Debated in Parliament on 16 Oct 2012.
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Order for Second Reading read.
Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."
The Voluntary Sterilization Act (VSA) was first enacted in 1969 and came into force in 1970. It was introduced to provide legal certainty for sexual sterilization procedures performed by registered medical practitioners, for the purposes of family planning.
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As this was a relatively new policy then, the VSA included a number of safeguards and these were: (a) controls on institutions where such surgical procedures could be carried out; (b) professional qualifications of the medical practitioners who could carry out such procedures; (c) the requirement for consent to be obtained before a person undergoes such procedures; and (d) protection for the confidentiality of personal information of those who undergo such procedures, as this is a sensitive and private matter.
Between 2003 and 2011, a total of 27,905 persons underwent voluntary sexual sterilization. The VSA was last reviewed nearly four decades ago in 1974. There have been many changes in Singapore since then, both in the healthcare landscape as well as in society in general. It is therefore timely for us to review and amend the VSA to ensure that it remains effective and relevant today.
In addition, Singapore is working towards becoming a party to the United Nations Convention on the Rights of Persons with Disabilities (the UN Convention). We are therefore making amendments to the provisions in the VSA that may be viewed as potentially discriminatory against disabled persons.
I will now elaborate on the proposed amendments to the VSA. Under the VSA, a person must give his or her consent before undergoing a sexual sterilization procedure. However, sections 3(2)(d) and 3(2)(e) of the current VSA provide that for persons who are "afflicted with any hereditary form of illness that is recurrent, mental illness, mental deficiency or epilepsy", the spouse, parent or guardian of such persons have the power to consent on their behalf, even though such persons may still be capable of giving their own consent despite their conditions. We need to change this.
The amendment in clause 3 of the Bill will align the VSA with the approach taken in the Mental Capacity Act (MCA), which came into force on 1 March 2010. With the amendment, a person is presumed to have mental capacity as defined in the MCA to make decisions for himself or herself, and should therefore give his or her own consent to undergo sexual sterilization, unless it is shown that the person lacks mental capacity. In this way, we will return autonomy to those with mental or hereditary illnesses, but who still have the mental capacity to give their own consent.
This amendment will also bring the VSA in line with the UN Convention to accord persons with hereditary illnesses or mental disabilities with the same legal rights as others. This will then enable Singapore to accede to the UN Convention, which we aim to do by the end of this year.
We have also received various feedback from families, interest groups and the public, on the issue of safeguards for those who lack mental capacity. Some were of the view that the decision to have such a person undergo sexual sterilization should rest with the family, as they will be the ones who have to care for the person and live with the consequences of such a procedure. Others have cautioned that there may be instances where the spouse, parent or guardian may not act in the best interest of the person who lacks mental capacity, in giving consent for such a procedure to be carried out.
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My Ministry has weighed all the concerns and views that have been raised, taking into consideration the important role of the family in such decisions, as well as the need to protect the welfare of this vulnerable group of people.
Clause 3 of the Bill will amend the VSA such that for persons who lack mental capacity, while the spouse, if the person is married, or the parent or guardian, if the person is unmarried, may be the one who first comes to a decision that the person should undergo such a procedure, as an additional safeguard, the spouse or guardian will need to apply to the Court for an order to proceed. Similar to the Court's role under the MCA, the Court may then make an order declaring that the treatment is necessary in the best interests of the person. This application will need to be supported by a doctor's report stating that the person lacks mental capacity to give his or her own consent to the procedure, and that the procedure is necessary in the person's best interests. Reference will be made to provisions in the MCA in determining whether a person lacks mental capacity, and whether the treatment for sexual sterilization is in the person's best interests.
The current VSA requires healthcare institutions that can carry out sexual sterilization procedures to be first approved by the Minister for Health. This requirement is a historical one. When the VSA was first enacted, hospitals and clinics in Singapore were not yet licensed or regulated by the Ministry. There was therefore a need for specific approval from the Minister, to ensure the safety and suitability of the institutions carrying out sexual sterilization.
However, this requirement has been made obsolete with the licensing of healthcare institutions under the Private Hospitals and Medical Clinics Act (PHMCA), which came into force in 1993. Furthermore, sexual sterilization involving tubal ligation for females and vasectomy for males are today relatively simple procedures that do not require any complicated equipment or setup. With clause 4 of the Bill, we will amend the VSA such that these procedures can be carried out in institutions that are already licensed under the PHMCA, without the need for specific approval from the Minister.
Under the current VSA, sexual sterilization procedures can only be carried out by registered medical practitioners who either have certain specialist qualifications or have acquired a certain amount of training or experience. These requirements are outdated and not reflective of the current practices.
Previously, a medical practitioner is allowed to perform a surgical procedure, such as sexual sterilization, just based on the fact that he had previously undergone a certain amount of training or experience in that area. Today, in the larger healthcare institutions, such as hospitals, they now rely on well-established credentialing systems, whereby only those practitioners who can show that they have adequate training and have kept up-to-date in their practice, would be allowed to perform certain types of procedures in that institution. So, we will amend the VSA to reflect current practice norms in our healthcare institutions.
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The amended VSA will allow registered medical practitioners in a PHMCA-licensed hospital or ambulatory surgical centre to carry out such procedures once they have been credentialed by their institution to do so. The respective institutions will be responsible for ensuring that they only allow medical practitioners who are adequately trained and possess the necessary skills, to carry out the procedures. In the smaller specialist medical clinics, which do not have such a credentialing system, the VSA will still require that such procedures be carried out by certain recognised specialists, such as surgeons, urologists, obstetricians and gynaecologists. These specialists are accredited as possessing the requisite qualifications and experience, and registered with the Singapore Medical Council.
Patient confidentiality and consent are the fundamental tenets of good professional conduct and practice of healthcare professionals, and the penalties for breaching these obligations should reflect the severity of the offence.
The penalties in the VSA for unauthorised disclosure of confidential information will be increased, to align them with similar provisions in other healthcare laws like the Infectious Diseases Act and the Human Organ Transplant Act. The maximum fine will be raised from $2,000 to $10,000. The maximum jail term of 12 months remains unchanged.
The VSA will also be amended to raise the maximum fine for persons who coerce or intimidate another person to undergo sexual sterilization against his or her will from $5,000 to $10,000. The maximum jail term of five years remains unchanged.
My Ministry conducted a public consultation on the proposed amendments on the VSA from 4 June 2012 to 2 July 2012. The feedback has been broadly supportive.
