Mr Speaker, Sir, I would like to thank Mr Loh Meng See, Dr Tan Cheng Bock, Encik Harun Ghani and Dr Lee Tsao Yuan for their support of the Bill. I would also like to thank them for their very thoughtful comments and for making helpful suggestions on how the Bill could be tightened in the Select Committee to ensure that the safeguards are effective. As the Bill will be committed to a Select Committee, I should not talk about the details but concentrate on the main principles which were raised. Mr Loh Meng See made a very good point that for the Bill to allow the individual to be autonomous and to make his own decision, family members should be consulted. Indeed, the position of the Health Ministry is that the making of an AMD should be an occasion and an opportunity for the person to discuss what may happen when he is dying with his doctor and immediate relatives. I do not think we are legislating for AMD in order to promote it and encourage its widespread use. In fact, Mr Loh Meng See was concerned that civil servants might become over-enthusiastic and take it upon themselves to push the AMD. There is no such intention. There is a need and the need is likely to grow. The facility should be provided for those who wish to make use of it, and for those who are prepared to take this burden upon themselves. I think they may save their own families from feelings of guilt and recrimination for years after they have gone, for it is very rare that whole families agree, especially when the families are big, on what the decision should be at the point of terminal illness. Many of us would have grandparents or parents, people we know well, people whom we love, who died in the intensive care unit and where a decision had to be taken. Some are strong, but not all of us are strong. I think it is for each and everyone of us as individuals to make an assessment of ourselves, our spouses, our children and say, "Okay, I think in my case, I better make an AMD. It will remove what can be a very heavy burden on them." But for some other individuals, they may say, "Look, I will leave it to my wife to decide because she knows exactly what my wishes are and I trust her entirely and I know she would not flinch from making a decision." So it is not a facility which we encourage everyone to resort to and certainly it would not be the objective of the Health Ministry to promote it as something good for everyone. But it is a serious decision made by an individual and we will conduct a programme of education for members of the medical profession, for medical staff in hospitals and for members of the public. This was a proposal which was made by Mr Loh Meng See, Encik Harun Ghani, Dr Lee Tsao Yuan and Dr Tan Cheng Bock. This is something that we will do. Some terms appear loose. Dr Lee Tsao Yuan mentioned that what is "reasonable" is unclear. It can never be clear because the decisions made are very judgmental. If it were so simple, we could have reduced it into a computer algorithm and the computer would spit out the answer "Yes" or "No". If it were so simple, there will be no need to put it to Parliament. It is because such matters require human judgment and human beings sitting in judgment that we say, "Look, let a panel of three doctors decide in consultation on the basis of knowledge, on the basis of an understanding of the practical problems involved and if they cannot agree, that itself is cause for concern. So refer up to another panel and if they still cannot agree, then no AMD takes effect." In other words, six persons are involved. I think that ensures with more than reasonable confidence that the intent of Parliament is scrupulously observed. There is also concern that doctors may rush to switch off life-sustaining machines. There should be no undue haste because in any case, we have to convene a panel and people must sit down in solemn deliberation to decide. There will be no undue haste. But there should also be no undue delay. What is reasonable, I would say, leave it to the medical profession to decide. They have a lot of experience in such matters and they confront such problems daily. We should not tie their hands by laying down specifically in Parliament what the acceptable time frame should be because it must vary from case to case. But it surely would not be the situation where they are rushing in an ambulance and the doctors decide immediately, "No, we must switch it off." No such case will arise. But, of course, when we sit down in the Select Committee, we should take a closer look and see whether the language can be tightened. But, however tight the language is, we must leave a lot of room for human judgment and for the wisdom of doctors, the wisdom of people solemnly appointed to make decisions. Mr Loh Meng See asked whether we should not have a fixed validity period for the directive. I do not think it is necessary. I think it is better to make it easy for it to be revoked. I do not believe anyone who has made a directive will forget he has made a directive, because it is not something which we enter into lightly. To make a directive, you need to fill in a form, you need to consult your doctor, you need two witnesses, you need to register, you need to receive an acknowledgment. It is something so devised that you will remember it for as long as you live that you have made a directive, any more than we forget that we have made a will, however young we might have made it. As to whether there is doubt on what constitutes "mental incompetence", I am not too worried because this is something which affects not just the AMD Bill but it affects the whole corpus of law. It is something which human society has had to grapple with from the beginning of civilisation. There is an extensive common law governing what constitutes mental incompetence. Mr Loh Meng See and Dr Lee Tsao Yuan raised longer term issues: how the AMD will affect our attitudes towards the family, towards old people and towards our own lives. These are questions which I am not really able to answer because they go beyond the AMD. They are the result of an ageing population, of young people having a different set of values, of medical technologies racing ahead at breakneck speed and often in ways that we ourselves do not fully comprehend. We are different from our grandparents' generation and the values that we hold are very different from the values they held. In the same way, the values which our grandchildren hold would be different from us, but it does not mean that they will all be bad. I think they will have their own wisdom, they will have their own sense of what is right and wrong and they will have to respond to a different set of technological and other social circumstances. I do not think that we should jump to the conclusion that making an AMD will automatically steer us in a different direction. In fact, the way we are doing it acknowledges the importance of the individual and the family. What we do not want is a situation where because we are tied in a legal lock, doctors are forced to treat even when parents and children object, because the doctors would tell the relatives, "Look, you may not sue me but someone else may sue me. And because I do not want to be sued, I would rather continue treatment." In other words, when a tendency to litigate on such matters puts tremendous pressures on doctors to err on the side of safety, to go beyond what they themselves and what immediate relatives know to be sound from a moral and professional standpoint. It is