Penny Low
Singapore
“These amenities will offer recreational choices and also prevent traffic congestion to the new town when it is built. Will MND look into these suggestions favourably and also work with MOT to prevent congestion?”
“Going forward, the quality of our lives will also depend on how well we can integrate knowledge with technology and creativity to find solutions with daily, social and economic concerns. What plans are there to encourage people to act responsibly, dream up new ideas and design for a better world?”
“Let us navigate the sea of change with mastery of seafaring skills, guided by the light of the stars and not by passing fancy ships. Only then can we continue to be that extraordinary little red dot the world envies; only then will we know that the future generations will continue to be world-beaters and make their families proud.”
“These considerations should be part of the MediShield Life design so that it is holistic, it incentivises the desired behaviour and it improves the overall health outcome of our Page: 122 nation.”
“Thank you, Deputy Speaker. Clarification, Sir. The Minister mentioned that MediShield premium payments can be paid for by immediate family members.”
“Mdm Speaker, there have been more reports on the increase in rodents lately and I am wondering whether NEA has done any study to discover the reason for such an increase, or is it that there is just more visibility of rodents in, especially, housing estates.”
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“Sir, I note that the Censorship Review Committee (CRC) has recommended various degrees of censorship in a few categories to cater to different people and different tastes. This is a strategic move that will help to further arts liberalisation without unnecessarily offending the more conservative segment in our society. However, it appears that the CRC's recommendations have somehow omitted the advertisements that appear in both HDB and non-HDB heartlands in places like coffeeshops and neighbourhood centres. I have received feedback that advertisments like posters which are neither ticketed items nor limited by geographical boundaries should observe a certain degree of decency, especially if they appear near institutions of learning, like kindergartens, schools and also places of worship. Would the Minister give his views on this and look into it so that the young minds are not inadvertently influenced and religious institutions are also given its due respect?”
“Hence, the presence of Internet cafes could also form a good platform and a far more effective means for new games to be introduced to the market. We should leverage on our competitive advantage to be an online gaming hosting hub for and beyond this region. We could quickly expand our creative pool to provide excellent gaming content and a vibrant multi-media industry. What about having a multi-media academy to this end? Perhaps, IDA as well can play the role of a facilitator to help small players form a consortium so that we are able to compete on par in terms of financial muscle with very established players in Korea and Taiwan. Perhaps, there could also be a review of the rules safeguarding the nerve centres of online gaming which is the LAN centres for Internet cafes. There could be ways to improve its vibrancy without compromising on the possible negative effects it might have on children. After all, research from the Gannett estimated world-wide spending in this industry to reach about US$150 billion by year 2005. We should not miss this boat. ITC Scholarships”
“I rise to highlight an area in the creative industries which is growing rapidly across the world. This is the MUD, or Multi-User Dungeon, and MMOG, or Massive Multi-player Online Games, which take place in the virtual world where users from all over the world meet online in the game server to compete or collaborate with each other. The online gaming industry began in Korea in 1996 and Korea is now a global leader. Taiwan joined the game in 1999 and a report by market intelligence, Centre of Taiwan's Institute for Information Industry, estimated the revenue generated from online gaming to have grown from US$14.5 million in 2000 to US$120 million in 2003. In fact, it has registered the highest growth rate of any entertainment industry. The online gaming industry in the Southeast Asian region was worth about US$533 million in 2002 and China is also beginning to catch on to the heat. In other words, the online gaming industry is set to boom and, according to Boston.internet.com, online gaming is a niche of the US$31.7 billion world-wide gaming market. The swift growth of online gaming is unprecedented. But the question is where is Singapore in this game. In Singapore, many industries are constrained by our scarce land resource and limited market size. But in the virtual world, the world is our oyster. Singapore is well positioned to take advantage of that. First of all, we are well-versed in English and Chinese language, of which more than 80% of the online games in the international market have been translated into the two languages. Second, our PC ownership is one of the highest and our Internet connectivity is pervasive. Third, there is also a proliferation of Internet cafes over the last three years, which has made computer gaming quite common.”