We have also received valuable inputs from various quarters, through the formal consultation process, as well as through our other usual feedback channels even after the consultation period is over. We have taken such input into account in finalising the proposed amendments to the VSA. I would like to thank all those who have taken an interest in the Bill and provided their valuable input.
In conclusion, Sir, this Bill will make the necessary amendments to update the VSA and ensure that it remains relevant to Singapore today. It will also amend the VSA to provide better protection for persons with disabilities and bring it in line with the United Nations Convention on the Rights of Persons with Disabilities. Sir, I beg to move.
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Question proposed.
Mr Speaker, Sir, in Mandarin, please.
(In Mandarin): [Please refer to Vernacular Speech on Pg 1026.] Voluntary sterilization has been practised in many countries for various reasons, as a form of birth control, for medical and social reasons as well as eugenics-based practices for the control of certain hereditary diseases. Because voluntary sterilization is surgical and carries with it certain risks and is intended to be permanent, it demands more robust measures to protect the individual against discrimination and potential abuse.
The amendments to the Voluntary Sterilization Act (VSA) are necessary to keep pace with the changes in society and to ensure that it remains relevant in the modern day context. The current provisions in the VSA are potentially discriminatory against those with disabilities, such as mental illness, mental deficiency and epilepsy, as it does not take into account the different severity of these conditions and many with such conditions may still be capable of giving informed consent.
Besides meeting the requirements of the United Nations Convention on the Rights of Persons with Disabilities and aligning with the Mental Capacity Act which came into force in March 2010, it also takes away the ambiguity and uncertainty of the legitimacy of the consent that the doctors have to obtain before performing the procedure on such persons who lack mental capacity.
For persons who lack mental capacity, the current provisions allow parent/guardian, if unmarried, or spouse, if married, to make the decision and give the consent for sexual sterilization procedure. While there have not been cases reported of wrongful intentions, this can be a potential problem without the necessary safeguards to protect such persons. It cannot be over-emphasised that the best interest of the patient remains centre-stage in all these debates on the amendment Bill. Questions have been raised as to whether a parent or a guardian should be allowed to consent to the sterilization of an incompetent person without an independent third party approval. The major concern is that a request for sterilization may be made to satisfy the needs or convenience of the person requesting the sterilization, and may not necessarily be in the best interests of the incompetent person. I am glad that the amendment mandates that sterilization of such persons may only be carried out if the Court declares that the sterilization is necessary in the best interests of the person.
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In addition, I strongly support the removal of the phrase in the current VS Act that "the doctor must certify that treatment is necessary in society's interest." Unfortunately, such a phrase may be misinterpreted to mean that sterilization may be carried out for eugenic reasons. Doctors or policy makers should not play God to decide who or who should not inhabit this world. Eugenic sterilization infringes on basic human rights. The perception that disability is inherently bad and people with disabilities lead blighted, tragic lives ignores and invalidates our actual lives and experiences. We must constantly remind ourselves that it is not the disability so much which restricts equality and full participation in society, but the combination of social stigma, systemic barriers and prejudices. How gracious and magnanimous a society is, can be reflected in how we treat and embrace the least fortunate amongst us.
(In English): Mr Speaker, please allow me to continue in English. The amendments to the Voluntary Sterilization Act (VSA) are necessary to keep pace with societal changes and the expectations of Singaporeans. It needs to stay relevant in the modern day context.
Sir, as Chairman of the GPC for Health and as a doctor, I fully support the decision to align the VSA with the Mental Capacity Act 2010. The amendments, as we know, make clear the conditions in which the process can be carried out, especially in the cases of persons who lack mental capacity. The formalisation of the process, will allow the doctor performing the procedure to know clearly the limits to which the process can be carried out.
As I went through the Bill, I noticed that one of the key elements is to align the Act with the United Nations Convention on the Rights of Persons with Disabilities (CRPD) and to impose a requirement for court order in cases involving treatment for sexual sterilization for persons who lack mental capacity to consent to such treatment. Such persons are unable to give informed consent, and thus cannot be considered voluntary in the true sense of the word. Paradoxical as it may seem, the title of the Bill is "Voluntary Sterilization Act". A more appropriate name will be "Voluntary and Proxy Consent Sterilization Act".
Majority of patients undergo voluntary sterilization for medical and contraceptive reasons. Sterilization to prevent pregnancy of a woman, who is mentally incapable of giving informed consent, must be performed after due considerations and in the best interests of the person. So, what are the possible reasons or justification for this procedure to be carried out on the mentally incompetent?
The obvious medical rationale would be to prevent harm, if pregnancy or delivery would endanger the life or health of the mother. The social rationale would be to prevent harm to the child if the mother is mentally unable to provide appropriate care for the child.
As surgical sterilization is an invasive procedure and it involves an element of risk, it is imperative for the doctor and the guardian to consider other alternatives of pregnancy prevention before proceeding with the application for court order for surgical sterilization. There should be strict guidelines for such proxy consent sterilization. It must be established that the person's mental capacity must be permanently incompetent and in accordance to the provisions of the Mental Capacity Act. It cannot be over-emphasised that sterilization is performed in the best interest of the patient and is also the most practical and least restrictive contraception available. The motivation for requesting sterilization must also be examined very carefully and whether they are in conflict with the patient's interest.
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Sir, while I agree and support the amendments, I do have some clarifications for the Minister on certain provisions in the amendment Bill. Singapore, having one of the lowest total fertility rates in the world, has a rather liberal legislation on voluntary sterilization. While I strongly support the need for more protection for persons with mental incapacitation, the law seems quiet on certain restrictions on sterilization seen in many countries, such as minimum age and parity requirements. A number of countries have specific age and parity requirements for sterilization. The most common minimum age is 25, and can be found in some Nordic countries. Some countries impose parity requirements only, which are based on a person's number of children. In Tunisia, an individual must have four children before obtaining sterilization for contraception purposes; while in Panama, a woman must have five children. Several countries, however, combine parity and age requirements. For example, Finland has a minimum age of 30 or a requirement that a person has had three children, if younger than 30, before sterilization is allowed.
Another issue of major concern in the context of voluntary sterilization is that of informed consent, that is, whether the sterilization is truly voluntary. As a legal matter, informed consent generally requires that the person seeking a medical procedure be provided information on the risks, benefits, alternatives and characteristics of the procedure. In the case of sterilization, required information would include that temporary methods are available, that the procedure involves surgery, that the surgical procedure involves risk and benefits, that the procedure is permanent and also worth mentioning is that the procedure does not provide any protection against sexually transmitted infections, including HIV. Thorough counselling is, therefore, important and I hope MOH can consider making pre-sterilization counselling a pre-requisite.
