Hansard, 2004-01-06

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) Ms Indranee Rajah 06 Jan 06 Jan Mr A Nithiah Nandan 07 Jan 14 Jan Assoc. Prof. Ho Peng Kee 07 Jan 16 Jan Dr Tony Tan Keng Yam 12 Jan 16 Jan Dr Jennifer Lee 23 Jan 11 Feb

ABDULLAH TARMUGI Speaker Parliament of Singapore

[Mr Speaker in the Chair]

1. Dr Mohamad Maliki Bin Osman asked the Minister for National Development since the implementation of HDB's new concessionary loan policies in January 2003, (a) how many applicants have appealed for such concessionary loans because of their failure to secure such housing loans from commercial banks; (b) how many of these appeals have been successful; and (c) whether HDB will

review its policy further in light of the cases for concessionary loans.

Mr Speaker, Sir, since 1st January 2003, HDB has ceased to provide market rate loans for certain categories of buyers. These include permanent residents, private property owners and high-income earners. In addition, those who have already enjoyed two concessionary loans and 2nd-timer households who have already enjoyed a concessionary loan and are buying a flat of the same or a smaller size are also ineligible. As HDB concessionary loans are subsidised by the Government, HDB has to ensure that they are given to those who need them most.

So far, HDB has processed 401 appeals for concessionary loans of which 51 were approved. The majority of the unsuccessful appeals were rejected because they could finance their flat purchases from the sales proceeds of their existing flats, or because they were not financially ready to buy a flat at that point in time usually because they did not have a steady income or their current income was insufficient to meet HDB's credit guidelines. Of the remaining cases, many had alternative accommodation. And there were also some existing lessees who had difficulty in servicing their mortgage instalments, whom HDB advised to remain in their existing flats and instead take up one of the various assistance schemes that the HDB has in place.

HDB has no plans to change its current mortgage loan policy. Nonetheless, it will continue to exercise flexibility and take into account the individual

circumstances of the buyers when they are considering requests for HDB concessionary loans.

Sir, with regard to those who choose to downgrade, one of the reasons is that they are not able to manage their current obligation. Would the HDB consider this on grounds that they actually are not able to pay, that is why they want to downgrade? But the restriction disallows them to do so.

Mr Speaker, Sir, we are aware that some need to downgrade because of financial circumstances. Our policy is to review each and every single case carefully. And, in particular, if any person has problems because of retrenchment, a severe pay cut, business failure, prolonged illness or death of the sole breadwinner, these are the types of cases which we would certainly look at very sympathetically. If any of the Members have residents in these circumstances, please support their appeals.

May I ask the Minister whether he knows of cases where residents are unable to get loans from commercial banks and as a result wanted to have an HDB loan, whether it is concessionary loan or not, and they would like HDB to assist. Is there any policy regarding such cases?

Mr Speaker, Sir, I think we need to study those cases carefully. Sometimes when a bank declines to issue a loan, it often indicates that perhaps it is not an opportune time for that person to purchase a flat of that size. He or she might be overextending himself or herself and really we are not doing them a favour. For cases like these, they often have to look either for alternatives or look for a smaller flat. Very

often, the sales proceeds from the existing flat are sufficient for them to buy a smaller flat, although it may not be in a location or a size of their preference. But like I said earlier, wherever possible, we will exercise maximum flexibility in applying this policy.

Sir, is it true that residents who would like to add a family member as a co-lessee, because they are not able to pay the current mortgage loan and their child perhaps may be able to help, such transaction is considered as a new transaction and therefore they would have to apply for a commercial bank loan and not be entitled to another HDB loan?

Mr Speaker, Sir, we have assistance schemes. One of them is to include more family members so that they can help to pay for the loan. In those cases, we would certainly help them maximally, in order for them not to have any disruption and not to have to move out of the flat that they are living in.

Mr Speaker, Sir, can I clarify with the Minister? Where a child's name is added to the list, the child is actually considered as a first-time purchaser and he would not actually qualify for concessionary loans in future if he is getting married and buying another property. Am I correct to say that?

If his name is added, it would be tagged as having enjoyed his first bite of the subsidy cherry. If he subsequently purchases a flat, then we would have to review the case again and make sure that he has not inordinately consumed housing subsidies. But like I said, I think the main point which I want to emphasise, and I want to repeat, is that although this policy is in place, the HDB is bending backwards to exercise flexibility to help

people who truly need help.

But let us also be cognisant of the fact that some people who, at a certain point in time, should not over-extend themselves and should not be purchasing a flat that is beyond their means. As long as we remember these two extremes and we help people in the most appropriate fashion, no Singaporeans would be deprived of housing; no Singaporeans would be turfed out unnecessarily. The key point is to help people appropriately.

Mr Speaker, Sir, if a family member is asked to lend his name to help the family in a crisis so that they can actually tide over the loan, how can that be considered as him taking a first bite of the cherry when he has not set up his family in the future?

Mr Speaker, I do not want to get too involved in a technical discussion which I can take off-line. There are many ways to help. If a person is just helping by contributing money to pay for the loan, he is not tagged as an owner. If he is not listed as an owner and is not using his CPF account, he is not tagged at all as having consumed his first bite of the subsidy cherry. But I think these are cases where we have to look at individually. And I would assure all Members that we will do our best to assist each and every family in the unlikely event that they run into problems.

2. Dr Teo Ho Pin asked the Minister for National Development (a) whether his Ministry has any plans to allow import of pork from Malaysia and (b) what are the measures in place to ensure that pork prices are competitive in Singapore.

Mr Speaker, Sir, the Agri-Food and Veterinary

Authority (AVA) has to ensure that all food approved for import into Singapore from a very wide range of sources is safe to eat. Pork can be imported from AVA-approved sources which meet Singapore's current food safety and animal health requirements.

Import of pigs from Malaysia was stopped from March 1999 due to the outbreak of the Nipah disease which affected pigs and humans (farmers and abattoir workers) who are in contact with the infected animals. In addition, Malaysia has also not been recognised by the World Organisation for Animal Health (OIE) as foot-and-mouth disease free. AVA is currently discussing with its Malaysian counterpart the requirements for the export of frozen pork to Singapore. And we will have to ensure that the requirements will be in line with international standards and practices.

Singapore has an open market. There are 19 countries approved by AVA to export pork to Singapore. AVA has a programme to increase the number of sources that Singapore can import pork from. The availability of pork from multiple sources will help to ensure that pork prices in Singapore remain competitive.

Sir, may I just clarify with the Minister of State. He said that Malaysia is not recognised by the World Organisation for Animal Health as foot-and-mouth disease free. Does it mean that it is not safe to consume pork in Malaysia? So, what is the advice to Singaporeans who travel to Malaysia?

Secondly, the prices of lean pork actually have increased quite a lot since 1999. It could be due to the demand of Singaporeans to consume lean pork. By increasing the supply, the demand is more for

fresh pork, not frozen pork. So maybe the Minister can clarify on that.

The third point is that there is a difference between frozen pork and fresh pork. I think we need to increase the sources of fresh pork, so that at least that will bring the prices down for fresh pork.

Mr Speaker, Sir, I thank the Member for the questions. I will handle them in reverse order.

Our current consumption of pork can be classified into three categories: fresh, chilled and frozen. Today, it is one-third each. I appreciate the Member's preference, and many people's preference, for fresh pork. Currently, we import about 1,000 pigs a day from the island of Bulan. These pigs are imported into Singapore and they are slaughtered in order to produce fresh pork. The key thing which we have to remember when dealing with fresh pork - and you are importing live animals - is that there is a significant safety issue, not just for consumers but for everyone who is involved in the import, the slaughter and the preparation of that meat. The AVA has repeatedly checked and audited the conditions in Bulan. It is a quarantined island. In that sense, we are very confident that it is safe to import those pigs and it does not pose a public health risk to Singapore.

When we talk about importing live pigs from other sources, we have to be equally sure that those sources are safe and will not pose a threat either as a public health threat or an economic threat. Nipah virus is an example of a public health threat. The foot-and-mouth

disease in pigs is not the same as the human hand-foot-and-mouth disease. Let me emphasise that you do not catch hand-foot-and-mouth disease from contact with pigs with foot-and-mouth disease. Nevertheless, foot-and-mouth disease in pigs is an economic threat. Because once a country is labelled as having been infected with foot-and-mouth disease, it affects its ability to import, export or to tranship meat products. From that perspective, Singapore cannot afford to go on the red list of countries with foot-and-mouth disease. That is why our caution with importing any animal from another country which is labelled as having endemic foot-and-mouth disease.

Nevertheless, we are working with our Malaysian counterparts, in particular in the state of Johore. I am confident that as they raise standards there and we work together, when the international organisation is prepared to certify Johore for a start, as foot-and-mouth disease free and we are confident that there is no public health risk of Nipah, then we can start importing from Johore. I have personally met the representatives from Johore and I have told them that we will do this step by step. Get international certification first, then we will move on as our first step to look into the possibility of importing frozen pork. You will ask why frozen pork, why not chilled,

why not fresh pork. The difference with frozen pork is that there is time for AVA to test the consignment to make sure it is safe. With chilled pork, you cannot hold it and test and then release it to the markets. And with fresh pork, you get all the other problems and potential complications that I told you about. So I want to assure Members of the House that we are actively looking to increase our source of pork. But we will do it safely, we will do it step by step, and we will do it in collaboration with potential exporters.

The Member's point about the price of pork is a valid one, and that is why AVA is actively sourcing for more and more sources of exports, ie, from people who can export pork to us. The current major source of pork for Singapore is Australia and, as you know, the grain prices have

risen because of the drought. The grain is needed to feed the pigs and also their exchange rate has increased compared to the Singapore dollar. All these things have contributed to the increase in the pork price over the last few months.

I want to also assure Members that we are also getting large amounts of pork from Brazil and China and, in fact, the extent of supply from China is increasing. And as all these supplies come in, we hope eventually to stabilise and, hopefully, bring down the price of pork. But this is a commodity which is internationally traded. We cannot unilaterally force and artificially bring the price down.

On the Member's point about advising the travellers, I think all of us are travellers and all of us need to take our appropriate precautions and, ultimately, take our own risks. The AVA, unfortunately, cannot and should not be in a position to certify the safety of all food all over the world. That is the job which we cannot perform. But in any country that you go to, be aware of what you are eating, what the regulatory system is and make your own informed choices.

Sir, just now, the Minister of State mentioned that the reason why we import frozen pork is that we need time to test the pork. So how does AVA test the 1,000 pigs coming to Singapore every day?

That is precisely the point. When you are dealing with 1,000 live pigs, you cannot hold them all out and test every single one of them for every single step. So the key point is you accredit the source, you accredit the transport system that brings them in, you accredit and check and audit the abattoir and then for those of you who have ever been to an abattoir, you will see our AVA officers at very odd times of the day, very early part of the

morning, actually checking the carcasses. So there is, whether you realise it or not, a very stringent system of checks on our food supply, and this is something we should not take for granted. If we were to alter it and lower our guard, we will do so at our own peril.

Mr Speaker, Sir, can the Minister actually give us an estimated timeframe when the international accreditation from the Malaysian farms would be completed and when can we actually start importing the pigs from Malaysia?

Mr Speaker, Sir, as this involves an international organisation and a foreign country, I am not in a position to make any commitment as to the timeframe.

3. Ms Braema Mathiaparanam asked the Minister for National Development (a) if he will give an update on the investigations by the Agri-Food and Veterinary Authority (AVA) following a report claiming that the dolphins acquired by Underwater World were not born in captivity but were illegally traded after their capture in the wild; and (b) how does the AVA ensure that animals brought in or bought by local operators do not contravene the Convention on the International Trade in Endangered Species of Wild Fauna and Flora, to which Singapore is a signatory.

Mr Speaker, Singapore is a signatory to the Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES). The CITES regulates the international

trade in endangered species to ensure that they are not threatened with extinction. The Agri-Food and Veterinary Authority is the CITES Management Authority in Singapore. Under Singapore's Endangered Species (Import and Export) Act, any import of species that is protected under CITES requires an import permit from AVA as well as an export permit from the exporting country. AVA will only issue permits for imports that meet CITES' requirements. The consignment of CITES species will be inspected by AVA officers at the point of entry to ensure compliance with CITES and with AVA requirements before it is released to the importer.

The acquisition of the six Indo-Pacific humpback dolphins, or pink dolphins, from Thailand by the Underwater World Singapore (UWS) did not contravene CITES' requirements. CITES allows the import of both wild and captive bred pink dolphins for captive breeding and education purposes if it is approved by the exporting country and if there are sufficiently equipped facilities to house and to care for the animals in the importing country. Thailand, as a signatory to CITES, had approved the export of the dolphins to Singapore. The AVA had assessed that the Underwater World Singapore, as a zoological facility, had met all CITES' requirements and, hence, approved the application.

Two supplementary questions, Sir. The Minister of State mentioned that, according to CITES, as long as it is wild or bred in captivity, it allows it to be imported. I am a little bit lost here as to what is the definition of "wild" if it is an endangered species when you are going to bring it and keep it within a specific area. How did that dolphin then come about to be? Is it captured in the wild then? Could I have some clarification on that? According to the report in the newspaper, the Oasis Seaworld was founded in 1990. The dolphins that came here, the average age,

according to the report, is about 26.

Ms Braema, no speeches. Your question, please.

They could not have been bred in captivity then. So how were the records checked?

Mr Speaker, Sir, the definition of "wild" means it is caught in the wild. Definition of "captive bred" means it has been bred in a zoological facility. Of the six dolphins, some, we believe, would have been caught, and some are captive bred. The point is that it is a red herring - if you can pardon the pun - whether they are captive bred or wild. Under Appendix 1 of CITES, as long as AVA is confident, that the Underwater World Singapore is able to take appropriate care of these dolphins, they are allowed to be imported, regardless of whether they are captive bred or wild.

Could I have the assurance from the Minister that in the way we have given the permit, we have not contravened the Convention then?

Mr Speaker, Sir, absolutely.

4. Mr R Ravindran asked the Minister for Home Affairs in the light of the changed societal norms and values whether his Ministry will appoint a Committee to review the law on sexual offences in Singapore.

5. Mr Chandra Mohan K Nair asked the Minister for Home Affairs whether section 377 (and perhaps section 377A) of the Penal Code (Chapter 224) will be reviewed with a view to amending, repealing or clarifying by way of

"Explanation", "Exception" or "Illustration".

Mr Speaker, Sir, may I take Question Nos. 4 and 5 together?

Yes, please do.

Thank you. Sir, MHA is currently reviewing the Penal Code in consultation with the Ministry of Law and the Attorney-General's Chambers. The aim of the review is to update the offences and penalties in the Penal Code to stay relevant in today's context.

Sections 377 and 377A are being examined as part of this review. Current societal norms will be taken into account in examining these sections. For section 377, one option being considered is to decriminalise consensual oral sex between a male and female so long as it is done in private and both of them are above 16 years of age. The fact is there has not been any prosecution for consensual oral sex in private between a male and female for many years, except in cases involving minors or those who are physically or mentally vulnerable.

Sir, there are several other provisions in the Penal Code and other legislation, such as the Children and Young Persons Act and the Women's Charter, that cover different sexual offences. In line with Mr Ravindran's suggestion, we will study if there is a need to expand, clarify or dovetail the scope of some of these offences. The review committee will consult MHA's Government Parliamentary Committee of which Mr Ravindran is Deputy Chairman, as well as other relevant Ministries and agencies, as appropriate. We expect to complete our review of sexual offences in two to three months' time.

Mr Mohan asked if we would be amending, repealing or clarifying section 377 or section 377A by way of "explanation", "exception" or "illustration". Sir, this is a technical matter, concerning drafting approach, which is for the legal draftsmen to consider once the policy considerations have been settled. MHA will consult the Attorney-General's Chambers on the most appropriate approach to effect changes to the law.

6. Mr R Ravindran asked the Minister for the Environment (a) what are the causes of the dengue outbreak in Braddell Heights estate; (b) what measures have been taken by the Ministry to eradicate the dengue outbreak; and (c) whether these measures have been successful.

Mr Speaker, Sir, on 16th September, the National Environment Agency (NEA) was notified by MOH of six dengue cases in Serangoon Avenues 2 and 3. NEA took immediate action to fog the area to get rid of adult Aedes mosquitoes. Fogging was repeated for a few weeks.

On the same day, NEA officers started door-to-door visits to distribute advisory letters and educational pamphlets on dengue prevention to the residents. They also inspected households, construction sites and outdoor places to search and destroy breeding grounds. In total, NEA found breedings in 63 households, a junior college, a construction site and on the roof covers of two water tanks at two HDB blocks.

To increase public awareness and to step up public education, NEA contacted the grassroots organisations on

7th October. More than 30 volunteers from the Residents' Committees (RC) joined in to help distribute the letters and pamphlets to the residents. By 11th October, all households in Serangoon Avenues 2 and 3 and 1,600 households in the surrounding area, including Braddell Heights estate, were covered. A roving exhibition was also held on weekends in the HDB void decks to inform residents about dengue and the preventive measures that they could take. The RC volunteers also helped to put up posters in the lift lobbies of the HDB blocks to raise public awareness.

Sir, with the strong support and active participation of the grassroots leaders and residents, the outbreak was brought under control by 12th October.

Since then, another outbreak involving four cases occurred in Serangoon Avenue 2 on 19th December. This time round, NEA immediately informed the CCC chairman on the same day and educational pamphlets were distributed again to the residents in the area with the help of RC volunteers. Fogging again was carried out and mosquito-breeding habitats that were found were destroyed. There were far fewer breeding habitats as a result of the heightened awareness this time round. No new cases have been reported in the current cluster. So with the early involvement of the community, the outbreak was more limited and came under control within a shorter time by 29th December, in other words, in 10 days.

