Public Consultation Paper on the Voluntary Sterilization Amendment Bill

Ministry of Health - Corporate Communications Division

Consultation Period: 04 Jun 2012 - 02 Jul 2012

Status: Closed

Summary

The Voluntary Sterilization Act (“VSA”) legalises sterilization in Singapore for social reasons and permits registered medical practitioners to carry out the procedure in authorised healthcare establishments. The Ministry of Health (MOH) proposes to amend the VSA to ensure that the VSA continues to remain relevant. It is timely to update the VSA to clarify that a person’s consent must be obtained for sterilization, as long as he/she has the mental capacity, as defined under the Mental Capacity Act (MCA), to make such a decision. With the amendment, our laws will also be updated to conform to the UN Convention on the Rights of Persons with Disabilities.

Detailed Description

PUBLIC CONSULTATION PAPER ON THE VOLUNTARY STERILIZATION (AMENDMENT) BILL

AIM

1          The Voluntary Sterilization Act (“VSA”) legalises sterilization in Singapore for social reasons and permits registered medical practitioners to carry out the procedure in authorised healthcare establishments. The Ministry of Health (MOH) proposes to amend the VSA to ensure that the VSA continues to remain relevant.  It is timely to update the VSA to clarify that a person’s consent must be obtained for sterilization, as long as he/she has the mental capacity, as defined under the Mental Capacity Act (MCA), to make such a decision. With the amendment, our laws will also be updated to conform to the UN Convention on the Rights of Persons with Disabilities.

BACKGROUND

2          VSA came into force in Singapore in 1970.  It was one of the pieces of social legislation introduced at the time to support family planning. The VSA and the regulations made thereunder provide for the protection of individuals in relation to sterilization. These include who can consent to a person undergoing the procedure, when a doctor’s certification for the procedure is required, where the procedure may be performed, and who may be qualified to do so.  The legislation also provides for the confidentiality of information relating to sterilization.

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3          Based on a 2002 study of Global Issues and Trends in Contraceptive Sterilization by Engender, there were 83 countries that have legalised and introduced legislation for voluntary sterilization, including the USA, Denmark, Iceland, Norway, Sweden, Hong Kong, India and China

Scope of Proposed Amendments

4          Broadly, the proposed changes to the VSA can be categorised into these areas of review :

[A]       Amendment 1: Consent for the Procedure

5          Under the current VSA, a person must give his consent before going for a surgical sterilization procedure. However, for persons who are “afflicted with any hereditary form of illness that is recurrent, mental illness, mental deficiency or epilepsy”, the VSA currently permits the parent/guardian or spouse of that person to give consent on behalf of the person. With the introduction of the MCA, which came into force on 1 March 2010, the above definition may not take into account that persons with the abovementioned conditions may still be capable of giving consent as defined in the Mental Capacity Act (MCA) (Pls see Annex A attached below). 

6          MOH proposes therefore to amend the VSA to align it with the MCA; that is, as long as the person has the mental capacity as defined in the MCA to make such a decision, his/her consent must be obtained for the procedure.

7          For persons who lack mental capacity as defined by the MCA, a doctor may still lawfully carry out the procedure on two conditions. One, consent must be obtained from the person’s parent/guardian (if the person is unmarried) or spouse (if the person is married). Two, as an additional safeguard, a doctor must certify that the procedure is necessary in the best interests of the person. Again, reference will be made to the MCA on what constitutes the best interests of the person undergoing the procedure.  The relevant provisions of the MCA are attached below for reference.

[B]       Amendment 2: Increase in penalties for breach of the VSA

8          Patient confidentiality is a fundamental ethical and legal obligation of healthcare professionals, and the penalties for breaching it should correspondingly be strict. The penalties in the VSA will be aligned with the provisions on disclosure of confidential information in other healthcare legislation (such as the Infectious Diseases Act and the Human Organ Transplant Act).  The penalty for disclosure of confidential information will be raised from a fine not exceeding $2,000, to a fine not exceeding $10,000. The jail term of not exceeding 12 months remains unchanged. 

9          This amendment also proposes to raise the penalty for persons who, by means of coercion or intimidation, compel or induce another person to undergo sterilization against their will.To account for the severity of the offence, the maximum fine will be raised from $5,000 to $10,000. The imprisonment term of not exceeding 5 years remains unchanged. 

[C]      Amendment 3: Healthcare Institution carrying out sexual sterilization need no longer seek approval from Minister

10        Under the current VSA, a healthcare institution must seek approval from the Minister for Health before it can carry out sexual sterilization.  The Act also required the medical qualifications of doctors carrying out sexual sterilization procedures and their duration of experience to be specifically prescribed.  As sexual sterilization is a relatively simple surgical procedure and does not need any special set-up for the carrying out of the procedure, these requirements will be removed. 

11        Instead the amended Act will allow sexual sterilization to be carried out in hospitals, ambulatory surgical centres and specialist medical clinics licensed under the Private Hospitals & Medical Clinics Act (PHMCA).  Registered medical practitioners who wish to carry out sexual sterilization procedures at hospitals and ambulatory surgical centres would need to be authorised by the healthcare institutions in question.  Where the procedure is carried out in a specialist medical clinic, the medical practitioner carrying the procedure would need to also possess surgical and obstetric qualifications that will be prescribed, or be supervised by another medical practitioner possessing the prescribed qualifications.  This is to ensure that only trained medical practitioners are allowed to carry out such procedures. 

Feedback

12        From 4 June until 2 July 2012, MOH is seeking views and feedback on the proposed changes. All feedback can be submitted via the online Feedback Form which can be accessed at http://www.moh.gov.sg/content/moh_web/home/legislation/eConsultation/topics/public_consultationonvsa.html, or emailed to moh_info@moh.gov.sg or mailed to the following address: Ministry of Health (Marketing Communications Branch-Public Consultation), College of Medicine Building, 16 College Road, Singapore 169854. More details of the public consultation can be found on the MOH website at the aforementioned link.

Annex A-MCA [PDF, 111 KB]

PUBLIC CONSULTATION PAPER ON THE VOLUNTARY STERILIZATION (AMENDMENT) BILL [PDF, 166 KB]