There is also concern that the amendment Bill provides insufficient protection to minors. Section 3(2)(c) dictates that persons under 21 can consent to sterilization for non-medical reasons, provided a parent or guardian also gives consent to such treatment. However, there is a deep concern as to what extent minors, especially those who are much younger, are able to comprehend the concept of sexual sterilization. Potential controversy may occur in cases where the other parent of the child objects to the procedure, for whatever reasons. A number of countries either have a minimum age where persons are considered capable of consenting to sterilization, or require a court order before a minor can be sterilized. This is not the case in our current or amended Bill.
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Sterilization undertaken solely to control fertility of and reproduction by mentally incompetent persons can be both contentious and potentially subject to abuse. When sterilization is contemplated, it should clearly be demonstrated that it is for the benefit of the individual and not solely for the benefit of the caregiver or a third party. The rights of the individual must always be protected. Section 3(2)(d) and (2)(e) dictate that for a person who lacks mental capacity within the meaning of section 4 of the Mental Capacity Act to consent to such treatment, if on application of the spouse, parent or guardian of the person, the High Court makes an order declaring that such treatment is necessary in the best interests of that person.
I would like to clarify with the Minister if this process of applying to the High Court would be tedious and costly and what assistance can be rendered to families who lack the knowledge and financial means to proceed with such an application.
In the rare event that the spouse, parent or guardian of a previously High Court approved sterilized mentally incompetent person decides to opt for a reversal of the tubal ligation or vasectomies, will an application to the court to reverse the procedure be required?
Sir, it is also useful that under the new amendment, the list of institutions carrying out sterilization will be expanded to all health institutions, as long as the doctor carrying out the procedure has the proper means, capability and qualifications to do so. While I agree that it is indeed useful to allow more institutions to carry out such process, may I know the process by which the checks to ensure that such procedures are carried out in accordance to the statutes spelt out in the Act? I understand that the amendment in section 6 gives public officers, authorised by the Minister for the purpose, to have the power to inspect the health institutions and examine records of such sterilization. How then is the public officer able to audit all such health institutions, clinics, hospitals and so on, to ensure that there is no deviance from the original intent of the VSA?
Sir, laws forbidding sterilization of the mentally incompetent may be nearly as dehumanising as the forced sterilization laws they replaced. The Voluntary Sterilization (Amendment) Bill needs to be carefully calibrated to protect the vulnerable, yet not be excessively restrictive. Weighing the complex medical and ethical issues involved and determining patients' best interest require one to be cautious and thoughtful, with individual case reviews with strict procedural safeguards. With that, I support the Bill.
Sir, overall, this Bill takes an important step to better align our Voluntary Sterilization Act (VSA) with certain international norms concerning the rights of disabled persons. However, the proof of progress will be in its implementation. I will also raise a concern about the Bill later in my speech.
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The Explanatory Note to the Bill states that this amendment seeks to align the VSA with the UN Convention on the Rights of Persons with Disabilities ("CRPD"), "by removing provisions which may lead to discrimination against disabled persons". Turning to the CRPD, Article 23 states that countries should ensure that "Persons with disabilities, including children, retain their fertility on an equal basis with others". In other words, the amendment should put disabled persons on par with others, as far as the decision to undergo sexual sterilization is concerned.
To this end, I agree that the current law does require amendment, as it is not satisfactory in certain respects.
Under the existing section 3 of the VSA, a person with "any hereditary form of illness that is recurrent, mental illness, mental deficiency or epilepsy" will be liable to be sterilized if two conditions are satisfied – first, that the spouse, parent or guardian consents; and second, that a doctor confirms that it is "in the interest of the person undergoing such treatment and of society generally". The section seems to assume that any person with a recurrent hereditary illness or any mental deficiency would be incapable of making up his or her own mind about sterilization, thus justifying the spouse, parent or guardian and a doctor taking over that decision. The current law also states that the doctor is the final gatekeeper of whether such sterilization is in the best interest of the person and of society generally. It is not clear from section 3 itself what considerations the doctor should take into account or how decisions had, in fact, been made in the past. The need to consider "society generally" also appears ambiguous, and may open the floodgates to eugenics where we only allow the fit to reproduce and the weak are denied the right to be accorded full human dignity.
To that extent, clause 3 of this amendment Bill seems to improve things. First, there is no longer a sweeping assumption that a person with a recurrent hereditary disease, epilepsy or mental deficiency is automatically not able to make these decisions; the new section 3 will allow others to decide only if the person is considered to be "mentally incapable" as defined by the Mental Capacity Act (MCA). Secondly, potential sterilizations of persons without mental capacity must be approved by the High Court. Such judicial oversight in itself will introduce more transparency and consistency in decision-making, as reasoned judgments may be published in law reports and serve to guide future cases. Thirdly, the amendment now makes it irrelevant to consider the interests of "society generally" as this phrase will be deleted from the section. The decision now whether a mentally incapable person should be sterilized will be based on the consideration of the "best interests of the person" alone.
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What then amounts to the person's best interests? This is not defined in the Bill, which instead directs us to Part II of the Mental Capacity Act for the relevant principles and definitions. Under section 6 of the MCA, determining the "best interests of the person" lists many considerations, including the person's past and present wishes and feelings; it also requires the decision-makers to place themselves in the shoes of the person, to ascertain what the mentally incapable person would have likely decided on his or her own, considering the person's wishes, beliefs and values. In addition, in deciding whether sterilization should be done on a mentally incapable person, the MCA principles would suggest that decision-makers should not be motivated by a desire to bring about that person's sterility; this is analogous to section 6(5) of the MCA, where decisions on life-sustaining treatment should not be tainted by a desire to bring about that person's death.
Sir, the reference in section 6 of the MCA to respecting the person's beliefs and values is vitally important in decisions concerning sterilization. As we are aware, there is a sizeable group of Singaporeans, particularly from the Muslim and Catholic faiths, who do not endorse sexual sterilization for contraceptive purposes. The Voluntary Sterilization Act itself at section 10 recognises that there are Singaporeans who have "conscientious objections" to sexual sterilization. While those with mental capacity can decide for themselves what they wish to do, those without mental capacity will have this very personal and intimate decision made by others. Extra care should, therefore, be taken in implementing these provisions. Those entrusted with assessing whether sterilization would be in the best interests of a person with mental incapacity should accordingly give due weight to the person's beliefs and values.
Order. I propose to take a break now. I suspend the Sitting and will take the Chair again at 4.05 pm.
Sitting accordingly suspended
at 3.44 pm until 4.05 pm.