“I wish to clarify that my description of the ecosystem itself did not refer to the people alone but also the infrastructure, including the rules and regulations. On the allocation of funds, I was referring specifically to the Library Building Fund of $200 million and not the NLB's Library 2000 development programme. ITC Industry”
“Yes. In the case of technopreneurs, we have given them the purpose-built One North. The same cannot be said of the artrepreneurs. Some of our national treasures are, in fact, housed in a very humble Telok Kurau studio. I urge the Minister to rethink our strategies, if we want to make serious progress in cultivating a creative industry.”
“I believe that understanding this will help us gain systematic knowledge of how things work naturally, and introduce specific policies to help nurture the cultural ecosystem and bring us closer to the vision. Obviously, these interventions do not refer only to fiscal or regulatory measures on the cultural scene alone. In fact, trends and policies affecting education, labour movement, technological development, philanthropy, capital infrastructure, consumer behaviour, urbanisation and the economy will have an effect on the content and structure, quality and quantity, as well as the creativity of the Singapore cultural fabric. I would like to ask the Minister whether these elements have been examined and whether the Ministry has also mapped out what affects what, whether we have also identified the pillars of our cultural ecosystem and, if so, what are they, and how does the Minister intend to allocate the budget to this end. I understand that a big portion of last year's budget went into the redevelopment of the National Library. Is this a key pillar that deserves such a big budget allocation vis-a-vis the needs for other cultural sectors? Ultimately, the success also depends on our pool of creative talent and employment opportunities. What efforts have been made to groom, attract and retain creative talents?”
“Sir, last year, MITA announced its plan to build a cultural capital by harnessing our artistic talents and cultural resources. We hope to better position ourselves for greater economic benefits and improved quality of life. While we know that art for art's sake does not work, art for money's sake will also have limited success. To fulfill MITA's vision of a cultural capital, we will need to first identify a cultural ecosystem that works for Singapore. Let me explain. Essentially, culture can be thought of as an overall ecosystem. Within it, there are numerous eco niches that affect each other and alter the fabric of the culture over time. For example, in the film industry, a good movie could only be made if you have good cinematographers, good son et lumiere (ie, sound and lights) team that captures the mood, good post production team that will create movie magic, as well as a good marketing team to promote the film itself. Of course, we will need good funding for any good films to come about. The lack of resources in any of these areas may undermine the economic potential of any good film and, obviously, the marketplace with its regulatory and cultural framework may also affect the success of the film. For example, the film "The Temptation of Christ" was a hit in some countries but a flop in others. I would like to ask the Minister if his team has made any attempt to identify the environmental factors like resources that feed into the system, the species that compete for the resources and growth, the systems lifecycle and eco niches, including the parasites and scavengers that will return material resources to the ecosystem itself, and their symbiotic relationship.”
“In fact, on 1st March 2004, the Consumer Protection (Fair Trading) Act (CPFTA) was implemented. We can actually build on that and develop certain nationally recognised trust marks to accredit good business practices for consumer confidence. In fact, under CASE, there is a programme called the CASETrust to develop a trust mark for consumer goods and services, in both brick and mortar as well as cyber store fronts. Let me declare my interests as the Vice-President of CASE and Chairperson of CASETrust Advisory Council. Both are non-profit organisations. CASETrust is a quality mark which stands for quality, trust and a "be sure, not sorry" policy. CASETrust accredits and promotes companies with good and transparent business practice and service delivery - accredited companies display the CASETrust mark at their store front and websites to enable consumers to distinguish themselves from the rest of the pack. Together with IDA, CASETrust also developed Trustsg to handle the vetting of Internet security practices. By this, we hope to build a Singapore Branding for Internet trading. CASETrust and Trustsg are part of Singapore Branding. The development of these trust marks generates benefits for Singapore far beyond the promotion of any single product or label. The intangible value of Singapore Branding spills over into spheres and industries. CASETrust and Trustsg can be a pillar for Singapore Branding. I urge the Government to give greater support to the development of CASETrust and Trustsg as part of the Singapore Branding strategy. Corporate Social Responsibility”
“This is especially important for hire purchase where consumers may have only one agreement with the finance company. Some hire purchase agreements are not governed by the Hire Purchase Act and it contains exemption clauses which severely limits liability for delivery and condition of goods. Third, they also have similar regulatory regime to apply to all three types of consumer credits that include things like disclosure regime, method of calculating interest rates, restrictions on administrative default and penalty charges, advertising and marketing regime, etc. I suggest that the consumer credit laws be rationalised so that different parts of the consumer credit industry may compete on equal footing. The result would be a more efficient market and a much more level playing field for both the consumers, the merchants and finance companies at work. Singapore Branding and CASETrust Sir, the Singapore brand is a key competitive advantage which will help us to differentiate ourselves from our low-cost neighbours and make an impact in the international arena. Recently, the Singapore Tourism Board also launched the Uniquely Singapore Branding experience exercise. That is product differentiation at work. In the past, Singapore used to be a shoppers' paradise and I note from Minister George Yeo's comment that tourists still do shop in Singapore because of the top brands that are in town and because we sell genuine goods. I say we build on this competitive advantage that we have. Whereas in other countries which are cheaper options, they may not have the assurance to the consumers of giving them genuine goods or, in fact, a return policy. In Singapore we can build on our premium reputation of trust and focus on areas like service delivery and product quality.”
