Khaw Boon Wan
Singapore
“Motor vehicle dealerships and showrooms have been closed since the start of the circuit breaker. As COE bidding is done mostly by the motor vehicle dealers on behalf of prospective owners, the Land Transport Authority (LTA) suspended COE bidding for the months of April and May.”
“Though stressed by the financial pain, they press on with the immediate priority of fighting the virus and supporting essential services. Post-pandemic, we will see how public transport evolves. Will demand for public transport services simply return to the pre-pandemic level?”
“Under our rail financing framework, the Government fully pays for the cost of building new rail lines. In other words, we do not recover the cost of building the Cross Island Line (CRL) from commuters through fares. The CRL project is being implemented and the final costs will depend on tender bids.”
“There are around 5,000 private bus operators with a combined fleet of 13,500 private buses. As we do not track the number of private bus trips and passengers, we do not have data on their carbon emissions.”
“There are nursing rooms at 50% of our bus interchanges. We will provide nursing rooms at all new bus interchanges and integrated transport hubs. For the MRT network, we will provide nursing rooms at all new interchange stations. We will also explore providing such facilities when MRT stations undergo upgrading.”
“Over the last three years, Singapore carriers have reported a total of 20 incidents of food allergies on board their flights. None required the use of epinephrine or emergency flight diversions.”
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“The intent is to empower the Council with a wider array of approaches to deal with ethical and professionalism issues arising amongst medical practitioners in Singapore. Singapore Medicine is not perfect, but it is generally well regarded for its high clinical and ethical standard. There will be some black sheep in the profession, unfortunately. When there is sufficient evidence, we never hesitate to take appropriate action against them. This way, we protect the reputation of the profession and safeguard the health and safety of all Singaporeans. QUALIFIED RELIEF TEACHERS (Shortage) 26. Mrs Josephine Teo asked the Minister for Education (a) whether there is a shortage of qualified relief teachers; (b) how is the appointment of relief teachers managed; and (c) what steps are taken to ensure that the quality of teaching is maintained during periods of relief teaching that last for several months.”
“Fourth, all new doctors who are eligible for full registration take the Physicians Pledge, a solemn oath, in the presence of the Singapore Medical Council (SMC). By taking the Pledge, new doctors re-affirm their professional responsibilities to patients and the need to uphold high professional and ethical standards as they embark on their medical careers. Fifth, in the hospitals and clinics, senior doctors and clinician mentors coach through personal examples, as they show the young doctors how they address professional issues that arise in their daily interactions with patients in the wards. Sixth, SMC has an established set of Ethical Code and Ethical Guidelines on all matters concerning the doctors’ professional conduct. On specific controversial issues, the National Medical Ethics Committee set up by the MOH provide further guidance on how doctors should carry out their duties and responsibilities. Finally, the Medical Registration Act (MRA) enables the public to lodge formal complaints to the SMC about doctors who misconduct themselves ethically or professionally. The SMC will convene a Complaints Committee to investigate each complaint. If justified, the Complaints Committee will refer the matter to a Disciplinary Committee for a formal hearing. If found guilty, appropriate punishment will be meted out to the errant doctor, including suspension or deregistration. The SMC publishes the findings of the disciplinary proceedings. To further safeguard public interest, anyone who is dissatisfied with the findings may appeal to the Minister for Health, whose decision will then be final. I will soon come to this House to propose several amendments to the MRA to further improve and streamline the Council's existing disciplinary processes.”
“My Ministry and I view issues of medical ethics and professionalism seriously. As the Member rightly pointed out, a high standard of medical ethics and professionalism is key to maintaining public confidence in the medical profession. By and large, our doctors are professional and ethical. Singaporeans have respect for our doctors. Every year, we commission a private survey company to interview a large sample of our patients. Singaporeans have consistently rated our doctors’ performance as "excellent". While questions on ethics were not specifically asked in the survey, the patients must have been sufficiently satisfied with the doctors’ professional and ethical standard, to give them an excellent overall rating. Achieving such an outcome requires a comprehensive approach. First, we start with the stringent selection of medical students. Our medical schools put their candidates through rigorous interviews and written assessments on ethical and moral issues. They also have access to character references submitted by the candidates’ past teachers and headmasters. Second, medical students undergo programmes to learn about medical ethics and professionalism both in classrooms as well as in real-life case discussions. Teaching and research in medical ethics and professionalism was further strengthened with the establishment of the NUS Centre for Biomedical Ethics headed by a renowned medical ethicist. Third, the teaching and learning of medical ethics and professionalism continues after graduation during clinical training. All doctors on specialist training undergo a compulsory Medical Ethics course before they can exit as accredited specialists in Singapore.”
“This way, we have protected the MediShield risk pool and enabled basic health insurance to remain affordable for the lower income Singaporeans who use the Class B2/C wards. For those who are uninsurable because of factors beyond their control, our 3Ms framework of regular savings through Medisave, heavy Government subsidies and Medifund, work together to ensure that no Singaporean is denied healthcare due to an inability to pay. MOTOR INSURANCE COMPENSATION SCHEME (No-fault motor insurance regime) 21. Mr Yeo Guat Kwang asked the Senior Minister (a) whether the Monetary Authority of Singapore (MAS) is satisfied with the current motor insurance compensation scheme set out in the Motor Vehicles (Third-Party Risks and Compensation) Act; and (b) whether MAS will look into the feasibility of a no-fault motor insurance regime.”
“MediShield and the Integrated Shield Plans provide catastrophic health insurance for Singaporeans to help take care of major illnesses which may lead to large hospital bills. MediShield is designed for patients who choose Class B2/C wards. It covers 84% of our total population. Integrated Shield Plans are provided by private insurers and designed for those who prefer Class A/B1 wards of public hospitals or private hospitals. They cover about half of our population. Singaporeans should subscribe to MediShield at least, and from young. The premiums are affordable and can be paid out of Medisave. The uninsured comprise two main groups: the young below 20 years and non-working spouses. For the young, we have introduced an opt-out scheme for new born babies. Almost all new born babies are now covered from birth. We are working with schools to get the students into MediShield. For the adults, we are working with NTUC to get their members to sign up for their spouses. We aim to reduce the uninsured percentage to a single digit. Health insurers do not cover pre-existing conditions as this would have the unintended effect of some buying insurance only when they are sick. This would be unfair to the existing policy holders. Instead, the correct response is for Singaporeans to get insured from young, preferably soon after birth, before any health condition develops. For commercial reasons, private insurers would prefer to only insure the young and healthy, attracting them away from MediShield, and leaving the high-risk members to MediShield. This phenomenon is known as "cherry picking" in the industry. That is why we had to restructure the health insurance industry in 2005, requiring all private Shield insurance plans to be integrated with MediShield.”
