Mr Deputy Speaker, Sir, I would like to thank Members who have just spoken for their comments, for their thoughtful suggestions, for their concerns and for some moving, inspiring words about the nature of life and the problem of crossing this twilight zone between life and death. I thank Mr Loh Meng See for his kind words concerning the process with which we brought this Bill into its Third reading. We have deliberately taken our time, spent almost two years now on it from the beginning, making sure that all sectors of our society were consulted. Many views were tossed up, considered and incorporated, where possible. Dr Soin asked whether we could not make the definitions clearer. If the definitions could be made clearer, there would not have been the need for this Bill. Does the Bill create grey areas where there were none? It does not, because the grey areas exist as a condition of life. Every day it is being faced by doctors in hospitals. Every day family members, doctors and specialists have to make decisions. Very often, imperfect decisions. Very often, without consensus. Very often, resulting in recriminations years after the patient had passed away. What we are trying to do here is to allow those who feel strongly about their own wishes to state them in advance so that doctors and family members will know when the time comes. And this, in fact, removes the heavy burden from those who would otherwise have to make the decision anyway in this grey area. It is not something which can be solved by words. Dr Soin said that definitions are tautological. They are not tautological. They are subjective. They are subjective precisely because this is an area in which we cannot escape from human beings having to apply their minds and their hearts and exercising human judgment and human wisdom. There is no way by which the words can be so cunningly redrafted that all of us can then say, "All right, let the words decide for us." That is not possible. And yet we know that decisions have to be made. Take, for example, a patient in the final stage of cancer suddenly having a heart attack. The doctors have to decide. Do you try to resuscitate the patient? All right, you resuscitate. The heart pumps again and the patient lives on for a few more days, maybe for a few more weeks. Is this what the patient would have wanted? Is this what family members want? Is this what doctors would have prescribed? Or a patient has an infection, dying from pneumonia. And today, with medical technology, with antibiotics, you can treat the pneumonia and keep the patient living for a few more days. As medical technology advances, there are all kinds of new methods that you can introduce to stretch out the dying process. Is it natural? Today, between doctors and family members, usually they can come to a decision, to a consensus. But as our population becomes more educated, I think they will become more litigious. And once a few doctors are sued in court for not doing enough, very quickly all doctors will keep on treating till the family members say no. And are we sure that family members can agree among themselves? Brothers, sisters, in-laws involved in a decision, very often it is very complicated. The result is tremendous stress for everyone. So if the person himself says, "Look, let me give my input so that you don't have to worry.", I think that is a great help. But, of course, if you as a patient decide, "No, I will leave it to my wife. I will leave it to my son. I will leave it to my doctor.", so be it. There is no intention whatsoever to conduct a campaign to promote the AMD. That is not the intention. The intention is to have it available for those who feel that they want it. And we will have a programme to educate all our doctors, health care practitioners and members of the public to know what it is about, so that they can make a choice. Dr Soin asked whether most people understand the concept of informed consent. They may not. And if they do not, they should not do the AMD. But if they understand what informed consent is and they decide to have it, I do not think it is for us to deny them this facility, which is why I am not in favor of further postponing this legislation. But we are not pushing it and I respect the comments made by many Members here that we should not rush into the implementation without due regard for the details. And as Dr Soin said, the devil may well be in the details, and I think she is right there. I am particularly appreciative of the views expressed by Dr Michael Lim and Dr Kanwaljit Soin who are themselves medical practitioners, advising me to watch the implementation and not to make it burdensome. In implementing it, we should not create new problems for ourselves which defeats the original purpose of the legislation. So we will try to create something which is the least burdensome to doctors and health care practitioners, something which can be widely understood by all, but something which in the end relies on common sense and human wisdom. Mr Cheo Chai Chen supported the legislation. But he mentioned that we should not reduce the number of witnesses from two to one in respect of the revocation of the AMD. I think Mr Cheo misunderstood what was intended. We are not reducing the number of witnesses required before we pull the plug. We are saying that if a patient decides to revoke his AMD, there need only be one witness. Because it may be a few minutes or a few hours of consciousness in between critical periods when a patient has changed his mind, and only one person may be there. That one person should be good enough. This matter was discussed at the Select Committee and we decided, "Look, that is right. If the patient has indicated any change of mind, accept it." I think that is fairer to him. Dr Michael Lim suggested that the panel of specialists, in the event that this matter could not be decided by the lower committee, if it goes up to the panel of three specialists, should not just make a decision on the basis of case sheets and case notes but go down to the bedside to look at the patient themselves. I will take up his point. I think here what we seek is not a rigid administrative procedure but good