“Sir, in Singapore, consumer goods purchased with credit arrangements by the merchants may be categorised into three main common categories. First, credit sales; second, conditional sales; and third, hire purchase. In all three types, the merchant either supplies the credit himself or arranges for a finance company to supply the credit. I may add also a fourth category, called the "credit sales", where the credit is arranged by both the consumer and the merchant independently of each other. At present, all four types of consumer credit transactions are governed by different regulatory regimes. Credit sales and conditional sales are unregulated. Hire purchases are regulated mainly by the Hire Purchase Act under MTI. Credit card sales are regulated by MAS who exercises jurisdiction only over the banking institutions and, hence, the credit part of the transactions rather than the underlying sales transaction. The result is a confusing array of rules and regulations applying to different types of transaction and inconsistent protection to consumers. For example, consumers who wish to select the best form of credit to purchase the consumer goods cannot make comparisons that are meaningful enough for them to make a decision. As such, they are, in fact, at the mercy of the merchants and there is unfair advantage at work. In the UK and Australia, such regulations have been reformed. In fact, they have rationalised some of these transactions so that the same regime applies to all three types of transactions. The areas that have been rationalised include linked-transactions and by this the sales and credit elements are conditional upon each other. They have also joint liability.”
“Sir, I would like to thank the Minister for his very comprehensive and assuring reply. I beg leave to withdraw the amendment. Amendment, by leave, withdrawn. The sum of $359,029,000 for Head M ordered to stand part of the Main Estimates. The sum of $337,741,400 for Head M ordered to stand part of the Development Estimates. Head N - Ministry of Foreign Affairs”
“This would ensure that those who ultimately stay behind would also have their retirement nest-egg and perhaps also serve as a tool to attract the desired migrants. I hope the Minister would consider the above suggestions favourably.”
“I suggest that the limit allowed for SRS contributions be revised upwards. Two, make it tax-free instead of tax-deferred instrument. The SRS is at present a deferred tax scheme for 50% of contributions. Perhaps the requirement to pay the tax after retirement has dampened the popularity of the scheme. The last thing we want to do is to encourage people to save for retirement and then tell them that they will be taxed when they make their withdrawals to fund their retirement. Hence, in view of the recent announcement to exempt tax on a list of investments like annuities, standard deposits and certain unit trusts, I suggest that we err on the side of generosity and make SRS either wholly tax-free or more obviously tax advantaged. Three, to allow voluntary employers' contribution. The SRS should be expanded to allow employers to contribute as well. Employers may find it advantageous, eg, to declare bonuses in the form of voluntary SRS contributions if it may be treated as a relief, as opposed to a deduction, for company tax purposes. With this relief, employers may even be able to declare higher bonuses out of the tax savings. Perhaps this proposal could be carefully studied and incorporated as part of a portable company-sponsored pension plan. Four, to allow non-citizens or permanent residents to contribute to SRS and root them to Singapore. By design, the SRS attracts mainly the higher income earners. It may also attract the non-Singaporeans who may have been here for a long time, and who intend to stay here in the long term. The fact that there are costly early withdrawal penalties in the SRS would already exclude those who are looking for short-term tax relief. In other words, the anti-selection issue is already taken care of.”