“Instead, the correct response is for Singaporeans to get insured from young, preferably soon after birth, before any health condition develops. For commercial reasons, private insurers would prefer to only insure the young and healthy, attracting them away from MediShield, and leaving the high-risk members to MediShield. This phenomenon is known as "cherry picking" in the industry. That is why we had to restructure the health insurance industry in 2005, requiring all private Shield insurance plans to be integrated with MediShield. This way, we protect the MediShield risk pool and enable basic health insurance to remain affordable for the lower-income Singaporeans who use the Class B2 and C wards. 3.00pm”
“MediShield and the Integrated Shield Plans provide health insurance for Singaporeans to help take care of major illnesses which may lead to large hospital bills. MediShield is designed for patients who choose the subsidised wards, Class B2 and Class C. It now covers 84% of our total population and 93% of all working Singaporeans. Integrated Shield Plans are provided by private insurers and they are designed for those who prefer Class A wards and the private hospitals. They cover about half of our population. Singaporeans should subscribe to MediShield at least, and from young. The premiums are affordable and can be paid out of Medisave. The uninsured comprise two main groups: the young below 20 years and non-working spouses. For the young, we have introduced an opt-out scheme for all newborn babies since December 2007. Practically all newborn babies are now covered from birth, 98%. We are working with schools to get the students into MediShield. For example, at the time of Primary One registration, we introduce a similar opt-out scheme. And, again, the parents are very sensible, less than 4% have opted out. So it is 96% coverage. For the adults, we are working with NTUC to get their members to sign up for their spouses. This is work in progress. Overall, we aim to reduce the uninsured percentage to a single digit. And I am quite confident we can do it because the new measures introduced since December 2007 had been effective. For the whole of last year, when we had a full year implementation of these new measures, MediShield membership increased by 200,000 members. Health insurers do not cover pre-existing conditions as they would have the unintended effect of some buying insurance only when they are sick. This would be unfair to the existing policy holders.”
“In just six months since SPUR started, more than 19,000 jobseekers have been placed into jobs, significantly more than the 13,000 for the whole of 2008. In addition, WDA had in May introduced SPUR-JOBS, a scheme to encourage recruitment and retention of trainees of SPUR and other WDA CET programmes. Within just one month, 50 companies have committed to hire 1,200 local workers in various industries such as retail, finance, infocomm, maritime and logistics. In this downturn, more PMETs have been affected compared to previous recessions. This is why we have implemented the Professional Skills Programme (PSP), including the PSP Traineeships (PSPT), to help PMETs and fresh graduates enhance their skills and employment prospects. As of end-May 2009, about 36,000 PMETs have been trained or committed to training under PSP. This package of measures has been effective in reducing retrenchment and unemployment rate as well as help unemployed find jobs. We will continue to focus on helping companies and workers tap on these measures. While the Government and unions can do their best to help, a successful placement can only be achieved if both jobseeker and employer have realistic expectations. WDA, the Career Centres and NTUC's e2i have a total of 25,000 job openings in their job bank presently, and are doing their best to try and match Singaporeans to these jobs. My Ministry will continue to monitor the situation closely and, where necessary, introduce new programmes to help workers and job seekers.”
“Sir, that is certainly a sound suggestion, and we did do that. We started a "flu.gov.sg" website. The associated website, whether it is from the Ministry of Health or some other Ministries, will also point towards that website. So, information is available, including the type of questions that Mdm Phua mentioned. I do not think Singaporeans were poorly informed in this particular exercise. As I said, the main media did a very good job, and so did the new media. Periodically, we do surveys on Singaporeans, how they react to this Influenza A (H1N1-2009). By and large, I would say the awareness level is very high. HIGH UNEMPLOYMENT RATE (Measures to assist the unemployed) 4. Mdm Ho Geok Choo asked the Minister for Manpower with unemployment rate remaining high in the first quarter of 2009, what other measures can the Government undertake to help the unemployed. The Minister for Manpower (Mr Gan Kim Yong): Mr Speaker, Sir, as the economy contracted, the seasonally adjusted overall unemployment rate rose to 3.3% in March 2009, from 2.5% in December 2008. The Government acted quickly and decisively to roll out the $20.5 billion Resilience Package during the Budget this year. Initiatives like the Jobs Credit, the Skills Programme for Upgrading and Resilience (SPUR) and the Tripartite Guidelines on Managing Excess Manpower have helped companies to cut costs and save jobs. The Government has also brought forward some of the hirings for the public sector, making available some 18,000 jobs over these two years, in addition to the jobs in the private sector. To help unemployed Singaporeans find jobs, WDA, NTUC's e2i, the CDCs as well as the CET Centres have stepped up efforts to better reach out and assist jobseekers on their employment and training needs.”
“Mr Speaker: Last question, Mdm Cynthia Phua.”
“There have been a lot of media reports on what different countries intend to do. Some of the media reports quote statements by pharmaceutical companies. I suggest that we take it with a pinch of salt, although we should not take too much salt as it is bad for your heart. The reality is there is a lot of uncertainty over when we will get this vaccine. And the key question is: Will it be safe? Will it be effective? Like all new drugs, we do need time and proper clinical trials to decide whether the drugs that we will be injecting into people are safe and effective. And all those studies take time. I doubt there will be any country which will go straight into vaccinating its population, let alone, in large numbers. Instead, many talk in terms of getting access to the supply of vaccines as an insurance policy. But whether you decide to start vaccinating, they will take it as a second-order decision. And we will be taking the same approach here. Singapore, being small, is at an advantageous position, as our needs are not that big. But for countries with a huge population, inevitably, they will have to prioritise. WHO gathered a group of experts, two weeks ago, and they published a set of very useful guidelines, totally unpoliticised, based purely on clinical arguments, setting out the priorities. Those at the top of the priority will be essential workers – to make sure that essential services can continue to function – including hospitals and the Home Team, for example, in the case of Singapore. And beyond the essential personnel, for the general population, we will start targeting the high risk groups. So, definitely, pregnant women will be quite high up on the priority, kids with other underlying medical conditions will also be given the priority.”
“Mr Speaker, Sir, we do issue guidelines to the PPCs and, in fact, we have organised several workshop sessions for the GPs. More than 500 of them have come forward to take part in this PPC network and we thank them for their service. The reasons for some of the confusing media reports were because we were in transition then. Remember all these happened just only in the last three months. We went through a lot, but it was just three months ago when this novel virus suddenly appeared. Inevitably, there was some "clumsiness" in implementation but, by and large, we have stabilised. What the guidelines are focusing now are on high-risk patients. As a doctor, Dr Lam knows that it is very difficult to make, without laboratory testing, a distinction between ordinary influenza and this particular strain, as the symptoms are practically identical. So, short of doing a laboratory test, we cannot establish whether it is due to Influenza A (H1N1-2009). But now that we know the mild or moderate risk nature of this virus, we can be a little bit more relaxed as to whether we make a mistake or not in the classification. Critically, we focus on the high-risk groups, certainly pregnant women, those with transplant history or with renal failure, etc. We can then focus our mind on their condition and, if necessary, admit them to the hospitals for testing. MCs are the same thing. In the earlier days, we were not sure how long the period ought to be and therefore there were some inconsistencies. But I think, by and large, the system would have stabilised by now.”
