françoise Baylis: Are the answers getting any better?
Mr. James Lunney: For the benefit of our colleague who asked this earlier, is anyone saying we should abandon embryonic stem cells? We have had witnesses here who say yes, we should, and those are ones who are working with autologous stem cells out of their own body and able to reinject them into the body.
I understand that with cancer therapy you can stimulate the marrow to release stem cells, extract them from a simple blood sample, centrifuge them, isolate the stem cells because of their smaller specific gravity, grow them in vitro, and put them back in the body. Now, under that scenario, the opportunities for commercialization would be very minimal, because you may need to patent a drug that stimulates the bone marrow, but the cells would remain the possession of the person donating them and they go back into his own body. Having made that point, perhaps you can comment on that.
My question here is related to another subject, and that is that the nuclear transfer you mentioned, Dr. Worton, was basically genetically identical for therapeutic cloning. I want to raise the question of mitochondrial or extra-nuclear DNA that would be there from the donor of the ovum. Does anybody know how compatible DNA from mitochondria would be with the nuclear DNA coming from two different beings in that cell?
Dr. Ronald Worton: You're absolutely right that the mitochondria would still be characteristic of the original embryo, and the DNA in them would be characteristic of the original embryo and not the nuclear donor. Whether that would turn out to be a significant complication in using those cells for therapy, it would be hard to hazard a guess right now. My guess is it wouldn't have a big impact, but those experiments haven't been done, to my knowledge.
Mr. James Lunney: So would somebody care to comment on the opportunities for commercialization with autologous transplant?
Dr. Ronald Worton: Even with autologous transplants, we still have to be able to control the cell. So if we take bone marrow from you and want to put it into your brain to help you with Parkinson's disease, we want to be absolutely sure that those cells are going to make neurons, and not bone or something else.
We don't know yet what the regulatory processes are, what molecules control that, but once we know that, it will very likely involve a biopharmaceutical or biotechnology company to develop those chemicals to make them readily available, and so on. It may well be that the only patent will be on that very process, and will have nothing to do with the stem cells themselves. That's the more likely scenario.
Mr. James Lunney: We've had information from other researchers that suggests that when autologous cells find themselves in a repair zone, they identify with the cells in their environment.
Dr. Ronald Worton: That's been the experience to a very large extent, but it's not exclusive.
Mr. James Lunney: It would eliminate a lot of the problems you've discussed.
Dr. Ronald Worton: Absolutely. There's no question that autologous stem cells hold a lot of promise. We believe a lot of the therapy that will be done with stem cells in the future will be done with adult stem cells. We believe we may need to do some research on embryonic stem cells to get to that point, because they are better at doing certain things, and we want to know why they are better so we can transfer those properties. We're simply asking, as the legislation does, to allow the work to proceed so we don't close that door. There may be one major disease or five major diseases where for some reason embryonic stem cells will do better, and we don't want to close the door.
Mr. James Lunney: With all due respect, with what we've discussed today and all of the discussion about the tremendous commercialization potential and millions of dollars to develop this line or that line and patent things, if we were able to find a simpler way that avoided all that commercialization, that would certainly be preferable. As was discussed earlier with witnesses, if there are millions of dollars at stake in patents, can we be sure the research industry is going to go for the simple answer that offers the most hope to Canadians, rather than the one that has the tremendous profits?
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Dr. Ronald Worton: Boy, that's a good question. Certainly the academic research community always tries to do things the simplest way and the cheapest way. We're dealing with relatively small dollars compared to the commercial outfits.
By the way, there isn't very much commercialization in the stem cell area. We've been looking at that as a network, to see how many companies out there are doing stem cell research and what their level of interest is in what we're doing, and there isn't very much right now. Some of the drug companies that started doing some stem cell research three or four years ago are backing off and taking a wait-and-see approach.
So right now the field is largely in the hands of academics in universities and teaching hospitals, and we're always looking for the simplest solution. I think one of the simplest solutions for some applications might be not to take stem cells out of anybody's body and grow them in culture and put them back, but rather put in a chemical that will stimulate stem cells in your own body to do what we want them to do. But developing that chemical and making it available in purified form, perhaps suitably modified to do its job without having any toxic side-effects, may require a partnership between an academic lab and a biotech company; or it might require transferring that information to the biotech company, so they can take it the next step to bring it to market.
The Chair: Thank you, Mr. Lunney.
Mr. Merrifield has another question.This will be the last one, if it's okay with everybody.
Mr. Rob Merrifield: I understand you're coming here from a scientific perspective and I appreciate that. I think we all do appreciate that around the table, and it's very informative.
From a scientific perspective, you're pushing for the therapeutic cloning or the nuclear transfer because you would perhaps not have to get those from a weaker stem cell. You would actually create them fresh rather than from the in vitro side of things. Let me clarify that.
In the United Kingdom they're developing embryos solely for the purpose of research rather than where we're at right now, sitting around this table, talking about what some people term as the “leftover embryos”. From your perspective, once we've moved to the leftover embryos, and if we're okay with that, if we can say, all right, the end justifies the means, then why would we not go to the area where fewer of them will die because we can get them before they go through the freezing process? Is that where you would be at, and would you have a problem going there as a scientist?
When I look through all of your briefs, I see that you all talk about ethics, and I'm wondering what ethical guidelines you're using and if you would be prepared to go there.
Dr. Ronald Worton: In my own mind I make a big distinction between research, which might use a relatively small number of nuclear transfer embryos, and therapy, which would require a lot more.
I certainly agree that if the generation of embryos by nuclear transfer for therapeutic purposes would require a larger number of frozen fertilized eggs for development, I don't know the availability of that. I was under the impression for a long time that they wouldn't be readily available, and certainly we do not want that to become commodified in the sense of a commercial enterprise to generate those. I'm also told by the folks in the in vitro fertilization area that frozen eggs at the one-cell stage are relatively available as well.
If we need regulations and we want to protect people from commodification of embryos or fertilized eggs, we can deal with that through regulation. We can also deal with it through legislation, if necessary. You don't need to stop the research on that material in order to prevent the commodification of the material. You can separate those two issues fairly cleanly.
Mr. Rob Merrifield: I would argue you don't need to start using those embryos to do the research on embryonic stem cells when you can do it in animals and you can do it from imported stem cell lines. There are arguments on both sides on it.
What I'm trying to drive to is this. Where are we going as Canadians and as a nation when we're prepared to go to where this legislation will get us?
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Dr. Ronald Worton: I'm certainly not arguing right now for research to be allowed in the area of therapeutic cloning. And I agree with a lot of the comments that Françoise made earlier. I'm only making the argument that I think Tim Caulfield has made repeatedly, and that is that to legislate against it when it might be valuable someday is perhaps premature. If what I heard earlier today from Françoise is correct, that it might be just as easy or even easier to change the legislation than the regulations, that gives me some assurance that we're not in a totally inflexible situation where we couldn't address this issue at a later time.
The Chair: Thank you, Mr. Merrifield.
On behalf of the committee, may I thank all our witnesses. You're extremely helpful to us; in other ways, you give us other things to worry about. It was terrific, and not just for this time but for all the times you've come. As you know, we're not averse to phoning you if we need you.
Thank you to my committee members. I'll see you tomorrow at 3:30 p.m.
This meeting is adjourned.