“Hence, to build both breadth and depth into the programme, could the Minister consider extending the MoneySense programme to: (1) address the specific needs of different market groups; (2) kindly detail and enlarge the network in which MoneySense co-funds, in other words, the participants and the vendors. I was told that only VWOs and NGOs are allowed as legitimate entities to provide such courses, and many actually do not have the expertise; and (3) to detail and enlarge the scope of programmes that is eligible under this scheme, that is, beyond that of talks and seminars. Maximum for Supplementary Retirement Scheme Sir, with the reduction in CPF contribution and the cumulative problems of an ageing society, the issue of retirement funding has gathered pace. CPF alone is clearly insufficient. Hence, the introduction of the Supplementary Retirement Scheme (SRS) in the mid-90s was an apt one. However, from the start, the SRS has various limitations that made it unattractive. Hence, I hope that the Minister would review the SRS and fine-tune it to incentivise people to invest in this scheme. Some suggestions include that of what my colleague said earlier, a review of the contribution ceiling, which is currently pegged to the CPF contribution rates. Although Minister Lim said that it runs the risk of becoming a very big tax advantage for wealthy individuals, the question is: how big is this risk? It is clear that nobody, especially the really wealthy, will put all eggs into one basket. In addition, why do we want to disincentivise savings for retirement purposes, which is what the SRS is built for? The rich may not always remain rich. When they get old they will still need some form of savings that is there.”
“Sir, I beg to move, That the sum to be allocated for Head M of the Main Estimates be reduced by $10 in respect of Code MA 1500. Sir, first, let me declare my interest in the financial service industry. After great efforts to get Government to spearhead and sponsor public financial literacy programmes, I am very encouraged by the introduction of the MoneySense programme. This is testimony that the Government listens. I would appreciate it if the Minister could give an update on the progress of this programme. 3.30 pm There was also feedback that only educational programmes that address the general public, regardless of age and gender, are given the green light and qualify for co-funding under this programme. Others that target specific groups, eg, senior citizens, couples, etc. will not fall within the radar screen of the MoneySense programme, even though they may be given due consideration selectively. Sir, I am puzzled by this. Financial planning and literacy means different things to different people. For example, a single's financial plan would differ significantly from that of a married couple's. And a married couple with kids will have very different concerns from, say, a retiree. Hence, while a seminar that explains a specific investment instrument like share investment or bonds could have general appeal, those aiming at helping a person to draw up a budget plan, or a financial plan, which is the first step to financial accumulation, must be made relevant to the participants' lifestage and even gender. This calls for a customised programme for each target audience.”
“I recount her story here to highlight the fact that with an aging society, her predicament may become more common sooner than later. This issue will not only affect those who are not married, but also those who are widowed or divorced. Do we have any solutions that are being drawn up? I urge the Government to beef up the Medisave account and liberalise its use for purchase of private and national catastrophic illness insurance. By this, I mean the major illnesses such as heart attack and cancer. I understand from the Health Facts Singapore 2003 that the principal causes of death in over 50% of cases are cancer and heart attack. In many cases, the sums in an elderly person's Medisave account are not sufficient to meet his long-term medical needs. Often, he will have to dip into his children's Medisave accounts as well. But this merely delays the problem from the current generation to the next. What happens when the child grows old? The better solution is the pooling of risks via catastrophic illness insurance. I support the concept of co-funding, but I should emphasise that it should not be restricted to the coverage of hospitalisation and medical costs alone. It should also cover the loss of income, which is especially important if the person is the sole breadwinner. It is also clear that the CPF is insufficient to meet the needs of the aging population. Very few people are disciplined savers who can put money away over time. Some form of compulsory arrangements can be encouraged, whether in the form of portable pension schemes or company sponsored pension schemes. Encouraging employers to set up pension schemes would need some pushing from the Government itself. It would be able to stimulate a demand for quality fund management capabilities.”
“While we speak a lot in this House about the slew of pro-family and pro-marriage proposals, we must not also forget the singles who have contributed to Singapore and are most vulnerable in their golden years. Recently, a 52-year-old single lady, Miss Tay Huang Huang, came to me for help. She works three-quarters of the day and hurries home to look after three elderly siblings who are also single and suffering from stroke and mental handicap. The 52-year-old herself suffers from depression due to her stressful home environment. She has not been able to find a home that will accept all four of them. She is worried that, with age and a deteriorating health, she may not be able to look after her siblings. In fact, she may not be able to look after herself! With advancement in medical science , which is also expensive, she is also afraid that she will outlast her resources. She is feeling both desperate and helpless.”
