Hansard, 2004-01-05

Under the provisions of clause 2(d) of Article 46 of the Constitution of the Republic of Singapore, the following Members have been granted permission to be or to remain absent from sittings of Parliament (or any Committee of Parliament to which they have been appointed) for the periods stated: Name From (2004) To (2004) Dr Michael Lim Chun Leng 13 Nov 16 Nov 27 Nov 01 Dec 11 Dec 14 Dec Assoc. Prof. Ngiam Tee Liang 16 Nov 19 Nov 24 Nov 26 Nov 17 Dec 20 Dec Mr Lee Yock Suan 18 Nov 21 Nov 10 Dec 16 Dec 20 Dec 21 Dec 25 Dec 29 Dec 02 Jan 03 Jan Mr Cedric Foo Chee Keng 19 Nov 22 Nov 07 Dec 09 Dec 11 Dec 24 Dec Mr Abdullah Tarmugi 21 Nov 21 Nov 08 Dec 12 Dec 08 Jan 14 Jan Dr Vivian Balakrishnan 21 Nov 23 Nov 08 Dec 22 Dec Column: 7 Mr David T E Lim 23 Nov 25 Nov 07 Jan 11 Jan Mr Lee Hsien Loong 23 Nov 28 Nov 15 Dec 31 Dec BG George Yong-Boon Yeo 24 Nov 29 Nov 07 Dec 15 Dec 15 Dec 27 Dec 05 Jan 10 Jan Assoc. Prof. Koo Tsai Kee 24 Nov 24 Nov 18 Dec 30 Dec Dr Tan Cheng Bock 24 Nov 14 Dec 06 Jan 10 Jan Dr Ong Chit Chung 27 Nov 27 Nov Dr Amy Khor Lean Suan 28 Nov 02 Dec Mr Gan Kim Yong 30 Nov 01 Dec 02 Dec 14 Dec Assoc. Prof. Low Seow Chay 30 Nov 15 Dec 17 Dec 25 Dec Mr Low Thia Khiang 30 Nov 17 Dec Prof. S Jayakumar 30 Nov 13 Dec 22 Dec 27 Dec Assoc. Prof. Dr Yaacob Ibrahim 30 Nov 05 Dec 09 Dec 13 Dec 18 Dec 26 Dec 31 Dec 31 Dec Mr Yeo Guat Kwang 30 Nov 06 Dec 08 Dec 11 Dec 14 Dec 19 Dec Column: 8 Dr Ahmad Mohd Magad 01 Dec 03 Dec 26 Dec 29 Dec 07 Jan 10 Jan 19 Jan 29 Jan 15 Feb 20 Feb Mr Goh Chok Tong 01 Dec 13 Dec Mr S Iswaran 01 Dec 04 Dec Mr Inderjit Singh 02 Dec 20 Dec Dr Lee Boon Yang 02 Dec 08 Dec 10 Dec 13 Dec 21 Dec 02 Jan Mr Zainudin Nordin 02 Dec 04 Dec 10 Jan 31 Jan Mr Chan Soo Sen 03 Dec 06 Dec 16 Dec 21 Dec 05 Jan 15 Jan Dr John Chen Seow Phun 04 Dec 19 Dec Mr K Shanmugam 04 Dec 21 Dec 30 Dec 01 Jan 05 Jan 31 Jan Encik Yatiman Yusof 05 Dec 06 Dec 18 Dec 20 Dec 22 Dec 24 Dec 09 Jan 15 Jan Mr Ang Mong Seng 06 Dec 15 Dec Mr Davinder Singh 06 Dec 08 Dec 11 Dec 25 Dec Dr Lily Neo 07 Dec 15 Dec Mr Chay Wai Chuen 08 Dec 19 Dec Column: 9 Mr Hawazi Daipi 08 Dec 19 Dec 26 Dec 29 Dec Assoc. Prof. Ho Peng Kee 08 Dec 21 Dec Mr Matthias Yao Chih 08 Dec 21 Dec 05 Jan 05 Jan 08 Jan 10 Jan Dr Ng Eng Hen 08 Dec 14 Dec 15 Dec 17 Dec Mr Ong Kian Min 08 Dec 20 Dec Mr Sin Boon Ann 08 Dec 09 Dec 14 Dec 31 Dec 08 Jan 11 Jan Mr Mah Bow Tan 09 Dec 24 Dec 06 Jan 07 Jan Dr Balaji Sadasivan 10 Dec 20 Dec 03 Jan 04 Jan 06 Jan 14 Jan Dr Tan Boon Wan 12 Dec 14 Dec Dr Wang Kai Yuen 13 Dec 16 Dec Mr Charles Chong 14 Dec 28 Dec Mr Chew Heng Ching 14 Dec 17 Dec Mr Lee Kuan Yew 14 Dec 17 Dec Mr Ahmad Khalis Bin Abdul Ghani 15 Dec 22 Dec Mr Khaw Boon Wan 15 Dec 20 Dec 21 Jan 25 Jan Encik Mohamad Maidin B P M 15 Dec 31 Dec RAdm Teo Chee Hean 15 Dec 19 Dec 02 Jan 10 Jan Column: 10 Mr Lim Swee Say 16 Dec 21 Dec Dr Tony Tan Keng Yam 18 Dec 20 Dec 28 Dec 31 Dec Dr Warren Lee 18 Dec 20 Dec Ms Irene Ng Phek Hoong 20 Dec 28 Dec 06 Jan 11 Jan Mrs Yu-Foo Yee Shoon 24 Dec 31 Dec Mr Lim Hng Kiang 01 Jan 13 Jan Mr Wee Siew Kim 05 Jan 11 Jan Mr Seng Han Thong 10 Jan 19 Jan Dr Ong Seh Hong 09 Feb 11 Feb

ABDULLAH TARMUGI Speaker Parliament of Singapore

The following Bills were assented to by the President of the Republic of Singapore on the dates stated:

22nd November,2003 (1) The Income Tax (Amendment) Bill (2) Statutes (Miscellaneous Amendments) (No. 2) Bill 28th November,2003 (1) Maritime Offences Bill (2) Computer Misuse (Amendment) Bill (3) Insurance (Amendment) Bill (4) Monetary Authority of Singapore (Amendment) Bill (5) Singapore Examinations And Assessment Board Bill (6) Regulation of Imports and Exports (Amendment) Bill (7) Central Provident Fund (Amendment) Bill (8) Consumer Protection (Fair Trading) Bill (9) Planning (Amendment) Bill (10) Urban Redevelopment Authority (Amendment) Bill ABDULLAH TARMUGI Speaker Parliament of Singapore

[Mr Speaker in the Chair]

1. Mr R Ravindran asked the Minister for Foreign Affairs whether the Malaysian Government has officially consulted Singapore or sought Singapore's concurrence on its proposal to demolish its side of the Johore Causeway and to build a bridge connecting Johore to the Singapore side of the Causeway.

2. Mdm Ho Geok Choo asked the Minister for Foreign Affairs in view of the recent overtures and call for a rethink on the multi-billion ringgit bridge project by Datuk Shahrir Samad of Malaysia, what would be Singapore's response to the bilateral relationship with Malaysia.

Mr Speaker, Sir, may I have your permission to take the first two Questions together?

Yes.

Thank you. In reply to Mr Ravindran's Question, to date, we have not had any request for consultations on this proposal nor has our concurrence been sought.

On 25th October 2003, that is more than two months ago, we sent a Third Party Note (TPN) to Malaysia on this subject. In that TPN Singapore reminded Malaysia that its unilateral decision to demolish its side of the Causeway in order to construct a half-bridge must comply with the principles enunciated in the ITLOS (International Tribunal for the Law of the Sea) Order [of 8 October 2003 on Malaysia's application for provisional measures concerning Singapore's reclamation works], and in addition, be fully consistent with the requirements of international law governing this matter.

Singapore decided to send this TPN because the Deputy Foreign Minister of Malaysia Datuk Leo Toyad was reported to have said in the Dewan Rakyat on 30th September 2003:

"I would also like to inform the honourable MPs that construction of the bridge does not need neither (sic) approval, agreement nor involvement of Singapore because it is being built on the Malaysian side of the border."

Our TPN pointed out that international facilities such as the Causeway cannot be lawfully demolished without the approval, agreement and involvement of both States.

We pointed out that in its Order, ITLOS had enunciated several points that were relevant to this issue. In particular, ITLOS said, "Malaysia and Singapore share the same marine environment in and around the Straits of Johore". The Tribunal also stated that "the duty to cooperate is a fundamental principle in the prevention of pollution of the marine environment".

In the TPN we expressed concern about the potential environmental impacts and also about the other impacts arising from the opening of the Causeway.

We requested Malaysia to provide Singapore with copies of relevant studies and reports relating to the potential marine and other impacts arising from the opening of the Malaysian side of the Causeway.

We assured Malaysia that we will examine these reports and studies with all deliberate speed and we proposed that a meeting of senior officials be convened as soon as possible to discuss these studies and reports and to address the question of how the opening of the Causeway would impact the marine environment in and around the Straits.

If I may turn to Mdm Ho Geok Choo's Question. I believe she is referring to reports in the Malaysian media calling for a rethink of the half-bridge. I should remind the House that when Singapore reluctantly agreed to the demolition of the Causeway and to build our part of a full bridge, it was as part of a package deal covering several issues. The one important part of that package was the continued supply of water from Johore for another 100 years from 2061. But Malaysia called off the package in October 2002. The building of our part of a full bridge, along with related CIQ revisions, would cost us over S$500 million. It would also sterilise the use of land under the bridge. From Singapore's point of view, the bridge was not cost effective

compared to the Causeway. It did not make sense for Singapore to agree to a full bridge and build our part of it at such considerable costs. We agreed to it only because of Prime Minister Mahathir's offer to supply water at 60 sen per 1,000 gallons beyond 2061.

After Prime Minister Mahathir withdrew his offer of future water supplies after 2061, Singapore has committed itself at considerable costs to building two new reservoirs, and expanding its facilities for producing NEWater and installing desalination plants. We believe that relations with Malaysia will be less fraught with potential conflicts if Singapore produces as much water as it can to supplement the existing Water Agreements.

Since Mdm Ho also asked about our response to the bilateral relationship with Malaysia, let me say that our relations with Malaysia are multifaceted and go beyond any single bilateral subject, whether bridge or other difficult issues that arose under Prime Minister Mahathir. We share extensive historic, economic, trade and people-to-people links. Both sides need to build on these links, and as you would have read about their meeting in Tokyo, both Prime Minister Goh and Prime Minister Badawi have stressed the importance of keeping bilateral relations good. We look forward to Prime Minister Badawi's visit to Singapore on 12th January 2004. We will welcome his ideas and approach on how we can put the past behind us and move the bilateral relationship forward.

Mr Speaker, Sir, would the Minister say that during Prime Minister Badawi's visit to Singapore the issue of the bridge will be discussed?

Sir, I prefer not to speculate on what issues Prime Minister Goh and Prime Minister Badawi will raise

during their meeting on 12th January. We will of course be willing to discuss issues that Prime Minister Abdullah Badawi may wish to raise and listen to any proposal that he may have. I think the broader point is that Singapore wants good relations with Malaysia and I am certain that both Prime Minister Goh and Prime Minister Abdullah Badawi will discuss issues in the same positive and forward-looking manner as in the first meeting in Tokyo. I believe both sides can continue to look for ways to cooperate for mutual benefit.

I should say that I noted that Foreign Minister Syed Hamid is reported to have told the media yesterday that, "It is up to the leaders to discuss what they deem appropriate during the meeting and they are free to talk about anything and everything." He added, "Our relations with Singapore are not just about solving such issues. We have other common interests ranging from economic to the social well-being of people in both countries." Let me say that I fully agree with the sentiments expressed by Foreign Minister Syed Hamid.

Two supplementary questions, Sir. The first question is: has there been any response from the Malaysian government with regard to our 25th October TPN? The second question is: what is our position if the Malaysians proceed to demolish the bridge and the ancillary services that are linked to Singapore?

We have not received any reply and I assume that they must be studying the matter. The only other development is that on 27th October last year, PUB received two notices from the Federal Lands Commissioner of Malaysia and three letters on 16th October 2003 from the Johore State Secretary informing PUB that the government of Malaysia intended to make alterations and improvements to

the Malaysian side of the Causeway and the permanent way connecting the mainland of Johore to the Causeway and they proposed a diversion of the PUB pipelines. It was not clear if the proposed pipeline diversions related to Malaysia's half-bridge plans. Neither was it mentioned if the diversions were necessitated by the construction of the Johore CIQ.

Therefore, we sent another TPN to the Malaysian government on 17th November 2003 referring to these letters and notices. Singapore reminded Malaysia of our previous TPN of 25th October and added that Malaysia had yet to respond to our concerns. It added that it was not clear from the letters and notices from the Johore State Secretary and Federal Lands Commissioner whether the so-called alterations and improvements were connected with the proposed half-bridge. We requested that Malaysia ensure that officials and contractors connected with the project did not take any action inconsistent with the rights and interests of Singapore under international law.

Mr Ravindran asked a second question: what happens if they proceed? Members know that it is my style not to speculate. Let us take things one step at a time. We have registered our concerns. Let them study our TPN and when they respond we will have to study their reply. I would want to wait and study their reply when it comes. I would not want to assume that they will take unilateral action in this regard of international law.

Sir, I want to ask whether the Minister is aware that after Datuk Abdullah Badawi took over as Prime Minister, the press and media have played up the good prospect of better relations between Malaysia and Singapore. I also want to ask: what next in our relationship? What would be the agenda or pace of negotiations? I think it would be of public interest to all.

The Member is asking me, in a sense, to prejudge the outcome of the discussions between the Prime Ministers which I want to avoid. I have already underlined that both sides have stressed the importance of good relations. Both Prime Ministers have underscored that they want to work for good relations.

When the Member asked what is next, I think the challenge for both sides in the new era is to look for ways of starting a new chapter in bilateral relations where we can press on with bilateral cooperation, work together in the interest of ASEAN and to do all this without being saddled by the deadlocked issues of the old era. Yes, there are issues from the old era which have to be addressed but we have to find a way of addressing them that we do not reopen the acrimonious paths which we have travelled in previous years.

3. Dr Chong Weng Chiew asked the Deputy Prime Minister and Minister for Finance how many persons had their New Singapore Shares (NSS) and Economic Restructuring Shares (ERS) confiscated by the Inland Revenue Authority of Singapore (IRAS) for not having paid their taxes.

Mr Speaker, Sir, the Inland Revenue Authority of Singapore (IRAS) does not confiscate the shares. The IRAS appoints the NSS and ERS Trusts as agents to recover the outstanding taxes when the taxpayer applies to exchange his NSS or ERS for cash. The IRAS is able to recover the outstanding tax only when the

taxpayer exchanges his NSS/ERS for cash.

The IRAS started to recover outstanding taxes from NSS and ERS in April 2003. So far 26,500 taxpayers have been notified of the IRAS' intention to recover their outstanding taxes when they exchange their NSS or ERS for cash. Their outstanding taxes amount to about $76 million in total. Since only 150 of the taxpayers have exchanged their NSS or ERS for cash, IRAS has recovered so far just $71,000.

I would like to assure the House that the IRAS only recovers tax arrears from encashed NSS or ERS as a last resort when all previous attempts to get the taxpayer to pay his taxes have failed. These 26,500 taxpayers have defaulted on their taxes for more than 3 years and have failed to respond to IRAS' numerous reminders and other enforcement actions. IRAS informs the taxpayers of its intention beforehand so that none of the taxpayers should be taken by surprise.

Sir, if the aim of the ERS is to help cushion the impact of the GST hike, which is especially so for the low-income families, and with the understanding that many low-income families do have many other arrears, including utilities arrears, could the DPM reconsider the confiscation?

Mr Speaker, Sir, I have just explained that we are not confiscating the shares. But taxpaying is the duty of every citizen. In fact, it should be one of our Civics lessons in school. And if you are owing taxes for three years and repeated reminders, then I think before we hand out any hong baos, you should pay your taxes.

4. Dr Amy Khor Lean Suan asked the Deputy Prime Minister and Minister for Finance (a) how many Singaporeans have not topped up their CPF for the ERS as at 31st December 2003 and (b) whether his Ministry will consider making some concessions for those who have missed the deadline for the top up, if they have good reasons.

Mr Speaker, Sir, 84,867 Singaporeans have not qualified for the second lot of ERS. This compares with 97,970 Singaporeans who did not qualify for the first lot of ERS last year.

The CPF Board and the Ministry of Finance will consider appeal cases from Singaporeans who have missed the deadline for the top up on a case-by-case basis, taking into account the reasons why they missed the top up.

Sir, I would like to ask the Deputy Prime Minister that given the significant numbers of Singaporeans who have not topped up their CPF this year as well as last year - 80,000 and 90,000 respectively - whether the Ministry has actually done any analysis to see if a significantly similar group of people were the ones who did not top up for the two years, and whether they know the causes for this, so that the help of the grassroots, for instance, could be enlisted much earlier in an effort to reduce the number.

Another question I would like to ask the Deputy Prime Minister and Minister for Finance is whether the Ministry also works closely with the grassroots who have been asked to assist in helping those who have not topped up to top up on the information that they gather. For instance, in my constituency, we found

that there was a man who was supposed to be 106 years old. When we went there, he had actually passed away eight years ago. Could such information be gleaned to update the records?

Mr Speaker, Sir, we try very hard to make sure that everybody knows that they have to top up $50 before 31st December 2003. We have worked with the grassroots. We have sent out lists of the people who have not contributed to all the Advisers, so that they can do something about it. We have put out information, posters at public places, newspaper advertisements, publicity on radio and TV, individual reminder letters. Grassroots have visited homes. It is quite hard to give money away in Singapore! Despite that, 87,000 have not topped up. It is slightly less than last year. I do not know whether the profile is the same or not. I would imagine that it is about the same profile.

Last year, after we gave a 3-month extension for the 1- and 2-roomers and welfare homes, the Advisers made a tremendous effort with the grassroots leaders. They went around to a lot of the homes. They found that many of the people had actually moved without telling us that they had moved. You know it yourself. I think if people have moved house and we do not know where they are, it is not really our business to look for them to give them the money. It is their business to let us know where they are so that we can help them.

This year, I do not think we should extend the deadline. But if anybody has any case with a plausible reason, we will look at it very sympathetically.

Sir, can I ask the DPM whether he would consider relooking the need for a top up given the fact that it has been proven to be a major exercise just to get people to top up, especially the groups who are

illiterate, low educated and low skilled? The grassroots leaders have been going around and we found that it has been a major exercise. Perhaps we should re-examine this.

