Mental Capacity (Amendment) Bill

Order for Second Reading read.

The Minister for Social and Family Development (Mr Tan Chuan-Jin): Mdm Speaker, I beg to move, "That the Bill be now read a Second time".

With your permission, Mdm Speaker, may I ask the Clerks to distribute the documents that illustrate the points I am covering in my speech.

Mdm Speaker : Yes, please. [Copies of handouts were distributed to hon Members.]

Mr Tan Chuan-Jin: As a country, we have done well to provide the conditions for Singaporeans to enjoy increased longevity. Our average life expectancy is now about 83 years and increasing. However, one of the issues that may arise in old age is the loss of cognitive ability. A recent study by the Institute of Mental Health shows that the prevalence of dementia was 10% among persons 60 years and above. This means that out of 100 elderly persons, 10 might have dementia at some point. I understand that Minister Vivian, when he introduced the Mental Capacity Act (MCA) a number of years ago, asked the same question – imagine all of us in this House here, quite a number of us will have dementia. The question is, will we be ready when it happens to us?

The loss of cognitive ability is, of course, not an issue that only affects older Singaporeans. Life, as we all know, is uncertain. Accidents and illnesses may rob us of our ability to make decisions at any time.

The MCA is a key statute that empowers Singaporeans to plan ahead and make their wishes known. It is writing into law what we feel is in our bones – that is, to enable us to live meaningful and dignified lives, even if we lose our mental capacity.

Passed in 2008, the MCA introduced the Lasting Power of Attorney (LPA). This is a legal instrument that allows each of us to choose someone we trust to make decisions for us, if and when we are no longer able to do so. We are called the "donor". The entrusted proxy decision-maker, who is usually a family member, is called the "donee". It also enables us to act in the best interests of our incapacitated loved ones. We can apply to Court to be appointed as "deputies" to act for our loved one who has lost capacity but has no LPA.

The MCA is undergirded by three fundamental principles. First, we respect the choices of a person who has mental capacity. We cannot assume a donor lacks capacity just because we think he or she could have made a better decision. This is so, even in respect of the choice of donee.

Secondly, family should be the first line of support and the community should also play a part in supporting those who do not have familial support when they lose capacity.

Third, the state must build a system with sufficient checks and balances to protect individuals who lack mental capacity from abuse or having their interest compromised. This has to be done without making access to LPAs too restrictive, which will defeat the purpose of the LPA in the first place.

The MCA has been in operation for about six years now. During this time, the number of LPAs registered with the Office of the Public Guardian (OPG) has grown significantly from 480 in 2010, to 8,400 in 2015. But, honestly, this is still not enough. More of us need to make our LPAs.

Over these past six years, we have also implemented the MCA framework. We have learnt useful lessons and it is timely to amend the MCA to meet emerging needs and strengthen its protection capability.

Let me now draw the attention of the House to the key amendments which we are proposing to the MCA. In summary, the amendments aim to:

(a) better prepare us for a future where there will be a need for professional donees and deputies to help those who do not have family or close friends to be their proxy decision-makers;

(b) better protect individuals who lack mental capacity from being abused or exploited by their donees or deputies;

(c) improve commercial certainty in the use of LPAs in transactions with third parties for the benefit of the donor; and

(d) improve the operations of the OPG to serve the public better, by equipping the OPG to handle higher volumes of LPAs and more complex investigative work.

In preparing this Bill, we have sought feedback from organisations in the legal, banking, insurance, medical and social service sectors, as well as members of the public. They have all provided very valuable insights and supported the proposed enhancements. We also studied the experience in some countries with a longer history of similar legislation, such as the UK and the US, particularly in Florida. These jurisdictions also have a more developed private sector to serve as professional donees and deputies.

Besides these legislative amendments, we are also undertaking some policy initiatives that complement these amendments. I will elaborate more on these initiatives later.

Families are a key source of support for our elderly. A large majority of donees and deputies today are family members. They have stepped up out of love and concern for the person whom they have been appointed for, and this is as it should be. However, there will be a small and increasing number of elderly singles or childless elderly couples who may not have family members or close friends to rely on to be their proxy decision-makers.

One MSF officer recently recounted to me her visit to a Dementia Day Care Centre. Some of the elderly there were in the early stages of dementia and were still lucid. Among them were a few single elderly with no relatives or close friends. They had worked hard and saved carefully for their old age. But they were deeply anxious, as they had no suitable person to nominate as their donee. They were actually quite afraid about what would happen to their dignity and quality of life when they lose capacity. They did not want to become wards of the state. The officer told me that she cannot forget the worry and anxiety she saw in their eyes.

The community has stepped forward to work with MSF on supporting a small number of such elderly who had no family support. About one-and-a-half years ago, we started work with public-spirited volunteers from the medical, legal, accounting and social work professions to form a panel of deputies. Once appointed by the Court as deputies, they helped to manage the affairs of the elderly persons and ensure that their finances are used for their care by setting up a trust with the MSF-funded Special Needs Trust Company (SNTC).

This arrangement – which is in the pilot stage with five test cases – has worked well so far. In one case, the elderly lady who was helped could use her finances to upgrade to a better room in a nursing home. She was happy with this. She was even more joyous that she could resume attending her weekly church service, as she could now pay for her transport fees and other incidental costs.

The number of elderly without next-of-kin will increase. In light of this, we intend to enable paid doneeship and deputyship services. The Bill thus introduces the concept of "professional donees" and "professional deputies". It empowers such elderly, especially those with assets, to have a choice and to give more complex instructions as to their care should they lose capacity.

Professional deputies are those who can provide deputyship services for a fee. They are appointed by the Court to act on behalf of individuals with assets who lack mental capacity and do not have family members or friends who can play the role of a deputy. We envisage that professional deputies would include licensed trust companies, as well as professionals, such as lawyers and accountants. They must not be related to the person they have been appointed for. A professional deputy must be registered with the Public Guardian (PG). We have not finalised the details of the registration framework and will be consulting stakeholders extensively before we do so. However, let me share some of our initial thoughts on how we think it will work.

To be considered for registration, the professional deputy should not be a bankrupt. He should also have sufficient knowledge of the MCA and what a deputy's role and responsibilities are. The PG will be empowered to cancel the registration of a professional deputy, if certain events occur. One such event could be that the professional deputy becomes bankrupt or is convicted of an offence involving fraud or dishonesty. Upon cancelling registration, the PG can apply to Court for the professional deputy's appointment to be revoked.

Unlike deputies, who are appointed by the Court after the individual has lost mental capacity, professional donees are chosen by the individual when he still has capacity. The Bill will limit professional donees to two groups, namely, (a) professional deputies who are registered with the PG; and (b) certain prescribed classes of persons, such as licensed trust companies, which can already act as donees and deputies under the MCA today. Licensed trust companies are regulated by MAS under the Trust Companies Act.