“This means that in the case of twins or triplets, the mother would be deemed to have automatically exhausted her entitlement and, by some stroke of miracle, no longer require any more maternity leave or cost subsidy should she be pregnant again. Another is the tax rebate for graduate mothers which applies to graduates up to 28 years old. Data from the Department of Statistics showed that graduate women are, on average, marrying at 27 to 28 years of age. This means that half of our graduate women will not be eligible for the tax rebate at all! And more if they do not conceive immediately after marriage. I urge the Government to urgently review this age criterion. We must also address the cost equation of declining fertility due to late marriages and genuine infertility. After all, it was cited that Singaporeans have one of the lowest sperm counts in Asia. During my MPS, I saw a young couple who were graduate professionals with stressful work environment. They love children but could not conceive. They were only 32 years old, and were turning to IVF. The success rate of IVF, I understand, is low and the cost is about $9,000 per treatment. They would like to have three children and, by simple calculation, it would cost them about $81,000. At present, only a maximum total of $4,000 per treatment and a lifetime ceiling of $12,000 may be withdrawn by a woman from her Medisave account to pay for IVF treatments. Given that more couples may be turning to IVF, I urge the Government to review the maximum withdrawal allowed from Medisave for IVF treatment. Do not penalise them; help them. Next, I would like to move on to the aging society.”
“I urge the MCDS to work with various agencies to identify couples at risk before they land up in courts. A good opportunity is to get parents waiting in the queue at polyclinics for their babies who are getting their innoculation to simply fill up a survey form to describe the state of their marriage, stress level and whether the mother suffers from post-natal blues. The information gleaned from such surveys can help to identify couples at risk and channel them for counselling before they break up. Again, as I have said, there have been quite a number of suggestions given by Members of this House on measures to help mothers and, in fact, fathers to cope with the weight of procreation. So, I will not dwell on them except to emphasise that all these measures and facilities, like infant care and childcare, should form a part of an unbroken continuum of family care and social support infrastructure. Next, I would like to move quickly to the cost factor. The cost factor has been mentioned many times, both by my residents whom I have spoken with, as well as by Members of this House. My sense is that the cost factor, real as it may be, is only as important in relation to the social value that they have. Having said that, I would still like to see the Government helping not just to subsidise the cost per se but to lower the cost of having babies, and also extend some of the current tax incentives. First, the baby bonus under section 42A of our Income Tax Act which applies only to the second and third child. My question is: why such a restriction?”
“Currently, the CPF housing grant of $30,000 to encourage young couples to live near their parents is applicable only to first-time applicants and applies only to HDB resale flats. Our matured parents already living in HDB flats cannot sell their flats and apply for the grant to live near their young married child. Second, the advantage of proximity is not heightened until the arrival of the first child. By then, either the the flats in mature estates are not available or the young couple has yet to fulfil the 5-year occupancy rule. I have received many requests for help by my Punggol 21 residents, and Sengkang residents as well, who are unable to obtain 4-room flats for their parents as these flats have been exhausted and what remain are bound by the ethnic quota. In other words, they are in a Catch-22 situation. I hope the relevant Ministry can do something about this. The erosion of pro-family values is evident in the rising rate of divorce. At the centre of this debate is our social aspiration for the 5 "Cs", meaning credit card, career, car, condominium and certificates. We have problems as long as child bearing ranks after these 5Cs. Ideas about children and the role of each spouse should also be discussed prior to marriage. Too many couples leave these issues to be negotiated until after marriage. The fact that married couples are off our radar screens until they turn up at the doorsteps of our courts means that the family care programmes available today may be too late and too little for many couples. In fact, a Research Bulletin from our Subordinate Courts suggested that the birth of the first child was a major transition that caused disruption and conflict between parents. Too many families were not coming through this transition intact.”
