Voluntary Sterilization (Amendment) Bill Second Reading – Opening Speech By the Minister for Health Mr Gan Kim Yong

Mr Speaker, Sir, I beg to move that the Bill be now read a second time.

BACKGROUND

2 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. Sexual sterilization in this case refers to the surgical procedures of tubal ligation for females and vasectomy for males.

3 As this was a relatively new policy implemented by the Government then, the VSA included a number of safeguards. 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.

4 Between 2003 and 2011, a total of 27,905 persons underwent voluntary sexual sterilization.

REVIEW OF THE VSA

5 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 generally. It is therefore timely for us to review and amend the VSA to ensure that it remains relevant today.

6 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.

7 I will now elaborate on the proposed amendments to the VSA.

AMENDMENTS TO THE VSA

Alignment with the Mental Capacity Act (MCA)

8 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.

9 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.

10 This amendment will also bring the VSA in line with the UN Convention, to accord persons with hereditary illnesses or mental disabilities 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.

Additional protection for persons who lack mental capacity

11 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 decision. 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.

12 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.

13 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 parent 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.

Removal of the requirement for “approved institutions”

14 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.

15 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.

Qualifications of medical practitioners

16 Under the current VSA, sexual sterilization procedures can only be carried out by registered medical practitioners who either have certain specialist qualifications (e.g. a Member or Fellow of the Royal College of Obstetricians and Gynaecologists), or have acquired a certain amount of training or experience (e.g. at least 6 months’ experience in a surgical unit of a Singapore “Government hospital”). These requirements are outdated and not reflective of current practices.

17 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.

18 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 such 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.

Increased Penalties

19 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.

20 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.

21 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 5 years remains unchanged.

PUBLIC CONSULTATION AND SUBSEQUENT FEEDBACK

22 My Ministry conducted a Public Consultation on the proposed amendments to the VSA from 4 June to 2 July 2012. The feedback has been generally supportive.

23 We have also received valuable input from various quarters, through the formal consultation process, as well as through our other usual feedback channels even after the consultation period. 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 this Bill and provided their valuable input.

CONCLUSION

24 In conclusion, 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.

Mr Speaker, Sir, I beg to move.