Sitting resumed at 4.05 pm
[Mr Speaker in the Chair]
Debate resumed.
Mr Speaker, before I speak, can I confirm that we have a quorum? I know a quorum would be achieved in due course, but I think it is a Point of Order.
Asst Prof Tan, are you challenging the quorum? If you are, we will go through the procedure.
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Mr Speaker, I do not understand the question.
The question is, if you are calling for a quorum, and you are challenging that there is no quorum, I will then go through the procedure. I want to clarify whether you are challenging the quorum because you seem to be equivocal in your statement, "I know you will achieve a quorum, etc, etc".
Yes, Sir. I want to request that there be a quorum.
Okay.
*Thereupon, a count was made.*
There are 11 Members present in the House. I will ask the Clerk to ring the bell.
*Members summoned into the Chamber as if for a division.*
We do now have a quorum. Asst Prof Eugene Tan.
Thank you, Mr Speaker. Sir, the Voluntary Sterilization Act was first enacted about 40 years ago. It was a very different era then in the way we treated people who lacked mental capacity. I wonder how we allowed such a state of affairs to persist for such an extended period of time. That was also a time when we, as a society, probably did not adequately respect the right of every person, regardless of his or her mental capacity, from unwanted bodily interference, including involuntary sterilization. It was also a time when a person who lacked mental capacity was treated as someone who was not entitled to basic rights, including that of personal inviolability and procreation rights. The Bill before us today will correct some of those inadequacies.
Sir, I will focus my remarks on clause 3 of the Bill which stipulates that voluntary consent is required for sexual sterilization from all persons with mental capacity. Where it relates to a person who lacks mental capacity, involuntary sterilization can only be carried out if, on the application by an appropriate person, the High Court makes an order declaring that the treatment is necessary in the best interests of that person. Clause 3 also stipulates that Part II of the Mental Capacity Act shall apply in such matters under consideration.
In particular, I would like to raise my concern regarding minors seeking sterilization under the proposed amendments. The proposed amendments require persons under 21 years of age to consent to sterilization for non-medical reasons, provided a parent or guardian, in the case of an unmarried minor, also consents; in the case of a married minor, the spouse's consent must be obtained.
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Sir, I must admit that I find it hard to comprehend why the Bill requires a Court Order to authorise the sterilization of persons lacking in mental capacity but does not require this for the sterilization of minors, who may also not be in a position, due to their relative youth, to give informed consent to sexual sterilisation. Would the lack of such a requirement result in a decision that is not made in the best interest of the child?
We are all aware that sterilization is an irreversible procedure that terminates a person's reproductive capacity. The termination of the reproductive function of a minor will more likely than not have both physical and physiological effects on the minor and will continue for an extended period of time.
I would also like to ask the Minister why the proposed amendments do not set out a minimum age at which minors are deemed capable of giving consent for sexual sterilization, together with the parent, guardian or spouse. A minor at 20 years of age and a minor at the age of 14 have very different maturity levels. To treat all minors alike would be over-inclusive. Would it not be better, in the interests of the child and of society generally – although I know this is not a consideration of the proposed amendments – to require a Court Order or at least an independent committee decision for minors below a certain age? Or, to provide optimum protection where a minor is concerned, how about requiring a third party, whether the High Court or an independent committee, to declare that sexual sterilization is necessary in the best interests of that person who also happens to be a child?
Would it not be prudent to take the position that any decision to sterilize a person who lacks capacity, whether a minor or someone who lacks mental capacity, should be made by the High Court or an independent committee? Such a requirement would underline our society's commitment to protect the rights of the minors and those who lack mental capacity.
Sir, I am also puzzled that the Bill seeks to incorporate only Part II of the Mental Capacity Act. I would regard Part III of the Mental Capacity Act as being integral to the extra safeguards and protection envisaged. In this case, in the context of sexual sterilization, Part III of the Mental Capacity Act would place the burden on the medical practitioners as well to take all reasonable steps to ensure that sterilization is in the best interests of the individual.
Sir, there is ample evidence throughout history, that sexual sterilization is sometimes carried out for expedient and instrumental purposes – chief among them is for contraception. In that sense, sterilization may be perceived to be a convenient method of care and control to parents, guardians or spouses who may think that they are acting in the best interests of the person for whom sterilization is sought.
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In this regard, it is timely for the Government to re-evaluate the support it provides to caregivers of people with intellectual disabilities. I appreciate that the demands on such caregivers are immense and that we should do all we can so that sexual sterilization is not seen as a method of care management.
Sir, we made a significant inroad when this House passed the Mental Capacity Act in 2010. The Act represented a fundamental change in mindset in which we do not treat people who lack mental capacity as people who have lost their dignity, their autonomy and their rights to lead as full a life as possible. Instead, such persons are to be respected like you and me, and the need to always act in their best interests.
There is much that is commendable in the Bill. The Bill is to be welcomed for providing better safeguards of the sexual and reproductive autonomy of persons who have intellectual or developmental disabilities. But I have deep reservations that it does not extend the same protection to minors.
Mr Speaker, I commend the Minister for Health for the amendments to the Voluntary Sterilization Act. In particular, I acknowledge the heightened protection the Bill seeks for persons with disability. It is also heartening to note that underlying these amendments is the intention to align with the Mental Capacity Act and, more importantly, with the UN Convention on Persons with Disabilities, which Singapore will be signatory to, very soon. This is, indeed, the right move and also in line with the vision set out in Budget 2012 for an "inclusive Singapore" and our vision for a more caring and compassionate society.
Indeed, sterilization is a major procedure. It is the irreversible termination of a person's reproductive function. It has serious implications that go beyond the physical. It has long-term psychological, mental and emotional consequences. More importantly, the issues are intertwined with a person's right to his or her own body, his or her sexual and reproductive choices. Without a fully informed consent, voluntarily given, it is invasive and a violation of a person's integrity, and violation of the choice and ability to reproduce, have children and a family.
In the case of Singapore, female sterilization is more common than male sterilization, and it is with this background that I base my comments.
Sir, every woman has the right to make informed and responsible decisions about her body. Where this right is in jeopardy, the state should step in and protect this fundamental right.
In the case of women with disabilities or who lack mental capacity, the UN Convention on the Right of Persons with Disabilities recognises that persons with disabilities have individual autonomy and independence, including the freedom to make their own choices. The Convention also recognises that women and girls with disabilities are subject to multiple discrimination when compared to able-bodied women. Thus, Article 6 makes it incumbent on signatories "to take measures to ensure the full and equal enjoyment by them of all human rights and fundamental freedoms", whilst Article 23 is more specific in stating that persons with disabilities, including children, have the right to retain their fertility on an equal basis with others.