“Children were a sort of status symbol and, hence, the more the merrier. Today, it is the reverse. Having a child is seen as a cost that even the well-to-do are unwilling to afford. Hence, while in the past having children is an automatic next step, today, we analyse and analyse the cost until we become paralysed by it. It is now an option and not a value proposition. The value transmission chain is broken, I suspect, when the extended families in kampongs were broken. In almost all families then, the generation of elders are the natural advocates of pro-family and procreation values. Their pleasure and joy at the announcement of a new marriage or the arrival of a new baby in the extended family are great encouragement for young couples to procreate. The extended family is a natural walking advertisement and reminder transmitting pro-family values. This is evident during Chinese New Year, where the pressure would be on singles and childless couples, myself included. Today, there are tours and escapades to help ease this pressure. We need to reconnect this value transmission chain - not so that I myself will be under pressure, but to solve the real issues of caring for the young. Many modern grannies these days also want to have fun. We need policies that will encourage the re-formation of extended families. I would like to give a couple of suggestions here where HDB is concerned. It is quite a unique situation in Singapore where marriage and procreation are sometimes tied to housing policies. While there are incentive schemes to encourage newly-weds to live near their parents, this scheme suffers from two inherent deficiencies. First, many newly weds prefer new flats which are directly purchased from HDB at market subsidised rates.”
“They told me that life is running on a spinning cog wheel with the need to oil it all the time; that life has become more technical and more demanding of time than ever before. Singaporeans are busy bees. We battle the high cost of living, battle with time, battle with stress and even battle with guilt - the guilt of not being able to spend time with our loved ones and friends. This intense battle is exacerbated by the advent of technology, which ensures that work follows us home, via e-mails and handphones, and even the short-cuts and non-English e-mail language and SMS language are fast gaining acceptance, as full spellings of words and sentences are deemed a waste of time. With the focus on work and catching up with the Joneses, there is insufficient time to be good spouses, concerned parents and active citizens. This is a clear and present reality we must cope with. However, we must not lose sight of what is urgent and important for our long-term survival. We will have no future if we focus only on the present. And the future is clearly in encouraging procreation, and cultivating them to become good citizens. The present is that we must help families balance work and family life, and create an environment that encourages procreation. This is not just tax incentives or monetary rewards, but also more flexible work arrangements that require a mindset change on the part of employers and childcare arrangements to help parents cope. For us to succeed, we will need to overweigh family values and underweigh materialism. In fact, I would go so far as to say that underlying all these is, in fact, a shift in the value system over the last 30 years or so. I remember that in the not so distant past, we had less to eat and wear, but we had more children to show.”
“Next, I would like to move on to the people sector. A lot has been said in this House regarding the various measures to increase the birth rate. I think at the core of a united nation is indeed a united family. I observed that at the height of SARS, many families became closer, as they took temperatures for each other, and reminded each other of hygiene habits and, in fact, they spent more time together. Perhaps in times of uncertainty, our traditional Asian family values emerge to remind us of what and who are closest to our hearts. Perhaps the fear of SARS prevented us from stepping out and forced us to face each other a little bit more at home. Perhaps, if SARS was prolonged, we might even experience a little baby boom! Perhaps, perhaps, perhaps! However, a rapidly aging society and falling fertility rate are no laughing matter. It will lead to greater pressure on the Government to spend more on social security, medical and long-term care benefits. Families produce the workers, managers and entrepreneurs of tomorrow. Families nurture the children who are our hope for the future. We all know that. Yet, why is the virtue of child-bearing devalued as we move up Maslow's hierarchy? To arrest this trend, we need to approach the problem holistically. We must recognise that in recent years, for many Singaporeans, the choice to have children weighs heavily. They look at their careers, their aspirations and the costs of bringing up children. When they do their economic sums, some may be persuaded to delay or decide against having children. These considerations are real and important in any policy discussion. I did a door-to-door visit on Sunday and upon every household that I met, which has children and young couples, I asked them if they wanted to procreate.”
“Obviously, the pool of offshore funds is a lot bigger than onshore funds. Hence, attracting family offices to Singapore is a function of further nurturing and growing the wealth management industry. It is also a function of recognising that delicate tax structures should be established in order to avoid the flight of capital to competitor jurisdictions such as Switzerland. Next, on the infrastructural development of our wealth management expertise and outsource support services. The Wealth Management Institute launched last year will help to develop our pool of expertise to service not just the big mutual funds and boutique funds but also the family office and consultants servicing wealthy individuals and families. I urge the Government to provide more support to a wider range of wealth management training. Together, our wealth management managers and consultants constitute the supply side of the infrastructure equation. In terms of backroom support services, this is a necessary area of growth, especially for boutique funds which do not have economies of scale to set up their own back office. Instead, boutique funds need to outsource their backroom functions - functions like compliance, risk management sytem, anti-money laundering and regulatory services, fund administration and even representatives of trading software platforms, which are usually headquartered in US or Europe. Currently, Singapore is lacking a critical mass of these providers. We need to develop such outsource service providers to support the wealth management universe. Further consideration should be given as to targeting types of outsource service that would maximise the benefit to the fund management industry and enhance Singapore's reputation as a leading and supportive centre for the industry.”
