MEDICAL (THERAPY, EDUCATION AND RESEARCH) BILL

Order for Second Reading read,

4.00 p.m.

The Minister for Health (Mr Chua Sian Chin): Mr Speaker, Sir, I beg to move, "That the Bill be now read a Second time."

The Medical (Therapy, Education and Research) Act, 1965, (now Cap. 160 of the Revised Edition) was passed by Parliament on 31st December, 1965, and was brought into operation on 7th January, 1966. It embodied two objectives:

(i) To allow under certain circumstances the removal of organs or tissues or the examination of the body after death. Such procedures could be undertaken when the person before death had expressly stated a desire that his body at death be used for any of the purposes of the Act. In the absence of any stated wishes of the person before death, the relatives could give the necessary consent for the procedures to be carried out.

(ii) To provide sufficient safeguards to ensure that the freely expressed wishes of a person are carried out. If there was a specific wish to donate his eyes or an organ, this would be carried out. Conversely, if there was a specific objection by the person no such procedures would be carried out.

The safeguards, however, went further, primarily for goodwill, that no such procedures could be carried out even if the person had explicitly wanted it before his death, if there was any objection by any surviving relative.

Almost from the onset it became apparent that there was a conflict in the purposes of the Act. As a result, it has not been as successful in its application in promoting the purposes of medical advancement. Because of the stringent provisions and ambiguities, there have been instances where the hospital failed to obtain organs from a dead person despite his having given consent before death or despite consent of his relatives having been given.

Perhaps this was the result of insufficient experience and over-caution at the time when the Act was framed. At that time the only transplantation operation routinely done in Singapore was the corneal transplant. Kidney transplant operations had not been quite perfected nor yet undertaken in Singapore. There was, therefore, little experience to fall back on in the drafting of the Act. The rapid advances in medical science and technology had in the meantime overtaken the legal provisions of the Act.

One defect of the Act soon became apparent. To ensure the success of the transplant, the tissue must be removed from the dead body as soon as possible after death. The legal provisions as provided by the Act do not allow this to be done because of the formal procedures to be taken. Some of these provisions are, worse still, quite ambiguous. Another defect is that the law allows any surviving relative to forbid a donation with the result that the hospital is unable to comply with the wishes of the donor who made them before death. The serious defects in the Act may be listed as follows:

(i) There is no definition of what is meant by any "surviving relative". There is no precedent to fall back on. Hence it could happen, even though this is only a theoretical possibility, that any relative, no matter how far removed, could come forward to object to the operation being conducted. This actually occurred in the famous case of the death of the American authoress, Grace Metalious, who had specifically willed her body to a medical school. But this was forbidden by her next-of-kin. The resultant controversy led to an amendment to the law of the State of Massachusetts.

(ii) As illustrated by the example I have just given, the properly stated wishes of the person may be overruled by some relative at death.

(iii) The phrases, that "such reasonable enquiries as may be practicable" must be made by "the person in lawful possession of the body of a deceased" to see whether any of the surviving relatives (who are not defined) object to the gift, are ambiguous. The vagueness of these provisions is especially deplorable in view of how critical it is that in transplant operations the time lag between donor's death and the operation should be kept as short as possible. A good deal of time is lost in going around sounding every relative to find out whether or not he or she objects to the use of the body for the purposes of the Act.

The phrase "the person in lawful possession of the body of a deceased" is invoked in the case where no specific statement has been made by the deceased before death. In which case the person lawfully in possession of his body can give consent. However, under the present law it is not possible to say with any degree of certainty who such a person is. There has, therefore, been much debate over the interpretation of the words "person in lawful possession". It was originally used by the draftsman of the Anatomy Act of the United Kingdom of 1832. This was a piece of legislation passed in the aftermath of the ghoulish activities of the body snatchers of Burke and Hare. The words were interpreted to include the Master of Workhouses and likewise the Board of Management of a hospital where an individual dies. This appears, however, to have been restricted now as not to include the hospital management but executors or close relatives of the deceased.

In the United Kingdom, the corresponding law known as the Human Tissue Act, 1961, on which our own Act was modelled on, had also been found to be inadequate. Like our Act, it was supposed to be comprehensive and to provide a charter for the advancement of medicine, research and education. It had replaced a preceding Act known as the Corneal Grafting Act of 1952 and an earlier Act known as the Anatomy Act, 1832. It was probably on the models of these previous Acts that the ambiguous term "person in lawful possession" had come down through to our present Act.

Because of this evident defect, the Health Minister in the United Kingdom in January 1969 formed an advisory group on transplant problems to make recommendations on amendments, if any, to the Human Tissue Act, 1961.