The passing of these amendments will just be the first step towards regulating the professional deputy and donee sector. We will consult the various stakeholders extensively before finalising the details. But the key principle behind the framework is this – mentally incapacitated persons are extremely vulnerable. Hence, the regulatory framework must ensure that a professional donee or deputy is competent, of suitable character and accountable to the relevant authorities for what he does.

Members may have concerns about the fees that professional deputies and donees will charge and what will be done for those who need these services but are without means. I assure members that for these individuals, MSF will work with partners to ensure that pro bono or low-cost services are available, just like what we did in the pilot.

Some may also ask why the Government does not provide doneeship and deputyship services. I do not think it is possible nor wise for the Government to be everyone's donee or deputy. It is certainly not appropriate for the Government to manage the assets and personal welfare matters of private individuals. Our role is to put in place an effective regulatory framework that enables these services to be provided, while protecting the interests of those without mental capacity.

Let me now turn to enhancing the protection of those who lack mental capacity from abuse or exploitation and share what we have learnt after operating the MCA for six years.

Members of the House will know of some of the cases we have encountered, where there were concerns about exploitative behaviour by donees. Some Members have also offered suggestions on how to improve the LPA framework to prevent such abuses from recurring.

I am relieved to say that these cases actually only form a small minority and the law has taken its course in protecting the donors. Nonetheless, we have reviewed the matter and propose two key amendments to the MCA. The aim is to enable pre-emptive action, so that individuals who lack mental capacity can be better protected against abuse by their donees or deputies.

First, the amendments will allow the Court to revoke a donee's or deputy's powers if there is significant risk of the donee or deputy abusing the person whom they have been appointed for. For instance, the risk of abuse would be significant, if the donee or deputy is convicted of an offence involving dishonesty or fraud. This offence could have been committed against some other person and not simply just the donor. However, the donor has no capacity. He is vulnerable. With the proposed amendments, the Court can pre-emptively revoke the donee's or deputy's appointment and eliminate chances of exploitation from happening.

Second, the amendments will allow the Court to suspend the powers of a donee or deputy, even if no prior application was made to it. Let me explain how this works. Say, for example, a deputy has been charged with an offence involving fraud or dishonesty and there is a real risk that he will dissipate the assets of the person who lacks mental capacity. We want to be able to suspend the deputy's powers while investigations are on-going. We cannot do it today.

We must have a prior or concurrent Court application to revoke the deputyship order. However, it is not appropriate to apply for a revocation as the deputy has only been charged, but not yet found guilty and convicted by the Courts.

With the amendment, we can now apply to Court to suspend the powers of the deputy without having to apply to revoke the deputyship order. We can, thus act pre-emptively and, hopefully, in a timely manner.

Let me illustrate how these two amendments will work together to better protect donors who have lost capacity. I will use the facts that are already known to the public about the case involving Mdm Chung and former China tour guide, Yang Yin. But I will just be using the case as an illustration. I will not comment on any aspect of the case which is still on-going in the Courts and I will also not comment further than what I will say below.

As is public knowledge, Yang Yin was charged with offences of falsifying receipts at his company and criminal breach of trust of monies belonging to Mdm Chung. In these kinds of cases, there is a cause for concern because the donee has been charged with an offence involving fraud or dishonesty and there is a risk of the donor's property being dissipated if nothing is done.

In order to preserve the donor's assets, the proposed amendment will now allow an application to be made to the Court to suspend the LPA immediately, without having to apply for a revocation of the LPA. Once investigations are complete and if the donee is eventually convicted of the offences, the Court may then revoke the LPA.

Some may suggest that we should be even more pre-emptive. Nip the problem in the bud at the LPA-making stage. For instance, make it mandatory for donors to inform their family members about their LPA, or give the PG the power to refuse the registration of an LPA if he suspects that the proposed donee is not a suitable candidate, or is not a family member.

But I think it is important that we must remember that one of the fundamental principles of the MCA is that the decisions of a person who has mental capacity must be respected. Where do we draw the line if we do not respect that person's autonomy?

The officers at OPG have encountered cases where both sides of the same donor's family have competing claims. In one case, the donor's daughter alleged that her brother had unduly influenced their mother to make an LPA appointing him as donee and restricted her access to their mother. According to her, he was eyeing their mother's property. On the other hand, the brother claimed that the relationship between mother and daughter was so estranged that their mother did not want to see her and never wanted to appoint his sister as a donee. So, who is right and who is wrong?

In another case, a donor appointed a friend to be his donee, even though he had three children as well as extended family. His children complained to OPG, but it turned out that there was no evidence of undue influence. In fact, the children did not appear to play a big part in the donor's life at all. And the donee turned out to be his close childhood friend whom he trusts.

So, these cases illustrate that each case has its unique circumstances. It is not for the PG to decide against a donor's wish. Neither is the PG the arbiter of another's choices, such as in appointing one child as donee and not the other. Doing so will compromise PG's ability to render objective reports to the Courts when called upon to do so.

The PG only steps in and, rightly so, when there is no family or friend to intervene for a donor who has lost capacity and the donee or deputy is not acting in his best interests.

Having said that, we do want to encourage donors to not only choose their donees carefully but to discuss their wishes ahead with their loved ones. Hence, we have amended the LPA Information Sheet to encourage donors to inform their family members about their LPA. We believe that this would enhance family support if the LPA needs to be activated.

Let me now move on to a different matter altogether. Besides making amendments to better protect individuals who lack capacity, we also want to improve commercial certainty for donees and third parties who transact using the LPA.

Currently, section 16 of the MCA protects a donee or any third party who transacted with the donee, if they genuinely did not know that the LPA has not been validly created. An LPA could be invalidly created, for example, if the donee handling property and affairs is an undischarged bankrupt at the point when the LPA was made. The third party transacting with the donee may not know of the donee's bankruptcy, which renders the LPA invalidly created. So, section 16 protects a third party in this scenario.

This Bill extends the current section 16 to situations where the donee or third party did not know that the LPA had been revoked or suspended. This amendment will also provide commercial certainty for subsequent transactions involving the donor's assets in such scenarios.

With this amendment, businesses will have confidence to transact with donees using the LPAs as there would be sufficient commercial certainty. And this is important because this will, in turn, help the persons who have lost mental capacity to access needed services.

Let me go on to the final part of the amendments. We do want to improve the operations of the OPG to serve the public better. We are grateful to all those who made suggestions on how to do this. We have already made some changes based on feedback received, involving the simplifying of the LPA form. However, there are other improvements that require changes to the MCA.