Sir, Singapore is located in a region where dengue virus and Aedes mosquitoes are prevalent. From time to time, there would be localised outbreaks of dengue. Community support and participation is vital in our efforts to reduce the incidents of dengue outbreaks. NEA will continue with public education. At the same time, from now on, NEA will

also draw on greater community involvement much sooner. It will notify the grassroots advisors, grassroots organisations and medical clinics in the affected areas much earlier than its past practice. In this way, the community is alerted much earlier, and can respond more speedily too. Working together, we believe we can reduce the incidents of dengue outbreaks, and bring any outbreak under control as quickly as possible.

Two supplementary questions, Sir. I thank the Minister for his reply. The first question is: does ENV have a complete checklist for their officers to undertake when they visit sites where mosquito breeding is suspected and whether, in this instance, there were cases where some areas where mosquito breeding was going on which were left out at the initial stages? The second question is: is there coordination between the Ministry of Health and the Ministry of the Environment and the private clinics in the respective areas where there

are cases of dengue being reported? I understand that some of the medical professionals, especially in private clinics, were unaware that there was a dengue outbreak and, as such, they were hesitant to diagnose some cases as dengue because they were not aware. Could we improve this process of communication with the local medical professionals?

Mr Speaker, Sir, the NEA conducts routine inspections on all facilities in all estates on a regular basis. For example, there is a 2-month roving programme to inspect schools within a certain area.

Mr Ravindran asked whether there is a checklist on where to inspect. The answer is yes. But if the question is whether, with a checklist, it is possible for any officer to cover every corner of the roof top, building and so on, the answer is no. Firstly, the area of coverage is big.

Secondly, these are preventive inspections. In other words, we conduct these inspections before any outbreak is reported, not after the outbreak. Once an outbreak is reported, there will be a re-inspection and, this time around, they will take much longer time and inspect more thoroughly. We will continue to enhance the checklist and, in particular, we will pay greater attention to those areas where dengue outbreaks are more frequent.

Mr Ravindran asked whether the MOH, ENV, NEA and the medical clinics can improve the level of communication. The answer is yes. In the past, the NEA would take about one week to 10 days before they alert the community. This is because the priority of NEA within the first seven to 10 days of an outbreak was to do whatever they can to contain the situation. However, in the case of Serangoon Avenue 2, it was very clear that functioning on its own, NEA took more than three weeks to keep the outbreak under control, whereas the second time round, with the early participation of the grassroots, they were able to do it in 10 days. The NEA has therefore decided that, from now on, on the day of outbreak, they will alert the grassroots organisations as well as all the medical clinics in the area so that we can fight the outbreak as one community.

Sir, I have seen some photographs of the cases that have been detected in estates in Kovan and Hillside Drive. I would like to request the Minister to get NEA to work with BCA, as well as the

landowners, for a more permanent solution.

Presently, what is being done is basically temporary. That means, they only clear the breeding ground. But the third-storey gullies are still there. So, these would be choked again after one week or a month. I think a permanent solution should be discussed with the landowners to see how they could redesign or redirect the water drainage system.

Mr Speaker, Sir, I thank Mdm Cynthia Phua for her suggestion. I will ask the NEA to follow up on her idea.

Sir, may I ask the Minister whether the mosquito trap called Ovitrap is effective in killing mosquitoes and, if it is effective, whether the Ministry has any plans to encourage more residents to install these Ovitraps so as to control the population of mosquitoes in Singapore.

Mr Speaker, Sir, the Ovitrap, referred to by Dr Teo Ho Pin, serves two functions. Firstly, it is used to trap mosquitoes, so that the newly-born mosquitoes will not be able to escape into the open. Secondly, the Ovitrap is used to estimate the population size and monitor the population growth of mosquitoes in the surrounding area.

Up till now, one drawback of the Ovitrap is that it is not so simple to operate. It is not just a case of putting the Ovitrap in a particular location and it will go into automated mode. The residents would still have to handle the equipment such as replacing the water and destroying the mosquitoes and so on. There are certain steps involved which some of the residents and grassroots volunteers have found quite difficult to follow. I am happy to say that NEA has come out with a simpler design. With this new design, more residents will find it easier to operate the Ovitrap. Our intention is to make greater use of Ovitraps, both to monitor the growth of the mosquito population in certain areas and, at the same time, help to contain the growth.

7. Dr Amy Khor Lean Suan asked the Minister for Community Development and Sports if he will (a) explain the rationale for the requirement that students admitted to the Sports School must meet the minimum aggregate points required for admission to the Express Stream in secondary school, and (b) review this requirement taking into account the Sports School's recent experience with its admission of the first batch of students who had taken the Primary School Leaving Examination.

Mr Speaker, Sir, Dr Amy Khor may be concerned that we might have excluded top student athletes who cannot qualify for the School, based on their academic results. This issue was also raised by several Members at the Committee of Supply debate in March last year. At that time, I had explained that the Sports School is set up primarily to cater to students who have the potential to excel in both their studies and sports but, unfortunately, have tremendous difficulties balancing both. However, I had also assured Members that very talented student athletes who cannot meet the academic criterion of the School will be assessed on a case-by-case basis. Indeed, as I had indicated then, the first criterion for admission is that the student must be talented in sports and that, only after he or she has crossed this first hurdle, will we look at his academic results.

Besides these two criteria, potential entrants to the Sports School also went through a technical skills test, fitness assessment, psychological profiling, and a personal interview.

The first batch of students at the Singapore Sports School started school yesterday morning. Amongst its 140 students are 26 students in the Normal (Academic) course. The School has accepted these students because its assessment is that they

can complete the 'O' level course in five years. Also, Sir, two of the 140 have been streamed to Normal (Technical) course. These two talented student athletes will be undergoing basic education in English, Mathematics and Science so that they will have the basic educational requirements to allow them to pursue upgrading courses in future.

Sir, as can be seen, the Sports School has and will continue to adopt a flexible approach to its admission criteria, if there are justifications for it.

Sir, first of all, I would like to thank the Minister and the Sports School for exercising flexibility in the admission of this batch of students. But, having said that, I would like to ask the Minister whether setting the minimum academic entry criterion for the Sports School at Express Stream would be a signal that academic performance is still pre-eminent. Would this not be contrary to what the Government has recently been preaching, that we recognise different pathways to success and different abilities of individuals, and would not this be contrary to the very objectives of actually setting up the Sports School?

Sir, on the contrary, as I have stated in my reply, we are looking at students who are talented both in sports and in their studies. So, I do not think we are sending a mixed signal by selecting the minimum criterion as the Express Stream. At the end of the day, we must ensure that when we allow the students to come to the school, they will continue to receive secondary education to ensure that they can complete and go on to post-secondary options.

Having said that, Sir, I think we must allow the Sports School to evolve. This is the first time that we are doing it. We have exercised some flexibility in allowing about 30-odd students to come in to the Normal course. We will continue to monitor the situation in the succeeding batch. We will study the requirements and see whether or not we can relax further.

In the longer term, the Sports School will look like an ordinary secondary school where we will have the bulk of the students in the Express Stream, with a couple of classes for Normal (Academic) and Normal (Technical). It is still a secondary school and, therefore, at the end of the day, it must meet those academic requirements that we have set for students in Singapore.

Sir, can I ask the Minister what is the key performance indicator for the Sports School and, although the Sports School has exercised flexibility, whether the current admission criteria will still exclude top sports talents from going into the school and, therefore, affect the performance of the Sports School itself?

Sir, we do not see the Sports School as the only school providing talent for sports in Singapore. It is only one of the pieces in the jigsaw puzzle. So, other schools will continue to produce talent for Singapore, and that must be the case. Our outcome must be that we must be able to provide a good secondary education for our students, so that they can go on to post-secondary and, at the same time, provide opportunities for them to excel in their sporting talent. If you ask me if we are able to produce some of our champions from the Sports School - and the word is "some", not "all" - I think that would already be a landmark for Singapore.

In the longer term, I think the Sports School can look into various other ways to continue to maximise potential talents that are within Singapore. At the moment, we do have some athletes who are not in the Sports School, or currently sports which are not catered for in the Sports School, but they are part of the Sports School where we have an arrangement with the National Sports Association.

So, I think the model would evolve as to how the Sports School can maximise potential sporting talents which are available in Singapore.

Sir, again, I would like to thank the Minister for saying that the Ministry will review the criteria. But I would like to ask the Minister to consider whether setting the criterion at Express Stream and not Normal (Technical) or Normal (Academic) would not also be a signal of an indictment actually of the capabilities of Normal Stream students as to their future potential, should they fall out of the Sports School and look for another career. Why should it be set at Express Stream? Should it not be reviewed seriously to take into consideration that Normal (Technical) students could also have other future?

Sir, it is for that reason that we have admitted 26 Normal (Academic) and two Normal (Technical) students, because we think these students have the potential to excel in both. In other words, they are able to complete the academic requirements of a Normal (Academic) or Normal (Technical) course and yet, at the same time, they display high potential talent in sports and, therefore, we are of the view that they can complete both and do well in both.

What are the post-secondary options

for these kids? I think it would be best left to the school to decide. We have to establish the criteria but, over time, we should study them and evolve as we go along. As I said earlier, we should give the Sports School a chance to start off. This is the first time we are doing it and, over time, as we learn from these experiences, we will be able to look at it in a more holistic manner.

Sir, I still want to appeal on this basis. If the Minister is saying that the Sports School is a normal secondary school, in the admission criteria booklet of the school itself ---

Mdm Phua, are you making a speech or are you asking a question?

Sorry. It is stated in the booklet that it admits students from Normal (Academic), Express Stream and Normal (Technical). So, can the Sports School not put that requirement as a minimum requirement?

Sir, all secondary schools have cut-off criteria. So, there is no difference for a Sports School in setting a criterion. And we have chosen to set that criterion as a starting point. I am not saying that this is cast in stone, but I think we should give the Sports School a chance to evolve and learn from this experience. Already, we have exercised flexibility, and I think that it is good for us to learn as we go along and then review it after a sufficient time.

8. Dr Mohamad Maliki Bin Osman asked the Minister for Community Development and Sports (a) what is his assessment of Team Singapore's performance at the recent Vietnam

SEA Games; (b) whether the schemes that have been put in place to promote sporting excellence in Singapore are producing the desired results; and (c) how can Singapore learn from countries like Vietnam who are able to produce numerous gold medallists within a short period of time.

Sir, Singapore won a total of 113 medals, comprising 30 Golds, 33 Silvers and 50 Bronzes, and finished in the sixth position at the recent SEA Games in Vietnam. At the last SEA Games in Kuala Lumpur in 2001, Singapore won a total of 95 medals which comprised 22 Golds, 32 Silvers and 41 Bronzes.

Singapore participated in 23 out of the total of 32 sports, and won medals in 19 of these sports. In contrast, at the KL SEA Games, only 17 out of 30 sports won medals, and this was notwithstanding a bigger contingent of athletes compared to the numbers we sent to Vietnam.

So, Sir, it is clear that Singapore's performance has improved significantly at the 22nd SEA Games in Vietnam.

The traditionally performing sports continued to do well, eg, table tennis won six gold medals, swimming brought us nine golds, eight silvers and six bronzes, and silat brought us three golds, two silvers and 10 bronzes.

Sports which have not done so well in the past have shown much improvement in the recent games. Athletics brought us four golds, four silvers and one bronze; bodybuilding, three golds, one silver and three bronzes; badminton, one gold and five bronzes. In addition, there were a few emerging sports. Gymnastics brought us three silvers and one bronze, and fencing brought us four bronzes.

Sir, there is a greater breadth and depth in our sports scene today. More

athletes in more disciplines are able to win medals. It is also encouraging to note that out of the 165 athletes who won medals, 30% or 47 athletes were below the age of 18 years. All these augur well for sports in Singapore.

Dr Maliki also asked whether the schemes that have been put in place to promote sporting excellence in Singapore are producing the desired results. Currently, various support schemes are available for our athletes and National Sports Associations. Athletes under the Athlete Career and Training Programme and spexGLOW, which basically help to make up for loss of wages of athletes whilst training full-time, contributed to about 70% of the gold medals won at last year's SEA Games. In particular, Joscelin Yeo, Christel Bouvron and Li Jia Wei displayed outstanding performances at the Games.

This showed that the enhanced support schemes had enabled the athletes to train full time and be exposed to higher standard of competitions, both locally and internationally.

In addition to funding support, athletes also received support in the form of greater use of sports science, exposure to more overseas training and competitions, and team building and motivational programmes.

The National Sports Associations (NSAs) have also been given much higher financial support than in previous years. Emerging sports like fencing and gymnastics, which received a two-fold increase in funding, put up commendable performances and won a combined total of three silver and five bronze medals.

In addition to financial support, the Singapore Sports Council helped the NSAs to develop multi-year high performance programmes, hire Technical Directors and coaches. Assistance was also provided in

terms of athlete selection, preparation, training methodology as well as logistics support during the Games. All these have paid off as the NSAs have shown that they were better organised and prepared for the SEA Games last year.

As to what we can learn from Vietnam, we will need to concentrate on a few selected sports and not spread ourselves too thinly. Many of the Vietnam's teams and athletes train full-time. In Singapore, there will be fewer athletes who would willingly give up their careers or studies to train full-time for long periods of time. Hence, it is important that we have schemes to support and encourage such athletes. It is also important that we work with all parties, whether schools or employers, so that the athletes are able to spend more time at training.

Singapore has an edge in terms of technology and advances in sports medicine and sports science, which have greatly helped our athletes prepare for high level competitions. We should continue to improve our sports science capabilities and ensure that NSAs, coaches and athletes are well appraised of technological and sports science developments.

Sir, I thank the Minister for the detailed response. I would like to ask what are the criteria that are used in setting targets for international meets like the SEA Games because I understand that for the previous games, the target was 22 golds and was based on the performance in the KL Games. Why is the target not set higher than the previous performance? Why is it based on the previous performance?

Sir, the target was not set by us. The CDM (Chef De Mission) himself decided that he

wanted to put a target for himself. But I think that is commendable to be able to push the athletes. What we do after every game is that we will review the performance of our athletes and our NSAs, look at the areas in which we have done well and the areas that we need to improve. I am very reluctant to do a crystal-ball gazing and decide what should be put as a number for ourselves. But internally, we know that there are some areas where we can improve and really aim for it.

As a matter of fact, some of the NSAs themselves have decided to put up some of these criteria internally so that they are guided by this target. We have kept the target internally as a planning tool for ourselves. Ultimately, what we want to do is to try and encourage all the athletes to maximise their potential. We performed well in the KL Games. I think we should try and improve even further than that, which we did. Setting at 22, which was the gold medals that we achieved at KL, means that we want to try at least to reach to the same level. To be able to do 30 is actually a tremendous improvement on our part. So we will learn from this experience and this should help us guide for the future Games.

Sir, may I first congratulate the athletes and MCDS on the outstanding performance in Vietnam. Can I ask the Minister what additional support and funding would be provided so that the athletes and NSAs can continue to do well in the future SEA Games?

Sir, I thank the hon. Member for the question because I think it is an important question. We are now going through a review of all the NSAs. We have done well, all of those who have participated in the recent Games. This will allow us to assess. We do have funding criteria that look at the performances of the various sports. I would like to assure the Member

that this review is being done currently with the view to assist NSAs. Even those NSAs which are emerging, which have shown potentials in the recent Games, we will look at it closely and see whether or not we could help them even further, not only in terms of funding support, but other types of support that may be needed to push their sports even further.

): Sir, may I ask the Minister what are other new programmes that MCDS will introduce to improve the overall sporting environment and also the sporting culture in Singapore? I would also like to ask the Minister how he intends to uplift the reputation and also the respectability view of the public towards our sportsmen in Singapore.

I think our sports champions are well-respected by Singaporeans in general. When Ronald and the badminton team did well in the recent Commonwealth Games and subsequently in the Singapore Open competition, there was a lot of support among Singaporeans for him and our badminton team. We will continue to find ways to expose our sportsmen and sportswomen to the general public, especially with the young, so that there is a base of young Singaporeans who may be interested to follow the careers of these athletes and see what we can do to increase their image and profile.

As to the new programmes, I will leave it to the SSC to explore on what are the things that we need to do. At this point in time, we are confident that the system that we put in place is adequate to meet the targets that we have set for ourselves in the Committee on Sporting Singapore. Participation rate amongst Singaporeans towards sports is on the rise. The recent SEA Games shows that we are able to achieve a higher level of excellence. But having said that, I will assure the Member that we will not rest

on our laurels. We will explore other ways to see how we can not only increase sports participation, but also continue to develop the sports industry in Singapore and to push for sports excellence in Singapore.

9. Mr Ng Ser Miang asked the Minister for Community Development and Sports (a) what is the progress on the planning and construction of the new sports hub; (b) when is this new sports hub expected to be completed; and (c) when will Singapore host the next South East Asian Games.

Sir, in 2002, my Ministry conducted a feasibility study on the sports hub project, primarily to determine its location, the facilities and capacity that would be required and the estimated project cost.

In 2003, a more in-depth study was conducted to determine the size of the sports hub site and transport accessibility to the site. Besides the infrastructural requirements, it is also critical that there be a sound business model for the sports hub. My Ministry is currently studying the ownership and funding model and looking into the details of the business plan and operational model. We hope to complete the new sports hub by 2009 or 2010.

Hosting of SEA Games is on a rotation basis. Based on the expected completion of the sports hub, the earliest that we can host the SEA Games would be in 2011. The host country for the 2011 SEA Games will only be decided in 2007.

Sir, I think that the new sports hub was first announced in this House in March 2001. The Minister has just mentioned that it is going to take up to year 2010 to finish the sports hub.