Mr Speaker, Sir, our basic philosophy is that you ought to do something to deserve something. Nevertheless, we have, this time, made some adjustments to the top-up requirement to make it easier, particularly for the older folks for whom it might be a burden. So, for Singaporeans aged 62 and above, they can qualify for the ERS simply by signing on a form and returning to the CPF Board. They do not even have to put any money in. And this form will authorise the Board to change $100 of their second lot of ERS into cash on the day the cash is issued and put it into their CPF account. When you cash in your second lot of ERS, you put some amount of money in, qualify for the second lot as well as for the third lot. So, if you are above 62, effectively, all you have to do is to sign on the dotted line and you can get your shares, and you do not have to come up with any cash upfront. I think it is not unreasonable to ask people to sign on the dotted line.

For other Singaporeans, what we have offered them is that when they exchange their second lot of ERS and take the cash out, which I think about 300,000 have already applied to do, then they can ask to put $50 of their ERS back in and that will count as their contribution for the third tranche. I think we have made it as easy as we can make it, short of giving it to you even without you doing anything. If we gave it to people even without their doing anything, then we would be in danger of giving it to more people, like Dr Amy Khor pointed out, who may be 106 years old on paper but, in fact, passed away some years ago. When the grassroots leaders went around last year,

they found a lot of people who had passed away and we did not know, because they may have passed away overseas. There is no death certificate here, and no report was made. The reason they did not report is that their partner, wife or housemate is still living and it is convenient for HDB to have two names on its record. So, I think it is good to ask for a signature. Then we know the person is still there.

Sir, given the experience of the last two exercises, could the Ministry work early with the grassroots to update the records, especially for those people where we have got information about their passing away or because they are illiterate and simply cannot understand or fill up the forms, so that there will not be a last minute rush to try and get these people to sign up before the deadline?

Mr Speaker, Sir, for those who have passed away, I do not think there will be a last minute rush! For the rest, we will see what we can do.

Sir, can I ask the DPM what assistance is being rendered to those who are in prison and DRCs? I have a couple of residents who have come to see me on this, because they are not able to do the topping up either because they said that information did not reach them or for whatever other reasons. What help is rendered to those in DRCs and prisons?

Mr Speaker, Sir, I will look into this problem. I was not aware that there was a difficulty. Usually, the families are there. The families can do it on their behalf. But if there are specific problems, I will look into it and see whether something more is necessary.

5. Mrs Fang Ai Lian asked the Deputy Prime Minister and Minister for Finance in view of recent changes in the Hong Kong and Malaysian budgets to improve their competitiveness in Real Estate Investment Trusts (REIT), what steps are being considered to maintain Singapore's lead in this industry and will the abolishing or reducing of the stamp duty on REIT properties be considered.

Mr Speaker, Sir, the Monetary Authority of Singapore (MAS) recognises the importance of property funds in creating liquid, transparent investment alternative for real estate investors and broadening the choice of tradeable securities in Singapore. Through the securitisation of their assets, property developers, both in Singapore and overseas, have an additional avenue for fund raising via a REIT listing here.

This is why we have sought to improve the environment for REIT offerings. The Government has selectively granted tax transparency status to the REITs, which means that income is taxed at the investors' level and not at the trust level. This measure had allowed REITs to obtain certain operational cost benefits. MAS had also raised the gearing level for property funds to 35% (from 25% previously) of the fund's deposited property in March 2003. Furthermore, a Singapore REIT's borrowings may exceed 35% of its deposited property if the credit rating of the fund or all of its borrowings is rated at least "A" by Fitch, Moody's or Standard & Poor's. These changes give REITs more flexibility to manage their capital structures. Hence, Singapore is still well-positioned as a competitive REIT centre.

In addition, Singapore's capital markets track record, strong presence of global fund managers and developed financial industry infrastructure make us an attractive location for REIT listings. We believe these are important value propositions for the development of

Singapore as an international REIT centre.

5. Mrs Fang Ai Lian asked the Deputy Prime Minister and Minister for Finance what has been the progress in (a) implementing the Economic Review Committee's proposals to promote the business of trust funds management in Singapore and (b) updating the relevant statutes governing trust and tax regulations in Singapore.

Mr Speaker, Sir, as part of our effort to develop Singapore into an attractive international trust domicile, various legislative and administrative refinements are in the works.

The Trustees Act is currently being reviewed and the updated legislation is expected to be passed in mid-2004. The Trustees Act was enacted in 1967. It was based on the UK Trustees Act of 1925, but unlike the UK, US and Canada, which have made significant changes to their trust laws, we have not made any major changes to modernise our Act. MAS and the Ministry of Finance are currently reviewing the Trust Companies Act, and the updated legislation is scheduled to come into force in the second half of 2004. MAS will also take over the administration of the Trust Companies Act from the Registry of Companies and Businesses.

As part of our efforts to improve the business environment for the trust industry, we had, in Budget 2003, extended the income tax exemption for foreign trusts administered by Approved Trustee Companies to include foreign trusts administered by any trust company in Singapore.

Sir, in updating the relevant legislation, what would the Deputy Prime Minister's

approach be in terms of balancing the need to protect the unit holders of these new instruments as well as ensuring that the new instruments will have a fair chance of being viable and attractive?

Mr Speaker, Sir, we have been taking soundings in the industry very extensively. We have consulted the practitioners, lawyers, as well as private wealth managers, private bankers, and we are taking inputs from the public too. So, it is a balance to make sure that the rules are fair and, at the same time, the instruments are attractive and viable and will be able to take off. I think with REITs, we have struck a good balance. We have had quite a number of successful REITs listed in Singapore and we will try to do the same for the other changes.

7. Mr Ng Ser Miang asked the Deputy Prime Minister and Minister for Finance what has been the experience with the requirement for public listed companies to report quarterly results and whether his Ministry will consider reviewing this requirement.

Mr Speaker, Sir, in today's globalised economy with large and growing cross-border capital movements, it is important that companies provide investors with timely and adequate financial information. Developed economies such as the European Union, Canada, US and Japan, as well as developing Asian economies such as China, India, Malaysia and Thailand, have all implemented quarterly reporting for their listed companies. As a major capital market, Singapore should keep up with international best practices which would enhance Singapore's transparency and standing as a world-class business and financial centre.

However, in the implementation of quarterly reporting, the Government is cognisant of our local conditions and concerns. In August 2002, the Council on Corporate Disclosure and Governance (CCDG) reviewed the original recommendation of mandatory quarterly reporting for all listed companies in Singapore made by the Disclosure and Accounting Standards Committee. The CCDG recommended a one-year deferment for listed companies with market capitalisation of $20 million or less. In April 2003, the Government decided to raise this market capitalisation threshold from $20 million to $75 million and to further defer the implementation date of quarterly reporting for these smaller companies, in view of the difficult business conditions.

Quarterly reporting has generally been beneficial for investors as they are able to track the performance of listed companies more easily. Investors receive, on a more timely basis, information on the financial performance of the companies they invest in. Listed companies have generally been able to comply with these requirements, except in isolated incidents where the company is reporting quarterly results for the first time, or the company is under judicial management.

In those cases, the companies have requested an extension of time beyond the 60-day period, and most of these requests were accommodated accordingly.

As I told this House last April, my Ministry will be reviewing the quarterly reporting requirement for smaller listed companies in mid-2005.

Sir, while there is benefit to quarterly reporting, I think it also represents additional cost. This is especially a burden to smaller companies. So, would the Minister consider raising the threshold of $75 million to a higher amount?

Mr Speaker, Sir, the Member's point is valid, but I think the $75 million threshold is quite a reasonable one. Because out of the total of 521 listed companies on the SGX, 193 are required to report quarterly and 328 are not required to report quarterly. So, the majority of companies - the small companies - will be less than $75 million. If we have more than $75 million market capitalisation, we are not so small.

8. Mdm Halimah Yacob asked the Minister for Trade and Industry whether households, in view of the Energy Market Authority's plans to open up the electricity market so that all consumers can choose which retailer to buy electricity from, will benefit in terms of lower costs and greater efficiency.

Mr Speaker, Sir, liberalisation of the retail market is one part of an on-going process to open up the electricity market to competition. This has already yielded significant benefits to all consumers, including households. Had fuel price remained unchanged, the average electricity price would have come down by 9.5% since December 2001. In the event, increased competition has helped to offset the increase in oil prices, which is today 10.3% higher than it was in December 2001.

The electricity retail market is progressively being liberalised to facilitate competition. About 5,000 large industrial and commercial consumers with a monthly consumption of above 20,000 kWh can already choose which retailer to buy electricity from. By the second half of this year, a total of about 10,000 large

consumers, who would together represent about 75% of total electricity demand, will be open to retail competition.

For the remaining 1.1 million small consumers, mainly households, the Energy Market Authority is now working on the details for opening the market to retail competition. The experience in other countries is that the extent to which consumers can actually benefit from lower costs and higher efficiency depends on how much cost-savings retailers can gain, and if there are other ways of creating value for customers.

For example, to achieve economies of scale, smaller consumers such as households may need to aggregate to form larger buying groups to reap savings. Some small consumers have also benefited because of the differentiated products and services that are offered by retailers. EMA is studying the experience of other countries, and will design our market structure to achieve the most optimal results.

May I ask the Minister of State, Sir, in that connection, whilst we are studying the experience of other countries, is there a not insignificant number of our population which are either illiterate or speak only dialect, Malay or Tamil who may not have the same degree of access to information as some of the others may do? So, when it comes to implementation of the system, particularly with respect to household consumers, may I ask if the Ministry will look into this issue to see how information can be given to such people, and how they can be helped, so that they can benefit from this policy of opening up the market?

Mr Speaker, Sir, the Member brings up a valid point and we will certainly ensure that adequate

information is provided, so that people can make informed choices.

9. Ms Olivia Lum Ooi Lin asked the Minister for Trade and Industry (a) whether the industry has been fully consulted on the decision to introduce an electricity vesting contract regime; (b) what benefits will the industry derive from such a regime; and (c) as vesting contract prices will change every quarter, (i) will these be published; (ii) how far in advance will these price changes be published and (iii) where will these be published.

Mr Speaker, Sir, as part of the restructuring of the electricity market, the Energy Market Authority has introduced the vesting contract regime, which commenced in January 2004. Due to the small overall electricity market in Singapore, the three major generation companies (or "gencos" for short) could potentially exercise undue market power. Vesting contracts have thus been introduced to curtail such market power. They require gencos to sell at least 65% of electricity demand at no higher than the vesting price, which is the Long-Run Marginal Cost of the most efficient generation technology within the system. The price for the remaining 35% of demand will be determined by competition in the wholesale electricity market.

The Energy Market Authority (EMA) conducted extensive consultations with industry participants between 2001 and 2003. It obtained feedback from the industry on market power analysis, as well as the design of the vesting contract regime in order to reduce risks and minimise costs.

Vesting contracts will enable market forces to work better in the electricity market, as they will curb the ability of gencos to hike prices by withholding supply. This will encourage more competitive bidding among the gencos to sell electricity, and ultimately benefit consumers. The proper price signals will be established in the energy market, and this will in turn facilitate the decisions of gencos and their investors, and whether or not to invest in new capacity to meet rising electricity demand.

The vesting price will be adjusted quarterly to reflect changes in fuel oil prices. SP Services Ltd will publish the vesting price for each quarter on its website, which is www.mssl.com.sg, one month before the commencement of the quarter.

Sir, in the new energy market, contestable consumers are faced with the challenge of electricity planning around their variable electricity consumption, and budget their forecast expenditure on electricity. So, therefore, in balancing resources committed to the electricity market, it appears that off-peak consumers may be unfairly penalised rather than incentivised. Can the Minister of State further comment on this?

Mr Speaker, Sir, there are two sources of variability. First, there is fuel oil price variability that affects the general prices of electricity. In the case of Singapore where we do not have access to cheap fuel oil, this risk is something which all of us will be faced with. The Member's specific question on off-peak users refers to the fact that in off-peak periods, the price of electricity in the pool may fall. I think this is something which the EMA and the

retailers will have to study, in consultation with the big users, to see how we can smoothen out our electricity demand. One way to do this would be to incentivise off-peak users by giving them the appropriate pricing signals. If we can smoothen out our demand for electricity, our overall system will become more efficient.

10. Mdm Ho Geok Choo asked the Acting Minister for Manpower if he will give an update on (a) the status of the wage reform exercise, including its related salary reviews, that was commissioned some months back; (b) the resources used for this exercise in terms of the experience of the people involved and the types of industries and companies that were invited to participate in the exercise; and (c) the take-up rate of companies embracing the new wage reform formula.

Mr Speaker, Sir, in response to the National Wage Council's call for companies to restructure their wage systems to improve wage flexibility and competitiveness, the Government set up a Tripartite Taskforce in July last year to review our existing wage systems. The Taskforce, chaired by my Permanent Secretary, comprises key representatives from the Singapore National Employers' Federation, the National Trades Union Congress and the Government. The Taskforce also drew on the expertise of a resource panel of experienced HR managers.

To tap the resources and experience of the industry, the Taskforce set up four working groups in the chemical, land transport, electronics and hotel sectors. The working groups were co-chaired by senior CEO/Human Resource Directors and union leaders recognised as leaders in

these sectors. The working groups have finalised their respective studies and have submitted their findings and recommendations to the main Taskforce. We intend to form working groups for other industry sectors later.

To gather feedback on the implementation of a flexible and competitive wage system, the Taskforce has conducted seminars and talks on wage restructuring for CEOs, HR practitioners, HR consultants and union leaders of various sectors. The response from the industries and unions has been very encouraging. There were clear consensus and readiness among the employers and union leaders to restructure their wage systems to improve their flexibility and competitiveness.

The Taskforce will be releasing its recommendations by end January this year at a National Tripartite Conference. The conference will discuss the features of the flexible wage system, how wage payment should be tied to company and individual performance instead of the length of employment in a company. My Ministry will assist companies and unions to promote the implementation of a performance-based wage system to replace the seniority-based wage system. We will also monitor closely the take up rate of the companies for these initiatives.

Can the Minister enlighten the House on how can we ensure sustainability of growth in companies in the restructuring of the wage system? My second question is: how can we build the element of flexibility such that we can trigger cuts and restoration readily? Thirdly, how can we convince employers, employees and unions to embrace the restructuring system at a faster rate?

Sir, these are the very issues that are discussed at the various seminars and workgroups. While the

Taskforce will attempt to create common platforms for the various groups to understand what we are talking about and to have common aspects, ultimately whether a company grows depends on its management and its ability to enhance its inherent resource. We understand, and we recognise, that various companies will have individual challenges, and it is not up to this Taskforce to be able to help companies grow. We can create the structures and the environment for them to speed up change.

Having said that, I must say there have been congruence and agreement among the principals. In fact, the union leaders, NTUC in particular, have been driving and pushing for these wage reforms because they understand fully well where flexibility is a means towards reducing retrenchments when the times are hard. So the impediment is not in the unions. The impediment is equally sometimes and even more so in terms of employers, and we are trying to bring them on board. And I think many of them have come around to understand that flexibility will help their competitiveness and also improve their companies' performance.

We will have this National Tripartite Conference. But we recognise that the implementation phase will be longer than this. Following that, my Ministry, together with the Workforce Development Agency and the unions, will go to the ground and help the individual companies reform their wage structures.

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11. Mr Ong Ah Heng asked the Acting Minister for Manpower (a) if he will provide statistics of those people who have lost their jobs during this economic downturn and (b) in the light of economic restructuring what are the measures being taken by the new Workforce Development Agency (WDA) to help them find new employment.

Mr Speaker, Sir, there are initial signs that the employment situation may turn around soon. Some 25,800 workers were retrenched in 2001 and about 19,000 workers were retrenched in 2002. Last year, based on my Ministry's survey on private sector establishments employing at least 25 workers, for the first nine months (we have only data for the first nine months of last year), some 13,600 were retrenched. So the number seems to be coming down. More importantly though, the number of workers laid off declined to 4,100 in the third quarter of last year; it was down about 21% compared to the preceding quarter. Another positive indicator of a possible turnaround on the employment front is the growth of employment by 900 - it is not a big number - but it signals the first quarter of employment growth as compared to eight preceding quarters of decline.

Among workers retrenched in the first nine months of last year, 6,000 were from the manufacturing sector, mainly from the electronics industry. The services industries retrenched another 6,800 workers, led by the wholesale and retail trade, transport and communications, and financial services. Other industries which laid off workers included business and real estate services (about 1,100) and hotels and restaurants (300). The construction industry had 500 retrenchments.

Mr Ong Ah Heng asked in light of the economic restructuring, what measures have been taken by the new Workforce Development Agency. The Singapore Workforce Development Agency (WDA) was formed in September last year with the mandate to help Singaporeans find, prepare for and keep jobs. Accordingly, WDA has employed several strategies to fulfill its mission. Firstly, it has identified where the jobs are through working

closely with industries, as well as economic agencies such as EDB. Over the past three months, the Agency has sourced for some 4,600 immediate vacancies in the manufacturing and logistics sectors,

and another 4,600 immediate vacancies in the services sectors. The Agency puts out to the public information on these existing job vacancies, the wages for these jobs and skills training programmes that will help job seekers acquire skills for these jobs, through the mass media and various job fairs. This will help job seekers in their job search.

Secondly, the WDA will help match Singaporeans to job vacancies. The WDA invested some $4.9 million to enhance its job matching services under the Distributed CareerLink Network Programme (DCN). It trained the officers at these centres to provide career coaching to job seekers. The Agency has also worked with NTUC to train some 200 union leaders and Industrial Relations Officers as job counsellors to help retrenched workers transit to a new job. It intends to do the same with the Community Development Councils to train community volunteers as job counsellors. Since December of last year, all job centres under DCN could tap into a national job bank and job-seeker database that will help DCN partners better assist job-seekers. In other words, we now have an integrated national system where you can key in information in the various job centres, whether it is NTUC, CDCs or the self-help groups, and there is a common platform. That is a national job bank as well.

Has it worked? Or has it bettered result? The placement performance of DCN centres, I am happy to report, has improved. When we first started in December 2001, we placed about 500 Singaporeans per month into jobs. Currently, the DCN partners chalk up an average of 1,400 successful job

placements per month. For the first six-month period between June and November 2003, some 13,000 Singaporeans have been placed into jobs through our programmes and the People-for-Jobs Traineeship Programme (PJTP), through NTUC, CDCs and self-help groups.

WDA has developed new ways to more effectively prepare job seekers for jobs. For instance, they started the Job Preparation Exercises for the electronic sector to help job seekers understand the clean room protocol in wafer fabrication plants and to test them for colour blindness. Literacy and numeracy tests were also included. The placement rate of job seekers in electronics jobs has more than doubled after the application of Job Preparation Exercises. And these exercises will be extended to other sectors as well.

The Agency has also initiated programmes to equip Singaporeans with new skills for jobs that are available. In the short space of three months, it has launched a number of new Place and Train programmes in the domestic cleaning, precision engineering, wafer fabrication, textile and healthcare sectors. In addition, the WDA has partnered SNEF in the Training for Employment scheme. Under this scheme, employers, through SNEF, can tap on a $1 million fund set aside by WDA to develop training courses to re-skill jobless Singaporeans to fill their vacancies.