First, we have seen a sharp rise in the volume of LPAs registered with us. We expect this trend to continue as the population ages and as awareness increases. In fact, we do want this to happen. So, we will introduce an Assistant Public Guardian to assist the PG in carrying out his functions. The Assistant Public Guardian will exercise all the powers of the PG, except the power of delegation. The Assistant Public Guardian will be an MSF officer.

Second, we also anticipate that the cases which the OPG has to investigate will become more complex, especially when fraud and financial exploitation have allegedly been committed against a donor with significant and different types of assets. The amendments will allow the PG to appoint an auditor to assist the PG in examining donees' and deputies' reports or any information obtained by the PG in the exercise of PG's investigative functions. The auditor appointed by the PG must be a public accountant registered under the Accountants Act.

Third, we will repeal section 33 of the MCA which established the PG Board. When the MCA was first enacted, the PG Board was created to review the way in which the PG's functions were discharged and to report to the Minister. This was something new to us and, to my knowledge, no board was ever set up in Singapore previously to specifically supervise the work of a public officer. But given that the MCA was an important and a new piece of legislation modelled after the English Mental Capacity Act, we thought it would be prudent to also follow England's practice of having a Board as well.

The Chairman of the PG Board has now recommended to me that the existing Board be replaced with an administrative Advisory Panel. As OPG has reached a level of maturity in its operations, he noted that in 2012, even England's PG Board too, was dissolved after being in existence for about five years. Even as we replace the PG Board with an Advisory Panel, I think it is important to ensure that there are adequate checks and balances.

First, the PG, like any other public officer in the Ministry, will continue to be accountable to the Minister. Appeals against decisions made by the PG can be made to the Minister. Ultimately, a judicial review and appeal through the Courts remain an option. Given these reasons and the checks and balances in place, I have agreed with the Chairman to replace the PG Board with an Advisory Panel.

At this juncture, I wish to place on record our thanks to the PG Board for its contributions during these six years. They have guided the OPG in the implementation of the MCA and were instrumental in establishing OPG's links with the medical, legal and financial sectors.

I mentioned earlier that the amendments introduced by this Bill will be complemented by policy initiatives that do not require legislative amendments. One such initiative involves helping families caring for adult children with intellectual disabilities.

It is not easy to bring up a child with intellectual disabilities, especially if the caregivers themselves are getting older. An MSF officer told me about an elderly couple in their 70s. They have two children with intellectual disabilities, who are in their 30s and 40s. Their father is a lorry driver, their mother a full-time caregiver.

They worry about their children's welfare when both of them are no longer around. They could will their assets to their children, but who will manage it for their benefit? Their case is urgent because they are no longer young. And these concerns are not uncommon. In fact, I think for many parents who have children with intellectual disabilities, this is one of their main areas of concern.

We have been working hard to address the concerns of these parents. First, we have worked with the special needs community to set up the SNTC, which I mentioned earlier. This non-profit trust company enables parents to set aside money for their child in a trust account, so that the trust money will be used for the child's care needs when they, as parents, are no longer around. Money placed in the trust will be administered according to a care plan drawn up by the parents with the help of SNTC.

This elderly couple signed up straightaway after hearing about the SNTC. They shared with us that their minds are definitely more at ease now, as SNTC will use their savings to implement their children's care plan after they pass on. We want to encourage more parents to make use of this service.

The second thing we are doing is to help parents who have children with special needs to obtain deputyship orders more easily. We have piloted a project with MINDS for parents of MINDS students to obtain deputyship orders. Three cases have obtained Court orders so far. The parents are grateful for the help extended. They initially hesitated due to concerns about cost and complexity of the process. But they realised that their fears were unfounded. Immediately after the Court hearing was over, one set of parents came out of the courtroom and thanked everyone involved. In another case, the whole family got involved. While the parents became deputies, the MINDS student's two older brothers who were in their 20s, became successor deputies. As successor deputies, they could take over from their parents should the need arise. This is a good thing.

We are very heartened by the experience, but we know that there is much work that needs to be done in this area. We are now working with MINDS to put in place a systematic process for every year's graduating cohort of students with intellectual disabilities. We also hope to start work to look at those who have already graduated, as well as cover other forms of relevant disabilities, including certain types of autism. We are also working with the Family Justice Courts on a user-friendly IT system to enable parents and laypersons to apply for deputyship orders without incurring high cost or hassle.

Mdm Speaker, the MCA is not a law for older Singaporeans only. It is a mirror for all of us. It reflects the way we want to live, across the different phases of our lives and across the generations. How we treat our parents and family members; how we ourselves want to be treated with respect, with dignity; and when we are no longer the man or woman we once were, how we want the younger generation to step in to hold our hands and help us along. Not in the direction that they want, but to respect the decisions that we, in our better days, had decided for ourselves. To this end, I urge more Singaporeans to think about their future, make plans and do up an LPA. This will help make the care-giving journey easier for your family members.

This mirror also reflects on the professional communities. As our population ages, we need more professionals willing to step up to serve as professional donees and deputies. The role of the Government is to create regulatory frameworks, such as the MCA, to allow us to live the best life possible, whatever our circumstances – in sickness and in health, in wealth or poverty, compos mentis or not.

But the MCA can only contain so much. Mdm Speaker, I said earlier that the MCA is merely writing into law what we feel in our bones. What is our collective understanding about the duty owed to the elderly and to respect the wishes of the mentally incapacitated among us? What is our joint action on the policy initiatives and family and community effort?

The most vulnerable members in our society – the individuals who lack mental capacity − are often the most invisible. Our duty is to protect them, to respect their wishes and to enable them to live with dignity. Mdm Speaker, I beg to move.

Question proposed.

5.15 pm

Ms Denise Phua Lay Peng (Jalan Besar): Madam, I support this Bill that seeks to amend and improve the current MCA. 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 LPAs have been 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 the 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 are 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 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 be 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 Chun versus her former tour guide, Yang Yin. It is alarming and I quote this just for discussion, as what the Minister had also quoted. 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 worth of her assets. It is also appalling that Yang could do as he pleased in his apparently calculated dissipation 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 OPG 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 the 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: (a) provide a set of fee guidelines for the types of legal services relevant to the MCA and the Bill; (b) 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 (c) allow the use of CPF and/or Medisave to pay for the required costs incurred in the 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 are 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 their behalf. 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 take 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 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 assistance 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 the 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 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 UK, for instance, already has its digital LPA services, which allow 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 these, 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 PG'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, CPF Board, grassroots and 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 to be so and many lives will be positively helped as a result.

I, therefore, urge that the Ministry reconsider 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.