“And if the virus remains mild, there may be little demand for the vaccine. Instead, the most basic strategy against an influenza pandemic is a very high standard of personal hygiene by all Singaporeans. This can be learnt by all and incorporated into our daily life. Singaporeans must also learn the sound habit of staying at home and away from crowds when unwell and have a runny nose, fever or cough. It is no fun falling sick and we must not inflict this on others around us. And if you must go out, please put on a surgical mask. Let me now address the specific queries by Mdm Cynthia Phua. Calls to 993 ambulance service were not charged. They are free. As the demand for 993 has shrunk considerably, we are winding up the service. In fact, we will stop the service tomorrow. The laboratory testing of Influenza A (H1N1-2009) is costly, at about $250 per test, but the Ministry of Health (MOH) absorbs the cost in full. So again, it is free of charge to the patients. Tamiflu is quite affordable, at $45 for a standard treatment cycle. It is chargeable, in line with our philosophy of co-payment. We do not regulate the charges by the Pandemic Preparedness Clinics (PPCs) but generally our GPs are price competitive and their fees are largely affordable. Those who need subsidised care can get it at the polyclinics. Let me assure Members that the lower-income families with Influenza A (H1N1-2009) or, for that matter, any other disease, will all be helped, if they have difficulty paying their medical bills. Medisave, MediShield and Medifund – the three Ms – are specifically designed for this purpose.”
“They had to be admitted to ICU for intensive care. With effective treatment, a couple have fully covered. But, unfortunately, one with a severe heart disease had succumbed to heart attack, with Influenza A (H1N1-2009) infection as well. Right now, there are still a handful in ICU, fighting for their lives and our doctors and nurses are doing their best to help save their lives. We need patients to come forward promptly, and not wait until their symptoms have become too serious to reverse. Second, we are reviewing our control measures in the past three months. There are valuable lessons to extract from this experience and we must plug any gaps and deficiency. Third, we are preparing Singapore for the next wave of Influenza A (H1N1-2009). Experts believe that the next wave may come when winter returns to the northern hemisphere and they worry that the virus may then become more deadly. This is not a certainty, as viruses mutate all the time and, often, they also attenuate and become less deadly. While we hope for the best, we must, of course, always prepare for the worst. An important aspect of the preparation is to ensure we have access to an adequate supply of a safe and effective vaccine. None exists today although there are many claims by vaccine manufacturers of such a supply before year end. We have an ongoing contract with an established vaccine manufacturer for a pandemic vaccine sufficient for our population. We are supplementing this contract with an order for one million doses from the vaccine manufacturer who can promise the quickest delivery. But we should not put all our eggs in the vaccine basket. Any vaccine based on the current mild strain may not be effective if the virus turns more deadly.”
“As the current virus strain is mild, this development is largely benign as almost all patients will fully recover. But there will be complications among some high-risk patients and even deaths. The overall risk of death is similar to normal seasonal flu, but the risk groups are slightly different. In normal flu, those over 65 years old are at highest risk along with the very young, under two years. But in this flu, younger adults are at higher risk than those over 65, if they have underlying medical problems, such as asthma, chronic problems with breathing, gross obesity (so do keep your weight), low immunity or are pregnant. That is why we are still in yellow alert. Over the past few days, we have stepped down many control measures, at the borders, at mass events, in factories and in offices. Temperature taking remains in schools and SAF camps. The influenza surveillance data suggests that Influenza A (H1N1-2009) prevalence should peak within a week or two and we can expect to step down temperature taking in schools from 1st August. For SAF camps, they will step down their control measures appropriately, in accordance with their specific operational needs. However, our hospitals remain on high vigilance and we continue to discourage visitation and remind all to practise infection control measures. In the hospitals and in various places, we provide reminders as well as surgical masks for the visitors to use. During this phase of the outbreak, there are three priorities. First, we are focusing on the high-risk patients and helping them enhance their chance of a full recovery. These are patients with underlying medical conditions, where the experience elsewhere suggests that they may face complications, including deaths. We have a few cases already.”
“It allowed us to better prepare our people psychologically for the eventual community spread. It allowed us to gear up our Pandemic Preparedness Clinics (PPCs) and our hospitals to free up isolation and ICU beds to treat the more complicated cases. We are now in the last leg of our battle against the first wave of the Influenza A (H1N1-2009) outbreak. But the war is not over yet. The enemy is still out there. Going by the experience elsewhere, more Singaporeans will get infected, reaching a peak before the numbers start to decline, as we observed in New York City, where the wave peaked in May-June and has been declining since. Experts refer to this phenomenon as the community acquiring "herd immunity". We track this development by a robust surveillance system of sampling patients with flu-like symptoms and determining the precise cause of their symptoms. Prior to community spread, none of the samples revealed any patient with positive Influenza A (H1N1-2009). Four weeks ago, the surveillance system showed that 13% of the samples were found to be Influenza A (H1N1-2009) positive. The figure moved up to 30%, two weeks ago. The latest data showed that 53% (more than half) of patients with flu-like symptoms had been infected with Influenza A (H1N1-2009). This number will continue to grow as the Influenza A (H1N1-2009) strain displaces the other influenza strains and becomes the dominant strain for this season. What it means is this. There are many influenza strains. Influenza A (H1N1-2009) is just one of them. If you happen to catch influenza during this period, say, the last few weeks or the next few weeks, the chances are, very likely, that it will be Influenza A (H1N1-2009) rather than the other traditional strains of Influenza.”
“Schools re-opened in July uneventfully and we had a successful hosting of the first Asian Youth Games, without any major incident. I want to thank all our front line staff – at the borders, in hospitals and clinics, in schools, in the laboratories, in childcare centres, Aloha and Pasir Ris holiday chalets, in 993 and 995 ambulances, in hotline call centres – for their dedication and diligence. They do their jobs seriously and put up with the discomfort of wearing N95s and surgical gowns. Many had their own travel plans cancelled and many worked long hours, pulling extra shifts to cope with the sudden surge in the number of suspect cases and patient load. I want to thank Singaporeans for their sense of social responsibility. Temperature scanners at the borders picked up only one-quarter, 25% of the returned travellers with Influenza A (H1N1-2009). The other three-quarters slipped through the borders because they had no symptoms at the time of arrival, but they promptly came forward to be tested when symptoms emerged. Many had to suffer long, agonising and uncomfortable waiting under the tent outside the hospital Emergency Department while their lab tests were being processed. I thank them for their patience and tolerance. After Mexico, US and Canada went into community spread of the virus almost immediately. They had to move straight into the mitigation phase. They had no time, no opportunity to even do any kind of containment measures. In Asia, some countries went into community spread after a month, despite very strong containment measures. Singapore was into community spread after seven weeks. We were lucky but I think the efforts jointly put in by all Singaporeans must have contributed to this outcome. The seven-week lag was valuable.”