The Agency will also help redesign jobs to create higher value per job that will allow better pay to attract Singaporeans. For instance, the National Environment Agency has worked with WDA to increase the productivity of cleaners through mechanisation and redesign of work processes. This has led to higher pay for cleaners and more Singaporeans taking up these jobs.

The results of these programmes are encouraging given the difficult labour market conditions last year. These initial successes will motivate WDA and its social partners further in implementing more programmes to help Singaporeans get jobs and bring down unemployment.

12. Mdm Ho Geok Choo asked the Minister for Community Development and Sports (a) what are the likely underlying trends for the declining birth rates in Singapore; and (b) while the Government has been using financial incentives to encourage couples to have more children, to what extent has this approach been successful.

Sir, Singapore's total fertility rate for the year 2002 was at a historic low of 1.

37. The declining birth rates are largely due to the rising singlehood rate, low marital fertility and uncertain economic conditions these past few years. For example:

- More people are remaining single either from lack of socialisation opportunities or deliberate choice.

- Couples are marrying later and as a woman's natural fertility declines with age from the late 20s, later marriages result in later and fewer births.

- Competing workplace demands and career priorities could have affected some couples' decision to have children. Some even consider children as unimportant to marriage. The proportion of childless couples has tripled since 1980 to 6%, while one-child families have more than doubled from 6% to 14%.

Evidence shows that economic performance and the number of births are closely correlated. The procreation

measures introduced in 2000 have unfortunately coincided with the recent economic downturn, and the success of these measures is unclear.

Having children is a personal choice, the decision of which is affected by a whole host of reasons, financial costs being one of them. Therefore, financial measures can at best encourage couples who plan to have children to have more of them earlier. These measures may not be able to persuade couples to have children if they do not want to. Therefore, apart from tackling cost issues, my Ministry, in consultation with the Working Committee on Marriage and Procreation and the Ministerial Committee chaired by Minister Lim Hng Kiang, is addressing other factors that affect couples' childbearing decisions, eg, lack of time and energy. My Ministry is developing more affordable infant care and childcare options, besides promoting work-life friendly practices, to help individuals balance their personal, domestic and work commitments.

In this connection, my Ministry is currently seeking public feedback on how to help families care for and have children. We are inviting feedback on the Baby Bonus Scheme and Work-Life Balance, and the details can be found on the Feedback Unit's website. We are also holding focus group discussions on marriage and procreation and those interested are more than welcome to attend.

Sir, would the Minister consider taking a two-pronged approach other than targeting at couples? Would the Minister also actually stretch a little bit down to children because he knows that very often we are addressing an issue that is just on the surface. But, to my mind, I think this is more a question of family values and whether such an approach would be taken at school where we will begin to continue to time pump in the message of the need for students to

be aware of the fact that when it comes to their time, they should be responsible adults doing their part for society and for themselves.

Sir, unfortunately, the Minister for Education is not in the House. I would have asked him to answer the question. But to answer the Member's question, we are working with the Ministry of Education through a variety of programmes, one of which is called the School Family Education Programme. Together with some schools that we have partnered, we work through the schools, not only in terms of promoting some of the family values that we all hold dear in Singapore, but also to help our school children, in terms of some of the issues that they confront. So we are working with the schools in some of these issues that the Member has raised. I am not too sure whether we will be successful in implanting in them the need to have a family. But I certainly agree with her that if we can start them young to understand the need to have a family and children as something that we hold dear in Singapore, we may have a chance in bucking this trend.

May I ask the Minister whether the financial incentives should also be extended to the first child to encourage more young couples to start a family? May I also ask him whether his Ministry is doing enough to make the environment more conducive to encourage couples to have children? For example, are there enough quality and affordable childcare centres, especially for infants, and in view of our increasing dual income families, is his Ministry doing enough to promote the mindset of both parents being providers as well as nurturers?

Sir, to the last question, I will leave it to the families to decide on how to balance the

family chores between the husband and wife. It is very difficult for Government to intervene to tell the husbands to take part of the role from the mothers. But I agree with her on the role of parents. However, most men nowadays realise that they have a role to play in not just providing for the family but in nurturing their children too. For example, we have a Centre for Fathering that has been around for several years to encourage fathers to be more responsible towards the development of their children.

I agree with the Member, Sir, that we need to provide enough supporting structure for our families. So childcare centres have been provided. We have about 638 childcare centres in Singapore. There are still sufficient places, and there is a wide range of childcare centres, not only for the top end or those who prefer more enrichment classes, but even for basic childcare facilities, there are enough places. The challenge is actually at the infant care and that is where we are trying to encourage the development. We have been working with some of the institutions, such as KKCH, where they have started a very succesful infant care. We have also worked with some VWOs. Mr Lim Hng Kiang has announced recently that the Government is looking into this area actively. So we hope to finish some of the studies in this particular area so that we can help young couples who have decided to have children to be able to balance both work and family commitments.

On the incentives for the first child, I agree with the Member that we do not have any incentives on, what we call, the non-tax measures. The Baby Bonus Scheme is meant for the second and third child. The first-child benefits are channelled through the various tax measures. But having said that, Sir, so far we do not see a problem, in terms of families having one child. The challenge

is to try and tweak the incentive in such a way to encourage families to have a second and third child. And that is why when the Baby Bonus Scheme was announced in 2000, it was meant only for the second and third child. And there is a reason for that, Sir. From the financial point of view, having two or three children, the cost incurred, in terms of the expenditure for childcare needs, will certainly increase with the number of children. At the moment, we are not considering non-tax incentives. But there are currently tax incentives for having the first child.

Sir, may I ask the Minister, apart from financial incentives, what other incentives can the Ministry provide to employers to encourage them perhaps to have other work options, such as flexi time, part time, three-quarter time work, or tele-working, because many of these work options that I have just cited are actually in a very preliminary stage in Singapore compared to many developed and even some developing countries. So I think it is obviously a case where incentives are needed for employers to explore some of these other work options to encourage women who do not want to leave the workplace but, at the same time, want to have more children. Hopefully, we will be able to increase our fertility rate.

Sir, I agree with the Member that we have to find a way to help our mothers to balance work and life. I think the Member may be aware that, since about three or four years ago, when Mr Speaker was the Minister then, we had started the Work-Life Unit in MCDS to look into promoting, what we call, family-friendly workplaces. A lot of the work has been through persuasion. We have also managed to develop a group of work-life consultants. And, here companies can tap on some of the subsidies which are available to help

them redesign some of their workplaces to allow women to balance work and life equally.

Having said that, Sir, I would like to say that the progress has been very good as far as MCDS is concerned. More companies are coming on board to adopt some of the work-life practices that we have been encouraging. It is new. But after three years or so of implementing it, more than 16 companies, mainly large companies, are on board in this programme. We are also trying to encourage some small companies. And if they can see the value of having a family that is happy, in being able to balance both work and life, I think that would be good for the company. So our approach has been through persuasion, providing some incentives to companies that are prepared to look at their work structures so that they can redesign it in order to make it convenient for working mothers to balance both work and family commitments.

Sir, would the Minister examine why there are so few infant care centres and review the various regulations that govern the setting up of these infant care centres?

Sir, the basic problem with infant care centres is that we need a high degree of specialisation because these are young children between 0-18 months. So, the ratio is something that we have to think through carefully. More often than not, we just do not need a childcare specialist but someone with some nursing capabilities.

Secondly, because of that, the cost would be high. At the moment, we have extended the childcare subsidy also to infant care, and it is a question of how do we balance this together with the development of the industry. It is new in Singapore. If my memory serves me

right, about seven organisations are running infant care. We are looking into helping more VWOs and even private-sector companies to come into this industry and open up more infant care centres for our young families.

13. Mr Ang Mong Seng asked the Minister for Community Development and Sports in view of the increasing number of aged persons living by themselves and the recent news of an elderly person whose death at home had gone unnoticed for days, (a) how many elderly persons are either living alone or with their elderly spouse in 2003; (b) what home visitation schemes are in place; and (c) what personal devices can be issued to monitor their safety and minimise the number of similar cases from recurring.

Sir, the Census 2000 report indicates that 6.6% of Singapore residents who are aged 65 years and above, live on their own. Another 13.9% live with their elderly spouse.

I share the Member's concern about elderly individuals living alone who may not get help in time should they need it. As more elderly come to live on their own, it is important for us to build stronger community support and involvement to safeguard their safety and well-being.

Sir, my Ministry is setting up various services to help the elderly age in place in familiar surroundings. Currently, three different types of services supported by MCDS offer visitation and regular contacts with elderly living on their own. These are the Befriender Services, the outreach programmes conducted by local Seniors Activity Centres and

Neighbourhood Links, and Home Help Services. Apart from these MCDS-supported services, there are Home Medical and Home Nursing services for the homebound elderly in need of medical care.

While different services have their specific focus, each one provides the critical service of "keeping an eye" on the elderly at home. Volunteer befrienders of the Lions Befrienders Service Association pay regular visits to poor and lonely elderly in the community. There are 3,900 elderly in the programme today. Twenty Seniors Activity Centres and 10 Neighbourhood Links have been set up so far in various neighbourhoods, particularly those with more elderly residents. The centre staff and the volunteers help to engage the elderly living in their area. They maintain a register of frail elderly, especially those living alone within their vicinity. With their permission, the staff or volunteers visit these elderly regularly. My Ministry plans to increase the number of Neighbourhood Links to 20 by 2005 to reach out to more of our elderly. Nine Home Help Services are available for the elderly who need help in their day-to-day activities at home, including hot meals, personal care services, laundry, housekeeping and escort for medical appointments. Today, more that 1,100 elderly are being served island-wide.

Since 1993, my Ministry has worked closely with the HDB on its "Project to Improve the Living Conditions of the Elderly" at 1-room rental flats. The project undertook physical upgrading to make the units elder-friendly and safe for the many elderly residents there. The HDB also installed an Alert Alarm System (AAS) that is manned by a suitable Seniors Activity Centre or Neighbourhood Link. The system allows the elderly to call for help simply by tugging a string, and is available at all units occupied by the elderly. For the less ambulant or non-ambulant and homebound elderly, the HDB may also issue a personal wireless

alarm transmitter that can be worn, either as a necklace or on the wrist. It can be used to activate the same AAS, if the elderly cannot reach the pull cords.

Sir, my Ministry will continue to work with other Government agencies and community organisations to better reach out to our elderly. However, the best efforts may still have gaps, if friends and neighbours do not also play their part in looking out for the isolated elderly in their midst. Community organisations, like Neighbourhood Links, will continue to engage the more ambulant elderly in their area to volunteer in community activities and provide a wider reach. Together, Sir, I am confident we can strengthen the community network for the support, assistance and monitoring of the well-being of the elderly living on their own.

Sir, I would like to ask the Minister whether his Ministry is satisfied with the standard of training that service providers in Seniors Activity Centres are receiving, such that they could assist older persons living alone in 1-room flats, even with the improved housing conditions, in a more effective way. There was an incident publicised recently where a person with a Seniors Activity Centre at his block could still go unnoticed for so many days after his demise.

Sir, we are quite satisfied with the training programmes that are being provided for the various centres catering to the elderly.

With respect to the case that the hon. Member has mentioned, it was an unusual case where this particular elderly was actually registered with the activity centre but he chose not to attend any of the programmes and he was alone and aloof, and remained outside the community. So, I think the system which we have in place

- we ask them for their permission as to whether we can go and visit them - is still valid. The question is whether or not we should make the effort on our own to go knocking door-to-door is something that we have to ask. This is currently being done by volunteers already through the Befrienders' scheme, but perhaps we could step up more such efforts, especially in areas where there are elderly living on their own.

14. Mr Ong Ah Heng asked the Minister for Community Development and Sports in view of the difficulties faced by Voluntary Welfare Organisations (VWOs) running old age homes in raising funds in the current economic downturn, (a) what schemes are in place to assist VWOs facing shortfalls in funds; (b) what is the amount of disbursements given, if any; and (c) whether there are any plans to increase such disbursements.

Sir, homes for the aged run by Voluntary Welfare Organisations (VWOs) comprise nursing homes and sheltered homes. The latter, ie, sheltered homes, are licensed by MCDS. Of the 19 sheltered homes currently run by VWOs, three are being financially assisted by MCDS. Each resident is funded at 50% or 75% of the norm costs, depending on their household income. My Ministry has set aside over $404,000 grants last year for these homes.

The remaining 16 sheltered homes have for many years chosen to raise their own funds, and I commend and respect their self-reliance. My Ministry stands ready to consider funding these homes, should they need it and apply for assistance. Some of these homes have also been receiving Community Chest funding under the National Council of

Social Service (NCSS). In addition, my Ministry also facilitates VWOs to source for funds from various private corporations and donors, as well as through fund-raising initiatives, such as the recent President's Challenge.

Apart from funding VWOs for running costs, my Ministry has also set up the VWO Capability Fund (VCF) in July 2002 to help VWOs upgrade the professional standards and capability of their staff, fund pilot programmes and support info-communications technology initiatives. This fund is managed by the NCSS, and it will provide $30 million over five years. As at October 2003, $3.8 million has been committed by the fund.

The annual operating grants given to VWOs are adjusted each year, based on the projected GDP growth. Under this principle, for FY 2003, funding to VWOs would have been reduced by 1.6%. However, my Ministry recognised the difficulties VWOs may face in these uncertain times, and did not reduce funding. This is notwithstanding the reduction of 3% in the CPF contribution.

Sir, VWOs are key partners in delivering social services, and my Ministry is committed to review funding quantums regularly to take into account the changed circumstances facing our VWOs.

15. Mdm Halimah Yacob asked the Acting Minister for Education (a) what is the percentage of Singaporean students studying in the local universities and polytechnics who have taken up loans to finance their education; (b) whether this number is increasing or decreasing; (c) how many have difficulties paying back

the loans after graduation; and (d) what other schemes are available to help needy students.

Mr Speaker, Sir, for Academic Year 2002/2003, about 32% of Singaporean students studying in our local universities took up a tuition fee loan to finance up to 80% of their cost of university education. 5% of them also took up an additional study loan to finance the remaining 20% of the cost of university education and living allowance. The additional study loan is available to students whose family income is within the MCDS' means-tested income limit for public assistance.

For polytechnic students, about 6% took up the tuition fee loan, and 0.1% took up the additional study loan in Academic Year 2002/2003.

Between 2000 and 2002, we have seen a slight increase in the number of students taking up a loan to finance their higher education. The number of students taking up tuition fee loans increased from 8,903 to 9,000 at the university level, and from 2,356 to 2,650 at polytechnic level during the period, ie, from 2000 to 2002. The number of students taking up an additional study loan increased from 860 to 1,376 at the university level, and from 32 to 51 at the polytechnic level.

As at 30th June 2003, the number of university graduates with outstanding loans was 15,854. About 1% of them, ie, about 150 graduates, have had difficulties in paying back their loans. Amongst polytechnic graduates with outstanding loans, who number 4,674, about 3%, ie, about 135 graduates, have difficulty repaying their loans.

Other schemes available to help needy students include the University and Polytechnic Bursaries granted by the CCCs, Mendaki Tertiary Tuition Fee

Subsidy, as well as the bursary schemes and loan schemes that are administered by the universities and polytechnics themselves.

Mr Speaker, Sir, I have two questions. With regard to those students in the universities and polytechnics who are not able to pay their loans within the time prescribed, are they given some flexibility to do so beyond the time prescribed? Secondly, are there on-going assistance programmes or counselling service provided to students who have financial difficulties throughout their period of study?

On the first question, students who have difficulties in repaying their loans can discuss with the banks for a restructured schedule for repaying their loans. But the maximum period remains unchanged, which is 20 years. It is quite a long period. So far, that has not itself been the problem for the small number of students who have had difficulties in meeting the payments on schedule. But rescheduling the payments so that they pay a little more later rather than earlier is possible, and they have to discuss that with the banks.

What is your second question, please, Mdm Halimah?

My second question is: does the Ministry have any on-going counselling service or assistance for the existing students?

Yes, there is a range of schemes. Besides the MOE-funded schemes which I mentioned, ie, tuition fee loans and so on, the universities and polytechnics themselves have their own bursary schemes. These are quite apart from what is provided by the community.

Sir, does the Minister consider 30% of students in the university not being able to pay and having to take up loans a high figure? Is that comparable to what many other countries in the world have, that 30% of students have to take up loans? How does that compare with five years ago, for instance, instead of just with 2002? And how will these have a bearing, if university fees continue to increase, as I think the full extent of the subsidy increase has not been met, in accordance with MOE's previous statements?

30% taking loans is not a high figure. There are countries where the figure is significantly higher. It varies internationally, depending on the rate of subsidy of university education. MOE is doing a thorough review of the financing framework for universities, looking at sources of funding, how the universities should spend their money, how much of an undergraduate and postgraduate education should be subsidised by Government, how should students themselves finance themselves, should they obtain loans, should they work during vacations, for instance, which is quite common in many countries. We are looking at it comprehensively.

My sense is that, over time, the percentage taking loans would go up, not come down. 30% does not indicate that students are in distress. This is in fact part and parcel of tertiary education. You expect to earn income after you graduate. You take a loan and, after you graduate, you use a small part of your income to repay that loan. It is quite common internationally, and I think we want to move increasingly in that direction, rather than upfront subsidies in a hefty fashion, for tertiary education. Certainly, for university education.

16. Ms Braema Mathiaparanam asked the Acting Minister for Education (a) how many secondary school students received financial assistance to pay their school fees while studying at the independent schools in the last three years; (b) what is the general socio-economic profile of students in our independent schools for 2002, as gathered from their pupil data forms; and (c) what steps has the Ministry put in place to ensure that a talented child, from a less well-off home, does not fight shy of listing an independent school as a first choice school after his Primary School Leaving Examinations.

17. Mdm Halimah Yacob asked the Acting Minister for Education in the light of the recent announcement by some independent schools to increase their fees (a) what assurance is there that students from needy families can continue to afford these fees; and (b) what assistance is being provided to needy students.

Mr Speaker, Sir, with your permission, could I take this Question together with the next Question from Mdm Halimah Yacob?

Yes.

Sir, 4,400 or 2 in 5 Singaporean students in the independent schools receive MOE scholarships. These students only need to pay the amount of school fees and standard miscellaneous fees payable by students in the Government and Government-aided schools, which is currently $12 a month. They will therefore not be affected by the increase in fees in some of the independent schools. Information on these scholarships is well publicised, for example, in the Secondary Schools Selection Guide that was issued to all Primary 6 students.

MOE also has in place a financial assistance scheme to help deserving students to defray the higher school fees in independent schools. Over the last three years, there was an average of about 600 Singaporean students receiving financial assistance in independent schools through this scheme. This constitutes 5.4% of Singaporean students in independent schools in 2003.