5.28 pm

Ms Sylvia Lim (Aljunied): Mdm Speaker, the Bill enhances the regime of the Mental Capacity Act passed in 2008. The Bill will allow professionals to become donees and the Court-appointed deputies under the Act. It also gives the Court additional powers to manage cases where a donee's or a deputy's powers may need to be revoked, restricted or suspended. While I support the rationale for the Bill, I wish to raise three concerns: first, regarding early intervention in problematic LPAs; secondly, about the process for parents of disabled children to be Court-appointed deputies; and, thirdly, to seek a clarification on the changes regarding the accountability of the PG.

First, early intervention in problematic LPAs. While the benefits of LPAs are clear, the risks have also been painfully clear in recent years. Vulnerable persons may sign away their rights to property to persons who have unduly influenced them. Besides the well-publicised case involving a wealthy widow, which Minister mentioned earlier, I have received feedback from residents concerned that a family member may have appointed someone outside the family as his attorney.

In these cases, it is foreseeable that some time down the road, when the LPA is activated due to mental incapacity, the attorney and the family may have disagreements and disputes over how the person should be cared for or his properties dealt with. I am not saying that a person is not entitled to appoint someone outside the family as an attorney. Indeed, I totally agree that there may be very good reasons why a person may not want a family member to be his attorney and may not want the family to know of such an appointment.

However, currently, all that is needed is for a standard form to be filled up by the person and issued by a doctor or lawyer who may not have any prior knowledge of the person or his circumstances. To illustrate, I am told that under a well-intentioned ground initiative, large groups of heartland residents were organised to make LPAs at the Ministry issued by persons who had not met them before.

Earlier, the Minister mentioned that the LPA Information Sheet is being amended to encourage donors to inform loved ones of the making of the LPA. I would like to ask if the default LPA form could retain a question asking the donor if he wishes to notify another person about the making of the LPA. Under the original MCA framework, if the donor named another person to be notified for the making of the LPA, the named person would have an opportunity to object to the registration of the LPA. The objection would then need to be assessed by the PG or the Court before the LPA can be registered.

Such a regime would enable LPAs granted in controversial circumstances to be flagged out early before the LPAs take effect. This potentially prevents the registration of unsound LPAs before the donee takes charge of the properties of the donor. Moreover, the objection to the registration of the LPA will likely be made when the donor is still mentally lucid and can give invaluable assistance to the PG or the Court to determine if the LPA should be registered or not.

Madam, this option to notify a named person was removed from the default LPA form in 2014. From what I gather, the Government did not see the need to retain this feature as it was always open to the donor to notify someone if he wished to. Nevertheless, my view is that it is good to ensure that the donor is always asked whether he wants someone to be notified so that he will direct his mind to that question specifically. If this is adopted, we will still be respecting the donor's wishes – he can decide whether he wants to notify someone else or not.

Madam, next, Court-appointed deputies. I next move on to deputies who may need to be appointed by the Court after a person has become mentally incapacitated. Their concern is about the legal cost associated with such applications. The estimated legal cost for such applications is about $6,000 to $7,000 even in the clearest of cases. For instance, parents of mentally-incapacitated children need a Court Order to act for their children once they attain adulthood. It is clear that these parents will continue to care for their children with or without a Court Order.

At last year's Committee of Supply debate, we were told that the Ministry would work with the Court to simplify the process and improve the accessibility of the Court processes and also to reduce the cost to make it easier for the families. It was reported in March last year that there was a pilot project involving law students which enabled costs of such applications to be brought down to about $250. In January this year, the Ministry said it was still working with the Family Justice Courts and MINDS on how to simplify the paperwork and process in such cases. This review has been going on for many months already. Is the Ministry able to confirm or estimate when this review will be completed?

Lastly, Madam, accountability of the PG. Earlier, the Minister explained the rationale for clause 11, on why the Public Guardian Board was being abolished. I have a question about clause 12. Currently, section 34 of the Act provides for the PG to make annual reports to the Minister about the discharge of his duties, and I believe these reports are uploaded on the website of the OPG.

Clause 12 repeals this provision totally, which suggests that the PG need not produce annual reports anymore. Could the Ministry explain why this section is being repealed? How would this affect the public accountability of the PG?

5.34 pm

Ms Joan Pereira (Tanjong Pagar): Mdm Speaker, I rise in support of the Bill. Last month, the Minister for Social and Family Development informed this House that 8,360 people had signed up for the LPAs in 2015. This was a big increase of 160% over 2014.

However, if we consider that only about 20,000 LPAs have been accepted since the MCA came into operation five years ago, the number of Singaporeans who have done their LPAs is still very low.

I recognise that this is not for lack of trying. The Ministry had made concerted efforts to raise public awareness. There were regular media coverage and public education efforts to get more Singaporeans to appoint donees to make decisions on their behalf in the event that they lose mental capacity in the future. I have seen colourful, full-page advertisements on the LPA in both the English and Chinese newspapers.

The Government had even simplified the forms and offered waiver of the $50 fees for the simpler and more widely chosen Form 1 applications between 1 September 2014 and 1 September 2016. Despite all these efforts, the general awareness is still not high, especially among the elderly.

Even those who are aware of the scheme are not pro-active in signing up. Some do not think it is necessary. Others assume erroneously that, by default, their spouses and children will be able to make decisions on their behalf. Yet others are superstitious and prefer to avoid this topic altogether. And, probably, the rest are procrastinating.

Considering our rapidly ageing population, it is important to get more Singaporeans to do their LPAs. With longer lifespans, the probability of loss of mental capacity in the final years is higher and will affect a greater number of people.

Without appointed donees, our Courts will have to hear more applications by affected families to appoint deputies when their loved ones lose their mental capacities. Not only will this be a strain on the resources of the families during a difficult period, it will also tax our public resources. Much more importantly, without appointed donees, the welfare of the elderly will be compromised as care and financial arrangements will inevitably be delayed.

Allow me to share a real-life example to highlight the hardships a family went through due to the absence of an LPA. And this is a case from my constituency.

An elderly gentleman fell ill and, after a prolonged stay in hospital, he was discharged as the doctors were unable to do more for him. His children took him home. His condition was bad but he hung in there and his children arranged for various medical equipment to be installed at home, which were quite costly.

He had his own HDB flat and funds in a few bank accounts. His wife passed away a few years ago. Unfortunately, his children could not draw upon the funds in his bank accounts and so they used their own money.

His children also had to support young children of their own. After a few months, they decided to seek help at a Meet-the-People session because the financial strain was increasingly harder to bear.

In such a situation, the children should apply to the Court to appoint them as deputies to manage their father's care as well as property and financial assets. However, this process is definitely more troublesome and time-consuming than if an LPA was done earlier.