“While some serious issues remain, experts have generally come to the conclusion that this virus is behaving more like the seasonal flu: it can spread easily but the vast majority of the patients can recover fully, even without hospitalisation. WHO has classified this disease as one with "moderate risk". By now, all countries have shifted their strategy from "containment", in other words, trying to contain the spread and minimising the number of infected patients, to what is called "mitigation", which is treating the high-risk patients and trying to minimise the number of deaths. In line with this approach, the World Health Organization has stopped counting the number of patients and doctors are now treating the patients clinically rather than subjecting every suspect case to Influenza A (H1N1-2009) laboratory testing. Moreover, most patients are now being treated by GPs as outpatients. Only the high-risk patients are referred to hospitals and hospitalisation is now the exception, rather than the norm. Likewise, travel advisory, temperature screening at airports, contact tracing and home quarantine measures have by now been largely stepped down. In Singapore, we have moved our outbreak alert level from green to yellow, then briefly to orange before we moved it back to yellow. Singaporeans have done well in this battle against the first wave of the Influenza A (H1N1-2009) outbreak. Our media have done a good job of keeping everyone informed. There was no hysteria or panic, neither was there any complacency. Singaporeans took the pandemic seriously, but also carried on their lives normally, going on June holidays and taking part in the Great Singapore Sale.”
“Sir, Mdm Cynthia Phua has asked four specific questions on Influenza A (H1N1-2009). As this is the first time we are discussing this subject in this House, I shall give a comprehensive reply on this subject. On 24th April, Sir, that was three months ago, the World Health Organization sounded the alert on a novel virus then circulating in Mexico and initially referred to as "the swine flu" by the media. As pig farmers raised their objection, the new virus picked on different names, including "the Mexican flu", "the North American flu". When cases began to appear in California, somebody suggested that it be called the "Schwarzenegger virus" and somebody even suggested calling it the "Terminator". The World Health Organization is less colourful and settled on naming it "Influenza A (H1N1)". While ground zero was Mexico, the virus quickly became a global pandemic and World Health Organization declared it as such on 11th June. This was of historic significance because in the last century there were only three such pandemics declared. The initial reaction by the world was one of grave concern. The data coming out of Mexico were serious. They reported a very high case fatality rate of some 6.2% during the initial period. The normal case fatality rate was less than 0.1% for seasonal flu so this was more than sixtyfold. Moreover, the casualties in Mexico were largely coming from the young adult population, including pregnant women. Three months after the WHO alert, the world has learnt a lot more about this novel virus and how to cope with it.”
“I see less need for a unified scheme for the reason that the extent of subsidy varies with bill sizes. The key point for the patient is "Can I afford the bill?" Is it a thousand dollars or is it ten dollars or is it one hundred dollars? Affordability will depend on the quantum of the bill size. In the step-down care, particularly at the outpatient level, outside of hospitals and nursing homes, the bill sizes are much smaller. On the other hand, in acute hospitals, the bill sizes can be very big. That is why we have very heavy subsidy for the expensive end and we reduce the subsidy level at the lower-cost end. That is why I think a unified approach will not work because it will end up either over subsidising those who may not need that subsidy or being too stringent on those who actually require a much bigger subsidy. EAR PIERCING SERVICES (Administration issues) 10. Ms Ellen Lee asked the Minister for Health with the rampant administration of ear piercing across Singapore such as that in jewellery shops (a) whether there are reported cases/trend of medical complications related to ear piercing and what recourse is available to aggrieved customers; (b) whether there are laws or regulations in place to regulate the conduct of ear piercing and, if not, whether there is a need to enact such laws; and (c) what are the health and safety standards required of shops in Singapore which offer ear piercing services.”
“If there is, it is not noticeable. When I was working on the proposal, we also looked at the demographic profile of the patients in existing Class B2 to Class C wards. We projected that more than 90% will not be affected. The actual results show the same thing. I think, by and large, Singaporeans choose their ward class carefully. We have financial counselling to advise patients to choose the right ward class. If you belong to lower income group, you go for the heavily subsidised wards. The outcome shows it. As I have explained before, the idea of means-testing is to pre-empt a future problem. I want to continue to upgrade Class C and Class B2 wards, and if you do not introduce means-testing, you will draw in many patients who can actually afford Class A and Class B1. Without means-testing, I will lose that leverage in ensuring that Class C and Class B2 remain reserved largely for lower income patients.”
“Sir, the purpose of means-testing in public hospitals is to enable lower-income patients to enjoy more subsidies than higher-income patients. It is a fair scheme and its implementation has been uneventful. With computerisation, the process is hassle-free and no patients have been inconvenienced. More than 90% of the patients are unaffected by means-testing and they continue to get the full Government subsidy. The average hospital bill sizes for Class B2 and Class C have remained relatively stable at below $1,500 and well within the Medisave withdrawal limits.”
“Yes, I will. And if we need to tighten the guidelines or regulations, we will do so. Question put, and agreed to.”
“So, will the Minister relook at these rules to make the entire process more transparent, to ensure that the Ethics Committee take steps to ensure that it has all the facts and to make the basis of its decisions clear?”
“You know we are a medical hub and we treat patients from all over the world, and they come for all kinds of reasons. And for transplants, kidney failure or liver failure, there is a genuine illness that requires treatment. I see no reason why we should single out organ transplantation, and say that organ transplantation that happens in Singapore must only be for Singaporeans. As a hospital that deals with foreign and local patients, we will treat all. The ethical principle of fairness, which I described earlier, still applies. But knowing the concerns, we will be discussing with our Ethics Committee to make sure that when they receive applications where the pairs are purely foreigners, they will have to be extra careful and much more thorough in their evaluation. What is the concern? The concern is not the transplantation itself. The concern is exploitation of the vulnerable, which applies to whether you are a foreigner or a local, and that process has to go through anyway. Mr Hri Kumar Nair: I would like to thank the Minister for his assurances and clarifications. In my speech I have outlined that my main difficulty with HOTA is really the approval process. The Minister said something which really illustrates the point. He said that it was suggested by a Member of this House that the approval process would include detailed interviews with the donors and recipients. But the regulations do not provide for that. The regulations provide that the Ethics Committee has a discretion whether to interview the donor and recipient. That is my point. Too many things are really left to the discretion of the members of the Ethics Committee.”