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With that as a backdrop, I have two main areas of comments and concerns with regard to the Bill. They are, firstly, the proposed increased protection for persons with disabilities and, second, the proposed increased protection for persons below 21. With regard to persons with disabilities, I acknowledge and applaud the amendment from the original draft of the Bill to now include a requirement that a Court Order is now required over and above the consent of the spouse of the married person lacking in mental capacity, and over and above the consent of the parent or guardian of an unmarried person. It seems to me that this shows that the Bill rightly takes cognisance of instances of family disputes which can complicate decisions that are purportedly in the affected person's "best interests". It also shows it recognises that caregivers of such affected people are already overstretched and may make decisions based on their own challenging situation. Caregivers now have recourse.
Turning now to the protection for persons below 21, I echo what Asst Prof Eugene Tan has said. In the Bill, under clause 3, section 3(2)(b) states that, and I paraphrase, a married person below 21 has to give consent, while section 3(2)(c) states that, for unmarried persons below 21, consent from a parent or guardian is needed in addition to the consent of the affected person to the sterilization procedure. I acknowledge and I applaud the amendment from the original draft to include a requirement in these situations, that the registered medical practitioner not only certifies that the affected person clearly understands but also it specifically makes it incumbent on the medical practitioner to give a full explanation of the treatment. However, my first concern with regard to this aspect of the Bill is that no minimum age is stated in the amendment. I do not see a distinction being made between minors who are capable of understanding the implications of the decision and minors who are not mature enough to do so.
Sir, in order for consent to be valid and informed, the person has to fully understand the implication of that consent beyond just the medical procedure. In this, I quote Dr Lam Pin Min, in the case of sterilization, the need for capacity for consent is even more crucial. I am doubtful that minors, especially younger ones, would have the capability or maturity to do so. Yet, the Bill does not reflect this distinction nor does it provide for a more rigorous regime.
My second concern is that for unmarried minors, only one parent or guardian needs to give the consent in this case. There is no requirement that both parents need to do so. With due respect, I find this troubling. It is against the established laws of guardianship where both parents have joint responsibilities. And here I would like to refer to Article 18 of the UN Convention on the Rights of the Child which specifically states that both parents have "common responsibilities" and also that parents be given assistance in carrying these out. Compare this with the provisions in the Women's Charter Schedule 2 which sets out who is to give consent in a marriage of a minor, where various scenarios of parental situations are listed, for example, where one parent had abdicated his or her responsibility, etc.
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In a serious matter like sterilization, it is even more imperative that a more rigorous regime with regard to parental consent is laid out. Further, there are also precedents from jurisdictions like the UK and Australia which recognise that while parents are in charge, in matters like sterilization which are irreversible, parents must answer to a higher authority, like the courts, if need be. It takes cognizance of the many instances where parents are in contentious relationships and may themselves be making the decisions based on their own emotions and not in the best interests of the minor. I do not see this concern reflected in the Bill.
I compare this with section 3(2)(e), under clause 3 of the Bill where a High Court order is required in a case of persons lacking mental capacity. It is disconcerting to note that no similar requirement exists for very young minors who would not be in a position to give fully informed consent and who, for all intents and purposes, can be likened to "persons without mental capacity".
With regard to "best interests", it is worth noting that in Denmark, Sweden and Norway, there needs to be approval by an independent committee. The absence of recourse to a higher authority in this aspect of the Bill is also not in alignment with the UN Convention of the Rights of the Child as set out in Article 3 where, and I paraphrase again, the primary consideration in any action for children must be that it is in the "best interests of the child".
So here are my recommendations: firstly, with regard to people below 21, set a minimum age for minors which should be 18, the age of majority in most jurisdictions. Second, both parents to be required to give consent and the Bill adopt the approach in Schedule 2 of the Women's Charter. Third, for persons below 18, the courts or an independent committee made up of, for example, psychiatrists, reproductive health medical practitioners and social workers who are not in a position of conflict, to make the decision and/or give consent. With regard to persons lacking in mental capacity, educating and giving even more support, financial, moral as well as with infrastructure, to caregivers who understandably are already overstretched and may be making decisions based on their own challenging situations, help them understand not only the serious implications of their consent, but also that disabled persons have rights too, under the Convention for People with Disabilities. Lastly, extending the same support to affected persons, especially in view of evidence that people with mental disability can indeed increase their skills. In fact, the UN Convention for People with Disabilities, which we will be signatory to, recognises that disability is an evolving concept. Society's attitudes based on empowerment will support these members of our society. As far as possible, teach them family planning, help them increase their understanding of their own bodies, in ways appropriate to their levels of understanding. I believe these will allow Singapore to be in greater alignment to the UN Convention that we will be signing.
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Sir, I acknowledge the amendments and I support the Bill. At the same time, let us also recognise that a person's right, especially a woman's and a child's rights to her own body, regardless of mental capacity, is inviolate. Let us support such members of our society by valuing their rights, turn to less intrusive ways as far as possible through education, awareness, self-empowerment tools and resort to sterilization only with sensitivity and compassion.
Sir, I thank the Ministry for its efforts to update the Voluntary Sterilization Act (VSA), an Act which is four decades old. The intent to align the Act with the principles underlying the UN Convention on the Rights of Persons with Disabilities and also the Mental Capacity Act to protect the more vulnerable is especially commendable.
I am also appreciative that a public consultation was also sought. However, the consultation period was from 4 June 2012 to 2 July 2012, barely less than a month. Not only was the duration itself short, but it was also during the school holidays when many professionals and parents supervising special needs persons were not available. This limited the extent to which more inputs could have been gathered on a subject matter that is as invasive and permanent as sexual sterilization. For future legislations of such nature which involve irreversible and ethical dimensions, I urge Government to seriously consider extending the periods of public consultation to allow for more proactive and deeper consultation of stakeholder groups such as families, advocacy groups, medical professionals and, in this case, even persons directly affected.
Nonetheless, I am very pleased that the Ministry has seriously taken the inputs of advocates, such as AWARE and others, and made a significant improvement for persons lacking in mental capacity. For this group, the Ministry has instituted a requirement for a Court Order before the sterilization of a person lacking in mental capacity in the final version of this Bill that is presented today. The shape of public consultations to come must indeed bear the desired characteristics of being genuinely open to inputs; graciously acknowledging and crediting inputs received and/or applied; and proactively seeking views of the public and, especially, relevant stakeholder groups through longer periods of public consultation.