“What does the IRAS consider to be investment income and what is considered to be the gains or profits from a trade, business or profession? Also, what information would be needed to be disclosed on the tax return in relation to offshore income? I urge the relevant authority to spell out in detail how it will make this distinction. The Government could look at examples in Europe, such as the Netherlands, where statutory safe harbour boundaries are put down quite clearly. The exemption of offshore income emphasises the bias against onshore income. Certain investments onshore are exempted while all investments offshore are exempted. If there is any uncertainty as to onshore tax treatment, the investment will most likely be moved offshore. Also, until the legislation is clear, investors may not invest onshore except in relation to the existing tax free list. Working on the list itself, I would also suggest the use of a white list versus the current, so to speak, black list. In fact, the use of a list can only ensure that Singapore remains a follower in relation to product development. Until a product is tested in the market, it is not possible to know whether investors will take to the product. One element of the acceptability of a new product is also its tax treatment. If the tax treatment depends upon the product being on a list, one cannot approach the market until one has been able to obtain an indication as to whether or not the product will be added to the list. This takes time, expense and creates a delay. In view of this, I am advocating a white list which will, I believe, increase the variety and desirability of onshore choices for onshore investors and create a greater degree of tax certainty. It is also necessary to attract offshore money.”
“It is not likely that they will shift to Singapore. But with the rapid rise of China and India, as well as the advent of technology, new wealth is created in Asia and it is wealth that is looking for a secure environment. This is our window of opportunity. Recently, Singapore was rated the least corrupt country in Asia by PERC. By comparison, the other two wealth management destinations in Asia, being Hong Kong and Tokyo, were rated approximately seven times more corrupt than Singapore. Our stable social and political environment, transparent Government policies, good corporate governance, sound banking infrastructure, IT and airline connectivity make Singapore an excellent environment to produce and preserve wealth. Singapore has the opportunity to position and develop itself into a financial wealth management hub of Asia. To do so, the legislation and incentives need to be streamlined and laid out unequivocally - to provide clarity and directions to a few groups of people. They are the product manufacturers, administrators, distributors and clients. A strong infrastructure could also be developed expeditiously. On the policies and recommendations, many of the current announcements and existing regulations are upbeat in policy intent, but foggy when executed. More certainty is needed in order for us to grow this industry. One of the announcements which came as a surprise, but a much welcome surprise, was the tax exemption for foreign source income. While the exemption is a significant positive step, the question remains with regard to the distinction between foreign investment and foreign business income. This implies that investors may not immediately deploy assets onshore until the distinction is clarified.”
“He caters to the day tourist trade and his revenue can already cover operating costs. Contrast it with the cost here, he would probably not have even successfully bid for a coffeeshop with S$29,000, let alone start it up. While in the past, those who were retrenched or less educated but were hardworking might have a chance in the informal economy, especially during those days where the hawker centre stalls and HDB shophouses were allocated at greatly discounted rates, this chance no longer exists. Most of these business opportunities, especially where rentals are concerned, are available only via tender. I was shocked when I first found out that the monthly rental of the first and only coffeeshop in Punggol 21 costs more than some of the shops along Orchard Road. At more than $100,000 a month rental, even such traditional industry is out of reach for the average and is certainly not for the faint-hearted or shallow-pocketed. We need to seriously reconsider the process and method of our pricing policy, especially where rent is concerned. We need to continuously look for ways to bring down business costs. In addition, I also hope that the $100,000 start-up exemption announced during this Budget be allowed to be carried forward for a specified number of years to the extent that it is not used in the start-up years. After all, few start-ups make money in the first three years. Many of my colleagues have expounded on entrepreneurs and their related issues and so I thought, in this debate, I would like to move on to the wealth management industry. It is one industry that has enjoyed specific mention this year. Let us recognise that a lot of funds and old money are already concentrated in places like Switzerland, Luxumberg and other tax haven jurisdictions.”