I think it is probably a very long time. Would the Minister explain why it would take such a long time?

Secondly, Singapore has hosted three SEA Games before, ie, in 1973, 1983 and 1993 when our term was due then. We are now unable to host the 2007 and 2009 Games and maybe we will host in 2011. I think there was some disappointment amongst our other SEA Games countries as well as our local sports fraternity. Could the Minister undertake to try to expedite the completion of the new sports hub so that we can host the Games earlier?

Sir, I wish I could expedite the project, but I do not think it is possible because it is a huge project. Our initial estimate shows that the project is exceeding half a billion dollars. So a project of that size, we will need to take time to study, not only in terms of its development, but we have to think what happens after we have developed the site. Give us a bit more time because we have to study this very carefully. The hon. Member, being a former Chairman of SSC, will realise that running sports facilities is indeed a massive exercise that will require good business acumen to ensure that the facilities do not become a drag onto the nation. But having said that, we are confident that we will be able to build the hub in time for at least the 2011 SEA Games. Rather than promising our colleagues that we will be able to host the Games in 2007 or 2009, let us be sure on our part that we have a completed facility which is tested, with a sound business model, before we go ahead.

I would like to assure the Members of the House that we are working vigourously to get the business model and

the funding formula out. Ultimately, when we have a sports hub, it must continue to contribute to the development of sports in Singapore and not be a drag onto the nation. I would like to assure the Member that we will try our very best. I rather not promise now that we can do it by 2007 or 2009, but give us some buffer so that we can do a proper job.

10. Ms Braema Mathiaparanam asked the Minister for Community Development and Sports following the Subordinate Courts report on maintenance payments, (a) what special programmes are in place to help the single-again families cope and be independent when maintenance schemes fail; (b) how many children from such families are being helped to remain in school; (c) what programmes are there to help jobless spouses, who default on payments, secure jobs; and (d) what kind of inter-ministerial cooperation is there to ensure that monies, such as the more than $6 million owing to estranged wives and children, can be recovered from ex-husbands without much difficulty.

Sir, single parent families who need help are encouraged to turn to the Family Service Centre in their neighbourhood for assistance. Many families have found support in areas such as counselling, child management, support group, life skills training, talks and workshops beneficial. There are two agencies, HELP Family Service Centre and As Salaam Family Support Centre, which specialise in supporting single parent families. They seek to provide single parents and their children with support, skills and knowledge to enable the family to manage change and overcome challenges.

Where maintenance schemes fail, there are social support schemes that needy

single parent families can tap on. These schemes provide not just financial assistance, but also support for their children's education and development.

Those who need interim relief can be assisted under the Interim Financial Assistance Scheme (IFAS) or the Rental and Utilities Assistance Scheme (RUAS). Under IFAS, the families receive a monthly allowance and, where necessary, grants to help them pay for the utilities and service and conservancy charges. For families with school-going children, they can seek help from the MOE Financial Assistance Scheme. If the families do not qualify for the MOE Scheme but are in need of assistance, they can apply to IFAS to help the family with school-related expenses, including fees, transport and examination fees. For those living in rental flats, they can apply to RUAS for help in their monthly rental and utilities bills. Their children may also be exempted from paying school fees.

Single parent families with young children can tap on existing pre-school assistance schemes to help them offset the cost of childcare or kindergarten education. The Centre-Based Financial Assistance Scheme for Childcare is one example. It provides a subsidy on top of the existing Government childcare subsidy. There is also the Kindergarten Fee Assistance Scheme (KFAS) that subsidises 75% of the monthly kindergarten fees, or up to $600 a year, whichever is lower.

Those who need help to pay for the before-and-after-school programmes for their children can tap on the Student Care Fee Assistance Scheme. This scheme supports children in non-profit Student Care Centres.

For jobless spouses who default on payments, and need assistance to secure a job, they can be assisted under the Work Assistance Programme (WAP). WAP

is designed specifically to help Singaporeans tide over a period of unemployment and, more importantly, to help the main breadwinner quickly get back to work. The programme is open to low-income individuals and families who may have lost a source of income and who are in need, including single parent families. It provides both employment and short-term social assistance to the recipients. WAP has been implemented since October last year.

Concerning the default of maintenance payments, the Family Court takes a serious view of the issue as it has an impact on the aggrieved party and the dependants. If an estranged spouse fails to make one or more payments required under a maintenance order, the spouse or ex-spouse may apply to the Family Court to enforce the maintenance order. The Court may enforce through one or more ways, including imprisonment, seizure of possessions or garnishee orders.

Apart from using legal channels, the Court has also engaged and partnered various community organisations to address the problem. For example, it launched Project Hope in March 2002 to help maintenance applicants who are in urgent need of financial assistance. Eligible applicants are given food vouchers to tide over this critical period and concurrently referred to the respective Community Development Councils for further assistance.

Last July, the Court also initiated Project SHINE (which stands for Supporting, Helping, Integrating, Nurturing and Enabling) to help applicants who have made at least three enforcement applications. The programme has since been extended to all applicants making maintenance as well as enforcement applications. The applicants and their families are referred to the project's community partners, comprising some Community Development Councils,

voluntary welfare organisations and self help groups, for a range of services

such as job matching, skills training, counselling for the parents, tuition and school fee assistance for the children.

Sir, may I ask the Minister on the last part regarding recovering some of the monies owing to, more often than not, the wife? How successful have these schemes been in recovering some monies?

There are lots of financial schemes which are available, which is well and good. What is the Minister's assessment on how available and accessible these are and made known to people?

Sir, on the first question, I do not have the details. I will refer it to my colleagues in the Ministry of Law to get some details on the success of the programmes carried out by the Family Court.

On the financial scheme, from the data that we have for the last few years, there is an increase. A lot more families are aware of the assistance out there. We have to thank Members of this House who have referred a lot of cases to the CDCs, and also to members of the public who have alerted us. I am confident that with the outreach programmes that we have put in place by the various partners in this scheme - the VWOs and self-help groups - the CDCs which are responsible for rolling out all these financial assistance schemes have been able to reach out to a wider network of people in Singapore.

Sir, the Minister has mentioned various schemes. They are very good for those who know how to use them. Is there a fast track system that is coordinated, so that for confirmed

maintenance cases and for genuine reasons that they are not getting help through the maintenance route, there would be this fast track to help them get assistance from the various other schemes?

Sir, I am not sure whether there is a fast track scheme. But I would like to assure the Member that if a single parent approaches our family service centre, notwithstanding the fact that there is a maintenance order, if she is in need of help, we will help her. I would like to assure him that the assistance to the family in terms of their needs will be catered for once they step into any of the various centres which are available island wide.

Sir, I would like to ask the Minister how many so-called jobless spouses have been helped to find jobs so that they can help their families. Secondly, does the Minister agree that this is a vulnerable group of people and, if so, what kind of inter-Ministerial cooperation can take place from the court at the point of the divorce settlement?

Sir, I must apologise as I do not have the number of people on the WAP scheme but I will try to provide the figure to the Member.

As to whether there is cooperation, I would like to assure the Member that there is close cooperation between MCDS and the courts, because this problem of maintenance orders does affect families. And families which are in distress will need to be helped. So we are in constant contact with our colleagues in the Family Court. And if there are ways in which the Member would like to suggest on how we can best improve our assistance programmes to these families, we will be most happy to discuss with her.

11. Mr Ong Ah Heng asked the Minister for Community Development and Sports in view of the unemployment situation will his Ministry consider relaxing the criteria for qualifying for the Home Ownership and Education Schemes for single parents who have two children and who possess lower than GCE 'O' level qualification.

Sir, the Home Ownership Plus Education (HOPE) scheme is not designed for Singaporeans who are unemployed. It is a programme to encourage young families with limited financial resources to keep their families small and stable by providing them with a comprehensive package of assistance. We would like the couples to keep their marriage strong so that the children can grow up in an intact family and supportive environment. We must give our young children the opportunities for them to succeed in life. The HOPE scheme replaces the Small Families Improvement Scheme (SFIS) but retains the same objectives as SFIS.

There are existing schemes that low-income single parent families can tap on to meet their various needs. Our schemes provide not just financial assistance, but also support for their children's education and development. Those who need interim relief and support can be assisted under the Interim Financial Assistance Scheme (IFAS) or the Rental and Utilities Assistance Scheme (RUAS). Under IFAS, the families receive a monthly allowance and, where necessary, grants to help them pay for the utilities and service and conservancy charges. For those living in rental flats, RUAS helps them with their monthly rental and utilities bills. Single parent families with young children can

tap on existing pre-school assistance schemes to help them offset the cost of childcare or kindergarten education. As I have said before, there is also the Centre-Based Financial Assistance Scheme for Childcare. This scheme provides a subsidy on top of the existing Government childcare subsidy. It also provides for a one-off assistance of up to $1,000 for eligible families to meet the upfront costs of placing their children in a child care programme.

There is also the Kindergarten Fee Assistance Scheme that subsidises 75% of the monthly kindergarten fees, or up to $600 a year, whichever is lower.

Similarly, those who need help to pay for the before-and-after-school programmes for their children can tap on the Student Care Fee Assistance Scheme. This scheme supports children in non-profit Student Care Centres. For single parent families who are more at risk, the Ministry has started a programme called the Healthy Start Programme which provides early intervention through providing appropriate support to the parents to strengthen their parenting and coping skills.

Sir, we understand Mr Ong's concern over those who are affected by the unemployment situation. For this group, the Ministry has recently implemented the Work Assistance Programme (WAP). WAP, as I mentioned earlier, is designed specifically to help Singaporean families tide over a period of unemployment and, more importantly, to help the main breadwinner quickly get back to work. The programme is open to low-income families who may have lost a source of income and who are in need, and this includes single parent families. It provides both employment and short-term social assistance to the recipients.

Resumption of Debate on Question (5th January, 2004), "That the Bill be now read a Second time.". - [Acting Minister for Health].

Question again proposed.

2.37 pm

Sir, yesterday, Mr Ahmad Khalis, cited an anonymous quote, asking "Is life worth living?" and answering it aptly by saying: "It depends on the liver". I know that Ahmad Khalis is no drinker. So, I suppose he means both the person and the organ.

Well, take heart too, Sir, and mind you, we will have to do it with our eyes open. Yes, Sir, make no bones about it, I do support the amendment Bill.

Sir, the Acting Minister has made his case very clear and we do need to amend the HOTA to extend it beyond "accident deaths" to include all brain deaths; beyond kidneys, to include liver, heart and cornea, and beyond "cadaveric organ donation" to also regulate living donor transplants.

We know Singapore is not alone in this. There are at least 21 countries in the world with presumed consent for organ donation. Of these, only two countries, Spain and Turkey, limit their legislation to deaths caused by accidents. None of these countries restrict the organs covered by their legislation to just kidneys.

We also know that the demand for organs for transplants exceeds supply. As of June 2003, there were 654 patients on the kidney transplant, 26 on liver and 5

on heart transplant waiting lists here. I believe the Minister may have a more updated position. For the kidney transplant waiting list, this is an increase of 15% over 1998. As a result, the average waiting time for a kidney has increased from five years to eight years.

Sir, this is obviously not just about statistics. This means even more hardship. This is especially true for Malay/Muslims, majority of whom are now not covered under the HOTA, as some true pledgings are covered under the 1972 Medical (Therapy, Education and Research) Act. It is sad to see the faces of many residents who suffer from those ailments, and their families, who seek help at our MPS sessions, CDCs, and also at the Ramadan Tabung Amal charity.

When the North East CDC held its Talk Shop series on 26th January last year to discuss the proposed amendments, we featured four special guests connected with organ transplants. One was a heart transplant recipient, the first Malay to do so; another a Chinese gentleman who had to wait eight years for a kidney transplant; a couple who became a living-related donor and recipient, and a mother of an eight-year old boy who died of a platelet disorder (bleeding in the brain) and she decided at his deathbed to donate her only child's organs for transplant. And there, three persons benefited from this benevolent act of hers. Her boy's kidneys saved a 12-year old girl and a 17-year old boy; his liver saved a 14-year old girl, and his corneas gave sight to a 54-year old woman. All heart-wrenching stories to share, and the latter heart-warming too.

However, for our first world Singapore, one that is well-known for being very professional and organised in managing its problems, this was not just a matter of clinical tackling of the situation.

The Government realises the sensitivities involved and has taken a step by step approach to handling the question of organ transplant, from the Medical (Therapy, Education and Research) Act (MTERA) of 1972 to HOTA in 1987, and now, further amendments only after another decade and a half. I welcome this approach.

I would therefore like to commend MOH for a careful approach in this matter. The Minister's assurance that efforts at educating the public will continue is worthy of note. Despite more than 30 years of tackling this problem, there are still serious doubts about HOTA and now its extension, in many quarters, including from religious circles and individuals who are still not convinced of the need. Yes, the majority of Singaporeans do agree, but there are still others who are troubled by it. It is good that the Act allows Singaporeans who have doubts about the system to opt out. Some 12,000 non-Muslims have done so, and this freedom to choose should continue. The educational process must also continue and I think it can and should also start as early as possible in the schools, for example.

I share the concerns raised by some of my fellow Parliamentarians, including those surrounding the definition of "brain death", professional as well as ethical considerations, and they need to be addressed. They must not be taken for granted and brushed aside easily. So are the personal, cultural and religious misgivings, but they need to be handled sensitively. One cannot under-estimate the risk of such issues being mishandled, including inadequate safeguards or the safeguards being abused. Let us ensure that there are sufficient ethical and professional safeguards to avoid the possible abuses, including sales of organs and/or wrongful removal of organs, as also cautioned by Dr Tan Cheng Bock yesterday.

Allow me now, Sir, to turn to the question of Muslims and HOTA.

I know that the Singapore Kidney Foundation, MUIS and the Muslim Kidney Action Committee have been working very hard to get more Muslims to pledge under MTERA. While in the earlier decade, only about 42,000 people or less than 2% of the non-Muslim population pledged under MTERA, about 14,000 people among Muslims or 5% have pledged their kidneys. The Muslim effort was credible - names like Mr Ameerali Tyeabali and Mr Bokhari Razak, among others, are worth applauding - but it was never going to be enough. I had my doubts from the very beginning about the opt-in system.

I remember asking Mr T T Durai of the Singapore Kidney Foundation, why not push for HOTA for the Muslims,

Mr Speaker, Sir, thank you for allowing me to join in the debate on the Human Organ Transplant (Amendment) Bill.

years back, but he cautioned that it took Singapore 15 years to bring the Singapore population around to HOTA and that we should not rush the Muslims as it might backfire. I knew that human inertia being such and added to that, earlier misplaced religious/cultural misgivings and human comfort level being what they were, and indeed still true to some extent till today, an opt-in system would not deliver the results necessary.

Later, after another 15 years, Mr Durai himself was desperately pushing for more Muslim pledges, if not to include them under HOTA, realising how critical the situation was. It is no longer just a question of opt-in or opt-out but serious financial and health burdens inflicted on many more Malays, as about 20% of those affected by kidney failures are Malays, compared to the population ratio of 14%. Moreover, if we want to achieve a better rate of compatibility in transplants, more Malays need to agree to pledge their organs.

Just to clarify, Sir, what Mr Chiam mentioned yesterday, organ tranplant and donation should no longer be an issue for Muslims. The Fatwa allows organ transplant and donation. This is also true for many other Muslim countries, including Saudi Arabia, Indonesia and Malaysia.

I am not a religious scholar. Such matters should be best left to them to decide. The Mufti and his Fatwa Committee in fact have been progressive in making rulings that meet the challenges of contemporary demands. While starting with a "No", following further investigations and enlightened interpretations of the Quran, the Fatwa had allowed organ donation and transplant. From kidney, the ruling now allows other organs too, like heart and liver. Even cornea, which was at first not allowed, is now possible. It is also positive in terms of stem cell research. I would like to urge MUIS and its Fatwa Committee to continue to be proactive and progressive in their search to make Islamic law more inclusive in times of need, whether in principle or in terms of emergency needs.

The condition set for waris and next-of-kin to approve, while understandable in promoting a collective sense of family responsibility and to avoid potential abuses of individual consent, should also be reviewed in the context of this urgent and pressing need to save lives. The Fatwa Committee might want to review whether it is possible to waive the need for waris in the context of emergency (darurah). If the concept of 'darurah' was invoked for the principle of organ donation, perhaps it could also be done for the process, ie, the opt-out system. It is after all a process. MUIS and the Fatwa Committee should consider that.

While waiting for that, for those who are waris or potential waris and have reservations countersigning the pledge by their next-of-kin or siblings, please think of the donors' wishes. The Fatwa Committee should encourage all waris to respect the donors' wishes. This, however, I see it as only an interim position. In the longer term, it would be viable only if Muslims are included in HOTA, not as a special or exclusive component, but indeed inclusive. Muslims cannot expect to have the cake and eat it. The disadvantages of being out of the system are real and the Malay-Muslims as a community cannot afford to let this continue. The health and financial considerations are indeed very serious.

I am nevertheless glad to see MOH agreeing to continue to work with NKF and MKAC to get more Muslims to pledge, with the waris agreeing, at the outset. Public education, Sir, must continue.

Mr Speaker, Sir, broadening the scope of the Human Organ Transplant Act is a right move, given that this would mean more people who are ill will be able to get a second chance to lead a normal life. However, there are a few issues which should be addressed under the proposed amendment to the Act.

