Mental Capacity (Amendment) Bill
Thank you, Madam. I support this Bill that seeks to amend and improve the current Mental Capacity Act. The Mental Capacity Act or the MCA was a significant one. Persons can appoint donees in advance to make decisions on their behalf should they lose capacity. The Act provided for the Court to appoint deputies for those who have lost capacity. It further enables parents of children with intellectual disabilities to appoint deputies to oversee welfare and other matters relating to the child.
Since the introduction of the Act, more than 17,000 Lasting Power of Attorney (LPA) were issued. This is but only a small percentage of a larger group of Singaporeans who ought to make use of the provisions of the MCA. The urgency is especially high for three groups of people.
One, families especially those with sole breadwinners who, due to injury or sudden deaths, leave their families helpless;
Two, persons at risk of losing mental capacity due to age. There is an estimated 450,000 Singaporeans above the age of 65 in Singapore. According to a nationwide study – and this is quoted by Minister as well – of 5,500 elderly residents and their family members, one in 10 people aged 60 and above in Singapore has dementia.
In my Kampong Glam constituency, I have witnessed the challenges of households where elderly residents lose their mental capacity and no prior arrangements were made for proxy decision-makers. As a result, much time and money are expended to ensure the affected elderly receive the needed care and support. Where property and finance are involved, the administrative hassle led to unnecessary anxiety and resentment, sometimes, resentment of those left behind.
The third group who ought to make use of the MCA provisions are families with special needs children. Now, they should not be limited to only those with intellectual disabilities. These families with children who are deemed to lack the capacity to make significant life decisions and in need of deputies to act on their behalf.
Madam, while I support the Bill, I wish to highlight five areas for the Minister's response. The five areas are:
a) more protection of Vulnerable Donors;
b) cost of MCA Applications and Services;
c) families of Children with Special Needs;
d) more Resources for Administration, Education and Outreach for the Office of the Public Guardian (OPG); and
e) the amendment to dissolve the Public Guardian Board
First, on the protection of vulnerable donors. Madam, one of the objectives of this Bill is to further protect those who are vulnerable and who do not have immediate family members to rely on to be their proxy decision makers. I am concerned with the clause in the current MCA which specifies the qualifications of a donee to simply at least 21 years old and a non-bankrupt when the LPA is signed.
We can learn more from the highly publicised case of Mdm Chung Khin Chu versus her former tour guide, Yang Yin. It is alarming and I quote this just for discussion, as what the Minister had also quoted on. It is alarming that a foreign citizen who is not related to the donor, can be granted an LPA that effectively gave him control of more than $35 million of her assets. It is also appalling that Yang could do as he pleased in his apparently calculated dissertation of Madam Chung's assets in the years before he was arrested.
The proposed amendments to allow the Courts to revoke the donees' or deputies' powers in the event of risk of abuse or exploitation, in my opinion, do not offer sufficient pre-emptive or upstream protection to the donor.
I therefore urge that there be stronger safeguards in the form of audits, whistle-blowing procedures and stricter due diligence in the granting of LPAs when the stakes are higher such as:
a) where the assets involved are of a sizable value;
b) where the donee is an unrelated party and/or a foreign citizen;
c) where the elderly donor is above a specific age, hence, more susceptible to conditions like dementia; and
d) where donor does not have any immediate family member.
Next, on the cost of MCA applications and services. In addition to the application fees to the OPF which are currently kindly waived by the Ministry, there are three costs for which I am asking for better cost management:
a) the remuneration payable for the deputyship and doneeship services for the professional services introduced in the amendments of this Bill;
b) the cost incurred for getting an updated medical report in the course of an MCA application; and
c) the fees payable to the lawyers for work done in explaining to the applicant, drafting the necessary papers and other disbursements.
I urge the Ministry to look into means by which these costs can be kept reasonable and subsidised in the case of persons with average or lower income. I recommend that the Ministry (i) provide a set of fee guidelines for the types of legal services relevant to the MCA and the Bill; (ii) work with the Polyclinics, Government Hospitals or an appointed panel of healthcare providers to issue the necessary medical report in a template that is acceptable to OPG; and (iii) allow the use of CPF and/or Medisave to pay for the required costs incurred in application and appointment of one's donee or deputy.
Next, on families with children with special needs. I wish to speak on behalf of the many concerned families with children, young and old, with special needs, being a parent myself and an activist in this community.
There is a full continuum of special needs with different persons manifesting varying degrees of mental capacity. Families with more severe needs find challenges as they navigate through the sea of uncertainty when their children become adults and many continue to need their families' supervision.