“There are two steps to this, and the process is important, as noted by many Members. My intention is that it will take us quite some time – it may take us a few years – before we stabilise on what is a good system. What I plan to do is, through the administrative system, we will craft, discuss and forge consensus on guidelines, which will then go to the transplant Ethics Committee for imple mentation, and we then study whether we need to tighten or loosen further. At some stage when things have stabilised and we can comfortably codify it into regulations, I will do so. As to regulation itself, Members are familiar with the process. You can always file a question in Parliament, and I will defend why we put the regulations one way or the other.”
“Mr Speaker, Sir, the short answer is this, I have looked at other legislations and nobody has done it that way. There are real practical difficulties. I am not finding excuses not to do so. I have mentioned "x" and "y". If you ask me now what is "x" and what is "y", I have a real problem telling you what should be "x" and what should be "y". From the comments I have heard this whole afternoon, Members are saying there must be consultation. Without passing this Bill, I cannot go to the next stage of consultation. Because if we decided that there is no need to pay at all, then the issue of how much should be "x" and how much should be "y" does not even arise. So, we need to go through this primary stage of allowing reasonable reimbursements, before I can carry on to the next stage for which we will consult widely. And, please, feel free to comment. I will welcome comments from Mr Christopher de Souza and others on what they think "x" and "y " ought to be. Until then, we are not able to build it into the primary legislation. That is my problem.”
“The outcome cannot be equal because the situations are different. But let us not begrudge somebody who is able to secure an altruistic donor, as explained by one Member, once he is out of the queue, it benefits everybody else who is on the waiting list, rich or poor. As to the final point on stage-by-stage implementation, that is something that I can consider as we proceed to discuss the details. The key point is we will engage the various hospital transplant centres and Ethics Committee members to see how we can operationalise many of these details, and if it means that step-by-step approach is better, we may do so.”
“On the first question of how the Ethics Committee will review each case. One Member made a comment that part of that process requires very detailed interviews with the patient, the donor, and those related to the transaction. And that is important. I would not say it is straightforward or easy, but it can be done, if you set out to do so thoroughly, to probe. Certainly, it will also depend on the amount of proposed quantum. If the quantum is large, we have to be more probing. So, what I would say is that it is not straightforward but it can be done, if you are determined to do so. My intention is to discuss with the Ethics Committee members, and we can learn from that process. The second question is how foreign donors look after their health when they go home. Once they go home, it is beyond my purview. But what I can ensure is that at the stage of taking consent, the risks involved and the requirements that they need to shoulder are fully explained to the donors and understood by them. That is why when setting the quantum, we have to take into account some of these costs. If the reimbursement amount is adequate, then at least my conscience is clear. The donors have received enough money to help them look after their post-surgery health. But if they decide to gamble that away the next day when they reach home, there is very little I can do. The third point on equitable allocation – those who are rich may have greater means of securing donors. I thought Mr Sam Tan made a thoughtful intervention this morning precisely about this point. Let us not talk about rich or poor. Let us talk about those who have larger families and therefore have more chances of getting a donor who is willing to help out than those who have smaller families.”
“There is no ideal system and we have to balance cadaveric organ donation with a higher living donation rate. Reimbursing living donors will, I hope, make it easier for some donors who are prepared to help their loved ones but rightly worry about the financial losses that they may incur and which they may not be able to afford, going forward. They look to us to help them fulfil their altruistic wish. On this note, I look forward to a strong vote of support from the House for this Bill. Please join me to protect the welfare of donors and save some more lives. Mr Speaker Sir, I beg to move.”
“We require the next few months to discuss with the transplant Ethics Committee, work with them on practical guidelines, discuss the first few cases of such payments, so as to forge some consensus on what reasonable quantums will make sense for Singaporean and foreign donors. We will be deliberately conservative at the start, and widen the range of reasonable quantums as we gain more experience and confidence. We will advise the transplant Ethics Committee to be particularly conservative when assessing donor-recipient pairs who are all foreigners, this is a concern that Dr Lim Wee Kiak mentioned. Singapore healthcare has a reputation for being of a high ethical standard. This is a reputation carefully nurtured over many years. We have no plan to destroy it. I value the comments made by Members in this House and I fully understand your underlying concerns. I will not let you down. In fact, I hope some of you will come forward to serve in the hospital transplant Ethics Committee, so that you can experience in real-life the struggles that patients and donors go through. There is now very strong medical evidence that the outcome for renal failure patients who get a renal transplant without waiting and undergoing dialysis is much better and more superior, than someone who receives his kidney after dialysis. In fact, the longer they undergo dialysis, the poorer the outcome, even with the transplant. That is why I am so passionate about wanting to raise the transplant rates, whether it is cadaveric or living. Very few countries have achieved a high cadaveric donation rate to be self-sufficient. Where it is achieved, there are also critics who say that it was the result of very aggressive "ambulance-chasers" which they find distasteful.”
“I feel strongly that we should move out of our current extreme position of ignoring the financial losses incurred by donors; we should allow some reasonable payments to be made to donors if their recipients wish to do so. Many other OECD countries have already taken this step a few years ago. This Bill does not make us a trail-blazer, as Mdm Halimah thought. Genuine donors are looking to us to give them a fair deal. Ms Sylvia Lim suggested that we put this Bill to a Select Committee. I have considered that but I am not proposing it because the primary legislations are straightforward. As Mdm Halimah noted in her speech, when she read the Bill conscientiously from page one to the last page, she found it a neutral legislation, for the simple reason that it was so by design. I extracted phraseology, clauses from legislations which are WHO consistent and globally acceptable. So how does submitting it to a select committee help to further improve on the language? As Mr Hri Kumar recognised it, it is the details following the passing of the legislation which are important – the regulations and guidelines that we will be sending out to the Ethics Committee. Ms Ellen Lee suggested that we can do more public consultation at that stage, and that is my plan. Members know my style. I subject all serious policies to public consultation. This particular Bill, for example, has gone into the end of second year. We have had two major rounds, the first round without a Bill, the second round with a draft Bill, and now this process in Parliament. Mdm Halimah asked that we implement the Bill in stages. This will, in fact, be the case. Payment for donors will not happen overnight.”
“Mdm Halimah said that she struggled with this Bill. I am sorry for imposing this on Members. But we are not alone in having to manage this predicament. Elsewhere, legislators face the same moral dilemma and that is why legislations on paying donors have also evolved slowly and gradually. Our current legislation, pretending that donors need not be compensated, is one extreme. Iran's legislation represents the other. I have spoken to patients on the waiting list for organs. I have spoken to genuine donors who parted with their kidneys knowing all the risks but who lamented to me the extra financial burdens they had to bear. I have also met foreign donors in the Philippines who were harshly exploited by organ trading syndicates. The law is not a mere product of an intellectual exercise. The law must be humane, practical and realistic about the imperfect world that we live in. Globally, the organ shortage problem will only get worse and the more we pretend that the black market in organ trading can be legislated away by simply prohibiting any kind of payment to the donors, the more it will grow. I do not believe that global legislations on donor payment will remain static. But I cannot run too far ahead of public opinion. From the public consultation and the concerns that Members have shared with me in the past, I have gathered that Singapore is not prepared to legalise organ trading and this Bill does not seek to do so. If you find the Bill objectionable because you think it is legalising organ trading in the Iranian style, please read the Bill again. It is not. This is a Bill about fairness, being fair to donors who do suffer financial consequences as a result of their act of donation. The current law shortchanges them.”