Ethics Committee

The new section 15B spells out the need for an Ethics Committee to oversee the removal of any organ at the hospitals. At the same time, the Bill proposes that the medical practitioner who is appointed to this Committee should not be employed or otherwise connected with the hospital. I feel that the Bill should stipulate the maximum term each member of the Committee can serve. If the same member serves on the Committee for too long a period of time, this will circumvent the spirit of the provision requiring that

the doctor who sits on the Committee should not be connected to the hospital. One would assume that the guiding principle of having this Committee is to have people who are independent-minded, making decisions to the best interest of the public. Therefore, there should be a time limitation for the service with the hospital to avoid a situation where they become too familiar with the hospital.

Further, the Bill does not specify the case of a lay person. Who are these people who can be invited to sit on the Ethics Committee, whether or not he or she should be an employee of the hospital? I propose that the Bill should stipulate that this lay person should also be someone not connected to the hospital. The lay person should be someone with some level of maturity and standing in the community.

Healthy organs

In clause 4, amending section 5(2), the organs may be removed not just from someone who died in an accident. It is expanded to include anyone who dies from any cause of death. There is also the expansion to the Act to include three other organs besides the kidney - liver, heart and cornea. It is relevant at this point for the Minister to explain how the Ministry ensures that the organ removed from a person is a healthy organ, in the sense that the deceased is not, for example, a sufferer or a carrier of HIV. With the increasing incidence of HIV, there is the likelihood that the deceased may not be on medical record as an HIV sufferer but is, in fact, a carrier. How does the Ministry address this problem as the impact to the recipients will be greater in view of the multi-organ donations? What is the due diligence that the medical practitioner will have to observe before the organ is transplanted to a recipient?

Is there a guideline from the Ministry for hospitals to comply with?

Definition of death

Since the scope of the Bill is broadened to include any cause of death and not due to any accident or otherwise, it is important that a new definition of when is a person considered to be dead be spelt out. Currently, two senior medical practitioners who possess appropriate post-graduate medical qualifications can certify the death of a person. This is provided: (i) they do not belong to the medical team that is involved in the organ removal; (ii) they are not involved in the care and treatment of the organ recipient; and (iii) their medical qualifications are recognised by the Ministry.

As the Bill now stands, everything is left to the opinion of the two medical practitioners. The families of the deceased would surely want to know, as a matter of fact, how is death determined. In the US, the definition apparently varies between some states. One definition is when a person experiences an irreversible cessation of spontaneous respiratory and circulatory functions. Another definition says there is an absence of spontaneous respiratory and cardiac functions, and because of the disease or condition which causes directly or indirectly these functions to cease, or because of the passage of time since these functions have ceased, attempts at resuscitation are considered hopeless and, in this event, death would have occurred at the time these functions have ceased.

We should make it clear in the Act so that there is no ambiguity in the determination of death. The next-of-kin, as you will well imagine, will be under a lot of trauma and distress when such a decision is to be taken. If the Act spells out the definition in a clear manner that a layman can understand, then the process will be less painful for the families of the

deceased persons. And I agree with Mrs Lim Hwee Hua's comment that the concern here is not solely on principle nor legality, but the added dimension or sufficiency of safeguards. And we have also been recently reminded of the accidents resulting in the training of commandos. Additional external checks should be done on a periodic basis so that comprehensive safeguards on the process of the certification of death are constantly present.

Recognition of benefits and penalties of the Act

There are many people who do see the merits of organ donation as an act of saving lives. However, they also believe that organ donation is an altruistic act and not to be carried out through an act of law. In this view, some may choose to opt out and then opt in through MTERA, or some are already in MTERA for many years. I would like to stay that way. Can the Act recognise this spirit of altruistic act of organ donation and recognise the individual choice, since the end result is the same?

Can the Ministry clarify the benefits and penalties accorded to a person who chooses to opt out for a cornea transplant and remain in HOTA for the other three organs, and subsequently by fate requires a cornea transplant? Will he be penalised and denied of the organs? These are examples of the many questions asked by the public which the Ministry needs to elaborate.

Public education

It is important that the Government should go back to the people and get everyone to understand what the new law covers when this Bill is passed. It is important that everyone understands what are the organs that can be donated

in the event of death. This is an important information that should be carefully explained to the people and we should make sure that it is filtered down with the correct messages. No one would want to see their loved ones lying in this condition with the thought at the back of their minds that the body they see is, in fact, devoid of the cornea, liver, heart and kidney, unless they strongly believe in the merits of the removal of the body organs to save lives. Hospitals should provide sufficient qualified counsellors to handle this highly charged state of emotive condition of the family members, especially when the donors are young. The Government should also muster the support of grassroots organisations, welfare bodies, religious bodies to help in this process. Here is the process in which once a decision is taken, the outcome is irreversible. The consequences can be very painful and traumatic as they haunt the conscience of the living for the rest of his or her life.

With these comments, I support the Bill.

Sir, I rise in support of the amendment Bill. It is encouraging to note that many seriously ill people are saved each year through organ donations. At the same time it is just as depressing to note that yet many more die each year, because there are simply not enough organs donated.

HOTA will change this as more organs for transplant can be made available to those who are in need. I applaud the Government for having the moral courage to introduce these changes despite the many issues and concerns that need to be addressed and clarified. Reassurance and practical solutions to allay the fears, apprehensions and concerns of Singaporeans will need to be put in place.

Sir, I would like to raise some of these concerns focusing on five areas:

The first area of concern is that the Bill focuses too much on the supply side of the equation. What is not surprising is the rationale that the MOH gives for the need to include liver, heart and cornea under this opt-out system. I reckon that the dire need for such organs is what prompts the Government to introduce the amendment. However, in my opinion, there is just not enough debate in this nation about the demand-management side of the equation.

We are not sure by what criteria patients who need these organs are given priorities one over the other. In the US, the authorities have developed rather elaborate contra-indications of who should get priority and who should not. There is no such set of contra-indications in Singapore or, at least, we are not sure what those contra-indications are as they are not made publicly available.

For example, I am pretty sure that a patient who is 85 years old, an invalid, and a widower would not be given the priority over, say, a patient who is a 35-year old and a breadwinner of his family. Another example would be a person who is a drug addict or a convicted criminal. How would he be placed on the priority list?

I am quite sure that hospitals in Singapore attempt to look into who best to give priority, when deciding on organ transplantation, but there are no clear and publicly available indications of who would be placed in the front of the queue. In the case of car control, the Government steps in on the demand side of things. In the case of organ transplants, the Government steps in on the supply side of things. There is nothing wrong with the approach. However, just as I feel that more can be done on the supply side of the car population, so I think that more can be done to indicate how demand of organs

can be better managed.

As far as supply of organs is concerned, since a person who decides not to opt-out is effectively saying "yes" to donating his/her organs, the amendment should also include something about the community giving back something to the immediate family members of a deceased patient who has his/her liver, kidney, or cornea removed upon the certification of brain death. A one-off benefit could include the defraying of funeral expenses; a one year write off of income tax being owed; grants and so on. Quite obviously, there must be a cap on the amount that can be given out, but in making this gesture, the Government will be signalling that it, too, is doing something about properly managing the harvest of organs in this country.

Sir, the amendment does not include other types of organs. A few years ago, there was a successful lung transplant being carried out in Singapore. Perhaps, we could also look into other organs, and some thought ought to be given to the issue as to the maximum number of organs that can be harvested from any single deceased patient.

The second area concerns the consistent application of HOTA on the population in a secular state like Singapore. Muslim Singaporeans have been excluded from the amendment on HOTA on presumed consent unlike all other non-Muslim Singaporeans. Should Singapore, as a secular state, pass a law differentiating the various religious groups? I would have thought that we should have a law that is consistent with our secular nation state status since there is no fundamental objection, as explained by the hon. Member Mayor Zainul Abidin.

Sir, the Muslim population forms a significant number in Singapore. With the amendment on HOTA providing for Muslims to opt in, I would like to check

with the Minister on the impact on Muslims who need organ transplants. I wonder, Sir, how many will die whilst waiting to be accorded the priority for an organ transplant. Can the Minister enlighten us as to the number of Muslims in Singapore waiting for organ transplants and what would be their priority in the queue?

The third area concerns the definitions and issues of brain death. Sir, as medical science evolves, the definition of 'death' is being expanded. Life can be prolonged artificially for the purpose of organ removal. This has raised questions as to when death takes place and does 'brain death' in all instances constitute death? Like my colleagues before me, I am concerned.

Some doctors, for example, claim that tests for 'brain-stem' death, the precondition for organ removal, can actually precipitate the condition. Understandably, there is a widespread underlying concern among the public as a whole that less effort may be put into saving the life of a patient if it is assumed that his organ can be harvested and used for transplant.

It was reported in the newspapers, sometime back, that a well known Japanese author observed that, in the interest of prolonging the lives of others for the greater good, American doctors administer heparin and phentolamine to the brain dead to keep their organs alive for transplant. The moral issue arises. Heparin prevents blood clotting within organs, whilst phentolamine widens the blood vessels so that more blood flows through the organs to keep the brain alive. These two drugs do not improve patient comfort or care but can hasten heart death. I understand that in 1997 an ethicist blew the whistle. To date, there is no consensus on the morality of using

these two drugs. I am interested to know whether these drugs are used by our Singapore doctors and, if so, how do we deal with the dilemma.

Sir, it is important that any debate of the issue needs to take account of these reservations with the aim of providing further clarification and reassurance. It is also important that there is enough information reaching out to the public so that those affected can be reassured and make better-informed decisions. For example, for a teenager reaching the age of 18 and who now qualifies legally to make a decision on HOTA, what kind of education or information sharing is put in place to sufficiently prepare these teenagers for making an informed decision and choice with regard to HOTA?

While feedback and surveys so far indicate willingness to move towards a system of presumed consent, we need to put in place sufficient mechanism to address the concerns of those who have not expressed support and to understand their reasons for not doing so. Only then, we can better convince those unconvinced of the cause that we are promoting.

The fourth area of concern is on the proposed regulation of living donor transplants. Here, I would like to make some observations on this issue in other countries. The HOTA Act 1989 forbids people from accepting organs from anyone not genetically related, unless it is approved by a panel of doctors. Even then, no money is allowed to change hands. The existing legislation is the same in the UK. This issue is being debated by the BMA in the UK at present. It has been proposed that the NHS is permitted to buy organs from live donors.

John Harris, Professor of Bioethics at Manchester University, argues for healthy donors to be given the right to sell

organs. According to him, "Thousands of lives could be saved by establishing an 'ethical market' in live organs. This payment should be tax-free and donors should not lose entitlements to state benefits." In an article in the BMA Journal, he says, "This would prevent the rich using their purchasing power to exploit the market at the expense of the poor. People would not be able to use wealth to jump the queue and rich countries should not be allowed to buy organs from the poor countries."

One proposal is to only allow organ trading to take place within countries or within a bloc of countries. Legalising the sale of organs would also remove the incentive for illegal profiteering from the trade. Opponents, include Alistair Campbell, Professor of Medical Ethics at Bristol University, who argued "Our body is not a piece of property in the sense that our house is. Also the consequence of a market in human organs is inevitably exploitative, as studies from countries like India have shown." According to Campbell, "Far from improving the lot of the poor, it worsens their situation. The notion of an 'ethical market' is a myth and it will only be the most needy who are ready to sell organs."

Surveys conducted in the US have shown that only 12% of people were likely to donate an organ for a financial incentive and 5% said that they were less likely to do so. At the same time, there are indications that more people in developed countries are offering organs for sale, often via Internet. In a recent case, a British woman offered a kidney for US$200,000 so that she could purchase an apartment. Studies have indicated that, not surprisingly, it would be the poorer section of society who would be most likely to sell their organs. Also, many live donors suffer a decline in their own health. Other studies conducted in the US into commercial blood banks indicated that there were four

times as many cases of hepatitis among paid donors, because offering payment attracted poorer and sicker donors, who sometimes lied about their health. As a result, commercial blood banks were curbed.

In all EU states, with the exception of Austria, payment for organs beyond reasonable compensation is strictly forbidden. But penalties vary from country to country and there is nothing to stop EU citizens from travelling abroad to purchase organs from live donors in countries where the practice is not illegal. Germany is the exception where it has an extra-territoriality clause which makes it illegal for a German citizen to purchase organs anywhere in the world.

Based on the above research findings, Sir, I am concerned that the issue of 'transplant tourism' is real and may catch up with Singapore. It is therefore prudent and timely, as we debate the proposed amendments to HOTA, that we also address the potential illicit trafficking of human organs more extensively. Specifically, what would be our stand with regard to the wealthy purchasing organs from living donors in developing countries? Therefore, I urge that legislation with regard to living donors and recipients needs to specifically address aspects such as definition of organ trafficking; the introduction of an extra-territoriality clause, as exists in Germany; removal of an organ by force; promise of payment or payment for an organ; participation of medical staff in the illegal transplant of an organ.

The fifth area pertains to new section 5(2) of the Amendment Bill. Sir, at this juncture, I would like to make reference to clause 4 which amends section 5(2) to allow organs to be removed from the deceased person who has died from any cause of death, and not just where the death was caused by accident or resulted from injuries caused by accident. From

the medical perspective, the removal of organs is very much a mechanical process. We must not forget that such an act can cause intense emotion in the next-of-kin of the dead person. Although there is presumed consent, it would appear to be more humane if we could include in this clause the following "after having informed the next-of-kin and explained the procedure of the removal of organs." Even if the intent is there to touch base with the next-of-kin first, it is good to have the inclusion as a check and balance to ensure that indeed this procedure is not inadvertently left out.

Sir, on this note, I support the amendment Bill.

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

After making a detailed study of the Bill, I would like to raise the following six points. One, the acceptance of the definition of "brain death". Advances in medical science and technology have led to a higher rate of success in human organ transplant procedures. This has brought a ray of hope to those patients whose organs are at the end-stage of the disease. The Bill would help raise the number of organs available for donation.

Surveys have shown that most Singaporeans support this Bill. However, they have also shown that there is a group of Singaporeans, especially the more conservative and elderly, who continue to have doubts and are apprehensive about the definition of "brain death". In fact, before the law was enacted in 1987, the Ministry of Health has, through the media and public forums, explained and discussed this issue and yet, 17 years later, there are still some Singaporeans who are sceptical and

worried about the definition of "brain death" due to their lack of understanding. It does show how people look at death and how it is dealt with is still very much influenced by traditional thinking. To them, a person is still alive so long as his heart is still beating.

One reason for this could be that we have not done enough to clarify the issue to the public through adequate and proper channels. Perhaps, we need to explain the issue more and in greater detail so that people have more confidence and trust on how we deal with death and the removal of organs from the cadavers. I suggest that MOH publish and distribute pamphlets and brochures in four official languages and hold public discussions at grassroots levels to explain the issue to the people. The subject may be taught in schools too. This will help more people to have a proper understanding of the question of brain death and other details of the Bill.

Another issue I am concerned about is the health insurance coverage for the living donors. More and more Singaporeans are now covered by medical insurance. I have asked a few agents from the various insurance companies about this matter and they told me that they were not sure about the impact of an organ donation on the status of the insurance policy of the insured. In the event of a donor falling sick, an insurance company may claim that it is due to an operation involving an organ donation in the past, and hence may refuse to honour his policy and compensation on this basis. This is rather unfair to the policy holder.

I would like to know what the Minister's position on this issue is, and whether legislation will be made to provide some kind of protection to the organ donors who are covered by the medical insurance. As far as I know, unlike other donors, a donor who claims

to be a direct relative is not subject to rigorous interviews and investigations to preclude the possibility of financial inducements. All that is needed is the provision of documents to prove his relationship and undergo a medical examination and psychological test. However, this could lead to abuse, especially when the so-called direct relatives, including uncles and aunties, come from foreign countries, such as China or India. It is difficult to verify the authenticity of the documents.

Hence, it is not easy to find out whether there is monetary inducement involved. To avoid the possibility of organ trading, I hope MOH will legislate to provide for a DNA test for the donor to prove his claim of being a relative of the recipient.

Fourthly, the punitive measures in the Bill are rather lenient. I fully agree with the Minister that we need to stop this nefarious transaction in human organs. The Bill provides for a fine of $10,000 or a jail term of not more than one year. This is peanuts to those who could reap huge profits from organ transactions. I personally feel that the illegal sale of human organs is more serious than illegal 4-D bettings. In the case of illegal 4-D bettings, an offender receives a fine of $20,000 to $200,000 and a jail term of not more than five years. Therefore, the fine should not be limited to $10,000. It should be raised to $100,000 or $200,000. This will deter trading in human organs, which may tarnish our reputation as a respectable medical centre.

Fifthly, under the new law, the age limit for a living liver donor is 55 years. On the other hand, the age limit for organs removed from a cadaver is 60 years. What surprises me is that the age limit for a living kidney donor is 65 years. When a person reaches 60 years, he is considered a senior citizen. At this stage,

the risks and the post-operation complications are greatly increased, especially for such major operations. Our desire to help the serious kidney patients should not cause us to neglect the risks taken by the otherwise healthy donor when he donates his organs. Perhaps, we should consider lowering the age limit for living kidney donors to 55, as is the case for living liver donors, to allay the fears of those elderly people who might think they are suitable candidates for such operations.

Sixthly, the Transplant Ethics Committee's definition of "lay person". I would like the Minister to clarify what is the meaning of a "lay person" to be appointed to the committee. I am afraid that an ordinary lay person may not possess adequate medical knowledge to fully understand what is required of him when he takes part in the committee's deliberations. I agree with Dr Tan Cheng Bock that the Transplant Ethics Committee is a very vital body. It may be advisable to lay down certain criteria for the appointment of such a person, to ensure that he has the ability to exercise correct judgement in the discharge of his responsibility. When an organ transplant operation is undertaken, certain ethical problems may arise. Under the Bill, a representative can enjoy immunity from a law suit, if he is acting according to the directive from the Director of Medical Services or the Transplant Ethics Committee. If a lay person does not possess sufficient medical knowledge to fully understand the implications of his judgement, he would not be able to make valuable contributions to the Transplant Ethics Committee. Why appoint him to the Committee? I would like the Minister to clarify the points I have raised above.