The first target group we must work with is the elderly. Many of them are not aware of LPAs. We should have more publicity in mother tongues, including dialects, as we have done for the Pioneer Generation scheme.

May I also suggest that we brief our Pioneer Generation Ambassadors(PGAs) so that they can share about LPAs with our senior citizens when they visit their homes? Our PGAs can explain the implications and the importance of selecting the right donees.

The third non-legislative initiative I would like to propose is to get registered medical practitioners who are certificate issuers to put up big, elderly-friendly signs indicating that they can witness and certify LPAs at their clinics. The OPG should design and issue these uniform signs.

Compared to registered psychiatrists or practising lawyers who are also approved certificate issuers, doctors are much more accessible to the general public. I am sure most people will feel more comfortable approaching their regular neighbourhood GPs to get their LPAs done. These signs will also act as visual prompts to their patients and remind them to do their LPAs.

Next, I would like to refer to the amendment to allow the Court to temporarily suspend a donee's or deputy's powers in the absence of a pending Court application. May I ask the Minister if he would share with us the process and duration required to get rid of an unsuitable donee or deputy?

Obviously, prevention is very much better than cure. Therefore, the process of selecting suitable donees or deputies should be rigorous. It is far better to choose a suitable one than to have to go through the process of getting rid of an unsuitable donee or deputy.

May I ask the Minister if the PG has a set of parameters to check against when it receives LPA applications? For example, if the donee is not closely related or is unrelated to the donor despite the donor being married with children, would red flags be raised? What if the donee is a foreigner? Would the PG arrange for an interview with the donor to clarify suspicious applications, follow up with his family members, and provide counselling and advisory services?

I believe strongly that the family should be the first line of support but, in the event that family members are found not to be suitable to be deputies, how does the Court decide on which professional deputies to be appointed? And for deputies who have been suspended, are their names made known in a register which can be accessible by the public?

I appreciate the Minister's response to my questions. I would like to conclude by reaffirming my support for the Bill.

5.42 pm

Mr Dennis Tan Lip Fong (Non-Constituency Member): Madam, I declare my interest that, as a lawyer, I have assisted in matters relating to the MCA.

Madam, I am in support of the proposed amendments to allow the appointment of professional donees and deputies. I recognise that it is necessary to allow such appointments as some persons who are subject to the Act may not want their family members to take charge of their personal matters or be their donee or deputy, or some people simply do not have a suitable relative or friend to be their donee or deputy.

Madam, fuller details of the requisite criteria and qualifications for professional donees and deputies should be provided in the Act or in this subsidiary legislation. The criteria should go beyond just allowing people to qualify as professional donees and deputies by merely being members of certain professions, say, for example, doctors, lawyers, accountants or even social workers, or even community groups. And I will also extend that to trust companies.

Each individual candidate for professional donee or deputy, including those working in trust companies, must have the relevant training. They must also possess the right attitude. Will the Minister please share with the House more details of the criteria and training for professional donees and deputies?

Next, the system of professional donees or deputies should be affordable and accessible to the average Singaporean. It is important that the fees of the professional donees or deputies be subject to control and regular review by the Ministry or by the Courts. Will the Minister please explain how the Ministry intends to ensure that the fees be kept affordable? How does the Ministry expect the Courts to determine the remuneration under the proposed new section 24(8A)(b)? May I suggest that the Ministry should have a fixed set of scaled fees which the Courts can then use as a guide or benchmark and this scale can be adjusted from time to time when necessary?

In any case, there may also be some people who will not be able to afford a professional donee or deputy and, at the same time, are not able to find a suitable person to do it for free. For deserving cases where the persons are unable to pay for a professional donee or deputy, it is important that the Ministry should still allow access to a professional donee or deputy by allowing such fees to be paid for or waived. I am indeed, encouraged by the Minister's opening remarks on this issue. Indeed, there should be an equivalent of a Legal Aid mechanism where the Ministry can fund deserving cases. Alternatively, the Ministry can consider starting a pool of suitable and trained volunteers who can assist in such cases on a pro bono basis.

Madam, I support the new provisions for the appointment of an auditor to assist the PG in examining any report of a donee or a deputy. I also support the new amendments for the additional persons, including the PG to apply to the Court for an order to suspend the powers of the donee and deputy. This will allow the PG to intervene in suitable cases where the donee and deputy may not be carrying out his duties properly and the interests of the persons which the Act seeks to protect can be better safeguarded.

Madam, as a lawyer, my observation is that the present application process for deputies, when compared to the previous regime, is more complicated, time-consuming and, possibly, more costly. May I suggest that the Ministry expend more efforts to dialogue with the Family Courts to see how the procedure can be further simplified so that it will take less time, require less paperwork and Court hearings are further minimised? They should, in fact, make it easier and less costly for any layperson to make such applications directly. For example, instead of using formal Court applications, summonses and affidavits, we can also consider using appropriate layman-friendly application forms, supported by statutory declarations. The current affidavit template can be converted to such a form.

Perhaps, we can really think out of the box here. If we can simplify the application, the legal fees can be further reduced. The Court filing fees for all documents can also be reduced by not having it pegged to the existing Court filing fees for Court summonses and affidavits. I would also suggest that even for the present regime, a detailed checklist can be published on the relevant website of the likely issues that need to be addressed in each application and the depth at which the issues need to be addressed. This will help lay people to better understand the requirements of the application readily. With that, Madam, I support the Bill.

5.47 pm

Assoc Prof Fatimah Lateef (Marine Parade): Mdm Speaker, this amendment Bill comes at a timely, critical juncture when, one, we are facing the steep curve of our ageing population; two, when our communities and families are getting more empowered and informed about such matters; and, three, most importantly, it is about mainstreaming and providing support for those lacking in mental capabilities and capacity amongst us.

With modernisation, our smaller nuclear families, "empty nest" syndrome, singlehood and widowed spouses from the longer duration of lifespans, especially for women, we have all these that are pointing in the right direction towards this updated Bill.

When there is a lack of our first line of support, which is the family, then donees and deputies will play a useful role. However, they have to be adequately selected, prepared and appointed. Will the Ministry be able to come up with a listing of eligible persons who meet the criteria? This can then be a checking mechanism and a safeguard, especially for those who really do not have family nor other persons for support. Moreover, we can expect many of these persons to be in the more advanced stages of their lives and we do not want them to be taken for a ride or be taken advantage of by unscrupulous parties. I, therefore, support the suggested aid for those who deserve it and also a kind of a Legal Aid mechanism mentioned earlier.

