Each sterilization case involving minors now has to be reviewed by a Hospital Ethics Committee. AWARE is very heartened that our lobbying efforts have resulted this measure.

On Oct 16, the Voluntary Sterilization Act (VSA) came into force, incorporating AWARE’s key recommendation that a Court Order be required before the sterilisation of persons who lack mental capacity to decide on such matters can be carried out. Read more about our concerns and recommendations here.

AWARE is also very heartened that our lobbying efforts have resulted in an additional safeguard for minors under the VSA: Each case involving minors now has to be reviewed by a Hospital Ethics Committee.

“To enhance our safeguards further, all cases involving minors who are not mentally incapacitated seeking sterilization will be referred to the hospital ethics committee for review,” Health Minister Gam Kim Yong said in Parliament.

These committees, which comprise healthcare professionals and laypersons, will “independently deliberate on whether the minor should undergo sexual sterilization. It will take into account all clinical, psychologically, social and ethical aspects of the case. Directives will be issued to the licensees of healthcare establishments under the  Private Hospitals and Medical Clinics Act (PHMC) Act, to all healthcare institutions to mandate this,” he noted.

This new safeguard adds to existing safeguards for minors (currently defined as persons under 21) in the VSA, which includes the following:

– A young person who lacks mental capacity, is given the same protection as that for an adult who lacks mental capacity. A court order is needed before sterilization can be performed.

–  The young person must give his or her own consent.

– His or her parent or a guardian must consent to having the young person undergo such a procedure.

– The amended section 3(3) of the Act requires the doctor to give a full and reasonable explanation as to the meaning and consequences of such a treatment, and obtain certification from such a person that he or she clearly understands the meaning and consequences of the treatment.

In our recommendations to the Ministry of Health, as part of the public consultation exercise for the amended VSA, AWARE urged that a minimum age be set at which minors are deemed capable of giving consent for sexual sterilisation (together with her parent(s)/guardian), and that a Court Order or at least an independent committee decision should be required for minors below this age.

We also sent our recommendations to all Members of Parliamement. On Oct 16, eight MPs spoke about the VSA before the Bill was passed: Lam Min Pin, Syvia Lim, Eugene Tan, Faizah Jamal, Denise Phua, Chia Shi Lu, Mary Liew, and Fatimah Lateef.

Lam Pin Min expressed concern over the extent to which minors, especially those who are much younger, are able to comprehend the concept of sexual sterilization. “Potential controversy may occur in cases where the other parent of the child objects to the procedure, for whatever reasons. A number of countries either have a minimum age where persons are considered capable of consenting to sterilization, or require a court order before a minor can be sterilized. This is not the case in our current or amended Bill.”

Eugene Tan also asked about the lack of a minimum age requirement. “A minor at 20 years of age and a minor at the age of 14 have very different maturity levels. To treat all minors alike would be over-inclusive. Would it not be better, in the interests of the child and of society generally – although I know this is not a consideration of the proposed amendments – to require a Court Order or at least an independent committee decision for minors below a certain age?”

Faizah Jamal spoke about the fact that for unmarried minors, only one parent or guardian needs to give the consent for sterilization. “I find this troubling. It is against the established laws of guardianship where both parents have joint responsibilities,” she said.

“I would like to reference Article 18 of the UN Convention on the Rights of the Child, which specifically states that both parents have ‘common responsibilities’ and also that parents be given assistance in carrying these out. Compare this with the provisions in the Women’s Charter Schedule 2 which sets out who is to give consent in a marriage of a minor, where various scenarios of parental situations are listed, for example, where one parent had abdicated his or her responsibility, etc.”

She also referenced precedents from jurisdictions like the UK and Australia. These countries recognise that while parents are in charge, in matters like sterilization which are irreversible, parents must answer to a higher authority, like the courts.

“It takes cognizance of the many instances where parents are in contentious relationships and may themselves be making the decisions based on their own emotions and not in the best interest of the minor,” she said. “I do not see this concern reflected in the Bill.” Besides calling for a minimum age and an independent committee, she also recommended that both parents to be required to give consent and the Bill adopt the approach in Schedule 2 of the Women’s Charter.

Mary Liew raised the point that in the case of minors, it is likely that “the minors’ parents or legal guardians who have tremendous influence on their lives, who would have influenced them to make that decision.” She suggested the need for a court order, or safeguards such as requiring at least two doctors to certify that sterilization would indeed be in the child’s best interests.

Denise Phua urged that the VSA be aligned with the United Nations Convention on the Rights of the Child, which defines a child as “a human being below the age of 18 years old”, and reiterated the need for an independent 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.”

Such a committee, she said, 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.”

Ms Phua also touched on the period of public consultation for the VSA, which took pplace from June 4 to July 2. “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.”

She suggested that public consultation periods for future legislations that involve such irreversible and ethical dimensions should be extended, “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.”

Read the full transcript of the Parliament debate on the VSA here.