I support the Bill.

Mr Speaker, Sir, thank you for giving me the opportunity to speak on

the proposed amendments to HOTA.

Sir, my colleagues before me have eloquently articulated the issues related to the proposed amendments - from the need to safeguard against the trading of organs in cases of living organ transplants to the ethical issues of what constitutes brain death to the procedures that doctors will have to adopt in declaring a patient for being brain dead. Some have highlighted the perennial problem of the lack of public education and the need to ensure that the public is kept aware of the developments and their individual rights and obligations. I share their concerns and I look forward to the Minister's response to these concerns in relation to the proposed amendments.

I would like to, however, focus on the issue of information sharing and public education, particularly on HOTA and the Muslim community. Sir, the issue of organ transplantation, as with many other issues, has often been said to be very sensitive to the Muslims. Dr Lily Neo yesterday and Mdm Ho today asked why the Muslims are given the choice to "opt in" when they are more vulnerable to getting kidney and other diseases - rendering them in a disadvantaged position should they be diagnosed with having such a disease. What is important to note is that, whatever the religion, the transplantation of organs requires the consent of the donor. In the case of non-Muslims, the consent is presumed, thus one is given the option to opt out if consent is not granted. In the case of Muslims, consent cannot be presumed. Islamic law stipulates that the consent must be given by the waris or the next-of-kin of the intended donor. Following the introduction of HOTA in 1987, the number of Muslims who have pledged to be donors has increased from 400 to some 14,000. This, however, as indicated by several of my colleagues,

makes up only a small percentage of all eligible Muslim adults. I have known of Muslims who are keen to opt in to HOTA but faced resistance from their waris. I think the issue is not to secularise the issue of consent for the Muslims, as suggested by Mdm Ho earlier, but rather the challenge is for MUIS and the Muslim community to convince the waris to provide their consent without compromising the prescribed laws on consent giving. MUIS must continue to reach out to the waris to understand and address their concerns and reservations about providing consent. Certainly, the question is: what is stopping the waris from giving their consent?

This is related to a more fundamental issue of whether organ transplantation is permissible in Islam or not. The Fatwa Committee of MUIS has ruled that organ transplantation is permissible for the purpose of saving lives. This is a similar position taken by several other religions, as I understand it.

Sir, indeed, the issue involving the Muslims is one of public education. There is a belief held by many Muslims that one is created and born complete with the necessary organs and, thus, one should return to one's Creator in the same manner. This is why, despite MUIS' Fatwa Committee's ruling on the matter, many Muslims are still uncertain about their willingness to be part of HOTA.

Sir, yesterday, Mr Ahmad Khalis had outlined in detail the developments of the Islamic rulings or Fatwas with regard to organ donation. Sir, the Fatwa Committee's ruling is not unique to Singapore alone. In fact, in arriving at its ruling, the Fatwa Committee makes reference to several Islamic countries and the International Islamic Authorities, like the Islamic Fiqh Academy in Al-Azhar, the authorities in Cairo and the OIC in Jeddah.

Sir, all over the Muslim world, the position of organ donation and transplant is similar. In Saudi Arabia, for example, the Senior Ulama Commission resolved that both living and cadaveric organ transplants are permissible on the grounds of saving lives. The Saudi Centre for Organ Transplantation prescribes specific protocols with regard to proclamation of brain death for the purpose of organ transplantation. Malaysia practises a similar opt-in system for organ donors and consent from the next-of-kin is essential before retrieval of organs. In Egypt, there is no legislation regulating organ transplants except for a 1962 law that legalises cornea transplants. Kidney transplants of related donors are allowed with written consent from the donors. In Turkey, the Directorate of Religious Affairs has approved of organ transplantation, proclaiming that the deadly diseases can be treated by people using modern medicines and techniques and remains in conformity with the demands of Islam.

Sir, I raise the above examples to highlight to the Muslim community that the Fatwa issued by MUIS' Fatwa Committee is in tandem with that of many Islamic countries. This is important to allay concerns expressed by some sectors of the community about the permissibility of organ donation and transplant in Islam. MUIS and the Muslim Kidney Action Committee (MKAC) will have to continue to educate the Muslim community on the Fatwa and address other concerns that they may have. I have heard of Muslims being concerned with who the recipients of the organs will be. Others have expressed concern about respecting the dead and the ability to fulfil funeral rites and obligations. A heightened public education campaign must be embarked on continuously to address these concerns. Sir, in such a circumstance, ignorance is not bliss.

Sir, yesterday, Mdm Halimah highlighted that Part IVA of the proposed amendment which relates to living organ donor transplants effectively suggests that the Muslims are already in HOTA. Sir, about a year ago, my wife and I lost a dear friend to leukemia. She was diagnosed with the illness some five years before her death. At that time, we were told that a bone marrow transplant was the best option for survival. All her family members were eager to donate their bone marrow. And so were we. But there was no suitable match. We looked everywhere, including her distant relatives in India, but our efforts were in vain. She succumbed to the illness at the end of 2002.

Sir, only patients of such diseases or illnesses and their loved ones will understand the sufferings and the longing for a donor organ to come by. Many will have to suffer in silence for a long time and perhaps may perish prematurely when their hope for an organ transplant is not fulfilled. I do not think we need to personally experience a loved one to be diagnosed to have a disease or serious illness to feel for his plight. This Bill is about saving lives. This Bill is about doing what we can to improve the lives of our fellow citizens.

As a citizen, I support the Bill. As a Muslim, I call on all my fellow Muslim brothers who are waris, to consider the greater good of humanity and show their support to their family members who want to be donors. If there are still reservations, I urge them to objectively bring these reservations to MUIS and the Fatwa Committee to be answered. I hope, in due course, more Muslims will opt to come into HOTA and do our part as more responsible and caring citizens.

Sir, I support the Bill.

(In Mandarin): Mr Speaker, Sir, I rise to

support the Human Organ Transplant (Amendment) Bill.

The inclusion of the non-accidental deaths, heart, liver and cornea into our system is the most effective way to increase the number of available organs for transplantation.

In theory, an opt-in system would be more ideal and meaningful.

However, experience shows that, whether in Singapore or elsewhere, the response to opt-in for donation has been far from ideal. In fact, according to a survey by the Ministry of Health, most Singaporeans actually support organ donations, but generally do not take the trouble to make the relevant applications.

Another survey done by MOH also indicated that there is still a small number of Singaporeans who are concerned that doctors might diagnose brain death prematurely. There is a group that is uncomfortable with the definition of "brain death" because, to them, a person is dead only when his or her heart stops beating. Most young people can understand and accept the concept of brain death. They also have faith in our medical personnel. However, there are some old folks and those who are not so well-educated who seem to have difficulty accepting this definition of death and they are concerned that the donors would be pronounced dead prematurely. This is probably due to a lack of understanding of the definition.

The Ministry has responded that it would be conducting regular public education programmes in partnership with the grassroots organisations to dispel such fears so that more people would be aware of the definition of brain death. I fully support this initiative.

We must build up the public's faith in our medical personnel. Doctors will do their utmost to save the life of every patient and will not treat their patients disrespectfully. We can also go through various channels and even use our mother tongue to let those senior citizens understand that their fear and concern are really unnecessary. As a matter of fact, once they have passed the age of 60, their organs will not be harvested under this Bill.

For those who wish to opt out for whatever reasons, I hope that the Ministry of Health will make the opt-out procedure simple and easy. We must not take away the patient's organs under any circumstances by taking advantage of the patient's ignorance or helplessness. This will be unethical and despicable.

Some Chinese people still hold dearly to very traditional beliefs, especially in funeral rites. They tend to believe that when a person dies, his body should remain whole. In my constituency's meet-the-people sessions, I have occasions to come across some residents who have just lost their relatives and they sought my help to stop the pathologists to do an autopsy on the deceased for fear that his body would be mutilated, as they want the deceased's body to remain intact. The Chinese people feel very strongly that it would be disrespectful to the deceased if his body could not remain whole and intact.

I would like to urge the Chinese people, who still hold on to these traditional beliefs, to change their mindset because with the advances in medical science, the organs of the dead now can be transplanted to save more lives.

As mentioned by some colleagues before me, recent studies in the United States have revealed that some heart or liver transplant patients suffer from kidney

failure within a few years after the transplant, and had to go for dialysis or even kidney transplant. It seems that there is indeed a sequela to these transplant operations. Therefore, I would like to urge the Ministry to step up its efforts to conduct various educational seminars and talks to promote healthy lifestyle as preventive measures. It is very important to educate Singaporeans on how to prevent the failures of organs and to change their diet and lifestyles. In view of the fact that we have a growing ageing population, the Government needs to educate the public. Otherwise, no matter how many organs we may have to harvest, they will not be enough to meet the demand.

I agree with Members who expressed concern over the illegal trafficking of organs. I know of a number of people who actually went overseas to purchase organs for transplantation. It is useless for us to enhance the penalty in Singapore for illegal trafficking of organs as people who are in need would just go overseas to acquire organs. They are eager and prepared to spend $20,000-$30,000 to buy a kidney for transplant and prolong their lives for, say, three to five years. We cannot stop them as they just could not afford to wait so long for their turn in Singapore. They would rather spend the money, and take the risk to go overseas to purchase the much needed organ.

Mr Speaker, Sir, if this sort of thing happens to someone close to you, would you have the heart to stop him from doing so? We cannot stop people from pursuing a healthy body by going overseas to acquire an organ. Therefore, it is important for the Government to educate our people on how to keep a healthy lifestyle so that their bodies will not be so prone to disease and their organs will remain good and healthy, and there is no need to go

for transplant to replace their failed organs.

Mr Speaker, Sir, I rise in support of the amendment to the Human Organ Transplant Act. The proposed amendments are indeed laudable as they will open the way for more organs of the human body to be made available for life-saving transplantation to individuals suffering from organ failures. The concerns I have with respect to harvesting organs from brain-dead persons as well as transplants from living donors, have been expressed by several Members. I shall therefore not repeat these.

However, I would like to express my concerns on the implications of continuing to exclude Muslims from the provisions of HOTA. When HOTA was enacted in 1987, Muslims were excluded because in the case of Muslims, according to the Shariah (or Islamic law), it is the waris (or the inheritor), who has the right to decide what to do with the body of the deceased person and this is sacrosanct. Thus, it is not permissible to remove any organ from the cadaver without the prior consent of the waris.

Sir, as Muslims are not included in HOTA, they need to pledge or opt-in if they wish to donate their organs upon their death. This pledge is not made under HOTA but under another Act, namely, the Medical (Therapy, Education and Research) Act 1972 (MTERA). Muslims wishing to donate their organs must also ensure that their waris endorse the pledge form as part of the condition of acceptance of the pledge.

Since 1990, the Muslim Kidney Action Committee (MKAC), which is a committee appointed under the auspices of MUIS (Muslims Religious Council), spearheaded many public education campaigns with

the support of MUIS, the National Kidney Foundation (NKF) and major Malay/Muslim organisations in Singapore to encourage Muslims to pledge their kidneys under MTERA.

To-date, after nearly 14 years of such effort at an expenditure estimated at $7 million (estimate provided by NKF), just over 14,500 Muslims have pledged their organs under MTERA. This represents a significant increase over the 400 Muslim pledges in 1990. However, in comparison with the number of Muslims who are eligible to pledge their organs, which is estimated to be 250,000-260,000, the current number of pledges only accounts for about 6% of the eligible Muslim population.

Sir, how do we get the vast majority of Muslims to become organ donors under MTERA? Can we continue to depend on the persuasive approach? I personally do not think so. Opting in is not a straighforward procedure for Muslims. The requirement for them to get their pledge forms endorsed by their waris is troublesome and most just do not bother to do it. Records also show that more than 12,000 Muslims had their pledge cards returned because they did not have the requisite endorsement by their respective waris. Even if the waris are not required to co-sign the pledge forms, the experience, not only in Singapore, but also in many developed countries, has shown that the persuasive approach can only achieve limited results and, at most, secure participation from between 2-5% of the population. In fact, it was in recognition of this that HOTA was introduced so that non-Muslim Singaporeans are deemed to have pledged their kidneys unless they choose to opt out.

Sir, as a Singaporean Muslim myself, and having consulted with many of my

fellow Muslim counterparts, I can say with great conviction that it is our desire to become part of the pool of organ pledgers together with non-Muslim Singaporeans. I believe that the vast majority of Muslims want to be included in the HOTA, not because they feel disadvantaged when being left out, but because like their non-Muslim Singaporean counterparts, they too deeply feel the desire to help save lives of their fellow Singaporeans who are suffering from organ failure. The MUIS Fatwa Committee, which is responsible for ruling on points of Islamic law, has confirmed that Islam not only allows but encourages organ donations for life-saving transplantations.

Mayor Zainul Abidin Rasheed and Dr Maliki have both spoken at length earlier this afternoon about fatwa in several Muslim countries being supportive of organ transplantation although in Saudi Arabia, for example, consent from a donor is still required. Muslims are acutely aware of the plight of persons, whether Muslims or non-Muslims who are stricken with organ failures, where transplantation is their only hope of living a normal life again. They are also aware of the sufferings of kidney patients who have to endure rigorous four-hour dialysis sessions, sometimes up to three times a week, to prevent toxins from building up in their bodies. Singapore Muslims want to do their part with other Singaporeans to provide hope to such patients. Sir, during an intensive public campaign conducted by the MKAC in the year 2000, more than 56,000 Muslim Singaporeans put their signatures in support of organ donation. This represents a significant verifiable response from Muslims of their desire to be included in HOTA.

I would therefore request the Hon. Acting Minister to seriously consider the inclusion of Muslims under HOTA to make them automatic organ pledgers together

with other Singaporeans. Sir, I would like to further propose that to overcome the issue of the sacrosanct rights of the waris over the deceased Muslim cadaver, the amendment should allow making provision that in the case of Muslims opting out of HOTA, it should mean that they are doing so not only on their own behalf, but also exercising their rights over those family members

they are a waris to. For example, assuming that Muslims are included under HOTA, if I, as a Muslim, choose to opt out, then all my family members, whom I am an immediate waris to, would be deemed to have opted out as well. However, if my unmarried son chooses to opt out while I am still alive, he does this only in an individual capacity. It should not affect me or his other siblings.

Having said this, I realise that this may not be as straightforward as it seems, but it could be further refined and developed. I thank Mdm Ho Geok Choo for questioning the exclusion of Muslims from HOTA in a Singapore which aspires equal treatment and opportunities for all. In a secular society like ours, we need to find creative ways to surmount some of these religious difficulties which I believe are matters of interpretation. There should be some give and take in order to make further progress. MUIS, as the supreme religious body for Muslims, can help facilitate this.

The inclusion of Muslims as part of the fabric of this Bill has been delayed for too long. It is timely indeed to seriously look into their inclusion in HOTA, as we deliberate this issue during this revision exercise.

Mr Speaker, Sir, I leave this House with a quotation borrowed from Mr Kofi Annan, Secretary-General of the United Nations, that he made during the 18th Singapore Lecture in February 2000, and I quote:

"All great traditions and religions overlap when it comes to the fundamental principles of human conduct: charity, justice, compassion, mutual respect, the equality of human beings in the sight of God."

Sir, the inclusion of Muslims will benefit all of us and I urge the Ministry to take steps to consider implementing it as soon as possible.

Thank you, Mr Speaker, Sir, for allowing me to participate in this debate. As an Opposition MP, I rise to speak in support of the Human Organ Transplant (Amendment) Bill.

As long as we are medically able and ethically persuaded, there should be no reason why an organ transplant operation should not be allowed to take place either from a willing brain dead person or from a willing living and able donor. The purpose is to save and/or improve the life of another critically and/or terminally ill patient, without which living is misery and death is most certain. However, my only two concerns for the Ministry to look into are as follows:

First, all Singaporeans are, by default, organ donors. Yet, they are not educated to understand the implications and consequences of staying put as an organ donor. Many people thought that it is okay to donate their organs when they die. But they do not realise that they would not be fully and completely dead. They are just brain dead, by medical definition. The heart is still pumping and their organs will be harvested when they are actually still breathing. If they had completely died, as their heart had stopped beating, then their organs would have been useless.

Sir, all organ donors and their families should be made aware of this fact so that

they can better decide if they want to opt out or stay put in this programme. Not enough effort is made to explain this point to our citizens. Even I, as an MP, do not know of this distinction until the Minister explained yesterday. What more of the general public. Since this is an opt out scheme, the Health Ministry should take on this mammoth task to explain the pros and cons of staying in this programme objectively to our citizens. Otherwise, citizens whose beloved family members are in a comatose brain dead condition will feel shortchanged and cheated when the organs of their loved ones are being harvested when they have not completely and fully died. The next-of-kin of a brain dead person should also have the power to decide whether to let go of their brain dead loved ones in such circumstances or to continue sustaining the brain dead using machines, hoping and hoping for a miraculous recovery.

Secondly, living organ donors of a kidney or any part of the liver should be Singapore citizens and permanent residents only. They can donate their organs to fellow citizens and permanent residents only and without any form of contractual or monetary transactions. This is because nobody in Singapore should be so poor or be so forced into by circumstances as to have to sell their organs for a living. The second reason is to prevent the creation of a black market for organ trading in the very poor and undeveloped countries where many see selling one of their kidneys as an easy way out of abject poverty.

Sir, Singapore has a global reputation to maintain, and we must be seen to maintain our standards of moral integrity and ethical code of conduct. We must not be seen to become a centre for the illegal trading of human organs. Other than the above two concerns for the Health Ministry to address, there is no

reason why human organ transplant, especially by willing, living and informed donors, should be prohibited by law.