If the students are not eligible for MOE Financial Assistance Scheme or need additional financial assistance, they can approach their schools. The independent schools each have their own internal financial assistance schemes and will also help source for support from community organisations to help needy students.

Ms Braema Mathi has also enquired about the socio-economic profile of students in our independent schools. About 50% of Singaporean students in independent schools live in HDB flats in 2002. About 17% live in 4-room HDB flats or smaller.

MOE is committed to ensuring that no deserving student is deprived of an education in an independent school because he cannot afford the higher fees charged in those schools.

May I ask the Acting Minister how does the Ministry encourage the child who feels that he or she cannot pay the school fees of these independent schools? What steps do the primary schools take to encourage such children to put such independent schools as first choice?

I do not get the sense that there is inhibition on the part of primary school students, even those from families with fairly modest means, to apply for independent schools. They are quite aware of the very generous scholarships on offer, the various

bursaries and other forms of assistance. The proof of it is that there is a fair number of students in independent schools receiving such assistance. We even have some independent schools that provide meal allowances and transport allowances, not just bursaries and scholarships to pay for their fees and the like. So, I think it is working quite well. Word gets around that the independent schools are not skin-flints. If you are a deserving student, and you qualify on merit, finance is not an issue.

18. Dr Amy Khor Lean Suan asked the Acting Minister for Education (a) what is the number of students who sought the help of school counsellors for the years 1999, 2000, 2001, 2002 and 2003 for the primary and secondary schools and junior colleges; (b) whether there are any guidelines or rules regarding the number of qualified counsellors for each school; and (c) whether schools are allowed to use only teachers to double-up as counsellors for students.

): Sir, MOE started data collection on counselling in 2001. In 2001, 2% of primary, 4.9% of secondary and 1.6% of students from junior colleges (JCs) and centralised institutes (CIs) were referred for counselling. Overall, 3.1% of the student population received counselling. Based on the counselling cases reported by schools in 2003, 2% of primary, 5% of secondary and 3% of students from JCs and CIs were referred for counselling. Overall, about 3.3% of the student population received counselling. Two-thirds of these students were seen by school personnel, including Teacher Counsellors, and a third were referred to MOE's specialists and external professionals. In recent years, some schools have observed an increase in self-

referrals by students and parents seeking counselling help for their children.

Schools have been advised that only qualified and experienced counsellors are engaged to work with pupils. Counsellors should be trained in guidance and counselling, and have appropriate qualifications such as a diploma or degree in counselling, psychology or related areas. The number of external counsellors for a school is, however, determined by the school itself, based on its resources and the needs of its pupils.

Counselling support in schools comprises a number of tiers. Support may be provided both by trained teachers as well as external counsellors engaged by the school. All teachers are trained in basic counselling skills so that they can provide basic counselling to pupils in need, as first-line caregivers. Pupils with more difficult problems can be referred to Teacher Counsellors (TCs) of which there are two in each school. TCs are trained in more advanced counselling and crisis intervention skills. Pupils with more serious problems are referred to the MOE-appointed School Counsellors or external professional counsellors who are engaged by the school. Further support is given by the guidance specialists and educational psychologists in MOE, who provide direct counselling to pupils and assist with making referrals to appropriate agencies, such as the Child Guidance Clinic and Family Service Centres.

Sir, I would like the Parliamentary Secretary to comment on the recent press reports that due to budget cuts, some schools have stopped engaging the services of qualified counsellors. If this was so, how would it affect the quality of counselling services that can be given to students who are in need of counselling by professional or trained counsellors?

Sir, as I have said earlier, each school has two Teacher

Counsellors who are able to advise and counsel pupils who have problems. We leave it to schools to determine whether or not they want to engage external counsellors. Up to now, about 70-odd schools are engaging school counsellors who were former school teachers or principals who have been further trained in counselling and are giving care to pupils. I do not think the number of schools which have decided to do away with external counsellors is very large. In any case, each school has Teacher Counsellors who can help the pupils.

Sir, I would like to ask the Parliamentary Secretary that for schools that do not have trained or professional counsellors, where would the students be referred to if they were assessed that they actually need help which is beyond the capabilities of the Teacher Counsellors?

Let me first reiterate that the two Teacher Counsellors are better trained compared to the other teachers. All teachers are trained in basic counselling so that they can provide first-line care-giving and advice to the pupils. The two Teacher Counsellors would be able to dwell deeper into their pupils' problems and would be able to counsel them further. If the school does not engage external counsellors but requires more specialised counselling for the pupils, it can refer the pupils to MOE.

19. Mr Gan Kim Yong asked the Acting Minister for Health in view of the varying bill sizes charged by the different public hospitals, (a) whether efforts have been made to review the operating costs and charges imposed by hospitals with higher bill sizes; (b) what has been the

outcome of such review if any; and (c) what actions have been taken to reduce the bill sizes of these hospitals.

Mr Speaker, Sir, the mission of our public hospitals is to provide good and affordable healthcare to Singaporeans, especially those from the lower and middle income groups. The key is to do more with less, so as to save money for the patients. Frills should be eliminated and unnecessary services avoided. This is of course not a once-off exercise but a continuous process of regular review of daily operations and clinical practices to identify areas of savings without compromising clinical care.

Some initiatives undertaken so far include group procurement, encouraging day surgery where appropriate and better discharge planning. They have resulted in more efficient use of resources, reduced length of stay and moderated the increase in healthcare cost.

The publication of hospital bill sizes is another initiative in this process of review. Hospitals can now compare their cost with those of other hospitals when treating similar types of patients. No two hospitalisations are identical. But on a statistical basis, if a hospital remains a significant outlier compared to the other hospitals, this must alert the management to review their way of handling such types of patients. This allows the hospital and the clinicians to ask intelligent questions about why their charges are significantly different from the others. Finding answers to such questions may then lead to actions which benefit both the hospitals and the patients.

An added benefit of publishing such statistics is that patients and their family physicians can now have a better idea of what to expect before their hospitalisation. They would be in a better position to make more informed choices with regard to their hospitals.

We have launched this initiative for three months now and I am glad that the public has welcomed the efforts. We will continue to improve on the contents of the publication.

The hospitals too have found the exercise useful and are actively following up. For example, Changi General Hospital (CGH) reviewed the medical conditions in which they had the highest bill sizes and found that their unit prices were not out of sync with the others. Their higher bills were due to differences in clinical practice.

Let me give you an example. Prostate operations, where CGH used to admit patients immediately for investigations when they turned up in the A&E for acute retention of urine. CGH has now adopted the other hospitals’ practice of doing the investigations for urine retention on an outpatient basis. Patients are now admitted only when they require surgery. This reduces the average length of stay by two days, with a corresponding reduction in the bill size.

Another example of a change in clinical practice is the substitution of oral medication for intravenous medication. The National University Hospital has introduced the use of oral re-hydration for paediatric diarrhoea cases instead of total intravenous hydration. This costs less and shortens the length of stay. Patient care is not affected.

Likewise, Alexandra Hospital has also reviewed their prescribing practices to encourage the use of cheaper alternatives, such as using standard instead of non-standard drugs for gastroscopy.

Let me quickly add that in some instances, higher bills may not mean bad practices. For example, CGH offers a more costly treatment for asthma. This is because CGH thinks that it is more effective in the long term, avoiding future

hospitalisation and therefore save costs for the patients overall.

We should encourage such diversity in treatment protocols among our hospitals. It allows us eventually to better assess which is the more cost-effective protocol which can then be adopted by others as the best practice.

Mr Speaker, Sir, I have a couple of supplementary questions. Firstly, I would like to ask the Minister whether he would assure Singaporeans that in the process of reviewing these charges, the quality of medical care will not be compromised. For example, I think Changi General Hospital has decided to shorten the length of stay for some of the hospitalisations. Would this lead to the doctors prematurely discharging patients?

My second supplementary question is that this comparison of fees is good and welcome. However, there is also a flipside of the story, ie, whether it would lead to some hospitals, realising that their charges are way below the others, looking towards increasing their fees as a result, and whether the Ministry has investigated whether there were any such increases.

My third supplementary question is whether the Ministry takes an active role in reviewing the charges imposed by hospitals or they leave the review to the respective hospitals.

Mr Khaw, you have less than a minute to reply.

Yes, I can give the assurance that quality will not be compromised. This is the starting point, that in this whole exercise, quality is paramount. But there are different practices. Medical practice is sometimes a bit of art and science, so it is not always clear which is the best regime. That is why I prefer a certain amount of

diversity. Some hospitals have a longer length of stay because they think on a long-term basis, it serves the patients' interests better. Others think they can do with a shorter stay. We cannot be sure which is better until some time has passed. Like all things, let us have experiments and, along the way, hopefully, there will be some enlightenment.

3.00 pm

Order. End of Question time.

[Pursuant to Standing Order No. 21(3), Written Answers to Question Nos. 21 and 22 on the Order Paper are reproduced in the Appendix*. Question Nos. 20 and 23-32 have been postponed to the sitting of Parliament on 6th January 2004.]

* Cols. 131-132

"to establish and incorporate the Accounting and Corporate Regulatory Authority, to provide for its functions and powers, and for matters connected therewith, and to make consequential amendments to certain other written laws",recommendation of President signified; presented by the Deputy Prime Minister and Minister for Finance (Mr Lee Hsien Loong); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed.

"to repeal and re-enact with amendments the Accountants Act (Chapter 2 of the 2001 Revised Edition) and to make consequential amendments to certain other written laws",

recommendation of President signified; presented by Mr Lee Hsien Loong; read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed.

"to amend the Companies Act (Chapter 50 of the 1994 Revised Edition) and to make consequential amendments to certain other written laws",

presented by Mr Lee Hsien Loong; read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed.

"to amend certain statutes of the Republic of Singapore",

presented by the Minister for Law (Prof. S. Jayakumar); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed.

"to amend the Fire Safety Act (Chapter 109A of the 2000 Revised Edition) and to make consequential amendments to certain other written laws",

presented by the Minister for Home Affairs (Mr Wong Kan Seng); read the First time; to be read a Second time on the next available sitting of Parliament, and to be printed.

Order for Second Reading read.

Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

This Bill amends the High Court (Admiralty Jurisdiction) Act in order to expand the current jurisdiction of the High Court in respect of shipping and maritime cases.

Sir, Singapore is one of the busiest ports in the world. We have positioned ourselves as a dispute resolution centre for maritime claims. In line with this, we established an Admiralty Court in 2002, to determine shipping and admiralty-related cases. As a maritime centre, it is important that our laws keep up-to-date with international maritime practices.

Currently, under section 4(4) of the High Court (Admiralty Jurisdiction) Act, a ship may be detained and used as security to satisfy certain claims against the owner of the ship. Such a jurisdiction is internationally accepted, and all major ports have similar legislation.

Leading shipping lawyers and members of the shipping industry have strongly recommended amending section 4(4) to also allow a ship on a demise charter to be used as security to satisfy a claim against the charterer. This is already the law in many jurisdictions, including the United Kingdom, Australia, New Zealand, Hong Kong, Malaysia, France, Italy, Greece, Netherlands and Spain. The Law Reform and Revision Division of the Attorney-General's Chambers studied the proposal and recommended its adoption. The Government has accepted the recommendation. This amendment will implement it.

A demise charter is a special type of ship hire, where the charterer is given full possession and control of the ship. The demise charterer has the power and the right to decide on the crew, the management and employment of the ship. These rights are very similar to those of an owner of the ship.

Sir, this amendment will plug a lacuna in our maritime law. As the current law only applies to the owner of the ship, a ship owner can avoid the effect of section 4(4) by operating the same ship as a demise charterer rather than as an owner. This can be achieved by the use of a separate entity that is controlled by the owner. The separate entity will operate the ship after entering into a demise charterparty with the owner. As the separate entity does not own the ship, the ship cannot currently be detained and used as security to satisfy obligations incurred by this entity. The amendment will prevent owners from avoiding the effect of section 4(4) by this method, as the new provision will allow the ship to be detained as security for claims against the separate entity.

This amendment will prevent ship owners from insulating their ships against such detention by using a demise charter. It will also bring our law in line with international practice.

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. - [Assoc. Prof. Ho Peng Kee].

Bill considered in Committee.

The Chairman: The citation year "2003" will be changed to "2004" as indicated in the Order Paper Supplement.

Clauses 1 and 2 ordered to stand part of the Bill.

Bill reported without amendment; read a Third time and passed.

Order for Second Reading read.

3.06 pm

Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

In 1987, this House took a big step in saving lives when it enacted the Human Organ Transplant Act (HOTA) based on the concept of presumed consent. By so doing, we made it possible for the removal, for transplantation, of kidneys of those who die as a result of accidents, unless they have earlier opted out. In this way, lives are saved and useful kidneys are not wasted unnecessarily.

Singapore was not the first in the world to have adopted such an opt-out scheme for organ donation. Several European countries pioneered the laws for presumed consent.

Since then, there have been at least 20 countries in the world with organ transplant laws similar to HOTA. These countries have concluded, as we have, that an opt-out scheme is a more effective approach to ensure that organs from those who die can be used to save lives.

Separately, we have the Medical (Therapy, Education and Research) Act of 1972 to allow Singaporeans to pledge their organs, through opting-in. Between 1972 and 1987, 27,000 pledges were received. After the passing of HOTA, we have continued to encourage organ pledging. Since 1987, we have received an additional 30,000 pledges.

Of these 55,000 pledges, three became kidney donors during the last 30 years, saving six lives. This is not a big

number. Nevertheless, we will continue to promote organ pledging as the spirit of giving, love and altruism is worth promoting.

Easing the restrictions of HOTA

Meanwhile, Singaporeans have continued to support HOTA. In the past 15 years, only 12,000 people have opted-out of HOTA.

To date, there have been 117 donors under HOTA. Together, they have saved 230 lives.

When HOTA was enacted, we deliberately kept it very restrictive. First, HOTA applies only to kidneys. Second, HOTA applies only to death from accidents. We took a very restrictive approach as we were breaking new ground and we did not want to unduly alarm Singaporeans. As Singaporeans have now become familiar with the concepts of brain death and presumed consent, I am proposing that we take the next step of easing these two restrictions so as to save a few more lives.

Beyond kidney to liver, heart and cornea

First, we are proposing to expand HOTA to also cover three other organs: liver, heart and cornea.

Beyond accident to other causes

Second, we are proposing to expand HOTA to also cover non-accidental deaths.

Living donor organ transplantation

In addition, we are proposing a third amendment to use HOTA to regulate living donor organ transplantation. In recent years, living donor organ transplantation has become accepted

throughout the world. It is performed on a regular basis in many countries.

In Singapore, we have carried out more than 400 living donor kidney transplants (since 1976) and more than 40 living donor liver transplants (since 1996). In fact, in the past two years, there were more living donor kidney and liver transplants than transplants from cadaveric organs.

There are important medical and ethical issues to be managed for living donor organ transplantation. It is therefore necessary to regulate living donor organ transplantation to protect the interest of donors, as well as to ensure that there is no organ trading.

Key features of the amendments

Let me now go into the details of the amendments.

Inclusion of liver, heart and cornea

First, clauses 3, 5, 6, 7 and 11 of the Bill will extend HOTA to include liver, heart and cornea.

In 1987, kidney transplantation was the only established transplant procedure. The first heart transplant and the first liver transplant in Singapore took place only in 1990. Since then, liver transplantation and heart transplantation have become established treatment modalities. For patients with liver failure or heart failure, organ transplantation is, in fact, the only way to save their lives.

Each year, we carry out about eight cadaveric liver transplants and two heart transplants. There are currently about 20 patients on the waiting list for liver transplants and five patients on the waiting list for heart transplants. The waiting list is not long, but only because patients with end-stage liver failure or heart failure often do not survive the waiting time. Each year, about 15 people

die while waiting for a liver and three people die while waiting for a heart.

Just two months ago, a 4-year-old girl died while waiting for a liver transplant. She had waited 31 months but in vain. Her parents wanted to donate their livers but, unfortunately, their tissues were not compatible. In the last two years of her life, she had to be hospitalised two to three times a month. She also had recurrent infections and spent the last three months of her life in hospital.

A few months back, a 41-year-old mother of two passed away while waiting for a heart transplant. She had developed heart failure after a viral infection. While waiting for a heart transplant, she had to be placed on a heart assist device to help her heart pump effectively. However, after 11 months on mechanical support, she developed a blood infection and passed away while waiting for a heart.

Every patient with organ failure clings on to the hope of receiving an organ transplant and leading a normal life. The inclusion of liver and heart under HOTA will allow

a few more of these organs to be used to save lives, instead of being wasted through cremation or burial.

Last October, a 50-year-old lady suffered from a very bad fungal ulcer in one eye. She required a cornea transplant. Fortunately, there had been a local donor three days prior to her operation and the Singapore Eye Bank was able to provide a fresh cornea for her. Without the local donor, the eye bank would have had to depend on an imported cornea. It would have taken about five days to arrive. By then, the tissue might not be in optimal condition.

Although cornea transplantation is not life saving, it restores sight to the recipient. By increasing the local supply of corneas, we would not only reduce our

reliance on overseas corneas but also ensure that the corneas obtained are of better quality.

The need for corneas will continue to rise as our population ages. In 1991, about 80 cornea transplants were carried out here. By 2002, the number had gone up to 200. Currently, half of the corneas are obtained from Singapore donors while the other half are obtained from the United States. However, the import of corneal tissue is not ideal. The procurement cost is getting higher. Aside from cost, overseas sources are unpredictable and the quality of the tissues is subject to external factors beyond our control. For example, it takes about five days to import a cornea. The longer preservation period would affect the quality of the cornea. The delay also precludes the availability of corneas for emergency cornea transplants.

In view of this, it is also desirable to expand HOTA to include cornea.

Inclusion of non-accidental deaths

Second, clause 4 of the Bill will extend HOTA beyond accidental deaths to non-accidental deaths.

To address the shortage of organs for transplantation, we have to ensure that cadaveric organs are not wasted. However, not all cadaveric organs are suitable for transplantation. Among all the patients who die in hospital, only a small number are suitable organ donors.

In practice, solid organs such as kidney, liver and heart will be suitable for transplant only if they are retrieved from patients who are brain dead and the underlying illness has not damaged the organs. Each year, we encounter about 40 such cases in hospitals. About one-third of these are due to accidents; the rest due to other causes.

For the purpose of transplantation, the cause of death really makes no difference. That is why in practically all other countries with transplant laws similar to HOTA, they do not differentiate deaths into accident and non-accident causes. However, as currently enacted, our HOTA restricts its scope to only accidental deaths. Now that Singaporeans have a better understanding of the importance of organ donation, I propose to remove this artificial differentiation that has unnecessarily wasted the number of organs which could otherwise have been available for donation.