In the United States of America the corresponding law is known as the Uniform Anatomical Gift Act. It is the product of three years of intensive study by a special committee of the National Conference of Commissioners on Uniform State laws. It had considered earlier drafts and reviews by medical and scientific groups and also received the endorsement of the American Bar Association.

Rather than touch up our existing Act with amendments here and there, it was decided to repeal it and replace it with an entirely new Bill modelled on the United States Uniform Anatomical Gift Act.

The present Bill before the House has, therefore, two purposes, namely, the repeal of the existing Act and its re-enactment. The objectives and scope of its provision remain the same while the operation of its provisions is now made clear and is without ambiguity.

It is designed to facilitate the donation and use of human tissues and organs for transplant operations and other medical purposes and provides favourable legal provisions for such activities.

To make its full beneficial impact on the community the purpose for which such anatomical gifts can be made, the provisions have been extended to include education and the advancement of dental science. The existing Act has no reference to dentistry. The salient points in the Bill are as follows:

(i) It permits the removal of an organ or the use of the body or parts of the body for examination or for medical education where a person has specifically willed it in writing or orally in the presence of two or more witnesses. A safeguard is provided for revocation of the gift by the donor at any time.

(ii) Where no specific wish has been expressed to make a donation of parts of a body or for a medical examination of the dead person, authority to do so may be given by relatives or by the Director of the Medical Institution if the body is not claimed after 24 hours.

The safeguard here is that if it is known that the person had specifically objected to such procedures, then the procedures cannot be carried out.

The provisions in the Bill which differ from those in the existing Act are as follows:

(i) Omission of all references to the ambiguous expressions, such as "persons in lawful possession" and "having made such enquiries as may be practicable".

(ii) And, this is more important, that the donor's wish takes primacy over all others. In the existing Act, any relative may forbid the removal or examination of the body and can thus veto the wishes of the deceased.

(iii) So as to avoid ambiguity as to which surviving relative or person who could legally authorise removal of parts of a body or the carrying out of a post-mortem, the Bill lists the relatives who may give valid consent in an order of precedence. By this, the wishes of a relative in a higher order in the list will take precedence over those relatives in a lower order.

Here again, a safeguard has been written into the provisions in that, if there be any conflict between relatives in the same order of priority, the authority to examine or remove parts of the body will not be given.

I should, however, like to mention that although it may be desirable to make this law as comprehensive as possible, we have deliberately not touched on the point concerning the removal of an organ from a living donor. In fact, there is no need to do so because within the medical services and profession there are codes of conduct which govern medical practice and which lay down rules on determining death, obtaining consent for donation of tissues and for the examination of bodies.

At the present stage of medical development in Singapore, the provisions as embodied in the Bill together with the safeguards should be sufficient to enable the use of the body or parts of a body for transplants and the advancement of medical knowledge, education and research.

Mr Speaker, Sir, I beg to move.

Question proposed.

4.14 p.m.

Tuan Haji Mohd. Ariff Bin Suradi (Kampong Kembangan): (In Malay): Mr Speaker, Sir, as the Minister for Health mentioned just now, this Bill will replace the present Medical (Therapy, Education and Research) Act, 1965 (Cap. 160). Section 4 of the present Act is incorporated in the Bill under clauses 12 and 15. The present practice under section 4 of the Act is that Muslim corpses are exempted from post-mortem. Can the Minister for Health give an assurance that this practice will be continued when the Bill is passed?

Mr Chua Sian Chin: Mr Speaker, Sir, the Member for Kampong Kembangan has referred to clause 15 of the Bill where it is provided that if a body has not been claimed for more than 24 hours after death, the Director may dispose of the body as he thinks fit. Clause 15 is, in fact, a repetition of the old provision of section 4 of the existing Act where it is stated:

`Where the body of a deceased person has not been claimed from a hospital, nursing home or other institution, maintained on public funds, for more than twenty-four hours after death, the Director of Medical Services may authorise, in writing, the use of the body or a specified part of the body or the post-mortem examination of the body for the purposes for which an authorisation in writing may be given under the provisions of paragraph (a) or (b) of section 3.'

The concern of the Member is: what about dead bodies belonging to persons of the Muslim religion? The present practice is that if the body of a dead person belonging to the Muslim religion is not claimed for more than 24 hours, the Director of Medical Services would invoke section 4 of the existing Act, which I have read out just now, and get the Muslim Religious Council to dispose of the body in accordance with Muslim religious rites. As far as the dead bodies belonging to the Muslim religion are concerned, they have not been touched by the Director of Medical Services, but he requests the Muslim Religious Council to do so. That has been the practice since the existing Act was passed in 1965, and I can assure the Member for Kampong Kembangan that when this Bill is passed the same practice will continue.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill. - [Mr Chua Sian Chin].

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