“The key is to ensure that the donors are fully informed of the risks that they are undertaking and that they are not coerced or induced into parting with their organs. The value of this Bill is that it will at least ensure that known financial losses to be incurred by the donors can be suitably reimbursed. Ms Ellen Lee commented on the Government's moral duty to take care of the health of the donors. Dr Lim and Mr Ang Mong Seng felt that as a society, we should care for these selfless donors. We do. We seek to take care of all Singaporeans, and not just organ donors. Our 3Ms framework ensures that. But citizens have a duty too, to save in Medisave and subscribe to MediShield and ElderShield from day one, and not just prior to any hospitalisation. The Government takes care of the rest, through heavy subsidy and offering the protection of Medifund. Over and above this, for those who feel strongly about caring for the donors, they can do so by donating to the VWOs when they are set up to provide additional assistance to the donors. Mr Christopher de Souza wanted my assurance that living donors would not be allowed to donate vital organs needed for survival, such as the heart, for payment. Let me assure him that no doctor will perform such a transplant as it will be tantamount to killing him. Mr Speaker, Sir, I know the controversial nature of paying donors. We all know the misery of patients with organ failure. We see the poverty around us in this region. We are all disgusted with the exploitation of the vulnerable by unscrupulous organ trading syndicates. But we also realise that it is unfair to allow genuine donors to bear all the financial consequences of their altruistic acts. It is a challenge to address the dilemma but we need to face it.”
“And clearly, in determining a reasonable quantum of reimbursement, we must take into account the vastly different costs of living here and overseas. When formulating quantitative guidelines for the hospital transplant Ethics Committee, we will prescribe a different and much lower reimbursement cap for foreign donors. This will not be discriminatory as the payment is for the reimbursement of expenses which is dependent on cost of living, not compensation for the value of the organs. The US allows payment for human eggs (we do not), the American Society for Reproductive Medicine has issued payment guidelines which I find useful for our reference. The guidelines effectively advise reproductive centres to probe more deeply for any proposed payment exceeding $X and to frown upon any proposed payment exceeding $Y. This, I think, could be a suitable model for our consideration. We can set smaller X and Y amounts for foreign donors as an example. Ms Ellen Lee and Mr Ang Mong Seng asked if organ donors are insurable or if they will attract additional premiums. If the potential donors are already insured, their insurance policy should not be affected by the transplant. But if they are not yet insured, insurers may require medical underwriting. As noted by Mr Ang Mong Seng, the critical period after each major surgery is the initial few days or weeks. But post-surgery complications may linger on much longer. Ms Ellen Lee was worried that, in the event of major complications, the healthcare costs and expenses may exceed the payments made to the donors. This is precisely why we must support this Bill. The Bill cannot fully cover all eventualities. For example, one known surgery complication is death and how do we put a value to human life? How much is enough payment?”
“The concern about organ trading should be addressed by the comprehensive safeguards that I have highlighted above and not by sacrificing the welfare of our foreign altruistic donors. But the Members' underlying concern is real. I know that and I am mindful of it. Mdm Halimah was worried particularly that the current recession would expose many poor foreign workers in Singapore to temptation and they would become easy target for exploitation by organ trading syndicates. Unfortunately, organ trading is happening in this region even as I speak. This Bill, I think as Dr Loo or Mr Hri Kumar put it, does not add to this phenomenon. The way to address this problem is better regulation and more effective safeguards, as what we are proposing in this Bill and what I intend to put in. There are ways to address this concern about possible exploitation of foreign donors. For example, if I were in the transplant Ethics Committee, I would be particularly alert to any representation by potential donors, who are recently retrenched unskilled foreign workers, and satisfy myself that there is no exploitation by the patient or an organ trading syndicate. It is difficult to codify the assessment as each case will be different, but if the ethics committee is well briefed on the ethical principles and mindful of the potential for exploitation, it should be able to distinguish genuine donors with full informed consent from victims of exploitation. As I said, we will be meeting with the Ethics Committee members and we will brief them thoroughly of the potential pitfalls. We will highlight Members' concerns in our briefing materials to the Ethics Committee members.”
“But such arrangements are best left to the donor and recipient to decide. On the other hand, there may be voluntary welfare organisations (VWOs) which want to promote organ donation and help some of these donors through ad-hoc financial assistance. I have received such an expressed interest in the past. Mr Ang Mong Seng and Mr de Souza made a similar suggestion for a charity fund to be set up to support living donors. VWOs have, in the past, been concerned about whether such initiatives are legal. The amendment will now allow such third-party payments to take place. I hope some of these ideas will materialise. Members who feel strongly about this and who spoke about it a few hours ago, I hope will come forward, volunteer, champion and support this cause. Several Members raised the additional challenge posed by foreign donors. To avoid the pitfalls, they suggested that we apply the law to Singaporeans only. Prof. Thio, in fact, argued that it is legitimate to draw a distinction between local and foreign donors in this manner. This will effectively prohibit any payment, even if reasonable and hence ethical, to foreign donors. I have a problem with this suggestion. How can we discriminate against foreign donors in this fashion? We either decide whether the payment is ethical, or not. Once we accepted that the payment is ethical, then it must be paid out. It must be allowed to be paid, whether you are a foreigner or a local. Our law cannot unfairly discriminate against organ donors purely based on their nationalities. The law must assure both locals and foreigners who undergo organ transplantation in Singapore, of the same high medical and ethical standards.”
“He is concerned that this may unwittingly open the door to organ trading. I would like to emphasise that the key principle of prohibiting organ trading, and the circumstances under which comprehensive reimbursement may be permitted, are clearly spelt out in the Act, and all subsidiary legislations have to follow these principles. We will issue subsidiary legislation, if necessary, to deal with technical and administrative matters and build in additional safeguards needed. These may need to evolve quickly and frequently over time, as we gain experience. I would therefore prefer not to hardwire technical matters into the Bill. In any event, all legislation is subject to Parliamentary scrutiny. I am confident that we can make this work as it has worked in many other countries. The easiest thing is for us to do nothing, but as pointed out by Dr Lam, that will be patently unfair to the donors who have parted with their organs and yet have to suffer the financial losses. Several Members asked who would pay the donors? The organ recipients would make the payment. Some Members suggested that a third party should administer the payment. Some payments will indeed be via a third party. For example, reimbursement for hospital expenses incurred by the donor can be done via the hospital. But there will also be payments which are made directly between the donors and the recipients, without going through any third party. Mdm Halimah suggested that part of the payment can be made via the donor's Medisave Account. I think it is a good idea, provided the CPF rule allows such a voluntary contribution. Mr Ang Mong Seng suggested having a trust to hold half of the money received by the donor to ensure that it is not frittered away.”