The Bill would therefore allow HOTA to cover non-accidental deaths. What are non-accidental deaths? They refer to deaths from medical conditions. Examples are deaths due to intra-cranial haemorrhage (bleeding within the brain or skull) and primary brain tumours. These are patients who have already died in the ICU (intensive care units) of hospitals but purely relying on mechanical ventilators to maintain their blood circulation and keep their organs viable for transplantation.

In the case of cornea transplantation, it only involves the removal of a thin button-sized layer from the surface of the eye. The cornea is a non-vascular tissue. It can be removed after cardiac death or brain death has occurred. There will be stringent medical criteria to ensure that only tissue that is suitable for transplantation is removed.

Regulating living donor organ transplantation

Third, clauses 3, 8 and 11 of the Bill will regulate living donor organ transplantation. In particular, a new Part IVA, comprising sections 15A to 15D, will be inserted into the principal Act.

Living donor organ transplantation is not without risks or problems. First, it exposes an otherwise healthy individual to the risks of a major surgery. For instance, among living liver donors, one in seven may experience some post-operative complications. This could range from a need for reoperation to even death. Fortunately, we have so far not had any living donors who developed complications and died as a result of donating organs. Second, there is the risk that the donor might be under duress or coercion to donate his or her organs. Third, there is the risk of organ trading. Organ trading is repulsive and repugnant. We must strictly prohibit it.

My Ministry has therefore established strict professional guidelines on living donor organ transplantation. The guidelines stipulate that the social, psychological and emotional profile of the potential donor must be fully assessed. A full medical examination is required, and the surgical procedure, operative risks and possible long-term effects must be fully explained to the potential organ donor.

While the Ministry guidelines are comprehensive, there is currently no legislative backing for the regulation of such transplants in Singapore. This limitation should be rectified.

The Bill will expand on the current professional guidelines. The new section 15A prohibits living donor organ transplantation except where certain conditions are satisfied. All living organ donor transplants would require prior approval, in writing, from the respective Transplant Ethics Committees in the transplant hospitals.

The committee would have to be satisfied that two major professional and ethical concerns are adequately addressed. First, the donor thoroughly understands the nature and consequence

of the medical procedures and has given his or her full informed consent. Second, there is no emotional coercion or financial inducement to donate an organ.

The Transplant Ethics Committees will make their own assessment and decision based on the available information. This includes the medical report, the psychosocial report and the case report as well as interviews with the donor and relevant parties where appropriate. This will ensure that the necessary safeguards are put in place.

The new section 15B makes provision for the appointment and functions of the Transplant Ethics Committees. There will be regulations to govern the appointment and the procedures of these committees. Every committee shall comprise at least three persons, including at least one independent medical practitioner and one lay person. The section also confers immunity from legal suit on the members of a Transplant Ethics Committee and persons acting under the direction of the committee for anything which is done in good faith by them for the purposes of exercising the committee's functions.

The new section 15C empowers the Director of Medical Services to issue directions in the event that a Transplant Ethics Committee is not discharging its functions properly.

The new section 15D provides for the Director of Medical Services to issue directions to the hospital or the Transplant Ethics Committee for the purposes of Part IVA.

Other amendments

In addition, clauses 9, 10 and 11 of the Bill provide for the insertion of relevant sections and schedules so as to empower the Director of Medical Services to compound any offence which is prescribed as compoundable, as well as to

specify the types of living donor organ transplants which should be regulated under this Act.

Public consultation

Mr Speaker, given the sensitive nature of these amendments, the Whip has been lifted to allow Members to debate and vote on the Bill based on their religious and ethical beliefs.

On my part, we have carried out extensive public consultations on the proposed amendments and the draft Bill. We took almost one year to do this. Many feedback sessions were organised. We also proactively sought the views of professional, religious and community organisations. The text of the draft Bill was also placed on the Ministry of Health's website for public scrutiny.

The public response has been good. Singaporeans accept the need for organ donation and organ transplantation in order to save lives and to reduce the suffering of those with organ failure. The majority were in favour of the proposed amendments.

If the House supports this Bill, we will continue with the public education efforts to ensure that Singaporeans are fully aware of these amendments and of how they will be affected.

Conclusion

Sir, today, there are many Singaporeans with organ failure who face financial hardship and unnecessary death. The amendments to HOTA cannot fully solve the problem of organ shortage. However, it will go some way towards saving lives and reducing suffering. I hope this House will join me in helping to save these lives.

Sir, I beg to move.

Question proposed.

Mr Speaker, Sir, I stand to speak in support of the Human Organ Transplant (Amendment) Bill.

Sir, I am a doctor, and as all doctors believe that saving more lives and reducing suffering are fundamental to our doctrine, I welcome this Bill for it will enable us to save more lives and give more quality life for many patients. However, I do have several concerns with regard to this Bill.

I feel that this opt-out scheme of HOTA is too imposing. I would have preferred just an opt-in scheme. Many have expressed disgruntlement that their body organs automatically do not belong to them after death. Although they can opt out, there is a penalty for doing so under HOTA. The explanation for the opt-out scheme has been that the opt-in scheme enacted under the Medical (Therapy, Education and Research) Act (MTERA) since 1972 drew very small donor response. My point is that, with our affluent society, it will be more civic to invite people to donate their organs rather than compelling them to do so through regulations. Is it right to base the poor response of our past record of our opt-in scheme for our decision to expand HOTA now? In the past, no concerted efforts were tried by MOH on public persuasion or public education to get donors to better promote our opt-in scheme. Could it be that the opt-in scheme has failed from the lack of effort on the part of the Ministry? Are we being seen as taking an easy way out again without even considering this implication of compulsion on the people? Is it right for us to progress as a society in this manner?

Brain death issue has been controversial. The worrying fact for many is whether people certified with "brain death" is really dead. Many reports in the media had published how "brain death"

patients had woken up after years of being in coma. One such case was noted in Europe recently - the patient was apparently in coma for 18 years. For the loved ones of many certified brain death patients, the acceptance of brain death is heart-wrenching, especially when this is instantaneously followed by the removal of the organs of their loved ones. How does the Ministry of Health ensure that organs are not removed prematurely? I have read that in the United States, the whole brain must stop functioning

for a diagnosis of "brain death" whereas, in Britain, brain-stem death is enough. Which one are we following in Singapore?

This Bill will expand the organs for transplant to include the cornea, heart and liver. Some have questioned why corneas should be included in this Bill as cornea transplants do not save lives and corneas can be imported easily. Cornea transplants have not been affected here in the past and nobody has been deprived here of cornea transplant. The argument against including the heart is that, since not many heart transplant operations are being done here, why is there a need for that organ presently? Also, due to their religion, some have expressed that they are uncomfortable with the idea of having no hearts in their after-life and having no sight if they had their corneas removed.

This Bill will regulate the living organ transplant. May I seek clarification from the Minister on a few points here? How is his Ministry going to regulate on the criteria concerning living donors and prevent abuses with regard to the deterrent measures? How is his Ministry going to ensure that donors are not under financial inducements or emotional coercion and duress to donate their organs? Are there safeguards to protect the interests of the donors because there is a risk of death or long-term medical complications? How do we ensure that the medical costs incurred in the course or as a result of donating their organs can be

addressed? Will those Singaporean recipients and donors who cannot afford to pay for their medical bills fall under the safety net of Medifund? How will this new proposed Bill affect foreign patients seeking organ transplant in Singapore?

Sir, Muslims have been excluded from HOTA; therefore, Muslims waiting for a kidney transplant will naturally have a very low priority. May I ask the Minister how he is going to address and help Malays who are apparently at higher risks of developing kidney disease? Kidney disease treatment, such as dialysis, is not only a costly but also a long-term liability and this will cause hardships to many Malay families. In the past, Muslims signed up as donors on finding out they had kidney failure so that they were eligible when they needed the transplant, usually several years later from the onset of kidney failure. Can they continue this practice?

Sir, I would like to urge the Ministry of Health to step up public education not only about HOTA but also to equip the public on how to prevent the need for organ transplants. As we know, the majority of kidney failure cases here have been the result of diabetes and hypertension. Therefore, healthy lifestyle promotion for prevention of disbetes and hypertension, early diagnosis of these conditions and good control of these conditions will help us reduce our need for more organ transplants. All efforts must be enhanced and monetary issues addressed, especially towards helping those who are poor to pay for their long-term medications for these chronic diseases.

Sir, may I now seek clarification on certain clauses of the Bill? Section 5(2)(f) of the Act suggests that there is no authority to remove organ if the designated officer, after making inquiries, has reason to believe that person was not of sound mind, unless the parent or guardian has consented to such removal. I understand that, legally, if a person is

already classified as of unsound mind, a committee of estate will be appointed to take care of that person's estate. If this is the case, the consent to be sought should be from the appointed committee, instead of the parents or guardians. Therefore, should this section not be amended to include consent to be sought from the committee of the estate, if any? If the designated officer, after making inquiries, has reason to believe that the person was not of sound mind, it ought to be deemed that no authority was given. The rationale is that person would not be in a position to decide whether to object to the removal of his organ and submit the objection.

Sections 9 to 13 (Part III Registration of Objection) suggests that any person objecting to the removal of organ will be given an acknowledgement form and, if he subsequently changes his mind, another form will be given to him. In this case, there will be several forms in the hands of his next-of-kin and this may cause confusion and may lead to the next-of-kin questioning this perceived discrepancy. In this way, may I suggest that a new clause be added to state that, in the event of discrepancy, the information recorded in the register shall be final and conclusive of the election of the person.

I hope the Minister can enlighten us on the points raised.

Mr Speaker, Sir, I rise in support of the proposed amendments to the Human Organ Transplant (Amendment) Act.

As the Acting Minister has pointed out in his speech, some 230 lives have been saved, since HOTA came into effect in 1987. Some people may feel that 230 is a small number compared to our national population of more than three million and

that it would not make any difference. It may not have made any difference to many Singaporeans, but it certainly makes a lot of difference to the 230 lives which were saved through HOTA and to their family members. It is for this reason that we are here today to debate the proposed amendments to the Act to expand the scope so that more lives can be saved. These amendments, if approved by Parliament, will undoubtedly make a significant difference to those who are currently on the waiting list for organ transplant.

Sir, we have come a long way. Over the last 15 years, most Singaporeans have overcome the initial fears and concerns of HOTA and come to accept the principle of presumed consent on organ transplant. It is therefore timely to move to expand the scope of HOTA so that more lives could be saved. While I expect more Singaporeans to be supportive of the proposed changes, we cannot take for granted that all of them have clearly understood the implications of these changes. In my dialogue with my residents, some of them, especially the older ones, still have specific concerns. We need to address their concerns if we were to have their unequivocal support. And I would like to elaborate on some of these concerns.

Firstly, the Bill is proposing to expand HOTA to include non-accidental deaths. In particular, this will include patients who are considered to be brain dead. The intention is quite clear. We hope that this will allow more organs to become available. It has been estimated that about 24 kidneys, for example, could become available for transplant if non-accidental deaths were covered under HOTA. The motive therefore is quite obvious. However, the inclusion of non-accidental deaths in HOTA may give rise to some concerns with regard to brain death. Although the Government has clarified, on several occasions, the definition of "brain death" and has

assured the public that adequate safeguards will be introduced to ensure that the declaration of brain death follows a set of very stringent clinical criteria, some Singaporeans are still concerned on two aspects. Firstly, whether brain death is reversible and, secondly, whether every effort will still be carried out to save the lives of brain dead patients. The question that lingers on in some people's mind is that, while a person may be certified brain dead according to medical definition, is he truly dead? Some still have the fear or hope, depending on how you look at it. Those who have been certified as brain dead may still wake up one day. And if their vital organs have been removed under HOTA, they will have no hope of recovering. This is particularly so as some have heard stories of supposedly brain dead patients miraculously returning to life.

It is important to dispel the myths of brain death and allay such fears. I am afraid that professional and medical definitions alone will not be persuasive enough, although they may be adequate as legal definitions. I think we may still need to explain in layman's terms what it means to be brain dead and why recovery is no longer possible. This is a tedious but necessary process. We must understand that sometimes such issues are not a matter of the brain, but a matter of the heart because emotions are involved. And we would need to take time to explain and to persuade.

It is also natural for patients and their relatives to be concerned, given the prospects of organ harvest, whether saving the patients' organs would be given higher priority than saving the patients' lives. For example, would doctors decide to disconnect the life support system so that organs can be obtained? It is therefore necessary to reassure patients and their families that

procedures and safeguards have been put in place to ensure that patients' interests will not be compromised when the Act is expanded.

Sir, inevitably, at the end of the day, there would still be people who choose to remain unconvinced and wish to opt out for a variety of reasons. The fact that some 12,000 people have opted out of HOTA over the last 15 years is evidence that we cannot hope to convince everyone. While we want to encourage Singaporeans to support HOTA, we must also respect the rights of any individual to opt out, if he so wishes. For this reason, I would strongly urge the Ministry to ensure that the process of opting out is kept simple and accessible, especially for the older people who may not be literate. I understand that MOH plans to inform all Singaporeans and Singapore permanent residents when they turn 21 that they will be covered under HOTA. I hope MOH will continue this practice and, for the convenience of the population, the notices should be multi-lingual.

Finally, Sir, I would like to urge the Ministry to continue its public education efforts. This is important in our efforts to reach out to Singaporeans to persuade them not to opt out of HOTA. Public education also plays an important part in our continued efforts to promote organ pledging. Communicating with the public is an on-going process and we must keep up the effort.

To summarise, Sir, my three points are: firstly, we must address the concerns of some Singaporeans on the clarity of the definition of "brain death" and assure them that patients' interests will not be compromised in favour of organ harvest. Secondly, while we want to promote HOTA, we must ensure that the opt-out process is simple and accessible. And lastly, we must continue our public education and communication efforts.

On this note, Sir, I support the Bill.

Thank you, Sir, for allowing me to join in this debate.

Sir, I congratulate the Minister for lifting the Whip on this Bill. The provisions of this Bill do touch on religious beliefs of many Singaporeans. Therefore, it is only right that the Whip be lifted and allow Members to vote by their own conscience.

Sir, I believe that it is the moral duty of all citizens to save lives and relieve pain. Accordingly, I would rise in support of the Human Organ Transplant (Amendment) Bill which seeks to widen the scope for getting more human organs for transplanation to save lives. Formerly, the scope of procuring human organs for transplantation was only limited to getting them from persons who have died in accidents. The organ allowed to be harvested was only the kidney. But with the enactment of this Bill, the list of organs allowed to be taken from dead persons

includes the liver, heart and cornea.

In addition to the enlargement of the list of organs allowed to be harvested from deceased persons, the Bill, when it becomes law, shall allow living persons to donate their kidneys and part of their livers for transplantation to another living person. Doctors soon shall also be allowed to harvest organs from dead persons who have not died from an accident.

All in all, this Bill, when enacted, is a breakthrough in medical science in Singapore. The scope for getting organs from deceased persons shall soon be very much widened, and donations of organs from living persons shall also be allowed. Although I agree to the donations of organs by living persons, at the same time, I sincerely hope that the Minister shall satisfy himself that there are sufficient safeguards against abuse and trafficking of human organs.

I note that the punishment under new section 15A(4) is only a $10,000 fine and a maximum of 12 months' jail and, under new section 18A, the Director can compound an offence under the Act for only $2,000. Under these kinds of seemingly light punishment, some people may think it is worthwhile to flout the law and indulge in trafficking of human organs or induce an unwilling person to sell his kidney for, say, $10,000. In turn, the trafficker may market the kidney for 10 times that price to a desperate rich man who needs a kidney transplant to save his own life.

As regards the jail sentence, normally a prisoner can get a one-third remission of his jail term. So, a person who trafficks in human organs can get off with an 8-month jail term and come out to enjoy his $100,000, less the amount he has paid to the seller of the organ. When there is evidence of trafficking in human organs in Singapore, I urge the Government to be strict on those wrongdoers, especially when a criminal offence is detected.

As regards the relationship between the donor and the donee of the human organs, it would appear that the Government still insists that there must be some kind of a close relationship between the donor and the donee of the organ. This is illustrated by the recent case of Ms Andrea De Cruz and her fiance, Mr Pierre Png. In that case, I was told that a Buddhist monk had volunteered to donate part of his liver to Ms De Cruz, but the Director of Medical Services rejected that offer on the ground that there was no close relationship between the monk and Ms De Cruz. The rationale is that where there is no close relationship in terms of family members, there is always a doubt as to whether the consent by the donor was genuine. In that case, Ms Andrea De Cruz had a happy ending, as she was saved by the donation of part of the liver by her fiance Pierre Png. In my view, in

cases of living donors, I hope that the Director of Medical Services shall still insist on a close relationship between the donor and donee of the organ to ensure that there is genuine consent on the part of the donor of the organ. If the close relationship is comprised of a blood relative, it shall all be for the better, because the organ donated shall have a better match with the donee and the chances of rejection shall be less.

As regards the First Schedule of the Bill, it allows, in addition to the kidney, the liver, heart and cornea to be removed from a deceased person for transplantation. Since the Bill has now widened the list of organs to be extracted for transplantation from a dead person, the important question one would ask is: when is a person dead? Is a person dead when his brain is dead? Again, I would like to get the Minister's assurance that Singapore has all the know-how and the medical equipment to diagnose a person to be brain-dead. Not long ago, a Taiwanese lady was thought to be brain-dead when she was in England. But when she was rushed back to China and given treatment, she recovered, so the report goes. I hope that such incidents shall never happen in Singapore, otherwise it can be embarrassing for Singapore, which is working to be a medical hub of this region. I am informed that Singapore, like the United States of America, has acceptable standards of what constitute brain death. I believe so. But I would still like the Minister to comment on this.

This Bill raises many medical and ethical issues. For example, how can a doctor take a human organ from a donor and at the same time not explain to him that there may be a risk to his life, or that he may develop health complications later on? Or how can a doctor convince himself that a donor has really given his full consent to donate one of his organs?

After this Bill is passed, it would appear that a doctor can legally take the organ of a deceased Muslim for transplantation when that Muslim has not opted out of the Act. Will the doctor do that, knowing that many Muslims interpret their religion as prohibiting the donation of human organs? In the case of Jehovah's Witnesses, their branch of Christianity prohibits the transfusion of blood. Does the doctor do nothing and allow a Christian of that sect to die without giving him a blood transfusion so that his much-wanted organs can be donated to sick patients who are in grave need of those organs?

I know these are difficult medical and ethical questions, but they have to be discussed openly and, hopefully, a consensus can be arrived at.

Mr Speaker, Sir, I rise in support of the proposed amendments to the Human Organ Transplant Act. The reasons are compelling and I shall therefore not repeat them. I would, however, like to address the issues which have arisen from the following amendments:

The inclusion of corneas and hearts;

The inclusion of non-accidental deaths; and

The regulation of living donor organ transplants.

In addition, when discussing the inclusion of non-accidental deaths, I would briefly revisit the issue of the determination of the moment of death, for harvesting organs, as these amendments may rekindle old perceptions and fears.