Sir, I support the amendment Bill.

Mr Speaker, Sir, with the amendment, many of us can play a greater part in helping those most in need of an organ donation. While I applaud the move to expand the Act to cover more organs and to include non-accidental death, I think that the amendment has not been bold enough. I would like to call for the inclusion of all Singaporeans as well as more types of organs in the Act.

Sir, as I am not a scholar on religions, I have surfed the Net to gather information and comments on the views on organ donation by various major religious systems. Not surprisingly, although with some differences, all major religions support the act of organ donation with a common view that saving life takes precedence and that the act of donating one's organ is seen as an act of charity and is accorded with great merit. From a humanitarian viewpoint, donating one's organs to save lives of fellow human beings is also of highest calling. Therefore, I would urge the Minister to consider expanding further the Bill to cover all Singaporeans regardless of race and religions. As this is an opt-out system, anyone objecting to organ donation will still be able to exercise their right to be excluded.

Sir, we should also remove the age criterion of limiting the potential cadaveric donors to those between 21 and 60 years of age, which precludes many otherwise suitable potential donors. Many of these younger and older persons who have died may still have organs that are medically suitable for transplantation. Hence, I would urge that the age limit for HOTA be removed in order to increase further the number of organs available to save lives.

Again, for those below 21, their parents or guardians could still exercise the right for them to opt out of the system.

Secondly, I urge the Minister to consider inclusion of more types of organs in the Bill. With advancement of medical science and technology, we will be seeing more and more of different body parts being transplanted to save lives and improve the quality of life. If this amendment Bill aims to save more lives, I do not understand why the skin and lung are not included while cornea is. Skin grafting is actually a life-saving procedure for patients with severe burns while lung transplant is the only hope for those with advanced lung disease in end-stage respiratory failure. In fact, many other organs, such as pancreas, have also been transplanted. May I urge the Minister to consider including at least the lungs and skin in this amendment Bill that could be used to save many precious lives?

Thirdly, I would like to touch on the need for more public education, a point that has been alluded to by many hon. fellow Members here. With HOTA in place for more than 16 years and MTREA more than 30 years, we are still having a shortage of organs available for transplant. I think this is partly due to some public ignorance and misconception on the procedure on organ harvesting and transplantation as well as the lack of knowledge of their own religious stand on the issue.

One of the common concerns that has been brought up by other Members here is the fear that removing organs from the body of the deceased will breach the norms defined by the traditional belief relating to death and the rituals associated with death. I therefore urge the Ministry to work closely with and through the religious leaders to spread the correct message that the act of organ donations is endorsed and approved by the respective religions concerned and to

eradicate the public's fears and misconceptions on organ donations and transplantations.

Lastly, let me touch on the performance of last religious rites for the deceased before the organs are harvested. May I urge the Minister to deal with these concerns with sensitivity and maybe to allow some form of rituals to be conducted for the deceased. Because at this dire moment before organs are removed, we should allow some religious representatives at hand to conduct the appropriate last rites for the deceased and his family. Because these religious rituals are important for the family to bid farewell to their loved ones and, in the due process, it actually helps the grieving family psychologically, spiritually and emotionally.

Sir, with these four comments, I support the Bill.

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

Sitting accordingly suspended

at 3.58 pm until 4.25 pm.

Sitting resumed at 4.25 pm

Debate resumed.

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

Organ donation has always been a sensitive issue, and the harvesting of organs, a controversial one, whether you look at it from the medical, social or

religious angles. However, the crux of HOTA is that of saving lives. The reality is that many patients who have a chance of recovery lost the opportunity to live or live an improved quality of life, because of the shortage of willing organ donors who no longer need them. This Bill will help increase the supply of organs for transplant in Singapore. There is a higher demand than supply for organ transplants all over the world. A similar shortage of organs for transplant in Singapore will result in Singaporeans heading for the less developed countries for organ transplant - countries where the standard of medical practice may be lower, and thus putting themselves at risk. To alleviate the suffering of this section of the Singapore society, we need to increase the availability of a greater variety of organs from a greater number of donors in Singapore.

There has been some debate whether it should be an opt-in or opt-out scheme. I thought it would be good if we take a look at the experience of the Medical (Therapy, Education and Research) Act (MTERA) which embraces the opt-in system. MTERA enables Muslims not covered by HOTA to opt into the scheme to donate their organs. MTERA also enables non-Muslims to opt into the system for organs not covered by HOTA. However, the number of donors under MTERA is not encouraging. I understand from the Organ Transplant Unit, Ministry of Health, that only some 56,000 donors (out of our entire population of about three million) have pledged their organs under MTERA. This is a very low percentage. And there is a waiting list for patients who need organ transplant. So while MTERA remains useful for the categories of people and organs not covered by HOTA, there is a need to expand the scope of HOTA to save more lives.

The opt-out system benefits everyone within the system. The benefit to a person within the system is that he enjoys priority in the event that he needs an organ donation from another person who has passed away. In other words, the opt-out system benefits the potential donor as well. And the expansion of the system under the present Bill will benefit more potential donors.

While I support the Bill, I do have some concerns with the prescribed tests for "brain death" and the procedure for harvesting organs from the brain dead. The debate in this House and the Ministry of Health's public consultation show that a big section of the public is still concerned about the concept of "brain death". There is a need for greater public awareness of the medical procedure for determining brain death and the procedure for the removal of organs from the brain dead.

I came across some American literature that said: "Often when "brain death" is declared, not all functions of the brain cease." The remaining brain functions may include continued brain wave activity and the brain continues to produce a hormone called arginine vasopressin that keeps the body's fluid and electrolytes in balance. There is also a phenomenon where a brain dead body may still exhibit flexion and muscle stretch reflexes, resulting in movements that resemble grasping.

In a book entitled, "The Nasty Side of Organ Transplant" by Norm Barber, an Australian cardiologist Dr David Wainwright was quoted that when the dissection begins, the brain dead body does not lay dead and still like a corpse. Instead, its heart beat quickens and its "torso jerks" and "arms and legs flail about".

When I looked up the Internet for related reports, amongst others, a British

anaesthetist, who also appeared in the Guardian newspaper dated 19th August 2000, was quoted as saying that anaesthesia is usually required for organ transplant from a brain dead body because, let me quote, "if you don't give anything at all,

the patient will start moving and wriggling around and it's impossible to do the operation. The surgeon always asked us [meaning the anaesthetist] to paralyse the patient."

The foregoing is an example of literature on the Internet or otherwise, available to our Singapore public. Such literature certainly generates unease amongst the potential donor public. Hence, I advocate that we must have more public discussions and awareness of this literature, (ii) upgrade our laws and procedure, where necessary, and (iii) differentiate our local practice from that in other countries (particularly that of the UK and Australia) wherever possible so as to dispel public unease.

As a first step, perhaps, we can try to understand the current state of affairs in UK and Australia. The UK legislation defines brain death to be the cessation of brain stem functions. This definition is less stringent than that in our own Interpretation Act (section 2A). We should distinguish between our track record and the UK experience.

The US and Australian legislation define "brain dead" to mean cessation of all brain functions. So does our Interpretation Act. However, since the 1980s, a US Presidential Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavorial Research has developed certain standards for the determination of brain death. These standards have been accepted worldwide. But a survey of these standards indicated that they test the physiological response of the body (such as its pupils and respiratory functions) to determine whether there is any sign of brain activity. The question is this: are

these tests prescribed some 20 years ago still adequate? Does the cessation of these few brain functions mean the cessation of all brain functions?

In Singapore, the prescribed tests for brain death set out in our Interpretation Regulations in 1998 were lifted from our old Rule 3 of HOTA 1987. Both were based on the brain function tests developed in the US, 20 years ago. The pertinent question is: have there been no new advances, medical breakthroughs, or change in medical consensus since then? I understand that Singapore doctors use EEG and other confirmatory tests to determine brain death. I urge the Government to review the prescribed tests for brain death to keep pace with the medical practice in Singapore.

Apart from the prescribed tests for brain death in Singapore, I also urge the Government to review the medical procedure in organ transplant from brain dead bodies. Literature from the US, UK and Australia shows that brain dead bodies are maintained on life support systems up to, and perhaps throughout, the harvesting and organ transplant procedure. This practice keeps their organs in optimum condition for transplants. The brain dead body is not allowed to shut down its bodily functions naturally. Hence, the "torso jerks" and "arms and legs flail about" as described by some doctors in the UK and Australia.

I believe that many sections of the public will find this practice distasteful. Even if a body is brain dead (and I mean cessation of all brain functions, as defined in our Interpretation Act), many sections of the public will still expect that the brain dead body be allowed to "shut down" its bodily functions, so to speak, before the harvesting begins. We treat a motorcar with more respect. Its engine is switched off and there is more than enough time for it to cool down before its parts are

cannibalised at the scrap yard.

We keep one minute of silence - out of respect in memory of the dead. Perhaps, we can also spare a few minutes of "shut down" time - out of respect for the body of the dead. These few minutes, as my colleague, Dr Ong Seh Hong, has pointed out, is an important ritual not just for the dead, but also for those alive. It is the crucial few minutes which allow the loved ones to grieve, bid farewell and do the necessary rituals to send the dead to another world. Whether it is social, religious or even psychological, any anthropologists and sociologists worth their salt will tell us that it is amongst one of the most important rites of passage in human history, and has great significance to those alive.

The advance of medical science should not be achieved at the expense of our human dignity. Literature in US suggests that there are medical procedures which can help preserve human organs during what is called the "warm ischemia" time. The advance of medical science should help us maintain our human dignity. With the emphasis on the biomedic and life sciences in Singapore, and in our quest to be a regional medical hub, we must be in the lead in such issues in order to be in the league.

All said, HOTA is about saving lives, and I support the Bill. But I urge the Government to review both the prescribed tests for brain death and the medical procedures for organ transplant from brain dead bodies.

Mr Speaker, Sir, let me first thank the 22 Members who have spoken on this Bill.

Among the speakers were two veterans in this House who also spoke on HOTA in 1987: Mr Chiam See Tong and Dr Tan Cheng Bock. I checked the Hansard proceedings of that session. Both of them were consistent in their comments and they remain strong supporters of HOTA all these years, as a way to save lives. I am cheered by the strong support given by all the Members for this Bill.

4.38 pm

I have listened carefully to all the speeches. I soaked in all your concerns and reflected on them last night. And this morning, I went through the media reports to make sure that I did not miss out on any point.

Let me now respond to each of these points. It will take a while but I hope you will bear with me. Let me begin with the most talked about issue, which is brain death. Most Members have expressed concern on this, even though it has been legislated 17 years ago. For example, Dr Lily Neo asked if the care for the patients, who are potential organ donors, would be compromised. She asked: would their organs be removed prematurely? Mr Gan Kim Yong asked if a brain dead patient would suddenly wake up from brain death. In similar vein, Mdm Ho Geok Choo asked if brain death, in all instances, constitutes death. She and Mr Chiam mentioned the recent case of Ms Tanya Liu, a popular Taiwanese newscaster, who was apparently saved from "brain death" by Prof. Ling Fung of Beijing. But it was an unfortunate misreporting by the media. I met Prof. Ling in my office here last month when she was here for a public lecture. And of course, we talked about Tanya Liu. She told me how Tanya's sheer determination and strong

family support, and of course combined with good clinical care, contributed to her recovery. But she was never brain-dead. She was only in coma.

Yesterday, Dr Lily Neo talked about an European case, 18 years in coma, suddenly woke up. I was not aware of that European incident. But that incident probably inspired a popular Hong Kong TV drama which is currently being screened by Channel U, Hun Qian Hun Hou, "The Awakening Story". It is about a woman who was unconscious for 16 years and suddenly woke up. The trouble is that, during the 16 years, the husband had a girlfriend. So you can imagine: big complications. My wife is hooked to this nightly drama, every night at 9.00 pm. As husband and wife should do things together, I too end up following the poor woman's emotional ups and downs. But, again, this fictitious character was in coma. She was not brain dead.

Given all these sensational news reports and popular TV drama, it is not surprising that lay persons should be confused. Some would harbour doubts about what really constitutes death. Mrs Lim Hwee Hua, Mr Iswaran and Mr Gan Kim Yong therefore rightly urged that I give a clear, unambiguous explanation on brain death and, preferably, in simple layman's terms.

"Brain death" means that all functions of the brain have stopped and stopped permanently. So it is not quite like what Miss Penny Low tried to explain just now that there are certain brain activities still happening. The loss of capacity to function is permanent, it is irreversible. There is irreversible loss of the capacity for consciousness. There is irreversible loss of the capacity to breathe. So this invariably leads to the state where all other organs, including the heart, also stop functioning. So Mr Steve Chia said, "You know, brain death, the heart is still beating." No, only because the machine

keeps it beating. And he asked whether "brain death" is completely dead. Of course. The fellow is completely dead, unfortunately. Yes, it is truly, completely, unambiguously and legally dead.

Hence, unlike coma, brain death cannot be reversed. A comatose patient, like Ms Tanya Liu was months ago, unconscious but she is alive. A brain dead is however dead, and not simply unconscious.

Mdm Ho Geok Choo commented that the definition of "brain death", and I quote her, "is still being debated within the medical profession." Actually, this is not so. The issue has already been settled quite some time ago. So I can assure both Mdm Ho and Mdm Cynthia Phua that, on this point, there is no ambiguity.

Who can determine if a person is brain dead? To certify brain death, the law requires two doctors to do so, but not just any two doctors. They must be experienced with specialist qualifications, like our Minister of State, Dr Balaji, and they must be independent: they must not be involved in the care of the patient, neither must they be involved in the care of the organ recipient.

Mdm Halimah talked about the Greek regime which requires three doctors to certify brain death. But in almost all countries, like Singapore, we stop at two. While three is more reassuring than two, two competent and independent doctors are quite sufficient for this purpose. And in practice, the entire process - if brain death were to lead to a transplant - involves many doctors, as I will explain later.

What constitutes brain death? There are stringent criteria for the certification of brain death. And these tests would clearly differentiate between a person who is brain dead and a person who is in coma. Our doctors adhere strictly to

these internationally-accepted protocol of seven clinical steps to check

for the slightest indication of life. These clinical tests include checking to see whether there is any response to various physical stimuli such as light, touch and pain.

Dr Lily Neo asked if we follow the British or the US method of certifying brain death, suggesting that there is a difference between the two. Just now when I listened to Miss Penny Low, she also read from the Internet about US and the UK and made some comment that the UK seems to be easier, lower threshold than Singapore, again suggesting that there are differences. I am no expert. So yesterday I asked Dr Balaji. Unfortunately, he is now on the way to India or is in India. He confirmed that, and I quote him here, "Brain death diagnosis in the US, UK and Singapore is medically identical".

In the US, the definition of death is based on state laws. As pointed out by Mdm Cynthia Phua, there are 50 different states; so 50 different ways of defining the same issue. However, there is a model Bill called the Uniform Determination of Death Act (UDDA) which acts as a template for individual state laws. This Act was the result of the President's Commission on Brain Death in 1981, and this was more than 20 years ago.

Whole brain death, as defined by this UDDA, is based on three criteria:

severe coma of known cause;

absent brainstem function (ie, the six brainstem functions are absent): and

sustained apnoea (ie, there is no breathing which is the seventh brainstem reflex).

These three criteria are medically identical to the British criteria for brain death, based on the absence of brainstem activity, ie, the absence of the seven reflexes in a comatose patient whose diagnosis is known.

So I am a bit puzzled by Miss Penny Low's recital of what she read in the Internet, suggesting that strange things are happening about brain death definition, and so on. Unfortunately, I cannot engage her on the technicality, because I am not a doctor and I never pretend to be one. But I agree with her that so long as there is information out there on the Internet which may be misleading, people in the know have a duty to come up and debunk it. And we certainly should not in this House propagate such misinformation.

In short, the diagnosis of brain death uses strict specialised medical definitions. As I said earlier, not all doctors are authorised to certify brain death. Only qualified specialists are authorised to do so. In Singapore, they have been doing so since HOTA was first enacted 17 years ago. The current Bill does not change the way brain death certification will be carried out.

However, there are situations where the seven clinical criteria cannot be fully performed. For example, one of the tests is on the eyes to see whether there is response. When the eyes are severely damaged, we cannot perform that test. The doctors would not be able to test the response if the organs have been injured or if the patient has been sedated and the medications that depress the brain functions are still circulating in the blood. Then, some of the clinical tests could not be performed.

Each year, we encounter two or three - not many, it is a handful - such cases where organs are damaged, etc. In such

situations, ancillary tests - like angiography - can be used to measure cerebral blood flow so that brain death can be certified. These ancillary tests are already used in many developed countries, eg, in the US. At present, however, our doctors in Singapore are not able to certify these two or three cases who are actually brain dead because our law does not specify such ancillary tests for cerebral blood flow.

My Ministry has, therefore, consulted the National Committee on Neuroscience and is working with the Ministry of Law to amend the Interpretation (Determination and Certification of Death) Regulations to include the tests for cerebral blood flow as ancillary tests to certify brain death in situations like this, where the seven clinical tests cannot all be performed. Let me stress that ancillary tests are to complement the clinical tests. They are not substitutes for the clinical criteria. If six of the seven clinical tests can be performed, then we must make sure we get 6 upon 6. The criteria for these six tests must be fully met before the doctor proceeds to carry out the ancillary tests in lieu of the seventh criterion.

The bottom line is this: no doctor will think about organ removal when there is still hope for life. The sole responsibility of doctors is to save the lives of their patients. The Bill does not change this basic responsibility in any way.