For example, in the UK, there is the Independent Mental Capacity Advocate (IMCA) who gets appointed to support a person lacking in capacity but has no one to speak for him. The IMCA can make representation on the person's wishes, feelings and beliefs and bring these to the attention of decision makers. In the NHS, for example, an IMCA is appointed for those who need serious medical treatment in hospital, for those staying more than 28 days in an acute hospital or eight weeks in a care home.

I am not saying that we adopt this wholesale. But, in it, there are, indeed, gaps and limitations that perhaps consideration of some modifications or a customised version might be useful for our setting.

It will also be useful for such a list to denote areas of specialisation of the personnel, such as whenever it is related to personal affairs, property, welfare or financial matters. This will reduce waste of time and expected changes that may need to be done later on if the wrong person is appointed.

Next, will the Ministry be able to come forth with a suggested remuneration guideline for such cases, which can also be used as a reference? This may require it to be tagged to a suitable market rate, but with some degree of flexibility. But the main aim would be not to overburden such affected families, who may already be financially over-stretched.

For those with mental incapacity who are institutionalised, for example, in nursing homes or attached to a VWO, can there be consideration for a "package offering" for them, especially for those with no next-of-kin and families? Importantly, also, there must be some guidelines to exempt or exclude those staff who are directly involved in the care of these clients from being their deputies for reasons of conflict of interest.

On dealing with requests for medical reports for such cases, can we have a systematic algorithm streamlined, clearly drawn up, because I find that this can actually be a rate-limiting step or factor in most cases?

When the Court suspends the donee's or deputy's powers in the absence of a pending Court application, can the Minister share with us the timeline within which this is acceptable before it needs to be considered void?

Finally, can the Minister explain and take us through how this Bill will work or be executed for those who have already signed or are in the process of signing the Advance Medical Directive? This would be an interesting point as we are facing the onslaught of an ageing population.

One more point, for a patient who has severe mental health disorder – I am not referring to the mild or moderate spectrum where symptoms can be controlled by drugs and therapy and they can function normally in society, the family and at work, which affects the insight and cognitive capabilities of persons – can they be covered under the MCA, and I assume they would, of course, need their medical specialists to verify and certify the severity of the illness in this case? And, of course, need to be given a case-by-case consideration.

In conclusion, Madam, a person is not to be treated as unable to make a decision merely because he makes one unwise decision. Any decision made under this Act for a person lacking mental capacity must be made in his or her best interest. In Malay, please.

(In Malay): [Please refer to Vernacular Speech.] Mdm Speaker, in amending this Act, we can do more to share information with the public. This is because many are unsure and unaware about the application of this Act. We must explain its details in a way that can be easily understood. Many people within our Malay community will not be able to understand the facts in its present form and, because of that, the number of people making use of this Act is very small. In fact, as they get older in the coming years, many will develop symptoms of dementia, stroke and others that can affect their intellectual capabilities.

Therefore, I would like to propose the following measures: firstly, explain the definition of "mental capacity" and the meaning of lack of mental capacity to the public; secondly, what is the OPG and how does it provide advice, counselling and assistance to the public; thirdly, what is the hotline that the public can call if they need to seek clarifications and are the staff able to communicate in Malay as well as the other languages; fourthly, simplify the application process, with an option to fill out a form or to do it online. If we are required to provide data and information that are 10 pages long, many will not even want to do it. With that, Madam, I support this Bill.

5.54 pm

Mr Louis Ng Kok Kwang (Nee Soon): Mdm Speaker, I stand in support of the Bill and I am glad that the Government is proposing amendments to enhance the protection of mentally incapacitated persons and also help Singaporeans and residents better plan for the future.

With the rising number of singles and increased number of elderly living alone, it is timely to introduce professional donees and deputies, as this group of people might not have family members who can help them. There are, however, a number of issues I would like to raise.

Firstly, ensuring family support remains the priority. We must continue to focus on family support as the priority. As emphasised by respondents during the public feedback exercise, the use of professional donees and deputies should be a last resort as family members should ideally be involved in making these important decisions for the person.

I understand it might not be easy to verify this, but can the Minister provide details on what steps MSF can take to ensure that family members were unwilling, unable or unavailable to help, especially before a professional donee is appointed?

Can the Minister also clarify if all professional donees will be registered with the PG since not all donees might be deputies?

Next, on section 25A(2) which states that "The Public Guardian may register a person as a professional deputy upon being satisfied that the person meets all the prescribed criteria". As raised previously by Members of this House, may I ask what these criteria will be, and will this information be released to the public?

As mentioned, now we have a rising number of singles and an increased number of elderly living alone. What is the Government's plan to encourage this group of people, especially those without family members, to make the LPA? It is difficult for the elderly to understand what an LPA is, let alone how to apply for one. Could the Pioneer Generation Office perhaps help with the outreach and provide advice to them on LPAs?

I appreciate that the LPA forms have been simplified and, for Singapore Citizens, the $50 application fee for the most common LPA form used is waived. This has probably resulted in the 160% increase in applications for LPAs in 2015, as compared to 2014.

But for the elderly group of people mentioned earlier, I doubt these measures will result in an increase in LPA applications from this group. We need to really reach out to them and make them aware of the LPAs in the first place. Also, as previously mentioned by other Members, the professional donees and deputies will clearly be charging for their services. Can the Minister give an idea of what the estimated costs will be?

As the demographics of people who might need this professional service will tend to be single, elderly and without family support, I am concerned that the use of this service might further result in a financial strain on them as they might already have limited financial resources.

I understand that MSF does already, on a case-by-case basis, waive application fees for LPAs for those who cannot afford the fees. Will MSF or the OPG also consider providing financial assistance to those who are unable to afford the fees of a professional donee or deputy? Will MSF also consider working closely with VWOs in the social service sector to develop the professional deputies and donees industry?

Working with the non-profit sector, rather than the for-profit sector in this case, might result in lower professional fees and better services. Staff members or volunteers of these VWOs may already be providing services to the individuals and will already be familiar with their needs and preferences.

Lastly, as the Minister has mentioned, parents of children with intellectual disability have to apply to the Court to appoint themselves as deputies for their children. Will MSF consider allowing parents of children with intellectual disability to be deputies by default? I believe this will help them save valuable time, energy and financial resources.

I understand that MSF – and the Minister has mentioned it earlier as well – has reviewed this recommendation and has decided against it. It is instead working on simplifying the process. Can the Minister provide further updates on how it is making the process easier for the parents of children with intellectual disabilities to be their deputies?

In conclusion, this Bill makes important amendments and will undoubtedly benefit Singaporeans. Mdm Speaker, I support the Bill.