Sir, the PAP Women's Wing has consulted with professional women and carried out a survey amongst some 300 women activists of varying ages and from

all walks of life. I shall be reflecting some of the feedback in my speech.

Firstly, the inclusion of corneas and hearts.

Sir, clause 3 seeks to add corneas, hearts and livers to the First Schedule in the definition of an organ. At present, a large number of corneas used for transplantation come from foreign sources and the challenges are well-known, as the Minister has already touched on. It would, therefore, be desirable to include corneas under HOTA. An equally compelling argument can be made for heart transplants.

In our survey, more than 50% of the respondents disagreed with the Chinese belief that corneas were needed in the afterlife, compared with the 32% who thought so. This appears to be more of a Chinese folklore or belief, rather than being rooted in any religious grounding. Nonetheless, some may feel uncomfortable that their loved ones, or some day, they themselves, will literally die "heartless". Hence, while this does not constitute violent objection, I would like to urge the Minister to carry out the necessary public education. The Minister may also want to allay the fears that there would be cosmetic defects in their loved ones whose corneas have been harvested.

The other concern raised revolves around the observation that cornea transplants are seldom life-saving, if at all. There is no reason in principle why we should adopt such a limited position, especially with regard to the debilitating effects of blindness. Of course, in saying this, I am not endorsing a carte blanche approval of any and every organ, the failure of which would have a similarly damaging effect on the body. It is, however, safe to say that the practice of

cornea transplants is well established here, and there are no ethical concerns that justify precluding their inclusion.

It remains to be pointed out that those who possess strong beliefs can always have the remedy of opting out of HOTA.

Secondly, the inclusion of non-accidental deaths.

Clause 4 widens the scope for inclusion of non-accidental deaths, which refer to deaths from medical conditions. As the Minister has said, many other countries have already included both accidental and non-accidental deaths in the legislation. We would, therefore, not be the first to make such a move.

Sir, non-accidental deaths were omitted from the purview of HOTA initially to allay any initial distrust of the Act, since it was easier to accept that very little could be done to save victims of bad accidents, as opposed to patients who were terminally ill.

However, with the purview now widened to cover all deaths, the onus is on the Minister and his officials to ensure that the criteria for certifying death are stringent and that the assessors are bound strictly by criteria that ensured impartiality. I shall elaborate on the determination of death shortly.

The fear appears to be more of possible inefficient policing, than one of principle. So long as there is efficient policing, there should be no objection to extending HOTA to non-accidental deaths.

Sir, with regard to defining the moment of death, since its inception in 1987, HOTA has always been applied to brain-death cases. This is notwithstanding the amendment to the Interpretation Act in 1998 to widen the definition of death to include brain-death.

The definition of brain-death used by Singapore is the same as that used in many developed countries, which is determined based on a well-defined standard set of clinical criteria. The point would thus appear to be moot at this late stage. However, as my colleagues Dr Neo and Mr Gan have alluded to, there is perhaps a renewed fear that with the growing breadth of HOTA, medical professionals may be less rigorous in their determinations of death, that they will be motivated by the competing prospect of potential donors. This may cause grieving families to wonder if the lives of their loved ones might have been prematurely truncated. In our survey, about half expressed such reservations.

Sir, medical professionals may be well-acquainted with the determination criteria, but the lay person, by and large, appreciates cardiac death, or when the heart stops beating, better than brain-death. Once again, our survey bears this out, with half feeling more assured with cardiac death for the harvesting of organs. I would, therefore, like to urge the Minister to carry out more public education on the stringent safeguards in place as well as provide adequate counselling for affected families. With this assurance, there should be no objection to the continued adoption of brain-death as a legal criterion of death.

Thirdly, the regulation of living donor transplants.

Sir, I note that living donor transplantation is widely accepted and performed regularly in many countries. There is currently no legislation, and it is timely to regulate such transplants. And most people are supportive of such transplants.

While the first class of transplants involving related parties is well understood and accepted, those between unrelated parties can potentially lead to organ trading, if stringent guidelines and policing are not in place.

I note the adoption of the spirit of wanting certain proof that the donor is not motivated by financial incentives. In addition, the following considerations should be addressed:

The medical risks to the donors and how to mitigate these risks;

Whether there is informed consent; and

Whether the donor is acting under duress.

There is a fear that legislation will not cover loopholes, such that a trade in organs will unwittingly develop. However, I note, Sir, that at present it is already illegal to pay for or trade in organs. Therefore, the proposed amendments should not raise the risk of a development of the organ-trade.

However, at the same time, there may be a need for a reasonable compensation to defray the costs and expenses of donors. In the United Kingdom, this is apparently allowed for to a certain extent.

Under the proposed section 15A for living unrelated donors, approval must be obtained from the hospital's ethics committee. The mainstay of section 15 relates to whether the donor has given informed consent, and whether

that consent is not obtained by virtue of fraud or duress.

It does not however preclude contracts which allow for the reimbursement of any expenses necessarily incurred by a person in relation to the removal of any organ or blood in accordance with the provisions of any other written law. It is debatable therefore whether this extends to loss of earnings. Some clarification by the Minister with regard to this point would be helpful.

Finally, a suggestion to the Minister for living related organ donations. These are in principle less susceptible to abuses such as organ trading, because of the presumption of emotional ties. However, there is also the fear that donors would feel pressured or even coerced to make a donation to a relative. The current professional guidelines issued by MOH do not require the approval of the hospital's ethics committee, so long as relevant evidence of kinship is produced. The Bill does not change this position. There has been the suggestion that such donors should be made to undergo psychiatric evaluations to ensure that there is no element of coercion or pressure.

On this note, Sir, I support the amendments to HOTA.

Order. I propose to take the break now. I suspend the Sitting and will take the Chair again at 4.25 pm.

Sitting suspended accordingly at 4.02 pm until 4.25 pm.

Sitting resumed at 4.25 pm

Debate resumed.

Mr Speaker, thank you for allowing me to join in this debate.

I rise in support of this Human Organ Transplant (Amendment) Bill, the intent of which is to enhance quality of life and to save lives. I think on that score, no one in this House can have any quarrels with the Bill.

My focus however is on the method and approach that are going to be used to achieve that objective. Like all good intentions, it is the means that need to be examined in closer detail. Sir, the Bill in particular addresses the issue of living donor transplants and that is the specific aspect that I wish to focus the bulk of my comments on, as many of the preceding speakers have covered many other areas.

Sir, the Transplant Ethics Committee envisaged by this Bill must be satisfied with three matters before it gives its authorisation for the removal of a specified organ from the living donor. Firstly, a living donor has to give consent. Secondly, the consent has to be informed, in the sense that he is of sound mind, able to understand the nature and the consequences of the procedure he has to undergo. Thirdly, as the Minister puts it, there must be no emotional coercion or financial inducement. These are important considerations for the Transplant Ethics Committee because it must, in its task, be seen to be objective, having the best interest of the living donor and the recipient at heart in coming to a fair and just outcome. The fact that most of these decisions may have to be made under the pressure of time, because lives will be at stake, I think, makes this task all the more difficult.

Certain questions arise when one contemplates how the Transplant Ethics Committee is going to go about its work. The Minister said that the Committee will ensure, through various reports from psychologists, doctors and so on, that the living donor is well-briefed, understands what the impacts of his action are on himself and his long-term health before he comes to a conclusion. Sir, this notion of understanding the nature and the consequences of his action is very important in this context, because the impact of a living donor transplant is quite serious. From what I understand from friends who are in the medical profession,

living donor kidney transplants have a mortality rate of less than 0.1%. On the other hand, living donor liver transplants have mortality rates that can range between 1-3%. When we start thinking about chances of complications, post-surgery, the probability increases significantly and as I understand it can be as high as 20-25%.

It is critical that whoever is contemplating donating his or her organ is well-briefed of the implications. This briefing must be done by individuals who are well-trained and impartial. This is the part that I am most concerned about. How will the Transplant Ethics Committee ensure that is indeed accomplished, especially when we think in terms of usually these scenarios are charged with emotions and the time pressure on the Transplant Ethics Committee will be significant?

The second element that comes up is: how will the Transplant Ethics Committee ensure that the donor is not under duress or donating pursuant to any contractual agreement or other understanding? What criteria will be used to judge what is reasonable compensation as opposed to inducement? Allow me to illustrate.

If a recipient compensates the living donor for the cost of surgery, post-surgery care and also the treatment of complications that might arise that may require long-term treatment, is that permissible under new section 15 of this Bill? If it is indeed permissible, is there a test as to what is a reasonable level of compensation? And if so, who will verify or audit to ensure that such payments are legitimate and not excessive? We can extend that argument further and Mrs Lim Hwee Hua had talked about it. If the recipient offers to compensate the living donor for loss of income during the period of convalescence after the operation has taken place, is that permissible? What if the post-operative complications diminish

the living donor's earning capacity permanently? Can the recipient legitimately make good on that shortfall?

There is a whole range of questions we can contemplate in this regard. The Bill itself leaves these matters largely unaddressed. I suspect partly because the Ministry's thinking is that it should be addressed by either the ethics committee's deliberations or in a court of law. But my own view is that we need to have some level of debate and clarity on the intent in this House to guide the committee and any other body that needs to think and address these issues. In general, the key question we need to ask is: are there any guidelines or provisions that are in place as to how remote such expenses or payments need to be before they are deemed not to be consideration for the sale of organs?

I would also like to seek a clarification from the Minister on the applicable age of consent under this Human Organ Transplant (Amendment) Bill. Sir, under HOTA, deceased between the ages of 21 and 60 may be the subject of authorisation for the removal of any organ for transplant purposes unless they have opted out. However, under the Medical (Therapy, Education and Research) Act, anyone of sound mind above the age of 18 can pledge his organs for transplant, education or research. So, the question that begs to be asked is: what is the status of a living donor or any other donor, for example, between the ages of 18 and 21 under this Bill? Can they donate? Certainly, from a public policy perspective, if the intent is to maximise the potential pool of healthy donors, we should allow those between the ages of 18 and 21 to do so. But this matter is again not explicitly addressed, and I would appreciate a clarification from the Minister on this.

Sir, given the magnitude and range of issues that need to be contemplated and

thought through by the Transplant Ethics Committee, it is important that we also ask the questions on how the Transplant Ethics Committees are structured, what is their composition and how they are going to go about their work. The most basic question that comes to my mind is: should the Transplant Ethics Committee be centralised or decentralised? This Bill envisages that each hospital will have its own committee. In other words, it will be decentralised. I think the key concern here is the trade-off between speed of decision making whereas a more centralised model will give us greater consistency. I think the concern with a decentralised model is: will the guidelines be applied in a consistent manner, meeting not just minimum standards but what we accept as social norms in approaching such thorny issues?

From what I know based on the readings I have done on this matter, I think the additional number of organ donations that might arise from this amendment are of the order of magnitude of a few tens in a year. If that is the case, then is this argument of concern over the speed of decision making of the ethics committee really strong enough for us to err in favour of a decentralised model? Or should we really be focusing on creating a centralised body which will respond efficiently if it is given the resources to ensure that matters such as proper counselling of the donors is done, and to build up a body of cases regarding this whole new and untested water of living donors before we, with some level of confidence, decentralise it to the hospitals? I think this is an important issue. My own preference would be to keep it centralised and then, over a period of time, once we are more comfortable with the application of the principles, to decentralise it. I would appreciate the Minister's elaboration on his thinking on this subject.

If the plan continues to be to keep the committee decentralised, then the question that I would like to ask is: how do we ensure consistency in practice across medical institutions? Will the Ministry draw up guidelines to ensure that all these ethics committees will operate within certain well-defined boundaries?

The issue of the composition of these ethics committees also needs to be addressed more specifically. As it stands, the requirement is that the ethics committee comprises no fewer than three persons, of which one must be a lay person and the other a medical doctor not employed by or related to the hospital in question. It is a good start. But if we think about it a bit further, what this means is that we could technically have a Transplant Ethics Committee of, say, seven members, of which one is a lay person, one medical professional not linked to the institution, and then five from the institution itself. Then there is the question of how will the decisions made by this Transplant Ethics Committee appear in the eyes of the general public. I think there is a need to ensure certain caps to the size of the overall Transplant Ethics Committee if, in fact, we may say that they should be set up in each hospital. And if they are going to be set up in each hospital, then there should also be an explicit limit on the number of professionals from that particular institution being represented on that committee. I think this is not to cast any doubts on anybody's integrity. This is more about being seen to be doing the right thing as much as doing the right thing.

Finally, I have a set of questions on the issue of public education. In preparing for this debate on this Bill, I spoke to several young lawyers, doctors and professionals. And as we know, under HOTA, Singapore citizens and permanent residents turning 21 are to be informed of their coverage under HOTA by the

Ministry of Health. All the young people I spoke to, and they are young enough to remember when they turned 21, do not recollect receiving any such notification. I would like to ask the Minister to confirm that, in fact, this is being done and that all Singaporeans and PRs will be told of their coverage under HOTA at the appropriate point in time.

A related question is with respect to foreigners who are here under permanent residence or other organisations. Are they informed and, if so, at what point upon getting PR or are there any other reminders to them? I would like to know this because I think it is, potentially, a problematic issue if our practices here vary with the norms or practices in their home countries. I think we need to be sure that foreigners coming to Singapore to live and work are well briefed of our practices under this Act.

Sir, I think a lot has been said about this. There is certainly a need to educate the public about the issue of what constitutes "brain death", since that is the key trigger for this Act to come into place for cadaveric donors. The concern I have here is that in talking to professionals and well-educated individuals, there is still a great deal of, first, uncertainty as to what is actually brain death. Is brain death reversible? Are the criteria for defining "brain death" arbitrary, and a whole host of other related questions. These sorts of questions and uncertainties act as an impediment to the effective achievement of the objective of this Bill. So, I think it is critical that the Ministry, together with its agencies, works to communicate the point clearly on what constitutes brain death and why Singaporeans should be assured that these are decisions that will be made after much thought and based on criteria that have been formulated after years of practice and assessment. I think that will go a long way in taking us closer to the objectives of this Bill.

Sir, this Bill does not introduce legislation on human organ transplant for the first time. It is an amendment that seeks to enlarge the scope of the present Act. Since its First Reading, the Bill had attracted or rekindled much public interest. The public debate includes matters such as the definition of "brain dead", society's values on respect for the dead, the possibility that doctors would be more concerned with harvesting the organ of a dying person than with saving his life and so on. These issues were debated when Parliament passed the original Act in 1987, but the public raised them again. While technically Parliament need not deal with such issues again, it is not wise for us to brush them aside. Such concerns are real, important and widespread. Indeed, some of my colleagues before me had raised the same issues.

One such issue is whether the Bill, if passed, implies that we lack respect for the dead. The original Act has been around for 16 years. How we respect the dead had not changed significantly. Our funeral rites have not changed much, and even if they do, it is not because of the Act. Except for a very small number, all deceased persons undergo the usual funeral rites and accorded all due respect as dictated by their beliefs and customs. This is mainly because for an organ to be considered suitable for harvesting from a cadaver, there are many conditions. So, the opportunity for transplant is small and rare. Perhaps this best explains why there have been few organ transplants from cadavers each year in spite of the Act. The figures were given by the Acting Minister for Health earlier. But it may be argued that this time the Bill includes other organs, such as the liver, the heart and includes non-accidental deaths as well. Will this open the floodgates? Will this opening up encourage less care be given to potential

donors? Looking at our experience thus far, I personally doubt it. There are hundreds of deaths due to accidents each year, but the average number of kidney transplants under HOTA has been about 13.5 per year. I am not aware of any complaint or allegation in the past 16 years that care to a potential donor was compromised due to interest in conducting a transplant. I believe that the same culture would prevail under the new provisions.

The easing up is not drastic. But the Ministry must continuously assure the public that this remains so. I understand that it is envisaged that two doctors certifying brain death for a potential donor must not be in the transplant team or be involved in the selection and care of the recipient. This mechanism removes much of the potential for compromise of medical care to the potential donor under the Bill. Perhaps the Minister could also enlighten us on measures that would ensure that the separation of roles of doctors would be rigorously implemented.

Sir, some members of the public questioned whether we should presume consent for cadaveric human organ transplant in the first place. This is a delicate balancing act. On the upside, the Act allows for lives to be saved and lives to be lived better. Here we are not talking about superficial cosmetic changes but we speak of the difference between life and death, and the difference between a reasonably healthy life as against suffering chronic ailments. The downside is whether we compromise the rights of individuals to decide and whether we unwittingly open ourselves to abuse.

Sir, it is not right to say that those who oppose the Act in principle even today do not appreciate the good arguments for it. They do appreciate the noble intention to save lives, but they

accord more priority to maintaining certain social norms as they understand it. Conversely, it is not right to say that those who support the Act or this Bill do not care about social norms. They do appreciate the need to uphold norms but they see the Act

as a humane way of manifesting equally compelling values where society, as a whole, decides that some sacrifice is justifiable. These arguments, Sir, and I believe many more eloquent ones, were made when the original Act was passed. But they are as relevant and applicable today as they were then. They deal with very important issues. It is not therefore surprising that the issues raised in 1987 were raised again recently. It is incumbent that this House and the Government in due course continue to handle these concerns appropriately.

That said, Sir, I see no reason for us to review the Act as such. Indeed, as our experience has shown, there is cause for us to improve on it. The thrust of the Bill is two-fold. The first is to expand on the types of organs and to include non-accidental deaths. The second is to regulate living transplant. Over the years, we have accumulated enough knowledge and experience to have the confidence that an expanded HOTA would not be harmful but instead be helpful to society. The figures provided by the Ministry support this contention. As such, I support the expansion envisaged by the Bill. The intention is to save lives, and our experience shows that the Bill, if passed, is likely to do just that.

Currently, there is no legislation regulating living organ donor transplantation, although the Ministry of Health has issued professional guidelines to doctors and hospitals. There is thus a level of uncertainty. It is bound to cause confusion among doctors, patients and potential donors. Already, Sir, there have been news reports of people in desperate conditions offering their organs for

money. This problem is exacerbated with great improvements in communication. If unchecked, transnational transactions in organs could raise even more difficult issues. It is therefore very useful that the legislature expresses its clear position on this issue. I think the Government has correctly identified the considerations in this regard - medical risk to the donor, genuine and informed consent, exclusion of children from being donors and motivation of the donor. The overarching concern is the ethical issue - whether it is right to mutilate one living person so as to benefit another. We say it should be permissible in genuine cases. So the Bill seeks to prescribe the conditions and processes to ensure that only genuine cases are permitted.