Yesterday, Dr Tan Cheng Bock - unfortunately he is not here - recalled the good old days when the medical practice was a noble profession. I am not a doctor but my career started in the Ministry of Health during that romantic era. Dr Tan lamented the slow erosion of the professional values as businessmen and administrators - he probably meant me - marched in and converted a noble profession into an industry.

I have heard of such caricature of the medical service. I do not fully agree with this description, although I understand the basis for some of this criticism. This is not the occasion to debate this topic. But I think Dr Tan knows that I am determined to help like-minded doctors like him, with sound professional values, ensure that medical practice return to the basics, and that is, to cure and relieve suffering and certainly not to bring harm. Money is a necessary evil but if a doctor is completely motivated by money and nothing else, then I think he or she has joined the wrong profession.

I do not believe that we have in our midst doctors who would be prepared to remove organs prematurely and declare brain death when one is not indicated, so as to benefit from the few dollars of surgical fees that he could get from the donor recipient. In any case, as I would explain later, we have many safeguards to prevent such a rogue doctor from completing his transaction. This is Singapore; this is not some third world country that Dr Tan described yesterday.

Mdm Ho talked about phentolamine and heparin and asked if we use these drugs on patients who are brain dead so as to keep their organs alive. I do not know one from the other. But the doctors in the Ministry of Health assured me that they do not do so.

So the Bill does not change the concept of brain death. What is new is that it will now extend HOTA to all deaths beyond accidental deaths. As I explained earlier, it was an artificial differentiation between accidental and non-accidental deaths, not seen in other countries with HOTA-like legislation. We should now remove the artificial differentiation so as to save a few more lives. But the inclusion of non-accidental deaths will not compromise the care of patients.

That is why we have three separate groups of doctors involved in any HOTA transplant. The first group of doctors looks after the organ recipient; the second group looks after the organ donor; and the third group is responsible for certifying brain death in the donor. Three totally different, separate, independent groups. There is, therefore, check and balance to ensure the highest ethical standard is preserved. In this way, we ensure strict compliance with the requirement that patients' interests will not be compromised in any way.

Let me now respond to the various comments on the choice of organs for HOTA.

Most Members support extending HOTA to include liver, heart and cornea. As Mrs Lim Hwee Hua puts it, the reasons are compelling. There were some Members who want us to do more, like Dr Ong Seh Hong. But a few expressed some reservations, like Dr Lily Neo, about extension to cornea and heart. Dr Ong Seh Hong and, I think, Mdm Cynthia Phua have mentioned the possible extension to things like the lungs, skin and pancreas.

For the moment, the need for skin is less urgent than for kidney, liver, heart or cornea. The skin bank has 10,000 square centimetres of skin in reserve. We actually need 40,000 square centimentres to be prepared for a national emergency. So we are not quite there yet. But we do have a bit more time to build up this reserve. For lung transplantation, it is still not fully established in Singapore. Our first case was only done in the year 2000. That is why I am reluctant to include skin or lung under HOTA. Similarly, there are many organ transplant procedures which are not yet well established. These include pancreas and intestines. Recently, Members may have read or heard of face transplantation,

where the ethical issues are even more complex.

Such new developments offer hope to those with organ failure. However, like all new procedures, there are technical difficulties and considerable risks involved. I prefer to take a cautious approach. In any case, we should be sure of public support before we extend HOTA to any new organ. We have not raised these new organs - skin, lung - during the public consultation, and it is not my style to spring surprises on Singaporeans.

It is, therefore, better to keep these outside of HOTA for the moment. But there is nothing to stop us from pursuing these organs under the Medical (Therapy, Education and Research) Act.

In this respect, I share Dr Warren Lee's observation that attitudes towards organ donations are slowly changing. It is certainly easier now than years ago when we approached the relatives of brain dead patients to consider donating their organs of their loved ones.

My Ministry will keep a close watch on all these new modalities. I will come back to this House to update the First Schedule of the Act when it is appropriate to do so, so that we keep in line with medical advances.

Yesterday, Dr Neo expressed reservations of some Singaporeans on the extension of HOTA to include cornea. While they support the extension to liver and heart, they have some problem with cornea as this is not life-saving. Moreover, foreign corneas are available. I accept that cornea transplantation is not life-saving. But the improvement to the quality of life for someone who would otherwise go blind is tremendous. Mr Zainudin yesterday gave us a fairly good account of the misery of the blind.

Last month, I read a local survey on what Singaporeans with serious myopia will do just to get back 20/20 vision. Many said that they were prepared to shorten their lifespan by 10% for that. I was surprised by this survey finding. But I think this gives us a sense of the value of a cornea transplant, even though it is not life-saving.

Members would know of Dr Lim Suet Wun, CEO of Tan Tock Seng Hospital. Dr Lim was one of our anti-SARS heroes. He led the team in Tan Tock Seng Hospital which played a critical role in our fight against SARS. So Dr Lim is known to most Singaporeans. But many will not know that Dr Lim was the beneficiary of cornea transplants many years ago, when I was still a colleague of his in the hospital. Without the transplants, Dr Lim would effectively be blind. His subsequent career and contribution to Singaporeans would have been quite different.

I know that there are some Singaporeans who still hesitate to pledge their corneas because of perceived religious concerns. But the religious leaders have all clarified that there are no religious obstacles to cornea donation. Part of the misunderstanding is that some people think cornea transplantation means removing the entire eye. It was so in the past, long long ago, but this is no longer the practice. Cornea is a thin layer of tissue on the surface of the eye. So it is not as if the cadavers will be disfigured.

Dr Amy Khor and Mdm Halimah stressed the need for us to respect the dead, certainly not to mutilate or disfigure the bodies. This is something that we who work in hospitals are extremely sensitive to.

Dr Neo also asked why we are including the heart under HOTA. As not many heart transplants are done here, why is there a need to include it? Every

life is worth saving.

There is a Chinese saying, "jiu ren yi ming, sheng zao qi ji fo tu", that is, better to save one life than to build a seven-storey temple pagoda.

Statistically, a few lives saved a year may not be impressive. But, as pointed out by Mr Gan Kim Yong yesterday, to the individual saved, it means a difference between life and death, and to their loved ones, it means a difference between bliss and misery. So I think the criteria for inclusion should be whether the operation is now an established treatment modality, and whether there is good public support for such a move. In fact, when we began our public consultation, the heart was not included. But the public consultation led us to believe that it is timely to include the heart under HOTA. This also seems to be the conclusion of Mdm Deputy Speaker who mentioned yesterday about a dialogue between the PAP's Women Wing and the professional women.

Let me now touch on the subject of living donor organ transplant. An entire new section will now be added to the main Act. As this is something new, it is right for us to spend some time on this and to make sure that we do it right. However, living donor organ transplant is not new to Singapore. Many Members have talked about the liver transplant on Ms Andrea De Cruz. This took place before the Bill. As I have said earlier, we now do more living donor transplants than cadaveric donor transplants for kidneys and livers. And the trend continues in this direction. The trend of more living donor organ transplantation is definitive. Mdm Halimah talked about Norway's experience with it. Dr Baliji told me sometime ago that in Norway, living donor kidney transplant is the norm. Chronic kidney dialysis is the exception. There, doctors push for live donor organ transplants because they believe that the quality of life for a person on dialysis is poor. As a result, it is normal in Norway

for a family member to donate a kidney and hospitals actively promote this practice. Norway is ahead of the curve on this matter. For us, I think the first step is to begin to regulate living donor organ transplantation.

Here, we have two key objectives. First, make sure that organ donation for money remains illegal. The Bill should not become a loophole for organ trading, as warned by Dr Amy Khor. Second, ensure that we protect our people against donating under duress. These are key abuses that Dr Neo stressed that we should guard against. To safeguard these, we need a total system approach with multiple checks and balances. An important player is the Transplant Ethics Committee. Without the committee's authorisation, no transplant can be allowed to proceed. The committee members have the responsibility of ensuring that each transplant is carried out in an ethical manner. It is a heavy responsibility as pointed out by many Members. They have to balance the interest of the donor and the interest of the recipient.

Mr Iswaran and Dr Tan Cheng Bock argued eloquently on the need for a centralised approach to this, with one national ethics committee, with Ministry of Health's participation, for the entire Singapore. In this way, we better ensure consistency of approach. On the other hand, there were Members, like Dr Amy Khor, who saw the value of a decentralised approach empowering the hospital-based Transplant Ethics Committee to take such decisions.

Actually, our proposed approach is a hybrid, ie, combining the benefits of a centralised and decentralised approach. At the national level, we have the National Medical Ethics Committee currently chaired by Dr Khoo Chong Yew.

It was previously chaired by Professor Y Y Ong. The National Medical Ethics Committee will discuss and forge consensus on policy matters. This group of wise persons will debate and assess what is the society's norm. This will be the platform where guidelines will be formulated for consistent application amongst the hospitals. Then at the transplant hospital, we will have the hospital's Transplant Ethics Committee which will decide on individual cases of transplants pertaining to their hospital. At the individual level, a decentralised approach is appropriate.

First, the final responsibility for the care and well-being of both the donor and the recipient rests with the transplant team and the hospital. The hospital-based ethics committee will be better placed to make the detailed assessment and arrive at a correct decision. Secondly, in some instances, urgent decisions have to be made. In such situations, the hospital's ethics committee will be able to review the case and respond immediately.

Both the national and hospital ethics committee will comprise members who are wise and who are experienced with sound judgement. Given the heavy responsibility of these committees, my Ministry will ensure that only respectable persons are appointed. That is why the composition of the ethics committees has to be approved by my Ministry. We all know that ethical decisions cannot be fully codified and converted into formula or computer programmes. In fact, there will be situations where two wise persons may not agree on the same case. We should not be surprised by such outcome. My plan, therefore, is to arrange for occasional discussions amongst the various ethics committees on the cases that they have encountered. As Mr Iswaran pointed out, in this way, over time, a body of cases will be built up which will help forge the society norms towards such issues.

Mr Ang Mong Seng asked just now how a layman, on such an ethics committee, will be able to play a role on such a medical and technical subject. But this is not a completely medical subject. When Mr Pierre Png volunteered to donate part of his liver to Ms Andrea De Cruz, the issue went beyond mere medical issues. In fact, the medical aspects were relatively straightforward. Was Pierre fit for the operation? Was he fully briefed on the impact on his health, both during surgery as well as post-surgery? But beyond these medical issues were many non-medical issues. Why did he volunteer? What was his relationship to Ms Andrea De Cruz? Were there any family or societal pressures? Laymen therefore play a crucial role in the ethics committee, and that is why we make it a requirement. There must be at least one layman. The strength of the lay person would be in considering social, ethical and non-medical issues. He or she will try to represent societal views on transplant issues.

Mdm Cynthia Phua suggested that the term of membership in the ethics committee be time-limited to avoid members becoming too familiar with the hospitals. I suppose this is akin to company auditors where we do require or encourage rotation of auditors to ensure independence. I agree with the spirit of the suggestion and we will take that into account when considering the proposed composition of the committee. But I will rather not hard-wire this into the law. The criteria should really be independence and competence. If a person is proven to be balanced and independent despite being long on the committee, I will prefer to extend this membership, instead of forcing him or her into early retirement.

Besides the structure of the committee, the Bill will also allow my Ministry to set the rules and procedures for the hospital's Transplant Ethics Committee. This is also a point stressed

by Dr Chong Weng Chiew. In particular, we will spell out the functions, responsibilities and procedures. My sense from both the public consultation and the many speeches I have heard in this House is that Singaporeans will prefer that we take a conservative approach to live donor organ transplantation. Where donor and recipient are truly related, the concern is to guard against emotional duress. Where donor and recipient are not related, the concern is to guard against organ trading.

Dr Tan Cheng Bock rightly reminded us of the large number of foreign workers here who will be especially vulnerable and potentially a source of exploitation. When a foreign worker, whom a patient never knew, suddenly pops up, claiming to be a distant relative, the antenna of the committee members must immediately pop up too. Ethics committee decisions are by consensus and this gives veto power to every single member. That is why Dr Amy Khor and Mr Iswaran's suggestion to limit the size of the ethics committee, I think, is not necessary. In fact, a large committee will make consensus making very difficult.

I worry less about hospitals pressurising the ethics committee to allow transplants than about the pressure from the media. In any high profile case, public sympathy may often go to the patient, with less regard for the interest of the live donor, especially if he or she is a foreigner. This is a scenario which I think is likely to happen. Whatever it is, we absolutely need men and women of strong character and conviction to be in the ethics committee.

Let me now talk about the act of organ trading. We have a consensus here that it is wrong and we should continue to prohibit it. Later on, I will talk about some discussions in the West which seem to want to push the boundary on this. But for the moment, we are all clear about

banning organ trading. The issue is how to ensure that it does not take place in Singapore. In this regard, Mr Chiam, Mdm Halimah and Mr Ang Mong Seng felt that our proposed penalty of $10,000 for such a crime does not seem right. I think Mr Ang Mong Seng suggested $100,000 or $200,000. Dr Tan Cheng Bock is worried that it might induce people to join in the trade, given the light punishment. I appreciate the sentiments.

I have not revised the quantum of the penalty because during the public consultation, it was not an issue. Nobody raised this particular point. But more importantly is that the main instrument to guard against organ trading is the overall framework that I talked about earlier. Penalty is just one element in this overall framework. In particular, the role played by doctors and the ethics committee. I agree with Mdm Halimah that organ trading and organ trafficking involve a long chain of players. Between the poor donor and the rich recipient - many hands are involved. But for a transaction to take place in Singapore, many people, including doctors, have to be involved. Organ removal and organ grafting cannot be learned from the Internet. A rogue doctor has to have the cooperation of the hospital management, the hospital ethics committee and, in some way, the Ministry of Health, and many other doctors involved in the care of the donor.

For these doctors, the penalty under HOTA, whether it is $10,000, $100,000 or even $1 million, is not a factor. Their career, reputation, oaths, ethics and responsibility to the Singapore Medical Council are the key factors. I therefore believe that there are sufficient safeguards in our overall system. That is why we have not revised the penalty quantum. Nevertheless, we will keep the feedback in mind and maintain a watchful eye.

Mdm Ho suggested that we adopt the German practice of enacting an extra-territorial clause which makes it illegal for a German to buy organs anywhere in the world. The problem there is enforcement and gathering of evidence. But it is something new in Germany and we will watch over this German experience to see whether we should similarly follow suit.

Dr Neo asked how the Bill will affect foreign patients seeking transplants in Singapore. Some Members also asked if we will end up a transplantation hub. Mdm Ho called it - a morbid term - "transplant tourism". This is certainly not the objective of this Bill or my Ministry. Our priority is to regulate living donor organ transplantation so as to prevent organ trading. It is to ensure that there is transparency for all parties involved - the donor, the recipient, the doctors performing the transplant. It is to ensure that there is objectivity and due process in decision-making. The Bill will allow us to set up a regulated regime for living donor organ transplants where locals and foreigners coming to Singapore can be assured of high medical standards operating within clear ethical boundaries. We must not become a hub or a player in organ trading, whether consciously or inadvertently.

Dr Chong Weng Chiew suggested that a database of all living donors be set up so that their post-transplant health can be checked. I agree. The Ministry currently maintains such a database. We will work with the transplant physicians and surgeons to monitor the longer term medical and psychological outcomes of the donors.

Let me now discuss the many helpful comments made by the Malay MPs. First of all, I thank all of them for their courage and support of the Bill.

Order. Mr Wong wants to move an exempted business motion.

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 Wong Kan Seng].

Debate resumed.

5.15 pm

Let me now discuss the Muslim issues. Muslims have not been able to benefit from HOTA as their religion requires them to also obtain the consent of their waris for organ donations. In other words, the consent of the donors alone is not sufficient. Hence, as pointed out by Mdm Halimah, section 5 of HOTA ended up excluding Muslims.

But as pointed out by the Malay MPs, Islam does not prohibit organ donation. Indeed, MUIS has clarified that it supports organ donation to save lives. The Fatwa Committee has also ruled that kidney, liver, heart and cornea donation and transplantation are permissible. But as explained by Dr Maliki, to pledge their organs, Muslims will have to do so with their waris' consent through the existing opt-in Medical (Therapy, Education and Research) Act.

The problem is that this opting-in approach has not been effective, not just with Singapore Muslims, but with any community in the world. And this is the

reason why we and many other countries have enacted HOTA-like legislation.

As noted by Mr Ahmad Khalis, only 15,000 Muslims have pledged their kidneys under MTERA. This is about 5% of the Muslim population. This is despite years of intensive efforts by community organisations such as the National Kidney Foundation and the Muslim Kidney Action Committee. The low pledge-in rate for organ donation is similar to the experience in other countries. Moreover, as Dr Lily Neo has observed, many Muslims sign up as donors only when they find out that they have failed kidneys. So, effectively, such donors do not really contribute to the pool. As a result, very few Muslims have actually donated their kidneys. Of the 70 potential Muslim donors who have been identified since 1988, consent for organ donation was given by the waris in only six cases.

The small number of kidneys donated by Muslims has put them at a natural disadvantage. First, because those who have not opted in get lower priority. Second, because the immunologic profile of Malays tends to differ from non-Malays. So it is more difficult for a Malay to obtain a kidney of the right match from a Chinese or Indian donor.

Organ matching is affected by the genetic make-up of the person, in particular, the Human Leukocyte Antigen (HLA). The HLA type is related to the ethnic group of the person. So persons of the same ethnic group are more likely to have similar HLA type. Better HLA matching between a donor and a recipient will lead to better outcome for the recipient. And when organs are being allocated, this is a one key consideration. Organs are precious and we want the best possible matching. And with a small number of Malay kidneys available for allocation, it is not surprising that there are few Malay recipients.

