Allow sterilisation only as last resort, MPs urge

SINGAPORE - Even as Parliament updated the Voluntary Sterilisation Act to better protect the mentally disabled, several MPs stressed the need to ensure that sterilisation is allowed only as a last resort.

They also want adequate steps to protect minors because sterilisation can be irreversible.

Speaking during the debate to amend the Act yesterday, some of the eight MPs called as well for compulsory education on the consequences and alternatives.

They included Nominated MP Mary Liew, who suggested doctors inform patients of alternatives before proceeding with sterilisation.

Ms Denise Phua (Moulmein- Kallang GRC) asked for better sexuality education for minors. This includes compulsory counselling.

All eight MPs called for more safeguards, particularly for those below 21 years old who may not be able to make an informed decision.

With the amendment, the law now states that a court order is needed before a mentally incapacitated person can be sterilised.

Some MPs, such as Dr Lam Pin Min (Sengkang West) and Nominated MP Faizah Jamal, suggested that the requirement of a court order be extended to minors seeking sterilisation.

Others, like Nominated MP Eugene Tan and Dr Chia Shi-Lu (Tanjong Pagar GRC), asked if independent committees or social welfare workers could be part of the decision-making process.

Health Minister Gan Kim Yong explained that for minors, there are four levels of protection.

First, the person must give his consent. Second, a parent or guardian must also consent.

Third, with the amended Act, a doctor is required to give a full explanation about sterilisation.

In doing so, the doctor must find out the motivation for sterilisation, explain non-surgical alternatives and procedures, and outline clearly the risks and benefits.

"Only when the young person fully understands the implications and consequences of sterilisation, can the doctor continue with the procedure," he said, adding that the patient must sign a form saying he has understood this and give it to the doctor.



Finally, cases involving minors must be approved by a hospital ethics committee, taking into account the clinical, psychological, social and ethical aspects of the case.

Mr Gan said directives will be given to health-care institutions to make this compulsory.

He assured the House that the decision to sterilise would not be made lightly.

"I'm confident there is broad consensus within our medical community in Singapore that doctors will be very cautious to perform sexual sterilisation on an otherwise healthy young person in the absence of any strong medical grounds or justification," he said.

Ms Sylvia Lim (Aljunied GRC) noted that the law now states that the decision on whether a mentally incapable person should be sterilised would be made in the person's best interests. She asked how "best interests" would be defined.

Mr Gan said the Mental Capacity Act provides a framework that gives guidance on assessing this.

He added that the Health Ministry will issue guidelines to doctors for assessing this.

These would take in several factors including whether the person is likely to regain mental capacity, and the personal beliefs and values likely to affect the person if he had mental capacity.

Mr Gan also disclosed that from 2003 to last year, a total of 27,905 people were voluntarily sterilised.

Of these, only nine did it because of a history of mental illness or hereditary disease, and eight of them gave their own consent.

The "vast majority" who undergo sterilisation do it because they do not want to have any more children.

Lack of quorum delays Bill

THE second reading of a Bill was delayed yesterday as not enough Members of Parliament were in the Chamber. It was the second such delay this year.

Yesterday, Nominated MP Eugene Tan pointed out the lack of a quorum when he rose to speak on the Voluntary Sterilisation Amendment Bill.

Assistant Professor Tan, who was the first speaker after the House took a 20-minute break, asked Speaker Michael Palmer if a quorum could be formed.

A quorum, defined as one quarter of the total number of MPs, excluding the Speaker, is needed for the passage of a Bill.

Prof Tan said: "Speaker, before I speak, can I confirm that we have a quorum? I know a quorum will be achieved in due course, but I think it is a point of order."

Mr Palmer noted that only 11 MPs were in the Chamber at that point, out of a total of 98. He asked a clerk to ring the bell to summon other MPs. Several MPs were then seen hurrying in. After about two minutes, there were 27 of them present, and Mr Palmer resumed the proceedings.

The Bill was later passed by a voice vote.

In July, a Bill to implement the Bus Services Enhancement Programme was delayed by a day. That was because there were not enough MPs to vote on it

when the debate ended past 7.30pm. It was passed the next day.

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