Sir, I would like to raise three key areas for which I hope to receive favourable consideration from the Minister. The first concerns persons below the age of 21. Sir, the Bill provides that a registered medical practitioner can carry out sexual sterilization on any person below 21 under two circumstances:
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(1) If the person below 21 is married and consents himself/herself to the sterilization; and
(2) If the person below 21 is not married and together with at least one parent or guardian consent to the procedure.
Sir, I would like to remind the Ministry that the definition of someone "below the age of 21" effectively means "any age from birth to below 21" – five, six, seven, 11, 12, 13. So, I find it onerous on a young person aged, for instance, 15 years old to partake in a life decision that is as invasive as sexual sterilization; a decision that is permanent, irreversible, to the extent that it will impair his or her ability to have children for the rest of his or her life.
Sir, I therefore urge that the Act be aligned with the United Nations Convention on the Rights of the Child which defines a child as, I quote, "a human being below the age of 18 years old" and to provide further safeguards for persons below 18. I urge that before any treatment for sexual sterilization is carried out on a person below the age of 18, that there be approval from a Committee comprising at least (1) an independent medical practitioner with relevant knowledge; (2) a non-medical professional, such as a Family Service Centre Counsellor or a Senior Medical Social Worker; and (3) an officer from a relevant Government agency, such as the MCYS. The Committee should be given the authority to approve or disapprove the application for sexual sterilization of the minor. The Committee shall consider the reasons for which the application is made; convince themselves that there are no other less restrictive and less permanent options; and that the final decision to sterilize is indeed in the best interests of the minor affected.
Next, on persons who technically are not lacking in mental capacity but need support. Sir, the other group for whom I would like to speak up is the group of persons with special needs who may not be technically defined as lacking in mental capacity under the Mental Capacity Act (MCA). Under the MCA, only a person who cannot understand, who cannot remember, who cannot weigh up the information and who cannot communicate a decision is deemed to be lacking in mental capacity. Sir, people with special needs fall upon a spectrum − from mild to moderate to severe. There are men and women who may fall through the cracks. These are persons who are legally categorised as mentally competent, but many of us know that they will still be vulnerable if left to make decisions on their own regarding permanent and irreversible ones such as sexual sterilization. They can be individuals who are mildly intellectually disabled; or persons with no intellectual disability but have other disorders such as high-functioning autism or attention deficit and hyperactivity disorders which may affect their decision-making abilities without help or support. For persons of such profiles, I ask for additional measures to help them arrive at the decision of whether or not to be sterilized, even if they are above 18 years of age. I urge that such persons, through either subsidiary legislations or codes of practices, undergo compulsory counselling by relevant professionals, such as a medical professional with relevant knowledge; a non-medical professional, such as a Family Service Centre (FSC) Counsellor and a relevant disability expert. Extra efforts must be taken to counsel these persons in a way that can be understood by them so that they are aware of other methods of contraception that are less invasive and less permanent; so that they know the consequences of sexual sterilization and so that they can truly make decisions in their own best interests.
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Finally, Sir, I am pleased that a court order must be obtained before the sterilization of persons who lack mental capacity, in particular persons with moderate to severe disabilities. This effectively ensures that significant decisions of such nature are made with two keys – one held by the person's family member and the other by an independent party convinced that such treatment is necessary and in the best interests of that person.
However, I urge that more professional expertise and focus be allocated upstream to ensure more effective sexuality education for the vulnerable in our country. Many of them, those with mild to severe disabilities, can be sorely lacking in knowledge in this area and are often at risk – either of being sexually abused, whether they are sterilized or not, or to be themselves sexually abusive to others because of the lack of effective education. In many instances, many of their families themselves are helpless, receiving different advice, sometimes contradicting, and not knowing how to help their children. They run the risk of thinking that sexual sterilization is the ultimate that will get them out of their fear and challenges. This is a grave matter of concern that has been brought up by both educators and families of persons with special needs who are young or older.
The need for sexuality education, counselling and even dealing with law enforcement agencies cannot be just left only to volunteers and disability organisations. There is a strong need for Government agencies, such as the Ministry of Health, Ministry of Education and MCYS, to rein in and provide resources to bring in more expertise and effective solutions to support the other helping hands. In summary, Sir, I support the Bill in principle and find it a vast improvement. However, I look forward to Ministry's favourable responses to my inputs on this Bill.
Mr Speaker, Sir, human procreation is recognised as a basic human right, and I welcome this amendment to the Bill, which significantly re-affirms the rights of those with mental disabilities. This amendment to the Bill will also allow Singapore to accede to the UN Convention on the Rights of Persons with Disabilities, joining the 103 other nations which have already ratified it.
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I wish to just highlight two aspects of the amendment, and make one observation. First, the amended Bill now fully recognises that those with mental disabilities often still possess the ability to make informed decisions regarding their own health, and this should be duly respected. The American Academy of Paediatrics Committee on Bioethics puts it both elegantly and forcefully when they say that "persons who have adequate mental capacity to make a decision about their health and health care are entitled to do so, based on their own interpretations of their interests, without undue influence from health care professionals, family members, or others."
However, for those who lack the mental capacity to do so, the court will now act as an additional safeguard in their interests, and caregivers and doctors alike will have to provide good reasons to the court why sexual sterilization will be ultimately in the patient's best interests. This is a fundamental change to the law, such that the rights of individuals with diminished mental capacity are better protected, and brings this Bill into alignment with the existing Mental Capacity Act.
The second point is that the previous implication in section 3 that sterilization can be performed in the interest of society is both woefully dated and irrelevant, and its removal from this Bill is certainly in our society's best interest. However, the welfare of those with mental disabilities, and also of minors, should not and does not depend on legislation alone. There have been many calls in this House so far about, perhaps, stricter regulation, and consultations, both within and without this House, have also seen many expressions that a higher bar should be set. However, if you just speak to people who look after those with mental disabilities, you would see that their responses are a bit less extreme and most of them actually express a wish that they retain some form of control over the medical decision-making of their charges. It is critical that caregivers, doctors and other healthcare providers continue to act in concert in the best interests of the person with reduced mental capability.
I have to say that the rights of caregivers to play a part in decisions regarding the medical care of their charges, have to be respected and protected as well, and medical directives regarding the conduct of doctors and healthcare professionals in the assessment of such cases have to be both robust and rigorous, in addition to being ethically beyond reproach.
Caregivers and doctors in particular, have to carefully deliberate whether, first, conception would truly be detrimental to the patient and offspring thus requiring a permanent prevention of reproduction, and second, whether sterilization is the least restrictive and most practical contraceptive option available. Although not explicitly required in the law, I would support the inclusion of psychologists, counsellors, welfare workers and such in the decision making process, to be as sure as possible that this recourse is truly in the patient's best interests. Perhaps the application by the caregiver itself should also be supported by a social worker's report in addition to the doctor's support, or the court should stipulate as such before making judgment.