“As pointed out by Mr Sam Tan, "the sum would vary from person to person". Hence, we have real difficulties hard-wiring in quantitative formulae, or reimbursement caps in the primary legislation as suggested by Mr de Souza. Though I appreciate his intention of wanting to do so (I would like to be able to do it if I can), I have a practical problem of doing it. Based on what I have read, all similar legislations in US and UK do not do so, for the reason that it is difficult and impractical. But we can certainly articulate the principles in guidelines, in both qualitative and quantitative manner, and provide a platform for the transplant ethics committees to share their experiences, compare notes and learn best practices. My intention is to use the next few months to discuss and firm up these guidelines with the transplant ethics committees. They have to be practical and defensible and fair to the donors. As we are breaking new ground, we will closely supervise the implementation, especially in the initial years. We will enhance our guidelines in the light of experience. We plan, for example, to include in the guidelines, a range of reasonable payment quantums, after we have had some experience dealing with actual applications for such payments. And that is the reason why we have difficulty, just like other jurisdiction elsewhere, on fixing the quantum from the start because until we have actually tried it out and learnt from the experience, we are all projecting and speculating. I hope Mr de Souza will accept that this is a practical way forward. We will not allow the transplant ethics committees to run unsupervised. Mr de Souza does not support the Bill because of the lack of details on the reimbursement mechanism.”
“We will work closely with these ethics committees and provide guidelines to help them conduct their assessments. We will enhance their capabilities by requiring them to undergo training, especially in medical ethics. We have the advantage of being a small country. There are only five hospitals where living donor transplant surgeries are done. This is unlike in other countries where there are hundreds, sometimes thousands of transplant centres, and the regulators there have a real problem of fully knowing the quality of the committee deliberations and ethical inclination of the members. Fourth, my Ministry will closely monitor the processes of these transplant ethics committees by requiring the hospitals to submit the relevant data after every transplant. We will conduct regular audits to ensure that these ethics committees fulfil the legal requirements in evaluating the transplant applications and comply with our guidelines. We will not hesitate to require the transplant centres to reconstitute their transplant ethics committees if we lose confidence in their ethical standards. We have such power. Fifth, we have an enforcement system to detect fraudulent practices and that was how we were successful in making a prosecution of organ trading last year. For the comments that I have heard overseas – who were preaching to us about organ trading – Singapore remains today, one of only a handful of countries where there has been successful prosecutions. And I think this illustrates the hypocrisy that Dr Loo mentioned just now. Given the diversity of donors' backgrounds, I agree with Dr Fatimah that the system needs the flexibility provided by the transplant Ethics Committee, to carefully consider all the relevant facts on a case-by-case basis.”
“I have talked to foreign donors in the Philippines who were exploited by the syndicates. So I personally feel very strongly about this step of ensuring that proper informed consent will be taken and it will be done. Third, every living donor organ transplant is subjected to a review by a Hospital Transplant Ethics Committee, whose job is to ensure that the donor is free from any undue influence, coercion, emotional pressure or financial inducement. Mr Hri Kumar has suggested, among other things, that these committees are not subject to sufficient regulatory oversight and that, technically, they are free to rubber-stamp applications for living donor organ transplants. Let me clarify that this is not the case. This is Singapore. This is not some Third World country. Any proposed payment arrangement between the recipient and the donor will be scrutinised and assessed by the committee as part of this review. The committee members must be fully satisfied that any proposed payment does not constitute an inducement to the donor. They would have to take into account at least the following factors: (i) the donor's age and nationality (local or foreigners); (ii) his relationship with the recipient; (iii) his financial and employment status; (iv) the post-surgery medical follow-up plan, whether he has adequate life and health insurance; and (v) the justification for any proposed reimbursement, including the relevant supporting documents. I agree with Ms Ellen Lee that the committee should be subjected to checks and balances. The composition of the committee requires my Ministry's approval. We can argue about whether is three enough or we need more, or if the composition needs to be changed. I can look into those areas, if necessary.”
“This is the first important step because the health of a living donor after organ donation is dependent on his health prior to surgery. We require all transplant centres to have a system in place for this, but we will go further. We are now working with the expert committee to formalise a set of best practice guidelines for the medical and psychological evaluation of all potential donors and there are such internationally accepted guidelines, eg, the Amsterdam Forum guidelines for kidney donors and the Vancouver Forum guidelines for liver donors. We will require the transplant centres to adopt such guidelines. Second, we have a system for informed consent established under the Human Organ Transplant Regulations, to ensure that the donors fully understand all aspects of the donation as well as the implications of becoming a living donor. Mdm Halimah, Dr Lam and Mr de Souza have stressed this point – every donor has to be fully informed about the potential risks, the need for long-term medical follow-up, as well as the cost implications, before consent is obtained. We will further tighten the consent process by drawing up a comprehensive checklist that transplant centres must run through with their potential donors to ensure that they are well informed. We will require every transplant centre to develop suitable communication materials and documents for informed consent that are easily understood by the donors, in accordance with their educational levels and their mother tongues. This is an important step and we will make sure it is done well and in line with international best practice. I feel very strongly about this particular point of informed consent because I have seen with my own eyes any failure to do so.”
“I must also explain that reimbursement only applies to living donors. It does not apply to cadaveric donors where allocation of organs will continue to be based on tissue matching, time on the waiting list and other clinical factors, as objectively determined by an expert committee. Hence, the concern of Mdm Halimah and Mr de Souza about rich patients jumping the queue for the cadaveric organs, does not arise. Indeed, as carefully pointed out by Mr Sam Tan, the Bill does not discriminate against the poor. Among living donors today, there is a good mix of high and low income donors. But as Members put it, the real challenge in donor reimbursement lies in the practical difficulties of making a distinction between what is reasonable payment and what is inducement. I agree with Members that the key lies with putting in place appropriate safeguards. Fortunately, we have examples to follow. The US, UK and other countries have systems in place to allow this to be done properly. We have studied their systems very carefully and we will incorporate the practical ideas in ours including, as I said earlier, some of the legislative clauses. We are also not starting from scratch ourselves. My Ministry has a working system in operation today to prevent organ trading and we will be strengthening it. Members rightly asked that MOH should provide operating details. As Mr Hri Kumar put it, the problem does not lie with the primary legislation but the problem lies with the processes in place to ensure that organ trading does not take place. So let me spend some time on how exactly we are going to do it. First, we have a system for donor evaluation and selection to ensure that only healthy and suitable donors are selected.”