precisely what this Bill is for. It is not as if once you have the Bill, those who do not make the directive are treated differently. It is because we are afraid that with growing litigation, doctors would behave in a certain way that we need this Bill to forestall the trend which we worry about. Indeed, this is the reason why I think there is an argument to be made that this Bill will make the legalisation of euthanasia less likely. We remove an important area of ambiguity. What we do not want is a situation where large members of the public are so angry that an unreasonable situation persists that they push for something even more unreasonable. Of course, Dr Lee suggested that I would not be here in 20 to 30 years' time as the Health Minister. I think she is absolutely right there. We cannot foreclose what Parliament 20-30 years from now will legislate. It may legalise euthanasia. It may revoke the AMD Bill. We do not know. That is for a future electorate, deciding what is in their best interest, voting in a new group of Members of Parliament, and they will in this solemn chamber decide what is the social consensus and what is good for the people of Singapore. But you can be sure that if I am still an MP at that time, I would oppose the Bill. Dr Tan Cheng Bock painted three hypothetical cases, which I thought were very helpful because they focus our minds on the practical realities. It is one thing to talk about it theoretically but, say, in the tragic case of Wah Liang, suddenly the reality was brought home in a very stark and, I think, painful way for many of us. But Mr Speaker, Sir, with due respect, I think Dr Tan misunderstood the Bill. It does not mean that if you have not made a directive that doctors are then under an obligation to continue treatment and that parents would have no say thereafter. That is not the position at all. If you have not made the directive, then the present situation continues, which means, ambiguous, doctors talking to parents, talking to spouses, talking to siblings, and saying, "Look, this is what we think is right. What do you think?" Then in that grey muddle, a decision is made and is accepted. Let us look at the case of Wah Liang. According to the press, he was brain dead. I am not sure if the reporters use the term accurately because being in vegetative coma does not mean you are brain dead. People can be in vegetative coma for years and still wake up one day. Such a case is not classified as terminal illness at all. It does not come within the ambit of the AMD Bill. To be brain dead requires a whole series of tests to be conducted - the checking of the eyes, pouring of cold water into the ear canal - to be very sure that the brain is dead and that if your blood is still circulating and your heart is still beating, it is because of machines keeping your heart beating, keeping your lungs pumping. If Wah Liang was indeed brain dead, as medically defined, and he had not opted out of the Human Organ Transplant Act (HOTA) - under HOTA, brain death is death - we would have been able to harvest his organs. If he had opted out of HOTA, then his parents' consent would have been required, and in this particular case, his parents did give consent. Dr Tan is also worried about the donation of organs of young people below the age of 21 years old. In fact, for all cases, whether under HOTA or under the Medical (Therapy, Education and Research) Act (MTERA), parental consent is required for all below the age of 21, and the making of AMD does not change that position. Whether or not you have made an AMD, if you are dead, and the parents are prepared for your organs to be harvested, they can be harvested. There is a slight ambiguity right now because brain death is only defined legally as "death" under HOTA but not for other laws. And this is something that the Health Ministry is looking at. We are not rushing. We will take a few years to think about it. And if we think it is necessary to clarify the position, not just for AMD or HOTA but for all our laws, we may then come back to Parliament to say, "Look. Let's formalise the definition of "death" to include brain death." And indeed, a number of countries have already done so. Dr Tan also mentioned the case of the young man who is kept alive under feed and he asked whether, under the AMD, we will continue to feed the patient, whether by the Ryle's tube or intravenously. In the Bill, it is made quite clear that palliative care includes the provision of food and water, however administered. But let us look at the language again in the Select Committee to make sure that there is no doubt as to what is our intent. Encik Harun Ghani explained the Muslim position. I thank him particularly for the support of this Bill and for clarifying the stand of the Fatwa Committee of MUIS on the AMD Bill. It is very good that MUIS has confirmed unequivocally that the Advance Medical Directive Bill does not in any way contradict the teachings of Islam, and this should remove any concern that Muslims in Singapore may have. Dr Lee Tsao Yuan expressed three concerns. She asked how can we be 100% sure that the patient is terminally ill. My answer is we cannot be absolutely sure. Miracles are always possible. All we can do as mortals is to do what is reasonable. And if divine providence wills a miracle, a miracle will occur regardless of what we do. Dr Lee was also concerned that we give too blanket wide and too unconditional a protection of medical practitioners from civil and criminal liability. In fact, this is not so. If you read clause 19(1), it makes clear that a doctor is only so absolved if the doctor has acted in good faith and without negligence. In other words, there is due diligence, he sits down, he applies his knowledge, his wisdom, and he comes to a decision. And if he does so, then he is protected. But if he was negligent, or he had acted in bad faith, or was guilty of gross misconduct, and this could be proven, then, of course, he can be sued in court for negligence and he will also be subject to disciplinary action for professional misconduct by the professional bodies. And if the circumstances so warrant it, he can be prosecuted in court for a criminal offence such as criminal negligence. Dr Lee also expressed concern that once we have AMDs, then imperceptibly doctors will shift position, ie, if they check that you have got no AMD, then they will continue treatment. We will make it clear in our education programme that this is not going to be the position, that the present situation will apply - that parents, siblings, children will be consulted and a decision made in consultation with them. But as I said earlier, my fear is, despite these consultations, because of the fear of medical litigation, doctors may act differently. And, indeed, a few months ago I spoke to a doctor from a private hospital, he treats rich patients, and he told me very frankly, "Look. As it stands now, I will always treat. They can pay. And I do not want to run into any legal trouble. So when in doubt, treat." And it was clear to me from the way he expressed his support of the Bill that there were cases where he treated when his professional training told him inside that he should stop treatment. This is not the position that we want and this is precisely the position that the AMD Bill is intended to correct. I believe I have covered the broad issues that have been raised by Members of the House. Let me thank Members again for their thoughtful comments and very helpful suggestions.