Sir, the final aspect that I wish to touch on is with regard to the position of the Muslim community as regards HOTA and the Bill. Presently, Muslims are excluded from the Act. They can, however, opt in. Those Muslims who opt in would qualify for the benefits under HOTA as do their non-Muslim counterparts. Such benefits include the right to receive organ donation and subsidised treatment. Those Muslims who do not opt in would not be eligible for such benefits. At the end of 2000, Muslims formed about 20% of Singaporeans who suffered from kidney failure and among new cases of end-stage renal failure each year. The MKAC (Muslim Kidney Action Committee) was then formed to encourage Muslims to opt in. After about 10 years of tireless effort and $7 million spent, the number of Muslim pledges increased 33-fold, from 400 in 1990 to 13,000 in the year 2000. However, this constituted only about 4.2% of the eligible Muslim population. Getting people to opt in proved to be no straightforward task.

The position of the Muslims, Sir, is expressed by rulings issued by the Muslim Religious Council (MUIS). In principle, the

rulings are based on the concept that the corpse of a Muslim belongs to his estate. As such, the waris (or the heirs) of the deceased have rights over the cadaver. Thus, nothing should be taken from the cadaver unless it is with the consent of the waris. So even if a Muslim wishes to opt into HOTA, the Muslim person has to obtain the consent of two of his waris. This was the position in 1987. Look in another way, the position of MUIS seems to be founded on the view that, firstly, the public interest to cure diseases has to be balanced against the rights of the waris over a cadaver; and, secondly, that the consent of the waris cannot be presumed by legislation, but instead such consent must be expressed in individual cases. This Bill does not change this position.

But a closer look, Sir, would show some interesting developments. In 1973, MUIS issued a ruling that if a Muslim made a will to the effect that his kidneys be donated on his demise, such a will would be considered void. However, this issue underwent not a transplant but a review in the 1980s. Based on the reinterpretation of religious principles and based on prevailing medical knowledge then, MUIS issued a new ruling to the effect that kidney transplant arising from accidental deaths, such as those envisaged by the original HOTA, was permissible. This ruling made in 1986 superseded the 1973 position. However, the 1986 ruling contained a proviso. The proviso related to the rights of the waris which I had mentioned earlier. Thus, as regards the 1987 HOTA, MUIS advised the Government that it was better that Muslims be excluded from the HOTA but they were allowed to opt in. This advice, I reckon, was in consideration of the need to recognise the rights of the waris. It was also felt that the Muslim community at that time would be more prepared to accept the opt-in scheme rather than the main regime where consent of the waris would be presumed.

There were other developments. In 1995, MUIS issued a ruling that living cornea transplant was within prescribed circumstances permissible. Earlier this year, MUIS also ruled that donation of other organs such as the liver and the heart is similarly permissible as donation of kidneys. I understand, Sir, that MUIS had also ruled that organ transplants from non-accidental deaths are, in principle, permissible. Further, MUIS recently ruled that for Muslims to opt into HOTA, it is sufficient that they obtain the consent of one waris and one witness, as opposed to the requirement for consent of two waris in 1986.

Sir, the developments mentioned show that the Muslim community in general, and MUIS in particular, are willing to relook at stated positions. They do so in the light of advances made in medicine and the changing needs of society. But they are also careful in reinterpreting established principles so as to minimise uncertainty and confusion among the adherents. I would urge the Minister and the Minister-in-charge of Muslim Affairs as well to see whether MUIS could suitably review the position as regards how the consent of the waris has to be expressed, to see whether we could bring its position closer to that of mainstream Singapore society without undermining established principles.

I understand, Sir, that our Muslim scholars are also mindful of the view of their counterparts in other parts of the Muslim world. At the same time, I believe they are aware of the views of fellow Singaporeans with whom they interact every day. I have no doubt that Islam, like other religions, promotes the saving of lives, granted that saving lives is not at all costs. I do hope that in due course the Muslim scholars and the Muslim community would advance a solution which would enable the community to

partake in HOTA while not undermining its principles in other areas such as the rights of the waris and respect for the deceased.

In conclusion, Sir, it seems to me, on balance, the Bill is better for Singapore. And if I may borrow a quote from an anonymous writer: "Is life worth living? It depends on the quality of the liver." I support the Bill.

Mr Speaker, Sir, I rise to support the Human Organ Transplant (Amendment) Bill.

The support given by most respondents at the Bill's public consultation organised by the Ministry for the past year is clear evidence that there is good trust in our health system and our doctors. Singaporeans know that the precious gift of life from fellow citizens will not be abused for monetary gain nor will it compromise the provision of healthcare for potential donors. However, having said all this, I have the following points and questions to raise.

The shortage of organs is not unique to Singapore. In a report "Human Organ and Tissue Transplantation" published by the World Health Organisation's Secretariat last year, it was noted that about 70,000 solid organs were transplanted annually worldwide. I quote, "The persistent and widening gap between patients' need for organs and the number available for transplantation" has become an international problem. The long waiting list has fuelled the growth of international black market in the trading of organs.

Nancy Scheper-Hughes, a professor of anthropology at the University of California, has written extensively on human organ trade. In an article, "The Global Traffic in Human Organs", she wrote: "In general, the flow or organs follows the modern routes of capital: ...

from Third to First World, from poor to rich ...".

A 2002 Canadian Broadcasting Corporation programme named "Deadly Harvest - Parts for Sale" highlighted the rapidly growing tissue industry, estimated to be worth more than half a billion dollars. Apparently, a person who procures and sells human tissue could make anywhere from $80,000 to $200,000 per body. Arthur Caplan, an ethicist at the University of Pennsylvania, stated that the tissue was worth "more than diamonds, in some cases". The market for solid organs is more difficult to estimate because it is illegal in almost every country. However, international reports point to a dark and exploitative sector which is growing by leaps and bounds.

What does all this mean to Singapore? Are Singaporeans immune to the lure of organs for sale? Not at all. Although we have no official statistics, for years we have heard occasional stories of sick Singaporeans going overseas for transplants. Often, the sources of the organs are suspect, with fatal consequences for the recipient due to organ mismatches and post-operative infections. Still, some continue to take the risk. They are afraid to join the ranks of those who have died while waiting or being forced to drop from the list while still being alive, because they become too ill to remain candidates for transplant.

To address this shortage and keep organ trading at bay, the Ministry has chosen the opt-out system, which has proven worldwide to work better and effectively in increasing the number of organs compared to the opt-in system. However, with an expanding aging population, we must ask how Singapore is to cope with the never-ending needs for donors. More and more citizens will live longer, with the failure of perhaps one

or two organs later in their lives.

Transplants would then become more and more attractive as a means of postponing the inevitable. The scarcity could never be satisfied for underlying the demand is the natural human denial and refusal of death. The Ministry needs to work with the hospitals to educate Singaporeans at risk about the pitfalls of obtaining organs from doubtful and illegal sources.

The next point I would like to raise is that the Act has specified that it does not apply to donors below 21 and over 60 years of age. Should the Ministry also specify, or at least provide some guidelines for the age of the recipients, in order to ensure that breadwinners and parents with young children receive priority?

The next point I am going to raise regards severe kidney disease as a real risk following transplantations. I came across an interesting publication in the New England Journal of Medicine in September last year. It concerns the largest study of non-kidney transplants ever conducted, that is to say, transplantation involving other organs, such as hearts and livers. It was stated that, after the operations, 16% of these patients suffered from severe chronic kidney disease. Subsequently, 33% of the group progressed to end-stage renal disease. The study involved 69,000 people in the United States who received transplants between 1990 and year 2000.

Successful transplantation is defined by the long-term survival rates and improvement in the quality of life of patients. Hence, the study underscores the importance of counselling potential recipients on the significant long-term risks of kidney failure associated with transplantation, in addition to the opportunistic infections, cancer and bone diseases. In addition, the same study found that liver transplant recipients had a prevalence of Hepatitis C of 21%, with an

associated excess risk of chronic renal failure. In view of this new information, I would like to know if there are regulations for hospitals to provide counselling to transplant recipients and requirement for them to update counselling materials and guidelines on a regular basis.

Successful transplantation also depends on continued medical follow-up and the patients' compliance with the regimen of immunosuppressive drugs. The expense of these medications and treatments for resulting complications can be very high. I would like to ask the Minister how many patients have applied for financial assistance for such therapy, the quantum of assistance, if any, in the last three years and what financial assistance schemes are in place for this specific purpose.

Next, I would like to touch on living donor organ transplants. Currently, for living related organ donation, genetic tests to prove the relationship between donors and recipients are not required in Singapore. However, it is required in the United Kingdom. Due to the potential for financial inducements in living organ transplants, I would like to recommend that the Ministry consider making genetic tests mandatory.

For living unrelated organ donation, the Bill has provided for the appointment of a hospital's Transplant Ethics Committee to perform the evaluation. As we all know, transplantation brings money as well as prestige to the hospitals. Therefore, there is a risk, however minimal or minor it could be, that a hospital would be tempted to encourage potential recipients to recruit potential donors more aggressively or even be involved in the process itself. While the presence of a medical practitioner not employed or connected with the hospital and an independent lay person on the

ethics committee can act as a safety check, it is definitely not foolproof. Different hospital evaluation criteria could emerge. Hence, I would like to suggest that clear, uniform and stringent regulations be laid out for all hospitals, both public and private.

We must also pay attention to the welfare of potential donors. Factors such as undue influence and family pressure can affect a donor's judgement. Are there any follow-up medical and psychological checks conducted for donors? It would be useful for the Ministry to set up a database of all living donors and conduct a study tracking their health and subsequent attitude towards the procedure. The results of this study would be useful to assist us in refining our health policy in the future.

With that, I would like to conclude my support for the Bill.

Resolved,

That the proceedings on the business set down on the Order Paper for today be exempted at this day's sitting from the provisions of Standing Order No. 1. - [Mr Mah Bow Tan].

Debate resumed.

Mr Speaker, Sir, the Human Organ Transplant (Amendment) Bill is an important Bill. With advances in medical science, organ transplant has become a common and effective procedure to save and enhance lives in many countries. The figures on deaths arising from failed organs are staggering.

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In Western Europe, there are 120,000 patients receiving chronic dialysis treatment. Estimates suggest that between 15% and 30% of transplantations in Europe die whilst waiting for an organ. In Singapore, as at December 2002, there were 666 people on the transplant waiting list for kidneys, 20 for livers and 7 for hearts. Between 1996 and 2002, 32 kidney failure patients and 110 liver failure patients died. The Acting Minister has also given some updated figures earlier on. In the US, it was estimated that, in the year 2000, organ transplantations had saved or enhanced the lives of more than 20,000 men, women and children.

If we can save more lives through this Bill that we are now debating, then we should support it. The amendment seeks to allow removal of organs in all situations where a person is brain dead, protect living organ donors and expand the scope of transplant to include the heart, liver and cornea. The existing law is restrictive as it allows only the kidneys from persons who died in an accident to be used for transplant. The Bill seeks to remove this and to allow transplant from other brain dead patients.

To me, this is a logical development as the existing restriction makes an unnecessary distinction between those who are brain dead because of accidents and those who are brain dead because of other illnesses, and there is no medical difference between the two. In fact, developed countries with established transplantation programmes do not make a distinction between deaths from accidents and other causes.

However, Sir, there is a concern among some Singaporeans, which my other colleagues have also expressed, that hospitals may prematurely terminate the care of a patient in order to use his organs for transplantation purposes. Now that the scope of the Act is being expanded, it is important that we address this concern. This could be addressed by putting in place effective rules and measures to determine when a person will be considered as brain dead. In some countries, the law prescribes a procedure before a person is considered brain dead. For example, in Greece, Article 7 of their law (821) provides that a patient must be declared brain dead by three specific physicians - the patient's physician, plus a neurologist or neurosurgeon, plus an anesthesiologist. None of these three physicians are allowed to be part of the transplantation team as a safeguard against premature termination of care to the donor. The organ must also be removed by physicians specialised in this field. I would like to suggest that the Minister consider introducing such a provision in our law in view of the concerns that have been raised concerning what amounts to brain death.

It is important that hospitals adopt clear rules on this and also inform and educate the public of the system that is in place. It is even better if this is stipulated in our law as the Greek law so provides. I am certain that this will help to generate greater public confidence that the interests of donors are adequately taken care of. The Greek law is also interesting in other aspects and reflect their cultural, social, norms and ethos. Their law provides for the body of the donor to be properly dealt with. The Greek law provides that the body must not look mutilated and must be made to look as normal as possible for the family's viewing afterwards. I think such a provision in that law will reasonate with Singaporeans because, culturally,

Singaporeans also would like to have the deceased bodies of their loved ones in one piece and not mutilated as a result of organ transplants.

Another key objective of the Bill is to regulate live organ transplants. As the Bill correctly points out, there is a need for regulations to safeguard the interests of living donors by ensuring that living organ donation meets ethical and professional standards. In this regard, Sir, I feel that the existing penalties to deter illegal buying and selling of organs in our Act may not be sufficient, particularly now that we have expanded the scope of the Act. Under section 14(2) of HOTA and new section 15A(4) of the Bill, the maximum penalty imposed on someone found guilty of entering into a contract, or arrangement to sell organs, is a fine not exceeding $10,000 or to imprisonment not exceeding one year or to both. This penalty clause has not been reviewed since 1987 and is, in my view, an insufficient deterrent. A maximum fine of $10,000 and a jail term of one year is nothing compared to the huge benefits and profits that can be reaped from organ trading. I think it is timely for the Minister, in the light of the current proposal to expand the scope of HOTA, to consider increasing the penalty to deter human organ trafficking.

Trafficking in human beings is a heinous crime. Trafficking in human organs is a crime of the same genre. It is equally heinous as the victims are usually the desperately poor and needy. Increasing the penalty would send a clear signal to all those who may be tempted to resort to such crimes that they would be severely dealt with.

Another concern I have, Sir, is with regard to both section 14(2) of the Act and new section 15A of the Bill and the issue here is whether they are extensive

enough to cover all the various transactions and steps involved in organ trading. Under section 14(2), a contract or arrangement under which a person agrees for valuable consideration, whether given or to be given to himself or to another person, to the sale or supply of any organ or blood from his body or from the body of another person, whether before or after his death or the death of the other person, shall be void. It is unclear whether this provision covers all the situations involved in organ trading. For example, does it cover a broker who acts merely as the agent to bring in the organs, or procure people locally, or overseas, who are willing to sell their organs, but who himself has no direct dealings with the person seeking an organ transplant? Does it also cover those who act as the contact points, or who knowingly make the travel arrangement, or engage in other activities to support the buying and selling of human organs? In this whole process of illegal organ trading, there is a long chain and we have to ensure that we put adequate measures in place to prevent organ trading.

Organ trafficking, Sir, is a worldwide concern. In the European Union Parliament, stringent laws are being considered to penalise human organ trafficking. The proposal is for those convicted of organ trafficking to be liable to 10 years of imprisonment. Hence, I would like to urge a review of the scope of these clauses which stipulate the penalty for buying and selling organs by ensuring that they are wide enough and are severe enough to act as a deterrent.

I would also like to suggest a review of section 15 of HOTA. The use of Internet and other forms of communications, such as SMS, has become very pervasive today compared to 17 years ago when HOTA was first passed. In some countries, the Internet has become a very pervasive tool for the buying and selling of organs. A simple

query on the Google search engine, for instance, would yield thousands of websites purporting to sell various body parts. Under section 15 of HOTA, all advertisements relating to buying or selling of organs or blood are prohibited.

Section 15, too, describes what amounts to an advertisement. It includes every form of advertising, whether in a publication, by the display of any notice or signboard, or by means of any catalogue, pricelist, letter or other documents whereby words are inscribed on any article, or by the exhibition of a photograph or a cinematograph film, or by way of words inscribed on any article or exhibition of a photograph or cinematograph film, or by way of sound recording, sound broadcasting or television or in any other way, and any reference to the issue of an advertisement shall be construed accordingly.

Perhaps, the Minister could clarify whether these new forms of communication I have cited, ie, Internet, SMS, will be covered under section 15(1) and, if not, whether he would consider amending this provision to add greater clarity to it, so as to prevent organ trading.

Sir, with the introduction of a new Part IVA under the Bill dealing with living donor organ transplants, Muslims will now be partly covered under HOTA. In this regard, the position of a Muslim living donor and that of a non-Muslim are the same, subject of course to the requirement of approval from the waris for Muslims. Muslims are now also regulated by Part IVA when it comes to living organ donations. In many countries, the use of organs from living donors has become much more important, compared to the use of organs from those who are brain dead. In 1999, there were 5.3 kidney donors per million population in the UK, 8.7 in Switzerland and 11.5 in Sweden. Norway has a very successful number of

live kidney donations among the European countries, with 24.6 people donating their kidneys per million population in Norway in 1999.

With a clearer framework for live organ donations provided under this Bill and more public education of the benefits of live organ donations, I can foresee that, over time, living donors will become a much more important source for organ transplants in Singapore, and this will benefit everyone, regardless of their religious convictions.

Sir, the removal of organs from Muslims who have died remains the same. Muslims are still required to opt in before section 5 of HOTA, which deals with the removal of organs after death, will apply to them. There are several fatwas from the MUIS Fatwa Committee on the issue of organ donations by Muslims after death. The key point to note is that Muslims are allowed to donate their organs, subject to the approval of the waris after a person's death. A key consideration for the fatwa committee's decision is that Islam places a high premium on saving lives and gives priority to the needs of the living rather than the dead. Hence, Islam supports transplants to save lives in emergency situations. The need to require the consent of the waris is the only reason why section 5 cannot automatically apply to Muslims.

Sir, there are great benefits for Muslims to be covered under section 5 of HOTA, as the rate of kidney failure among Muslims is much higher. So long as Muslims are excluded from the ambit of section 5, we will have less priority when it comes to organ transplants. Although dialysis is one way of dealing with the problem, it is not a better solution compared to a kidney transplant.

As I mentioned earlier, with a more favourable framework that is now in place

for live organ donations, Muslims would also benefit. However, it is important that we continue to exhaustively explore all avenues that are currently available to save lives. I, therefore, call for on-going discussions among our Muslim religious scholars, the MUIS Fatwa Committee and the Muslim community, in consultation with key international Islamic jurists and ulamas, on how best we can maximise the use of organ donations prescribed under section 5 of HOTA. Fatwas on organ donations have actually evolved quite a bit from the original position enunciated in 1973, where kidney donations were prohibited. Since then, with tremendous developments in medical science and more is known about the risks of organ transplants, a new fatwa has allowed kidney donations, subject to the approval of the waris. Over time, taking into account the concerns and needs of the Muslim community, this is one issue we need to focus and get resolved. We need to find a way of dealing with the issue of consent from the waris.

In conclusion, Sir, I support the call made by several colleagues for an extensive public education programme. This is important as there are legal, social and ethical issues involving human organ transplants, and the public needs to be properly informed and educated to overcome major concerns which cannot be addressed by the law alone.

On this note, Sir, I support the Bill.