“Our Bill, in fact, contains an amendment to raise the penalty on syndicates involved in organ trading. This Bill is to catch up with what many OECD countries have already done for many years. In drafting our amendments, we took reference from similar legislations in several of these countries, copying almost word for word and using their various phraseologies, including some of the terms in clause 3(f) that Members talked about. We are correcting our current extreme position of criminalising all kinds of payment to the donor. For example, currently donors are charged by the hospitals for all their transplant-related medical and surgical expenses. The recipients are prevented by HOTA from reimbursing the donors for these expenses. The proposed amendments will bring us in line with jurisdictions such as the US and UK to allow some payments to be made to the donor. Let me also clarify that we are not making it compulsory to reimburse living donors. We are not compelling every patient to reimburse his/her donor. We are merely allowing organ recipients, if they wish, to make some payment to cover the financial losses incurred by their donors. In fact, I will not be surprised if many living donors continue the current practice of not requiring any reimbursements from the recipients. This would address the concern of some Members that low-income recipients may not be able to afford such payment, because they may be able to continue to get donors who are not asking for such reimbursements. But in the event that some donors may need such reimbursements and the recipients agree to do so, the law should not prevent it from happening. The law is currently preventing this from happening, and that is what this Bill is all about.”
“Thio asked how pair matched organ transplants will be regulated. She noted that in other jurisdictions, the transplant surgeries are carried out simultaneously to avoid situations where one of the donors decides to back out. Dr Lim Wee Kiak stressed the need to carry out such procedures simultaneously. Indeed, this will be the requirement for paired matching, that the surgeries will all be done simultaneously. Our Bill includes provisions for subsidiary legislation to be made to regulate organ transplant arrangements, including mandating that paired transplants be simultaneously performed, if it is necessary. We can achieve such an outcome administratively because the operations are carried out in our hospitals, but we will study if there is a need for an explicit regulation. Let me now address the more controversial issue of payment for living donors. While all Members supported the good intention to reduce the financial losses incurred by donors through reasonable payment, Members were concerned that it might lead to organ trading, and Singapore becoming a regional organ trading hub. For example, Miss Sylvia Lim was concerned that the coverage of reimbursement under clause 3(f) of the Bill was so wide that it could be a backdoor for organ trading. I think a number of other Members mentioned this point too. During the public consultation stage, the World Health Organization and many Singaporeans expressed a similar concern. Let me reiterate that this Bill does not legalise organ trading. During the public consultation, decriminalising organ trading and the Iranian model were often cited. But this Bill is not to legalise organ trading. Hence, Mdm Halimah's concern about the Bill affecting Singapore's relationship with its ASEAN neighbours, does not arise.”
“Our preliminary projection is that the list will then surge beyond 1,000. But that has to be the case because once we lift the age limit, we must expect that more seniors will be able to benefit from the amendment. This gets to show the real quantum and the size of the problem that we have to deal with. Dr Fatimah Lateef would like us to go further and lower the HOTA age limit from 21 years to 18 years. While I am open to the suggestion, the yield will be small. While every donor counts, organ donation is an important decision and we do want people to have carefully considered the implications of HOTA before they decide. That is why I think 21 is still preferred to . In any case, those between 18 and 21 years of age who feel that they have sufficiently considered the matter and wish to take an active step forward can make a pledge of organ donation under the Medical (Therapy, Education and Research) Act. All supported the proposal to allow paired matching. Dr Fatimah Lateef called for the establishment of a "systematic, proactive and well-organised living donor registry" to support paired matching. I agree. The National Organ Transplant Unit of the Ministry of Health will take charge of this assignment. The same unit will also take charge of setting up a Donor Care Register to monitor the health of the donors. Mdm Halimah and some other Members are curious about the long-term health of the living donors. If the donors are well selected, there is good medical evidence overseas to suggest that there are few adverse medical impacts. But there is little local research on this. The proposed register will allow us to track long-term clinical outcomes and allow us to better understand the long-term impact of organ donation, if any. Prof.”
“Mr Speaker, Sir, I thank Members for their very valuable and thoughtful comments. As I listened carefully to all the speeches, I can understand how US Treasury Secretary Tim Geithner must have felt these few weeks. He was determined to do a good thing but was being criticised left, right and centre. But I appreciate the comments, including the last one by Dr Loo Choon Yong. If this were a piece of legislation to decriminalise organ trading, then I can understand where the objections are coming from. As I will explain very carefully later, it is not. As Members listen carefully to what I have to say, I hope most, if not all, who have objected earlier may find that it is in their conscience to be able to support this Bill without feeling guilty about it morally or ethically. Let us start with the easiest one. All supported the proposed lifting of the age limit for cadaveric donors. Dr Lim Wee Kiak gave a good explanation of why healthy organs from elderly donors can remain suitable for transplantation. He asked how we would assess the health of the organs in practice. We have an expert committee to help us on this. They have drawn up comprehensive requirements for the evaluation of potential donors. This will include a rigorous evaluation of the donor's medical history and organ function just before death and, where indicated, pre-implantation biopsy of the organ, to ensure that only healthy organs are used for transplantation. Dr Lim Wee Kiak asked what would happen to the waiting list once we lifted the age limit. Dr Loo Choon Yong has mentioned the figure of 563 – I think that is correct. As I said before, once we lift the HOTA age limit, we must by reciprocity also allow seniors above 60 to remain on the waiting list.”
“A short answer is we will leave this to the experts. We are not experts and they will assess by risk categorisation as I articulated in my reply just now. Those who require institutionalisation, they will be institutionalised. FOREIGN STUDENTS IN LOCAL UNIVERSITIES (Admission criteria) 3. Mrs Josephine Teo asked the Minister for Education (a) what criteria are used to assess the suitability of foreign students seeking admission to local universities; and (b) how the profile of foreign students in Singapore has changed.”
“I cannot remember all the details because it is quite a thick report which they published. I remember my Permanent Secretary held a press conference just a few weeks ago when they asked for a second round of additional resources. I cannot remember all the details because it was quite a comprehensive report, going through all the key areas and systematically trying to plug all those gaps. But I do remember some major highlights in the report – society's attitude, destigmatisation, more public education. That is why I was personally quite concerned about recent incidents involving mentally ill patients. When I read the news, it bothers me because I think, inevitably, it will push our work backwards on trying to change public attitude and raise acceptance of the mentally ill. No doubt, there will be some which are in acute difficulties and require professional help but the vast majority of the mentally ill are like you and me, in that they can carry on their lives if we give them a chance.”
“I thought the answer is "yes". In the past, no, but I think they now have 24-hour hotline for such access, including referrals from grassroots leaders. Of course, there must be a network and prior contact made. We train them, so that they know what numbers to call. If necessary, they will send nurses down to visit. So, we would do all this.”