5.58 pm

Ms Rahayu Mahzam (Jurong): Mdm Speaker, I thank the Minister for his clarification on the proposed Bill. I would like to take this opportunity to address two matters: firstly, the specific proposal in respect of "professional donees" and "professional deputies"; and secondly, public access or ease in applying for the LPA or obtaining an order for the appointment of a deputy.

I welcome the introduction of the "professional donees" and "professional deputies" and the creation of a registration framework for professional deputies. I note this proposal will address the emerging needs of the ageing population in Singapore, especially with the increasing number of elderly singles or elderly couples who do not have children. These elderly may not have next-of-kin to be their donees or deputies and can refer to a registered group of professionals or assistants.

In addition to such scenarios where no next-of-kin is available, I believe that the services of these professionals can also be extended to situations even where there may be next-of-kin present. I acknowledge that one of the key principles of the MCA is that the family is the first line of support but also note the community has its part to play.

The role of a donee or a deputy can be very challenging. It may be that the available family member is not the best person to help carry out the role, for example, if the family or next-of-kin is overseas. In respect of the appointment of deputy, it may also be that there are disputing family members and one way to avoid the impasse amongst them would be to engage a neutral professional. I know of situations where the finalisation of an appointment of a deputy for an individual is delayed because of disagreements amongst family members. One possibility of resolving this issue is if the family and the Court in appropriate situations have the option of appointing a neutral third party, a professional deputy, to carry out the task, subject to specific orders made by the Court.

I would, therefore, like to seek clarification from the Minister if it is envisioned that the appointment of a professional deputy will be extended to such scenarios. I would propose that it should be, as it would provide options for the family and the Court in appropriate circumstances.

[Deputy Speaker (Mr Lim Biow Chuan) in the Chair]

The Minister had earlier mentioned some criteria for the appointment of professional deputies and donees. I believe it is also important that there be a proper training programme put in place before a person or a class of persons become qualified professional donees or deputies. The role of a donee or deputy is a serious obligation and may require the professional to make complex decisions. In particular, as the professional deputy will have to be registered with the PG, there is a need to ensure the high standards of the professionals as the public will come to rely on the register, expect that the professionals have been screened and can be trusted. There should be a framework to ensure adequate training as well as proper guidelines and supervision of both professional donees and deputies.

I now move to my second point regarding access to the public in creating the LPA and obtaining an order for the appointment of a deputy. A pertinent issue to address is whether costs will be an impediment and this is a common issue which has been raised by a few of my hon parliamentary colleagues. At this juncture, I would also like to declare that, as a lawyer, I have assisted clients in their applications for appointments of deputies.

With the introduction of professional donees and deputies who will be remunerated for their services, there is an issue as to whether there will be guidelines on the appropriate costs to be charged by these professionals. In the case of an appointment of a deputy, typically, lawyers are involved and parties have to incur legal costs. If parties also choose to appoint a professional deputy, there will be additional costs. I, therefore, think that it is important to put in place a transparent cost structure so that such costs do not become an impediment for those seeking to create an LPA or obtain an order on the appointment of a deputy.

The other aspect of improving access of these processes to the public is public education and the simplification of processes. In respect of the LPA, although there has been much public education on its importance and processes, there is still some way to go in helping more people get the LPA done early. To this end, I think efforts can be ramped up at the grassroots level or through volunteers, as alluded to by my colleague Ms Joan Pereira earlier, like the PGAs, to facilitate the registration of the LPA. It may be necessary to bring the process down to the masses, such as making the arrangements for obtaining the appointment with the Certificate Issuer and facilitating the completion and submission of the LPA at community touch-points, such as the CC or CC events.

I would also like to highlight that the applicant of an LPA would also have to incur costs in obtaining the endorsement of a Certificate Issuer. I note that these costs are not prescribed or controlled by the OPG. While the cost may be relatively low for standard situations, this may still be a significant sum for low-income Singaporeans. The Ministry may wish to look at how we can assist this group to defray this basic expense to encourage and facilitate the creation of LPAs.

In respect of the appointment of deputies, many have commented that the process can be complicated, long-drawn and fairly costly. As a lawyer, I understand that the process needs to be sufficiently rigorous, as an order to appoint a deputy is a very serious one. A deputy will be given powers to make decisions on behalf of an individual who can no longer make his or her own decisions. Measures need to be put in place to ensure that proper checks are made, sufficient information is given to the Court and all questions are answered. This could explain why legal costs can be quite high.

However, I believe there can be some effort to assist low to middle income families with this. To an extent, there is already some assistance to those who qualify for legal aid. There are, however, families who may not qualify for legal aid and the costs of obtaining the order on the appointment of a deputy may be a financial strain on them. This is especially so if they have had to spend much of their income on medical expenses. One way to assist is to create a simpler process, one which still preserves the rigour that ensures proper checks are done but does not require complicated legal paperwork.

As a start, the proposed simplified process can be used for straightforward situations, for example, where there is an intellectually disabled adult child whose condition has been certified by doctors and there is no complicated family dispute to be concerned about. I am heartened to note that there are efforts looking into this matter with the pilot project with MINDS, which I hope will be further developed and there will be discussions with the Family Justice Courts to develop a user-friendly IT system for the application of deputyship. These efforts will go a long way in facilitating the process and alleviating the hardship for many families.

In conclusion, I note that there are other legislative amendments, including those that seek to better protect individuals who lack mental capacity by extending the Court's powers to revoke or suspend a donee's or deputy's powers, as well as to improve the operations of the OPG. These proposals are a step in the right direction, with sufficient safeguards to protect and serve the public. Mr Deputy Speaker, I, therefore, support the Bill.

6.05 pm

Ms Jessica Tan Soon Neo (East Coast): Mr Deputy Speaker, the MCA allows individuals, while they still have capacity, to plan in advance for a time when they may lack the capacity to make decisions for themselves with respect to the areas of personal welfare and financial matters.

With an ageing population and the likely association of cognitive impairment with illness or just ageing, it is timely that the amendments seek to better protect the interests of persons who may lose their mental capacity.

The amendments take into account changing realities in Singapore. People are living longer and we are also seeing an increasing number of elderly singles or elderly living with their aged spouses without children. These elderly may not have next-of-kin.

Clause 2 seeks to amend section 2(1) of the Act to make provisions for the introduction of professional donees and professional deputies and the registration framework for professional donees with the PG. The amendments will enable the elderly who may not have family members who could act as suitable donees or deputies to appoint professional donees and deputies to make advance plans for themselves in relation to decisions on their personal welfare, property and finances. As professional deputies and donees are appointed with remuneration, can the Minister provide clarification on the fee structure for the remuneration of donees and deputies? How can we ensure that this stays affordable? Are there regulations for professional donees and deputies and what are the measures to ensure that they have the qualifications to be able to perform the very complex roles that they are entrusted with?