Mr Deputy Speaker, Sir, organ donation is an emotive issue, which may be influenced by the donor's cultural values and dearly-held religious beliefs. For some people, it concerns the wholeness of the body for the afterlife. For others, it constitutes a question of respect for the departed. But, equally important, the statistics show that

each year a significant number of people perish because suitable donor organs cannot be found in time. From a secular perspective, the issue boils down to one of whether we should, figuratively speaking, "sacrifice" the already dead for the benefit of the dying, in order that they may have another chance at life.

It is entirely appropriate that the Ministry had embarked on an extensive public consultation and feedback programme on the proposed amendments. I am also pleased that the Whip has been lifted for this Bill, and rightly so, given the religious and perhaps ethical questions it might raise in the minds of some people. Allowing MPs to vote according to their conscience and beliefs reinforces the intention of the Bill, that it is not meant to take away an individual's rights to his own body.

But, Sir, whilst I personally support the Bill, there are three key issues which I would like to highlight and urge the Ministry to seriously consider.

Firstly, as with many of my colleagues before me, the issue refers to not just extensive but sustained, systematic public education. There are still some who advocate an opt-in rather than an opt-out system, as this would allow the rights of the people to be better respected. In an ideal world, I would agree that it would be better to have an opt-in rather than an opt-out system. This will allow Singaporeans to make an informed, conscious choice to opt in and pledge their organs, rather than, as one respondent to MOH's online feedback noted: "relying on their ignorance not to opt out".

However, in reality, not many will opt in, as they are inclined not to think about the subject of death, since it is something that they deem far away or "won't happen to me yet". For others, it is also

something unpleasant or taboo. Or as another respondent to MOH's online feedback declared: "If it is an opt-in system, I will not opt-in, as it is too much of a hassle. While I do not mind donating my organs, it is not a priority for me." Hence, I support the present opt-out system. Indeed, I think it is a pragmatic approach.

However, once this Bill is passed in Parliament, it affects the majority of Singaporeans and PRs. Many may be oblivious to the fact that they are subject to the provisions of the Act, unless they opt-out.

Furthermore, every year, a new cohort of individuals will reach the age of 21, when they become automatically subject to the Act, unless they opt out. This group must also be educated on HOTA, so that the Act, which operates based on presumed consent, truly does not take away or diminish the individual's rights.

I strongly believe that the Government must keep up with its efforts to educate the public on the implications of the Act on a regular basis. If not, very quickly, the public may forget about the Act. There is already some evidence of this from recent public feedback regarding the Bill. The concerns over an opt-in versus opt-out system, the definition of brain death, safeguards to ensure that doctors do not prematurely diagnose brain death, and the fear that the body may be mutilated, are not new and have been debated some 16 years ago, when HOTA was first enacted.

Indeed, a Select Committee was even set up to receive representations on the original Act. Yet, these same concerns have been raised in the most recent feedback sessions, showing that such concerns continue to gnaw, either because they are deep-rooted and cannot be easily overcome or, perhaps more

likely, many of the feedback participants are not aware of the previous debates and responses.

In fact, an incident I recently encountered clearly illustrates the need for on-going education efforts to reach out to as many individuals as possible. When I told one of the senior directors of my company a few days ago that I was preparing to speak on HOTA at this Parliament sitting, he asked, "HOTA? What HOTA?" Of course, the acronym will never scale the heights of brand recognition achieved, say, by SIA, or even for that matter the PAP. Nonetheless, whether it is HOTA or the words spelt out in full, the man-in-the-street is probably - and I beg the indulgence of Mr Deputy Speaker, Sir, to use Singlish in this House - "blur like sotong".

The Acting Minister for Health noted: "I see no reason why properly explained, properly educated, why we cannot achieve this higher pledge rate." Singapore's rate of organ pledging is low compared to those of other cities outside Asia. Can it be partly because the public has not been extensively and properly educated nor continuously reminded?

It was reported in the Straits Times of 22nd February 2003 that the Ministry is to conduct regular public education programmes in partnership with community organisations. I would like to ask to what extent this has been done. I cannot recall any organisation coming forth to give the grassroots and residents in my constituency an educational talk on HOTA. Continuous public education on HOTA is not just to ensure that Singaporeans make an informed decision, in this case, "not to opt out". But, beyond this, better understanding about organ donation may also encourage more people to sign up, outside the scope of HOTA, under the Medical (Therapy, Education and Research) Act enacted in 1972.

In its public education efforts, I would like to suggest the following areas which the Ministry could pay attention to.

Firstly, as an Asian society, Singaporeans' views are still likely to be shaped by religious or superstitious beliefs. There is thus a great need to clarify misconceptions and allay fears pertaining to this emotive subject. The Government should, therefore, work closely with the religious organisations and actively enlist their help to reassure the public that organ donation is not contrary to their religious beliefs.

Secondly, from our experience in fighting SARS and administering the NSS and ERS, the grassroots could be mobilised to educate the community about HOTA. This will be especially helpful for the senior citizens who do not read the newspapers, surf the Net or even watch current affairs programmes on TV.

Thirdly, in the previous debate on HOTA in 1987, the then Acting Minister for Health had, in response to Members' concerns, informed the House that following a 6-month intense public education campaign, every year from henceforth, all Singaporeans reaching the age of 20 years will receive a reminder concerning HOTA. I would like to ask the Minister if this practice has continued ever since and, if so, in what form the reminder takes.

Fourthly, as new cohorts will come under the Act each year, it is best to educate our young so that they will not be averse to organ donation. Moreover, they can help in bringing the message across to their parents and grandparents. An encounter a friend had on a bus illustrates this point. She overheard a young mother asking her daughter to eat - something in a cup which she was spooning and wanting to put into the child's mouth.

The child told her mother, "No eating on the bus!". Even though the mother insisted, the child did not give in, repeating what she believed was the etiquette, over and over again, "No eating on the bus". After a few minutes, the mother got the point and did not pursue the matter.

I think this incident illustrates how important it is for us to educate our young in order to reach out to those supposedly older and wiser, and who think they know better. I would like to ask the Minister if efforts have been made to educate students from secondary schools and above on organ donation. If not, I would like to urge the MOH to work closely with the MOE and other community organisations, like the NKF, to reach out to the students who would be future donors, so that they clearly understand the motivations of the Act.

Finally, the MOH could spearhead an annual "Organ Donation Awareness Day" with welfare and community groups

such as the NKF and the CCC. This could form part of a systematic and sustained effort to educate our young, and the public in general, about the critical need for organ donation and, at the same time, allay their fears and concerns.

My second point relates to living donor organ transplants and the Transplant Ethics Committee. Of the three major amendments the Bill seeks to incorporate in HOTA, the regulations for living donor organ transplants would be considered the most significant and far-reaching.

A press report discussing whether HOTA should include more organs besides the kidney, noted that many people in fact think that HOTA includes more than kidneys. A Gleneagles Hospital consultant, liver transplant surgeon, K C Tan, was quoted as saying, "Many people, even doctors, have assumed all along that the Act refers to all organs. If

you accept the Act, other organs should be no different from kidneys."

But whilst the majority surveyed are for the inclusion of more organs, there are also detractors who feel that body parts should not be treated like unwanted furniture or auto spare parts. Thus, I support the MOH's stand of adopting a cautious approach of excluding the lung under the current amendment to HOTA, even though there were requests for its inclusion, as lung transplant is not yet established.

However, MOH should constantly review the usefulness and appropriateness of including other organs such as the lung and allow for such inclusions as soon as it is deemed suitable. Perhaps, the MOH could set up an Organ Donation Advisory Committee to review the scope of organ donation in Singapore, assess existing guidelines and make recommendations to the Minister on how rules can be changed in keeping with the times.

The recent high profile incident involving actress and presenter Andrea De Cruz alerted the public to the benefits of allowing for living unrelated organ transplants under special circumstances. The incident has perhaps also made the public more receptive and aware of the need to clearly spell out the rules permitting such transplants.

This would make the regulations and conditions under which living donor organ transplants, particularly those between an unrelated donor and a recipient, more transparent and safeguard against outlawed practices, such as organ trading. In our quest to save more lives, we certainly do not want to unwittingly create possible loopholes for organ trading, and where life and death is the outcome of price bidding or the influence of the powerful, as is already happening in some countries.

There are merits for each hospital's Transplant Ethics Committee to assess and decide on living organ transplants, such as direct and faster access to information which could spell the difference between life and death. But there is also a need to put in place measures that will ensure uniformity of standards, strict independence of the ethics committee and the pooling of expertise and resources, especially in tiny Singapore.

MOH should establish comprehensive, transparent and clear guidelines, rules and procedures for the ethics committee in order to reduce as much ambiguity as possible on the part of the ethics committee in making decisions regarding the eligibility and suitability of a living donor.

The composition of, and criteria for, appointment of the ethics committee should also be made transparent to allay public concerns regarding the neutrality, professionalism and integrity of the committee. The ethics committee should preferably comprise not just a medical doctor with no vested interest in that case, but also psychologists and trained counsellors to assess the donor's motivation for organ donation. In this regard, I agree with my earlier colleagues' comments that perhaps there should be a cap as to the number allowable in the ethics committee, as well as a maximum number of representatives from the institution itself.

My final point relates to respecting the dead. When HOTA was introduced in 1988 to cover only kidneys, there were already concerns from the public that the body may be mutilated when the kidneys are harvested. Now, as more organs are to be included, there is clearly genuine concern over the possible mutilation of the body. MOH needs to reassure the public that it fully understands and

respects the strong emotional ties between the deceased and the family, and that the body would be treated with utmost respect.

Before harvesting the donor's organs, the family of the deceased should be informed and counselled on the procedure and what to expect to see after the surgical operation, so that there will not be any added undue concern at a time of their bereavement. I would thus like to ask the Minister to assure this House that the bereaved donor's family will be properly informed and counselled by doctors and professional counsellors before the organs are harvested.

In conclusion, Sir, I would like to note that Singaporeans largely understand the primary motivations of HOTA to save lives. Hence, many support the Act and the proposed amendments, but they also have legitimate concerns regarding the Act and the Bill, some of which I have raised, and for which the Ministry must continue to attempt to overcome.

With this, Sir, I support the Bill.

Mr Deputy Speaker, Sir, thank you for allowing me to join in the debate.

Sir, the inclusion of the liver, heart and cornea to the list of organs covered by the opt-out system or presumed consent system under Singapore law is to be welcomed. It has been long in coming, but Singapore is still one of the few countries in the world where this system exists. No doubt there are 20 countries, but we are still in the minority, happily so.

Having presumed consent legislated will reduce wasted time and opportunities, when organs which would otherwise have been able to save lives, go to waste

because people do not understand the issues involved. Transplantation of kidneys, hearts, livers and corneas is already part of the practice of medicine for many years. For those receiving kidneys and corneas, they receive additional life to the years, whereas for those receiving hearts and livers, it is often literally the gift of life itself. But cadaveric organ donation is not only the means of obtaining human organs. In reality, the number of cadaveric transplants may never be sufficient since Singapore has a low rate of deaths among otherwise healthy citizens since we have safe roads and safe streets. Nevertheless, I see many positive effects of this law.

We need to gradually get Singaporeans used to the idea that donation of body parts for the common good is a worthy objective. Increasing acceptance of the idea of donating one's organs when we are dead, and these organs are of no longer any use to us, means more will come forward to donate, not just organs or tissues after death, but organs and tissues not covered under current legislation before us. These organs and tissues include the pancreas, which can provide insulin for those with diabetes mellitus, the lungs and even the intestines. The transplantation of these other organs, while proven useful in certain situations, is still not yet widely established. Hence, I believe that this is why they are not listed in the legislation before us.

Nevertheless, if someone is known to need such an organ and a suitable donor is found, having this current HOTA legislation will make it much easier for transplant coordinators, who will be speaking to the next-of-kin regarding the presumed consent of donation of their liver, heart, cornea and kidney, to also bring up the subject of possible donation of these other organs for the saving of lives.

The Government has consulted widely with many sectors of the population and with religious leaders on the provisions of this legislation. I am pleased to note that this amendment has wide support. Yet, we recognise that not everyone will be willing to donate organs. There are some for whom the thought of a loved one being buried or cremated less than whole would cause extreme grief due to personal or religious reasons. We have to respect this and not make it difficult for people to opt out. We need to ensure that the public are clearly aware of what their decision to opt out or opt in entails. In this, I reflect what many of my other learned colleagues have said.

At this age of 21, when a citizen is given a form to sign to make a choice of opting out of the organ donor pool, this decision is binding. While it can be subsequently revoked, and the person can decide to opt in again, it would mean that under the provisions of the Act, he or she will no longer enjoy the original degree of priority in the queue for a suitable donor organ should he or she need one in the future. This measure is probably to prevent people from making frivolous decisions or deciding to defer entry into the donor pool until it is clear to them that they themselves will be needing a donor organ.

My colleagues have spoken about the position of those in the Muslim community. But as has been pointed out, these people can also opt in. This is, therefore, fair to both groups of people, ie, those opting out and those opting in, as well as those who already, by not opting out, have presumed consent. It may be presumed that those who conscientiously object to donating their own organs will also similarly be strenuous in not wanting to receive a donor organ from another person. By the same reasoning, no one who does not want to be a potential donor should be able to benefit ahead of someone else

who was willing to be a donor himself or herself. I hope that there will be ample opportunities for conscientious objectors to register their choice and that the provisions of the Act will be made known widely annually, perhaps during the annual volunteers week or some other similar occasions. We need to do more to ensure that not only are people aware of the issues when they sign the option form, but that it is clearly made known to the public about how and where they may be able to make the choice of opting out. Doctors and medical staff, whose responsibility it will be to speak to the next-of-kin of possible removal of donor organs in individual cases, will then face less difficulties and less misunderstanding.

In time, we hope that the population's attitude will change such that there will be more support for donation of other tissues, such as blood samples for research or cord blood and placenta of new born babies for programmes such as a public cord blood bank, which can in turn help stem cell transplants and turn this concept into a reality for more Singaporeans. Transplant medicine is a difficult but established field of medicine. It is an area which will give Singapore a niche advantage compared to other providers of medical care in the region. But to progress, our people must have more experience.

Mr Deputy Speaker, Sir, this proposed law is also important in that it gives a legal framework for the donation of human organs for transplant from living donors. Many people have spoken about this point and we realise that the procurement of donor organs from live donors for financial consideration is very much a reality in many parts of the world. Some of these take place in very dubious circumstances. I am sure we in Singapore would not want to be in any way party to such exploitative practices. We also recognise that organ transplantation is a major procedure, not only for the

recipient, but also for the donor in the case of living donors. Many have spoken about the possibility of coercion or pressure.

To take up a point which has been raised by others about what risks are actually involved, I believe it is possible for competent authorities, such as the Ministry of Health, working with a respected body of experts, to put up on the web or in printed form, a set of information listing what are the currently accepted ranges of complications, mortality risks, possible long-term complications and such like, which will be considered to be commonly agreed upon at a given point in time, and revised from time to time. This, if given out and publicised widely, will make it possible for consent, counselling and such like to be given in a transparent way and with reduction in the risk of buyers. This will also make it easier for people to talk about what might be sufficient compensation should something go wrong. What then comes under the ambit of the law and what does not come under the ambit of the law in terms of monetary compensation could also be spelt out a bit more clearly. I believe that with this sort of clarity of information, people will be much more inclined to support the law in practice.

I also hope that the ethics committees that would be constituted under the ambit of the law would not only do their work fairly and transparently but also in a timely fashion. Because in a lot of transplant cases, time is of the essence.

Sir, on this note, I support the Bill.

Thank you, Mr Deputy Speaker, Sir, for letting me speak.

In 1987, when the Human Organ Transplant Bill was debated in this House, many of the concerns, fears and reservations of the different racial and religious groups were addressed and many were accepted. At that time, the issue was quite focused on kidney transplant. The donors then were mainly brain dead. But today, we are moving to involve more organs - the heart, the liver and also the cornea. And we are also involving living donors. So there is a difference. Of course, this brings into question ethical and also moral issues. I believe these issues were thrashed out by the Ministry at grassroots level and I am sure they must have been addressed. But having heard Dr Amy Khor, I realise that a lot more work has got to be done by the Ministry, because many people are still not very familiar with this term "HOTA".

Sir, today, I would just focus on one issue which I thought is very important, and this is my fear, that we need a very careful monitoring of the potential commercialisation of organ transplant. With the advances in medicine, better anti-rejection drugs, better equipment and management, transplant has become less scary and more acceptable. At the same time, the practice of medicine over the years has also changed. Medicine is treated less as a profession and more as an industry. This, to me, is very sad. But, unfortunately, this seems to be the trend. In fact, in our White Paper on Health, medicine was called an industry. Therefore, like any industry, the practice has also become more business-like than medicine, unlike in the past. Thus, hospitals have to be profit-orientated and they open their doors to receive patients.

Transplant medicine can be a big money spinner for hospitals, because patients needing such transplants will find ways and means to do it. So, hospitals will want to add this field of medicine to the schedule of practices to give prestige to the hospital and also as another hospital service. When hospitals open

their doors for transplant medicine with money as the motive, there lies the danger for abuse. In some parts of the world, patients going into the operation theatre to remove an appendix have found, later on in life, that they have lost one of their kidneys. But it is a bit too late already.

Can this happen in Singapore, you may ask? I would be more confident that this would not happen 30 years ago when I took up medicine and went into practice. But today, I am not so confident. Somebody asked me, what is so wrong for somebody to want to sell his organs? It is a buyer's and seller's market, just like buying commodities. I think it is not so simple. The potential donor may be, as many have said, under duress, coercion, inducement or promise.

We have a very large foreign worker population in Singapore, many under work permits. They come here because they need money to send to their poor families. They are a very vulnerable group and could be exploited. A foreign worker may be approached and is prepared to sell one of his kidneys under the promise of a large sum of money. He knows his life is less in danger if he does it in a Singapore hospital. So, I ask, where are the safeguards?

If we read the Bill, there is an ethics committee that is to be established in every hospital. I think it is a good safeguard. And this ethics committee has a very heavy responsibility and it has a composition of at least three members, one of them must be a doctor not practising in the hospital, and another is a lay person. This committee that is set up looks good. And they have to satisfy themselves of a whole list of concerns before agreeing to any transplant.

I have gone through this legislation. I must say it is quite water-tight. It must be so because Singaporeans must be

assured that the transplant is carried out ethically. Like I said, the Transplant Ethics Committee is a very important committee because they have to do all the assessments and they also must have consensus before they agree to any transplant. But I notice that the representation in this Transplant Ethics Committee has got no Ministry of Health's representation. I wonder why. Maybe the Minister can let me know. It is silent on the Ministry of Health's representation.

But what puzzles me is that the outcome of the decision of the hospital ethics committee, if I had read the Bill correctly, is that it has to be subjected to the Ministry's Director's final approval. If this is so, why not set up a central ethics committee, as proposed by Mr Iswaran earlier on when he made a very excellent speech on why they should not decentralise the ethics committee at the individual hospitals but should be centralised at the Ministry of Health? I think he did it very well and I do not want to go through all his points.