Last year, a group of parents with special needs children wrote to me to share their fears and anxieties about their children who have already past the age of 21 with no appointed deputies. A mother mentioned that her global-developmentally-delayed daughter needed a treatment that requires general anaesthesia (GA). The young lady could not sign the papers as she was deemed to be without full mental capacity. Neither could her parents sign on her behalf because they had not been appointed as her deputy.
Closer to home, an adult with special needs whom I personally know was in need of a wisdom tooth surgery which requires GA as well. This was at a government dental centre. Similarly, the parent was informed by the staff that for an operation that required a GA procedure, she must produce an LP before the young adult could go for the surgery. The young adult is technically not intellectually disabled – his IQ is above 70 but he has moderate autism. I confirmed yesterday that the young man has still not gone for his surgery. He probably has gotten used to the pain.
Another father shared of his challenges to be appointed as the deputy of his autistic daughter, who is moderate to severely disabled. He was quoted a hefty sum of a few thousand dollars, which I think is very high, by a law firm in a public housing estate. This father could not comprehend why it would be so cumbersome and costly to have himself, as a father, continue to make decisions for his daughter. Many like him are lost and helpless.
One more story. A family residing in my Constituency came to ask for my help several times. The elder sister of a man with severe mental disability wanted me to help appeal for a rental flat from HDB for both of them. The HDB had considered the man to lack mental capacity to sign a tenancy agreement and since he is without a deputy, the elder sister has to navigate through several agencies to solve their lodging issue. They are non-English-educated.
Now, I am grateful to the Ministry for proactively piloting a project with MINDS to help parents of MINDS students obtain deputyship orders. However, the pace is a tad too slow, in my opinion, and does not include adults above the age of 21 for whom their parents could no longer act on behalf of. There are many of such families who continue to live in worry and anxiety.
In cases where medical treatment is involved and deputies' consent needed, time is also not on their side and the person with special needs sometimes suffer their physical pain in silence. Although the law permits healthcare professionals to act in a patient's "best interest" and not requiring consent from a deputy if there is none, there appears to be a lack of awareness and fear of liability on the part of the medical fraternity to perform major procedures on this group.
In this regard, I would strongly recommend that the Ministry takes three actions.
One, further simplify the process of application of deputyship for persons with special needs to cut down both costs and administration. Go beyond the MINDS pilot. It is not true that only persons with intellectual disabilities need proxy decision-makers. One way is to engage and resource the special schools or the major disability organisations to be part of this application process and validate the need for deputyship.
Two, appoint co-ordinating agencies such as the SG-Enable, the National Council of Social Services and/or the Agency for Integrated Care to promote awareness, educate and provide the required legal and financial assistances for an application under the MCA.
Finally, identify and train a pool of community-minded medical professionals and lawyers who can be the "go-to" list for MCA applicants for especially families with special needs children.
Next, Madam, on more resources for administration, education and outreach work done by OPG. The savings resulting from a proper management of affairs when one loses capacity far outweigh the initial cost. The current 17,000 LPAs registered are only the tip of the iceberg. Many more Singaporeans need to come on board this bus and hence, the OPG has its work cut out for it. Related parties such as property agents, HDB frontline officers and healthcare personnel must to be educated too.
The OPG needs to be future-ready and work on new digital services so that users can more easily access their services. The United Kingdom, for instance, already has its digital LPA services, which allows users to apply for LPAs online, anytime and anywhere. We need to cater to that group too and provide better, faster and cheaper services. For all this, additional resources are needed.
Madam, I know this is not yet the Budget debate but I wish to ask for additional resources for the OPG.
On dissolving the Public Guardian Board. Lastly, on the proposed amendments that repeal the provision for the Public Guardian Board and remove the need to make an annual report on the discharge of the Pubic Guardian's functions.
Madam, the OPG under Mr Richard Magnus had performed a commendable job. He and his team have built a strong network with the Law Society, College of Family Physicians, the CPF Board, the grassroots and the social service agencies. The LPA form and processes were simplified. Free postage was negotiated with SingPost, and the Ministry had waived the application fees for a period to encourage more sign ups.
The Board has also done an excellent job no doubt due to its broad network and wisdom. I feel that it is still early days to dissolve the Board and retire the members. There is merit to have a Board that provides the external inputs and supervision. Our Asian culture is such that conversations regarding end of life matters are not common. There are mounting challenges in translating the policies of the OPG to the ground. The numbers will soar if we get it right and we want it so, and many lives will be positively helped as a result.
I therefore urge that the Ministry reconsiders this repeal and delay the decision to dissolve the Public Guardian Board. With that, in conclusion, I want to thank the Board and the OPG for running a good race in the last five years and I look forward to more good years. I support the Bill, Madam.