“In fact, soon after the announcement of the 2% cut, the Singapore Zoological Gardens also announced a retrenchment of staff. Could these people be retrained to perform other duties? For example, many of them are not only knowledgeable about the animals they look after, or the functioning of a zoo, they are also passionate about it. They can be retrained to become 'knowledge guides' and give our zoo an added dimension of being a truly learning journey. Many people are willing to spend thousands of dollars out in the African safari, not only because it has got beautiful sceneries, but because the experience of being in the wild is accompanied by highly proficient guides who transform that visual experience into a unique learning experience. It is also a value-added service and an experience which they will continue to talk about over the years. We should go beyond retrench and retrain to restructure our economy and seek to grow people in their areas of expertise and passion. Only then can we bring out the best in our only resource. On the private sector entrepreneurs, the move towards a broad-based approach in germinating entrepreneurs is a laudable one. It recognises that an entrepreneurial culture is only possible when it is broad-based. Outstanding entrepreneurs and even future MNCs can only come about with a critical mass. The measures put in place, however, need to be more robust. It is almost a cliché to talk about the high cost of doing business in Singapore. Start-up costs are equally daunting. I heard about a retrenched professional in his 50s, who looked south, to bring bread back to his family. Armed with S$29,000, he started a 3-storey seafood restaurant in Bintan, complete with a sizeable living quarter and a separate office.”
“Mr Speaker, while last year's budget focused on jobs, jobs, jobs, Budget 2004 seems to focus on production - produce jobs, produce entrepreneurs, produce a vibrant wealth management industry and, of course, produce babies. All these are to be done via broad-based cost-cutting measures as well as allocation of funds to meet specific needs. I shall again tackle it using the 3P approach - public sector, private sector and people sector. On the public sector, I recognise the success and efforts of the Government in setting up the Cut Waste Panel, the ZIP and the Pro-Enterprise Panel. A lot of the wastages that have been talked about in this House have been addressed quite adequately. Hence, the 2% cut across all Ministries, except the Ministry of Defence, is another step in the right direction. After all, the private sector corporate austerity programmes have already been in place for some time, and anything less austere in Government spending will look conspicuously inappropriate. However, I also hope that the 2% budget cut will apply to the frills and extras, like glossy and colourful hard-bound annual reports that are mass distributed, posh offices, unnecessary layerings and so on. It should not translate into a 2% drop in service standards or increased costs to the public, eg, in charging information which were previously given free. And, as my colleague, Mr Leong Horn Kee has mentioned, it should also not result in a cut in community-related projects. Although some manpower may need trimming, extra efforts must be exercised to help retrain or redesign works so that those retrenched will not end up adding onto the tens of thousands who are already unemployed.”
“My question is: how many households in new towns, like Punggol 21, still do not have access to cable, and when can they expect to be able to access the cable service?”
“I am heartened to note that there are other channels which the Ministry will use in future if such a situation does arise. During that period of time, a number of my residents, especially in the town of Punggol 21, who are affected ---”
“Sir, I thank the Minister for his very comprehensive answer. During the SARS outbreak itself, there were a number of national messages which were carried through the cable vision, and some of these broadcasts via cable were quite necessary because they involved teaching people how to wash hands and wear masks, and so on. But those households without access to cable vision had no access to such messages. How do we ensure that if there are other such national messages to be broadcast, that these currently 20,000 households will not be left out of such messages broadcast?”
“Mr Speaker, Sir, we have often heard that migratory birds are responsible for spreading the Avian flu. How real and widespread is this phenomenon? And where is the closest incident of such an infection by migratory birds within this region? Also, how real is the risk of migratory birds bringing Avian flu to Singapore's shores? Last but not least, does the Minister see the need to further reduce the number of birds, ie, on top of the normal culling process, such as crows and mynahs in Singapore? And what plan does he have in mind?”
“Sir, I am glad to hear that there is a decreasing trend instead of an increasing trend of juvenile delinquency. But in terms of severity of the crimes, are the crimes committed by juveniles getting more severe?”
“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. Mdm Deputy Speaker: Order. Mr Wong wants to move an exempted business motion. 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]. HUMAN ORGAN TRANSPLANT (AMENDMENT) BILL Debate resumed. 5.15 pm”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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.”
“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: (a) severe coma of known cause; (b) absent brainstem function (ie, the six brainstem functions are absent): and (c) sustained apnoea (ie, there is no breathing which is the seventh brainstem reflex).”
“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?”