Voluntary Sterilization (Amendment) Bill
Sir, I thank the Ministry for its efforts to update the Voluntary Sterilization Act (VSA), an Act which is four decades old. The intent to align the Act with the principles underlying the UN Convention on the Rights of Persons with Disabilities and also the Mental Capacity Act to protect the more vulnerable is especially commendable.
I am also appreciative that a public consultation was also sought. However, the consultation period was from 4 June 2012 to 2 July 2012, barely less than a month. Not only was the duration itself short, but it was also during the school holidays when many professionals and parents supervising special needs persons were not available. This limited the extent to which more inputs could have been gathered on a subject matter that is as invasive and permanent as sexual sterilization. For future legislations of such nature which involve irreversible and ethical dimensions, I urge Government to seriously consider extending the periods of public consultation to allow for more proactive and deeper consultation of stakeholder groups such as families, advocacy groups, medical professionals and, in this case, even persons directly affected.
Nonetheless, I am very pleased that the Ministry has seriously taken the inputs of advocates such as AWARE and others and made a significant improvement for persons lacking in mental capacity. For this group, the Ministry has instituted a requirement for a Court Order before the sterilization of a person lacking in mental capacity in the final version of this Bill that is presented today. The shape of public consultations to come must indeed bear the desired characteristics of being genuinely open to inputs; graciously acknowledging and crediting inputs received and/or applied; and proactively seeking views of the public and especially relevant stakeholder groups through longer periods of public consultation.
Sir, I would like to raise three key areas for which I hope to receive favourable consideration from the Minister. The first concerns persons below the age of 21. Sir, the Bill provides that a registered medical practitioner can carry out sexual sterilization on any person below 21under two circumstances:
(1) If the person below 21 is married and consents himself/herself to the sterilization; and
(2) If the person below 21 is not married and together with at least one parent or guardian consent to the procedure.
Sir, I would like to remind the Ministry that the definition of someone "below the age of 21" effectively means "any age from birth to below 21" – five, six, seven, 11, 12, 13. So, I find it onerous on a young person aged, for instance, 15 years old to partake in a life decision that is as invasive as sexual sterilization; a decision that is permanent, irreversible, to the extent that it will impair his or her ability to have children for the rest of his or her life.
Sir, I therefore urge that the Act be aligned with the United Nations Convention on the Rights of the Child which defines a child as, I quote, "a human being below the age of 18 years old" and to provide further safeguards for persons below 18. I urge that before any treatment for sexual sterilization is carried out on a person below the age of 18, that there be approval from a Committee comprising at least (1) an independent medical practitioner with relevant knowledge; (2) a non-medical professional such as a Family Service Centre Counsellor or a Senior Medical Social Worker; and (3) an officer from a relevant Government agency such as the MCYS. The Committee should be given the authority to approve or disapprove the application for sexual sterilization of the minor. The Committee shall consider the reasons for which the application is made; convince themselves that there are no other less restrictive and less permanent options; and that the final decision to sterilize is indeed in the best interest of the minor affected.
Next, on persons who technically are not lacking in mental capacity but need support. Sir, the other group for whom I would like to speak up is the group of persons with special needs who may not be technically defined as lacking in mental capacity under the Mental Capacity Act (MCA). Under the MCA, only a person who cannot understand, who cannot remember, who cannot weigh up the information and who cannot communicate a decision is deemed to be lacking in mental capacity. Sir, people with special needs fall upon a spectrum − from mild to moderate to severe. There are men and women who may fall through the cracks. These are persons who are legally categorised as mentally competent, but many of us know that they will still be vulnerable if left to make decisions on their own regarding permanent and irreversible ones such as sexual sterilization. They can be individuals who are mildly intellectually disabled; or persons with no intellectual disability but have other disorders such as high-functioning autism or attention deficit and hyperactivity disorders which may affect their decision-making abilities without help or support. For persons of such profiles, I ask for additional measures to help them arrive at the decision of whether or not to be sterilized, even if they are above 18 years of age. I urge that such persons, through either subsidiary legislations or codes of practices, undergo compulsory counselling by relevant professionals such as a medical professional with relevant knowledge; a non-medical professional such as a Family Service Centre (FSC) Counsellor and a relevant disability expert. Extra efforts must be taken to counsel these persons in a way that can be understood by them so that they are aware of other methods of contraception that are less invasive and less permanent; so that they know the consequences of sexual sterilization and so that they can truly make decisions in their own best interest.
Finally, Sir, I am pleased that a court order must be obtained before the sterilization of persons who lack mental capacity, in particular persons with moderate to severe disabilities. This effectively ensures that significant decisions of such nature are made with two keys – one held by the person's family member and the other by an independent party convinced that such treatment is necessary and in the best interest of that person.
However, I urge that more professional expertise and focus be allocated upstream to ensure more effective sexuality education for the vulnerable in our country. Many of them, those with mild to severe disabilities, can be sorely lacking in knowledge in this area and are often at risk – either of being sexually abused, whether they are sterilized or not, or to be themselves sexually abusive to others because of the lack of effective education. In many instances, many of their families themselves are helpless, receiving different advice, sometimes contradicting, and not knowing how to help their children. They run the risk of thinking that sexual sterilization is the ultimate that will get them out of their fear and challenges. This is a grave matter of concern that has been brought up by both educators and families of persons with special needs who are young or older.
The need for sexuality education, counselling and even dealing with law enforcement agencies cannot be just left only to volunteers and disability organisations. There is a strong need for Government agencies such as the Ministry of Health, Ministry of Education and MCYS to rein in and provide resources to bring in more expertise and effective solutions to support the other helping hands. In summary, Sir, I support the Bill in principle and find it a vast improvement. However, I look forward to Ministry's favourable responses to my inputs on this Bill.