To compound the problem, Malays are at higher risks of developing kidney disease. Mdm Ho Geok Choo asked how many Malays are on the waiting list. 20% of the 700 patients on the waiting list are Malays, even though Malays make up only 14% of the total population. In other words, Malays are 50% more likely to develop end-stage renal disease than other races.

For these patients with kidney failure, the suffering is real. As Mr Zainul Abidin told us just now, at the Meet-the-People sessions, we have all heard these heart-wrenching stories. Many have to endure years of kidney dialysis while waiting for a kidney.

We should try to reduce this problem. Dr Lily Neo asked what could we do. Unfortunately, given the religious considerations, there is no easy solution. Fortunately, as pointed out by Mr Ahmad Khalis and Mr Zainul Abidin, MUIS has been regularly updating its interpretation, in the light of medical advances. I therefore share their hope that, in due course, there might be a fresh interpretation of how the consent of the waris could be expressed. Mr Ahmad Magad just now spoke about some possibility of an alternative process of giving consent. It sounds very complicated to me, but I think it is worth exploring to see how it can be done. The end objective is to see whether we could, as he put it, have an inclusive approach, so that the Muslim community could come under HOTA.

Meanwhile, for as long as we cannot overcome the religious requirement, the Muslim community will have to make an extra effort. What are they? First, to prevent organ failure through healthy lifestyle and careful disease management. So, please join me in all my marathon runs. Second, to promote organ

pledging. My Ministry will work with the Muslim community to encourage more to pledge to donate their organs. But, honestly speaking, we have already tried this for many years, with so little effect. So, I share Mr Zainul's pessimism.

One solution is to encourage living donors, like in Norway. In this way, we can meet the waris and religious requirements. The regulation of living donor organ transplantation under HOTA will apply to Muslims. Another way, of course, is what Mr Ahmad Magad talked about just now - be creative to see how the process of waris' consent can be managed. But this is something for the Muslim community to think through and discuss. I support Mdm Halimah's call for the Muslim scholars, MUIS, the Fatwa Committee and for international religious scholars to press on with these discussions to see how the constraint of section 5 can be overcome. My Ministry will provide the appropriate support. If they need me to speak in the mosques and so on, I will be most happy to do so.

Let me now address some of the operational issues related to this Bill.

Some Members commented about Singaporeans who may not want to donate all the four organs, maybe only one or two. Yes, the Bill allows for selective opting out. So you can say, "I opt out of cornea but I opt in for the rest."

Mdm Cynthia Phua had two queries. One is when a person opts out of an organ but not the others, what about the penalty? The two-year penalty only applies to the specific organ which is being opted out, but not to the others. I think that is fair. She quoted a strange case of somebody who opted out of HOTA but opted in through the opt-in scheme. I do not know whether there are such persons. I am not a lawyer. I suppose when you have two different

decisions which contradict, the most recent decision applies.

Mr Gan Kim Yong asked how one could go about opting out. It is actually quite simple. These forms are available at hospitals, outpatient clinics, and they can also be downloaded from the Ministry of Health's website.

Mr Gan Kim Yong, Mr Zainul and many others rightly pointed out that we should fully inform Singaporeans about HOTA and what they should do if they wish to opt out. After the Bill is passed, we will carry out a six-month public education campaign to inform everybody. We will be sending out information brochures to all households for this purpose. I take Mr Ong Ah Heng's point about printing brochures in four languages.

Moreover, as pointed out by Dr Amy Khor, this should be a continuous sustained effort, as there would be new citizens, new PRs, and new Singaporeans who turn 21. Dr Khor made the helpful suggestion that we organise annual awareness activities to inform and educate Singaporeans on organ donation, on HOTA and organ pledging. This we will do.

On Singaporeans turning 21, we do send out letters containing HOTA and opt out forms in four languages to every such individual. We batch this, not every day. We do it twice a year. My eldest daughter just turned 21 a few months ago. I notice that she did receive a parcel by registered mail.

Recently, I did a welcome reception for new citizens and new PRs in my constituency. So, I did a casual check with them about HOTA and they do know about HOTA. In fact, at the reception itself, my grassroots leaders did some presentation to them about Town Council, community centres, how to join the

activities, and HOTA was one of the topics in the presentation. But no amount of public education would reach every single Singaporean, but we should always do our best.

Mr Gan is worried about the elderly who are illiterate. We will try to reach out to them too.

Mr Ong Ah Heng called on older Singaporeans to change their mindset about organ transplantaion, brain death and so on. Actually, I think many senior citizens are supportive of HOTA and the amendments. But I agree that we have a duty to help educate the sceptics and provide them with the right information.

Dr Ong Seh Hong asked if families of the dead would be able to perform the last rites before the organs are removed. Yes, they can.

I also totally agree with Dr Lily Neo and Mr Ong Ah Heng that public education should stress the preventive aspects; in other words, to prevent the organ from failing by adopting a healthy lifestyle.

Dr Lily Neo proposed two drafting amendments. First, she proposed that section 5(2)(f) be amended to provide for the consent of the committee of the estate to be obtained for the removal of an organ from a mentally disordered person who has died. This is an existing section. It was included in the original Act to exclude HOTA from persons of unsound mind, unless the parent or guardian has given consent.

Dr Neo would like to empower the committee of the estate to provide consent for removal of organs under HOTA. A committee of the estate is appointed by a court under the Mental Disorders and Treatment Act for a particular purpose, and that purpose does

not include medical decisions on treatment or related matters. So, I am afraid Dr Neo's proposed amendment is not doable. In any case, the current provision of leaving that decision to the parent or guardian, in my view, is sufficient.

Second, Dr Neo suggested that HOTA be amended to state that the information recorded in the objector register shall be final and conclusive. This is indeed the policy intent. I have checked with the Attorney-General's Chambers and they confirmed that this is indeed the legal position of the current Act.

Mr Ang Mong Seng asked if organ pledgers and non-HOTA objectors are subject to higher insurance premiums and whether they will lose the medical coverage. There is no basis for insurers to discriminate against organ pledgers and regard them as having higher health risks. Indeed, I am not aware of any insurance policy where insurance premiums are dependent on organ donation status.

Mr Ang Mong Seng also asked why there were different age limits for different organs. No, there is no such difference. HOTA has one common age limit of 60 at the upper end, and is not organ specific. On the other hand, Mr Iswaran noted the different age thresholds for the young - 18 for opt in and 21 for opt out. This is true. I suppose the reason is that for HOTA, we have deliberately made it more restrictive and hence limit it to adults above 21. However, for opt in, where a conscious decision has to be taken, we have lowered the age threshold. Young people now mature quite fast. It is increasingly difficult to set a good age of consent. That is why for the live-donor portion of HOTA, we have decided not to hard-wire in the age threshold, but to allow the

ethics committee to make a decision on a case-by-case basis.

Some Members talked about our low organ pledging rate, and this is true. This is despite many years of work. I suppose part of the reason is that people do not want to talk about death, but death is one constant in life. We are not immortal. We all have to face death one day. I think it is far better that we prepare for death while we are still alert, rational and healthy, than to let our loved ones scramble in desperation at a time of sudden shock and grief.

Members may remember the case of a woman in Florida last year who has been in a persistent vegetative state for more than 10 years. She is alive. She can breathe. However, she is unable to take in food or water on her own. But if she is fed through a tube, she will live; if not, she will die within a week or two. The doctors have to insert a tube into her stomach to feed her. Because this is an invasive procedure, consent is needed. Since she is in a vegetative state, someone has to act for her.

Herein lies the difficulty.

Her husband felt that she would not have consented, but her parents felt that she would. There were lengthy court proceedings over the years. The feeding tube was inserted, removed and then re-inserted as the court proceedings progressed. What a life! And what trauma it brings to the loved ones!

In the hospital ICU, when a brain death occurs, we often face the anguish and moral dilemma of relatives. Many are not sure what their loved ones would have decided: would he or she have wanted to donate the organs to save lives or would they have preferred not to? If the person has clearly indicated his decision, either by actively opting in or by actively opting out, the relatives would be saved the anguish, especially at a time of

sudden loss.

Is it not better that we register this clear decision when we are able to, instead of leaving our loved ones to speculate? It will only take a few minutes. 50,000 Singaporeans have made this clear decision. Anecdotally, I know that several Members in this House have done so and pledged all their organs.

Dr Neo asked if we have tried our best to get more to pledge. I am sure more can be done, and I will. But the global experience is not optimistic. There is an organ shortage everywhere, even in the most civic-minded society.

HOTA is not a perfect solution but a practical approach to a real serious problem. It should not be a substitute for organ pledging, but both can co-exist. That is why we will continue to promote organ pledging. And we will work with all and sundry - religious bodies, professional and community organisations, and so on.

As I said, we are not alone in having low organ pledge rates. In the United Kingdom and the United States, despite many years of promotion, they are equally short of organs. That is why more than 20 countries have enacted HOTA-like legislation. In the US, at least 13 states (including California and Texas) have begun to enact laws which provide for presumed consent, starting with cornea.

But meanwhile, the gap between organ supply and demand continues to widen. So not surprisingly, we begin to read about radical ideas of paying for organs to save lives.

Like Mdm Ho Geok Choo, I have read about the suggestion in Britain of creating "an ethical market in live donor organs and tissue". Maybe I am conservative, but I find "an ethical market for organs" a contradiction in terms.

I read in the Boston Globe another article saying that altruism alone will not be enough to meet the need for organs. While the author was against trading of organs by live donors, it advocated the trading of organs from the dead. What do Members think? What do Singaporeans think? These are complex ethical issues which we may have to confront one of these days.

Meanwhile, I belong to the old school which believes that all organ donations must be altruistic in nature. We will not allow any financial incentives to be given. However, I see nothing wrong in meaningful gestures to recognise generous acts of altruism. For example, some limited waivers of hospital charges are currently provided to the immediate family members. However, I would be reluctant to hard-wire these financial gestures into the Act, as it seems to be proposed by Mdm Ho.

Mrs Lim asked if recipients would be allowed to reimburse lost earnings of donors. Such an intention should be made known and considered by the Transplant Ethics Committee. If the committee assesses that this does not amount to organ trading, then it can be allowed.

Finally, let me respond to comments on how organs are allocated to those on the waiting list. Mdm Ho noted that in the US, elaborate contra-indications of who should get priority and who should not are developed and made public. We have a Committee headed by Prof. Goh Lee Gan to prioritise and make such decisions in a rational, scientific, equitable and unpoliticised manner. There are three main considerations.

First, we want the best possible matching of tissue type to ensure the most optimal outcome. It would be a great pity if a transplanted organ ends up being rejected. So medical criteria,

particularly tissue type compatibility, are important considerations. As a result, our transplant success rate is comparable, perhaps even better, to the best centres in the world. In Singapore, 90% of renal transplant patients have grafted kidneys that are still functioning after one year. 75% are still functioning after 10 years. Our 10-year graft survival results of 75% are significantly better than the US figure of 50%. Credit must be given to the Committee's careful patient selection.

Second, HOTA non-objectors and Muslim pledgers should have priority over HOTA-objectors and Muslim non-pledgers. I think this is fair. This has been enshrined in HOTA since the very beginning.

Third, those who have been on the waiting list longer will have priority over those with shorter waiting time.

Socio-economic factors are not taken into consideration. We do not discriminate between rich or poor; politicians or non-politicians; skilled or unskilled; employed or unemployed; male or female. Age is however a consideration as this is closely linked to medical suitability and outcome of the transplant.

This set of selection criteria is formulated by Prof. Goh Lee Gan's Committee. It is made known to the transplant community. There is nothing secretive about it.

Is it useful to publish it? I am not sure how useful it is to the layman. I myself have tried to decipher the various technical details. After spending some time on it, I found myself completely lost in the jungle of alphabets like HLA-A, HLA-B, HLA-DR, SGPT. I decided that I should stick to my core competence and

not try to play doctor.

Mdm Deputy Speaker, I think I have responded to all the comments made by the Members. I am sorry for taking a long time on this because I deliberately want to address all the points made by the Members on this very important topic. I am grateful for your patience, and I am grateful for the Members' strong support. Despite the sensitivity of the topic, Members have been able to give the Bill their support.

Brain death and possible abuses were some of the important issues raised. These are legitimate concerns and we will ensure that when these policies are implemented, there will be continued emphasis on safeguards and strict ethical standards.

As Dr Chong Weng Chiew puts it, the support shown by most Singaporeans for this Bill is evident - that they trust our healthcare system; they trust our doctors. This is a trust earned through the decades. We must not do anything to weaken or, worse, abuse that trust.

Order. Mr Khaw, your one hour is up.

Thank you.

May I seek three clarifications, Mdm Deputy Speaker?

May I seek clarification on sections 9 to 13 with regard to several forms that may cause confusion and perceived discrepancy? The Minister said earlier that finality of decision is based on what is recorded in the register, and that is indeed the policy intent. May I ask the Minister why should it remain only as a policy intent? Would it not be better to make this amendment at this Second Reading to express this policy intent so as not to give rise to uncertainty or

discrepancy in the future in respect of this issue of finality? Why can we not take this opportunity to have this final issue resolved once and for all?

My second clarification is on section 5(2)(f) on my suggestion to also include consent to be sought from the committee of the estate, if any. The Minister replied that this is not possible as the committee is set up under the Mental Disorders and Treatment Act. My question to the Minister is whether the reason why a committee is appointed, instead of the parent or guardian, clearly indicates that the committee is in a better position to make the decision. If it is the intent under the Mental Disorders and Treatment Act that the committee be in charge of the affairs of that person, surely the intent ought to be applicable under HOTA. May I also ask, since the courts are of the view that the committee is a suitable party managing the affairs of the person of unsound mind as compared to the parent or guardian, this must surely apply to HOTA as well.

My last clarification. The Minister earlier asked who would behave like opting out of HOTA but opting in for MTERA, as the question posed by Mdm Cynthia Phua. May I ask the Minister whether such a person will be the one, due to principles, who prefers the personal choice of opting in under MTERA rather than under the compulsion under HOTA? Therefore, would such a person be penalised for doing so?

On finality, it is more than policy intent. I have checked with the Attorney-General's Chambers. They were quite clear that the various sections (9, 10 and 11), as currently drafted, make it clear that whatever information is in the objector register is the final position, irregardless of all the paper work that may have been changed over time. So it is more than policy intent. It is my policy intent, and it is

already the legal position. I am not a lawyer. I stand advised by AG's Chambers.

The second point is about mental disorder. Although I was long ago in the Ministry of Health, I could not quite recall this Mental Disorders and Treatment Act, what prompted the setting up of this committee of estate, what was the thinking behind that, which I could check. But whatever it is, the legal position is that committee has limited functions, and the functions are spelt out in the Mental Disorders and Treatment Act. And that function does not go into issues like giving consent on giving away the organs. So, it is completely and legally untenable to accept the Member's amendment. In any case, my position is, as a policy, leaving it to the parent and guardian for a decision like this is good enough.

On the last point about a Singaporean who opts out of HOTA and opts in, and who will be such a person, I do not want to speculate on what is the reason why the person decides to opt in and opt out. But whatever it is, that is his or her personal choice. Again, as I said just now, I am a non-lawyer. I just assume that the latest decision should apply, if the two decisions were to contradict. But I could be wrong, I do not know.

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. - [Mr Khaw Boon Boon].

Bill considered in Committee.

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

Clauses 1 to 11 inclusive ordered to stand part of the Bill.

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

Mdm Deputy Speaker, Sir, I beg to move,

"That this Parliament, noting the Report of the Commission on Parliament Staff as contained in Paper Misc. 8 of 2003, accepts the recommendation of the Commission as contained in paragraph 8 thereof and resolves in accordance with such recommendation."

Madam, in accordance with Article 51(6) of the Constitution of Singapore, a Commission consisting of the Speaker, the Deputy Prime Minister and Minister for Finance, the Acting Minister for Education, the Chairman of the Public Service Commission and myself was set up to consider a proposal to adopt a new Language Executive Service (Parliament) for the Simultaneous Interpreters.

The Commission has presented its Report to Parliament on 28th November 2003. The salary of the Simultaneous Interpreters has remained unchanged since 1st January 1994 when it was revised as a result of a civil service-wide salary revision. Since then, the job scope of the Simultaneous Interpreters has expanded and the existing scheme of service provides no progression in their salaries. To reflect the expanded job scope and the interpretation and translation skills of the Simultaneous Interpreters, their job title has been redesignated as Language Services Officers.

The Commission also noted that the scheme of service for the interpreters and translators in the other Ministries/departments and the Judiciary has been recently reviewed and revised. Consequent upon the revision, an enhanced scheme 2003 and a newly created scheme known as the Language Executive Schemes (LXS) for these interpreters and translators came into effect on 1st June 2003 and 1st July 2003 respectively.

The Commission has proposed a new scheme to be known as the Language Executive Scheme (Parliament) which will follow the LXS scheme structure for interpreters and translators in the other Ministries and the Judiciary. With the implementation of the new scheme, the Language Services Officers can enjoy performance-based pay, clear and timely progression, and self-directed career development. Unlike the existing scheme, the Language Services Officers must possess graduate degree entry qualifications, with the additional requirement of a relevant language major. On conversion to the LX Scheme (Parliament), officers will retain their current salaries.

The recommendation of the Commission is

contained in paragraph 8 of the Report.

The House is asked to accept the recommendation of the Commission.

Madam, I beg to move.

Question put, and agreed to.

Resolved,

That this Parliament, noting the Report of the Commission on Parliament Staff as contained in Paper Misc. 8 of 2003, accepts the recommendation of the Commission as contained in paragraph 8 thereof and resolves in accordance with such recommendation.

Resolved,

That Parliament do now adjourn to a date to be fixed. - [Mr Wong Kan Seng].

Adjourned accordingly at

Twelve Minutes to Six o'clock pm

to a date to be fixed.