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In conclusion, I support this amendment that strengthens the legal framework and protection afforded to persons with mental disabilities with respect to voluntary sexual sterilization. That the courts now have the final say in deciding whether sterilization should be carried out in those who cannot decide for themselves, does not in any way, however, diminish the rights and responsibilities of their caregivers and doctors in these situations. I support the amendment to the Bill.
Mr Speaker, Sir, I am deeply heartened that this Bill now requires a court order to be made before someone who lacks mental capacity to consent can be made to undergo sexual sterilization treatment.
With this amendment, we have removed provisions that may lead to discrimination against disabled persons. We are now better aligned to the United Nations Convention on the Rights of Persons with Disabilities. This Convention provides a basis for upholding the rights of persons with disabilities and contains specific provisions of relevance to the issue of involuntary sterilization.
The change to this Bill to give better protection to persons lacking in mental capacity is the right move as sterilization is an irreversible medical procedure with profound medical and psychological effects. People with disabilities – they too have their rights and should be protected against the arbitrary action of their spouses, parents or legal guardians. A court order could give the court a chance to evaluate whether the decision to sterilize a person who lacks mental capacity is being taken in the person's best interests and not just to serve the convenience of caregivers.
However, I would like to seek a clarification from the Minister on the rationale for not imposing a similar requirement of a court order for sterilizations carried out on minors below the age of 21 years. This Bill allows parents or guardians to make the decision on behalf of the minor so long as the minor has given consent. I am very concerned that the Bill assumes that very young minors are able to make such a profound, permanent and life-altering decision on their own. In most cases, chances are that it is the minors' parents or legal guardians who have tremendous influence on their lives, who would have influenced them to make that decision. In such a situation, to protect the interests of the minor, the law should require a court order before sterilization of a minor is allowed.
Also, unlike the provision for those lacking in mental capacity where the decision has to be made in the person's best interests, there is no such requirement for minors. I would like to ask the Minister whether he could consider amending the proposed section 3(2)(c) to require a court order to be made before a minor can be sterilized, and for such sterilization to be carried out only if it is in the best interests of the child.
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If this is not possible, since the law is already crafted in this manner, could the Minister consider putting in place safeguards, such as requiring the certification of at least two doctors, that the sterilization would indeed be in the child's best interests before the procedure is carried out?
Also, I would like to suggest that as part of any process to ensure fully informed choices and consent, the doctor performing the sterilization must inform the patient that sterilization is a permanent procedure and that alternatives exist, such as reversible forms of family planning. I would also like to suggest that the doctor ensures that all information must be provided in a language that the person understands and in plain, non-technical language appropriate to the individual concerned. With these comments, I support the Bill.
Sir, this Bill has been around since 1970, when it was enacted to support family planning. Indeed, it is time to review it. The major change is that persons, who have the mental capacity to choose and decide rationally, will have the right to do so in planning to have their sterilization. This offers better protection for all, including the disabled, and recognises their rights. It will safeguard their sexual and reproductive autonomy. It also aligns with our Mental Capacity Act 2008 and the United Nations Convention on the Rights of the Persons with Disabilities, which Singapore is expected to be a signatory to, very, very soon.
This Bill will allow persons with hereditary illnesses, physical disability without mental incapacity and diseases such as epilepsy, the right to make their own decisions. This decision, Sir, can be a very private and a very emotional one for the affected person.
If the disabled person does lack mental capacity, then the burden of decision making, care and support, certainly falls on the parents and the next-of-kin. Parents and next-of-kin, generally, have been making the decisions and they would have the best interests of the affected person in mind but it may not always be true. At times, we know decisions can be made as an "act of convenience". Perhaps, alternatives, such as counselling, education and hormonal therapy, are better options in certain cases.
In Britain, for example, Sir, there is the Court of Protection, which is a specialist court for all issues relating to persons who lack the capacity to make specific decisions go through. The court makes decisions and appoints deputies to make decisions in the best interests of those who lack the capacity.
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In Australia, in 1992, the High Court ruled in a case about parents of a mentally disabled child applying for sterilization, that it was beyond the ordinary scope of parental powers! This had then set the precedence for court or tribunal authorisation to be required for any sterilization procedure to be carried out on a child, which would rule on the best interests on a case-by-case basis.
Now, what indeed is the "best interest of the patient" and who is the best to determine this? For example the "best interest" can change and evolve with changes in time, timing, age of the person, social level of acceptance and, of course, the maturing of society. Therefore, the need for an objective decision with the use of a court order in these cases. I also have the following queries, Sir:
How many persons with disabilities have been sterilized in the last 10 years in Singapore under the VSA and who had been the decision maker in such cases? Have we, so far, encountered any problems where the decision had to be revoked?
Next, pertaining to the consent for the procedure, for persons lacking mental capacity, consent must be obtained from the parent, guardian, spouse and a doctor who has to certify the procedure is necessary, and in the best interests of the person. For those who need to seek a specialist or a psychiatrist for certification, can MOH consider setting an acceptable, reasonable fee range for the purpose? This is because specialist fees can indeed be high and these affected families are often already faced with numerous financial challenges in their day-to-day lives.
Can the Ministry also advise on how the processes for applications can be streamlined to help facilitate? Also, does the next-of-kin have to do this personally or can the institution they are in follow up and help as well to facilitate the applications with the necessary supporting documents?
Also, Sir, can the ethics committee, which is present in all healthcare institutions, be utilised, to some extent, to assist and facilitate in the processes and procedures pertaining to this Bill?
In conclusion, Sir, I commend MOH for reviewing this Bill, for aligning it with the Mental Capacity Act and also global best practices and for giving these affected individuals the right to uphold their dignity, their autonomy and, of course, their best interests. I support this Bill, Sir.
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Mr Speaker, Sir, let me thank all the Members who have given their views and voiced support for the Bill. Let me now address the comments and suggestions made by the various Members.
Members, such as Dr Lam Pin Min, Asst Prof Eugene Tan, Ms Denise Phua and Ms Mary Liew expressed concerns about the protection accorded to minors or young persons below the age of 21. They have asked why we do not also require a court order for minors undergoing sterilization, or impose an age requirement. They have expressed concerns that these young people may not fully understand the consequences of such a procedure and would not be able to make an informed decision due to their young age.
I agree with their concerns.