medical practice. In other words, if doctors in the committee cannot decide, there must be good reasons why they cannot decide. If the panel feels that they have got to go down to assess the situation for themselves, then they should go down. But I do not think that we should prescribe it in law. As to whether doctors who unthinkingly and without malice divulging information being hauled to the Medical Council or to court for infringement, I think here we will apply common sense. The purpose here is not to make life difficult for doctors but to help them help the patients they are looking after. Mr John De Payva asked why is there a need for confidentiality. I think it is important to have some safeguards on confidentiality because the fact of an AMD itself may change the way doctors treat their patients. There is that possibility. The Medical Ethics Committee, which first looked at this matter, discussed it fully this was discussed by the Health Ministry also and we decided that, like the making of a will by a human being, the contents of the will, if it is to be divulged, should be divulged by the patient himself and not by those who are custodians of that will. Because we do not know whether he wants others to know. And in the case of doctors who are treating him, it may affect their decisions. But if the patient himself decides to inform his wife, his relatives, his friends, his doctors, it is perfectly in order, because that is the patient's own judgment. But the law should protect him in the event that he wishes to have confidentiality. In the case of spouses and immediate family members, indeed, we are going to recommend that in all cases, the AMD be made in consultation with family members. But however you consult, in the end, it is your own decision. The family doctor ought to be one of the witnesses, but we cannot be sure that the family doctor is the best doctor in every case. Because depending on the person, he may or may not have a family doctor. He may have a family doctor in name, but he may not be the family doctor he goes to all the time. Sometimes he goes to see his company doctors, sometimes he goes to a polyclinic. Sometimes for different conditions, he sees different specialists in hospitals. So it is very difficult for us to put in the Bill a special place for the family doctor. But in all cases where a GP is recommended, it is the family doctor who should be there, because he would know the patient and his family the most. And that point would be taken into account when we implement this Bill and conduct our education programme. Mr Imram raised what he felt to be an inconsistency between the number of two doctors required to certify brain death under the Human Organs Transplant Act (HOTA) and the three doctors necessary to certify terminal illness. In the case of HOTA, brain death is defined as death. It is only for HOTA. It is not for all the other statutes. As I mentioned earlier in this House, at some point in time, we will have to resolve what is the position of brain death in our law. In fact, brain death is the most conclusive definition of death, much more than the heart stopping. To certify brain death, the issue arises when you keep the heart pumping artificially, but in fact the brain is dead. Then you got to certify that the patient is in fact brain dead before you can then switch off the heart/lung machine to stop the heart from pumping. The procedures are quite complicated. It involves checking the cornea, pouring cold water into the ear canal, a series of seven tests which are very technical in nature. These are not subjective. These are objective criteria to determine brain death, internationally accepted, which is why there is no need to have more than two doctors to do it. In the case of AMD, we are not certifying death. We are certifying terminal illness and that inherently is a more subjective view, which is why three doctors are required. It may well be that the patient is already brain dead and has made an AMD, and the three doctors decide that he is already brain dead. Therefore, he is already terminally ill and therefore they can switch off the heart/lung machine. But for most cases of terminal illness, it is not so straightforward and therefore three doctors are required. Mr Imram also asked what happens if someone comes under both HOTA and has made an AMD. So we have, for example, a case of someone involved in a traffic accident and therefore coming under the ambit of HOTA, assuming he has not opted out, and let us say he has also made an AMD. If he is already brain dead, then he is defined as dead under HOTA and the issue of AMD does not then arise. In other words, in the case of someone being covered by both, then HOTA comes first because he is by definition already dead, and therefore the AMD does not arise. Mr Imram also asked whether it is necessary to have this two-tier system, that the more tiers you have the more you condemn a person to death. I think that is turning things the wrong way round. We must not forget that a person who has made an AMD has made a serious decision that he does not want the dying process to be prolonged when he is terminally ill. So we should respect that wish. If a lower committee of doctors cannot decide, we are submitting it to a higher committee in order to be doubly sure that we are acceding to his wish, and that we are not at all condemning him. Sir, I believe I have answered the main issues raised by Members. As I said earlier, we have taken a long time to discuss all aspects of the Bill, turn it around, look at it front side, back side. The problem is now implementation and I fully respect the concerns of Members that good implementation is very important and I assure Members that we will not take this lightly and that in our education programme and in the development of administrative procedures, we will try to anticipate all problems, gain some experiences as we go along, make a review after a year, make adjustments if necessary, come back to this House if necessary, so that what we have is something which is a facility some of us can resort to with a certain peace of mind if we feel that it is good for us and for our family.