First, let me clarify that a young person below the age of 21 years, who lacks mental capacity, is given the same protection as that for an adult who lacks mental capacity. A court order is needed before sterilization can be performed.
In the case of an unmarried young person below the age of 21 years, who does not lack mental capacity, there are four levels of safeguards. First, the young person must give his or her own consent, unlike in the case of a person lacking in mental capacity. Second, his or her parent or a guardian must consent to having the young person undergo such a procedure. Thirdly, the amended section 3(3) of the Act requires the doctor to give a full and reasonable explanation as to the meaning and consequences of such a treatment, and obtain certification from such a person that he clearly understands the meaning and consequences of the treatment. Fourthly, cases involving such young persons will be required to be referred to the hospital ethics committee for review.
There are sufficient safeguards.
Let me elaborate. In dealing with unmarried young persons, the doctor needs to, first of all, satisfy himself that this young person is able to understand matters relating to procreation and sterilization. If this person is too young, and not mature enough to understand the doctor's explanation on sterilization and its implications – a concern highlighted by Ms Faizah Jamal – the doctor cannot proceed any further. In such a case, there can be no informed consent and, without the young person's informed consent, the doctor cannot perform the sterilization. This is regardless of the wishes of the parents or guardian.
For the young person who is mature enough to have sufficient understanding of the matter, the doctor will then need to assess if he or she really wants to undergo sterilization. Members have requested that such young persons who want to undergo sterilization be properly counselled to ensure that they appreciate the gravity of the procedure and its consequences.
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The College of Obstetrics and Gynaecology of the Academy of Medicine Singapore has set out good practice principles from medical professionals in the taking of informed consent. In the case of informed consent for sexual sterilization, the doctor has to counsel the person and ascertain the motivation for sterilization, explore all other non-surgical alternatives and reversible procedures available and clearly outline all the risks, benefits and prognosis of the procedure. Only when the young person fully understands the implications and consequences of sterilization, can the doctor continue with the procedure.
Ms Faizah Jamal expressed concern that only one parent or guardian is required to give consent. Let me clarify the consent of the parent or guardian in this case will act as a safeguard and is required in addition to the young person's own consent. The consent of the parent or guardian does not replace the consent of the young person. In fact, should a parent or guardian refuse to give consent, doctor also cannot carry out the procedure.
To enhance our safeguards further, all cases involving minors who are not mentally incapacitated seeking sterilization will be referred to the hospital ethics committee for review. The hospital ethics committee will independently deliberate on whether the minor should undergo sexual sterilization. It will take into account all clinical, psychological, social and ethical aspects of the case. Directives will be issued to the licensees of healthcare establishments under the PHMC Act, to all healthcare institutions, to mandate this.
This is similar to the suggestions by several Members, including Assoc Prof Fatimah Lateef, Ms Denise Phua and Asst Prof Eugene Tan, to have independent committees to assist in the decision making process.
I am confident that there is broad consensus within our medical community in Singapore that doctors will be very cautious to perform sexual sterilization on an otherwise healthy young person, in the absence of any strong medical grounds for justification.
Dr Lam Pin Min had asked why the VSA did not impose parity requirements based on the number of children that a person has. I think it is best to leave the decision of family size to the couple.
Dr Lam Pin Min and Assoc Prof Fatimah Lateef are concerned whether the court application process may become too complicated or too costly and pose an additional burden on families. I understand and appreciate these concerns. MOH is working with the courts to make the process as streamlined as possible. Mental capacity assessments are also available as a subsidised service in our restructured hospitals and polyclinics.
Several Members and Dr Chia Shi-Lu also suggested the inclusion of psychologists, counsellors and social welfare workers in this decision-making process. Understandably, since such cases can be complicated and involve social factors and family-related issues, the court may call for and take into account inputs from all relevant parties, if it deems appropriate to do so.
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Ms Sylvia Lim cautioned that we ought to be mindful in determining what constitutes "best interests". I agree. It is indeed a very complex subject. It is often complicated by different factors and circumstances that are specific to the particular case. The MCA itself recognises this and it provides a framework that offers guidance on what constitutes best interests. And it is because the best interests of a person who lacks mental capacity is such a complex matter, we have decided that it should not be left solely in the hands of any one individual or caregiver, but should instead be decided by the court, taking into account the doctor's report and after considering all relevant medical, social, ethical aspects of the case.
Assoc Prof Fatimah Lateef had asked who had been the decision maker in the sterilization cases over the last 10 years. In the vast majority of these cases – 98% of them – most people undergo the procedure because they have achieved their desired family size and decided not to have any more children. For these cases, the person himself or herself had decided and given their own consent to undergo sterilization. During the period from 2003 to 2011, there were only nine cases where the patient underwent the procedure because of a history of mental illness or hereditary diseases. The record showed that in eight out of these nine cases, the patients gave their own consent. There was only one case where consent was given by the person's parent.
Dr Lam Pin Min had asked how MOH would check whether the law is being followed by the institutions. Under the regulations, every doctor who performs a sexual sterilization procedure on a minor is required to submit a report to MOH within 30 days of that treatment. MOH officers also routinely perform licensing checks for all healthcare institutions. During these inspections, officers will call up records and case files, including those of patients who have undergone voluntary sterilization in these institutions, to ensure that processes and requirements specified under the VSA have been complied with.
Ms Denise Phua felt that the period for public consultation was perhaps too short. Our public consultation period of four weeks was within the norm. Feedback channels have always remained open, even after the consultation period was officially over. Nonetheless, we take Ms Denise Phua's feedback and we will see how we can further improve on our consultation process in the future.
Mr Speaker, Sir, let me conclude. The amendments seek to better protect those who lack mental capacity in mandating that the parent, guardian or spouse apply to the court for an order allowing the procedure to be carried out. We also want to ensure that VSA remains relevant and reflect current medical practices. These amendments will also bring Singapore in line with the UN Convention on the rights of persons with disabilities.
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I appreciate comments and suggestions by Members about providing education and support to the disabled and their caregivers. Although some of these comments do not relate directly to the amendments in the Bill, I am sure the relevant Ministries and agencies will follow up on them. MOH will continue to monitor the situation on the ground, work with key stakeholders to ensure smooth implementation. Sir, I look forward to Members of the House for their support on this voluntary sterilization amendment Bill. Mr Speaker, Sir, I beg to move.
*Question put, and agreed to.*
*Bill accordingly read a Second time and committed to a Committee of the whole House.*
*The House immediately resolved itself into a Committee on the Bill. – [Mr Gan Kim Yong].*
*Bill considered in Committee; reported without amendment; read a Third time and passed.*
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