Clause 13 introduces a new section 36A which now allows the Court to revoke a donee's or deputy's powers if there is significant risk of abuse or exploitation of authority by a donee or deputy, even if his or her undesirable behaviour is not directly related to the LPA or Court order appointing him. This will enable the Court to revoke the donee or deputy if they have been convicted of an offence involving dishonesty or fraud against another person and not just the person lacking mental capacity. This is an important improvement and enhances protection for the donors. The current Act only allows the Court to revoke a donee's or deputy's powers if he is likely to act outside of the authority given to him, or is behaving against the best interest of the person who lacks mental capacity.

The Bill enhances the protection of individuals who lack mental capacity as the proposed amendments would allow the Court to also temporarily suspend a donee's or a deputy's powers in the absence of a pending Court application, during which investigations could be carried out. This is an improvement on the current situation in which an application to Court has to be made to remove a deputy or donee for the Court to do so. This is to protect the wealth of the person who is mentally incapacitated, while investigations are on-going.

Sir, while the amendments seek to enhance the protection of persons who lose their mental capacity and vulnerable individuals, by improving the Court's ability to intervene and to ensure the interest of these persons, we must, however, remember that the MCA was built on the principle of the right of individuals to choose with regard to decisions on their personal welfare and finances.

Hence, while these amendments enhance the protection, it will still require the Court to respect the decisions made by individuals when they have the mental capacity to do so, even if these decisions may seem unusual, unreasonable or unwise to some of us. We must, however, recognise that there may be undue influence that could impact a person's ability to make the right choice for himself. In this regard, will the Ministry have programmes and measures to help ensure that individuals understand the implication of the appointment of donees and the LPA? This will support and help them make the right choices for themselves when appointing donees.

This Bill strives to strike a very difficult balance, a balance between enhancing protection and making it less onerous for individuals, while they still have the mental capacity, to plan and make decisions for themselves with regard to their personal welfare and private wealth. Sir, I support the Bill.

6.10 pm

Mr Vikram Nair (Sembawang): Mr Deputy Speaker, I speak in support of the Bill. This Bill is part of our evolution in dealing with the rising challenge of mental illness. The predecessor to the MCA was the Mental Disorders and Treatment Act (MDTA). The MDTA allowed the Court to intervene where it was established that the person had lost his mental capacity. This obviously created problems because, usually, when that happened and the Court action took place, there would be the inevitable dispute on the formation of the Committee. The MCA evolved in the process and allowed the creation of the LPA.

The LPA is a provision that empowers people to make decisions while they are still mentally healthy on who should determine their affairs in the event they lose their mental capacity. The roles and responsibilities of people appointed under the LPA, the donees, are very wide-ranging. They include matters relating to the personal welfare of the person, which includes sensitive topics like where the person will stay, what medical treatment he will get, whether surgery is opted for. These are extremely personal matters. They will also deal with the property and affairs of the person and this also includes sensitive matters, such as whether or not they keep the place he is staying at, whether or not the flat should be sold, how the expenses should be managed.

It is only right that all these very sensitive matters are dealt with by a donee chosen when the person still has his mental faculties. In this respect, the amendments allowing for professional donees are to be welcomed because what they do is they expand the class of people who can be appointed by a person while he still has his mental capacity. I would also suggest the class of persons to be treated as professional donees – it has not been set out in the Bill and I believe this will be set out in subsequent legislation or by guidance given by the Minister – my suggestion for the professional donees would be to define this class as broadly as possible. I believe different considerations apply for professional donees and deputies. Professional donees would, ultimately, be people who are selected while the person still has mental capacity. In this regard, describing this class broadly would allow a person to have more choices as to who he picks as a professional donee. It gives individuals a chance to appoint professionals where they believe professionals may be more reliable than family members.

In practice, being a lawyer, one sees many unhappy situations where family members are involved in personal affairs and this can be for many number of reasons arising from differences of opinion as to how the person should be treated, to even more sensitive matters such as where there is a great deal of expense to be determined, the family members may have other vested interests in preserving the assets or the property, as opposed to taking care of the welfare of the person. So, where there are all these sensitive trade-offs to be made, it is sometimes helpful to have someone who is outside the family to make the decision. For this reason, I think professional donees are necessary. This is also a system that had some practice in the UK, and I think there would be good guidance for us from there, too.

My other suggestion for the professional donees is this. The LPA is currently relatively user-friendly. People can download forms, they can execute them before lawyers or selected doctors, and this is relatively straightforward. The number of applications – I have heard different numbers in the course of today's debate – I believe it would be at least 8,400 people. What I would suggest is, if we are allowing professional donees, standard forms should also be created for the terms on which professional donees are appointed. Perhaps, guidelines can also be given on the fee arrangements and limits that one would expect for professional donees.

I would also suggest these fees begin only after the professional donee starts managing affairs. The more we standardise these processes, the easier it will be for the user. Obviously, the high-income users or people with higher net worth can get professional advice and vary from the standard form. But for most ordinary people, it would be helpful to have standard forms for the appointment of professional donees.

Let me now deal with the next issue. This is professional deputies. Professional deputies are somewhat different creatures from the professional donee. Professional deputies are appointed by the Court. So, typically, professional deputies are appointed only in situations where a person has not actually executed an LPA. So, this comes in where a person has not had a chance to make a choice. I did a straw poll of some of my parliamentary colleagues and I am sad to report that, myself included, none of us has executed our LPAs yet. So, my guess is that there will be a very large class of people who have not executed LPAs. What this means is that the professional deputies will be increasingly important because the reality is that, despite all our best intentions, most people will not make this decision beforehand, and this decision is going to end up before the Court.

For this reason, I would suggest that the class of people to be listed as professional deputies should be relatively narrow and confined. The professional deputies will arise only where a deputy has not been appointed. So, typically, if a person has some loving family members, they will apply to Court to be deputies. There will be no fees involved, and this should be a relatively straightforward process.

However, if there is a dispute between the family, then the disputing family members may also appear before the Court at this time. They will have their dispute before the Court and the Court will make them decide whether to appoint the deputy or if it wishes to appoint a professional deputy. It is in these kinds of situation where the Court's judgment would be extremely important. The Court's judgment will invariably be based on what they believe will be in the best interest of the person. And obviously, the Courts, quite rightly, have a wide discretion in this.

There is another reason the professional deputy is very important – why this list should be kept tight. This is because once a person is on the list of professional deputies, first of all, that would also be a signal to people appointing professional donees that this is a potential person that they can go to, if they do not have any family contacts. So, in that sense, the list of professional deputies is a signal to the public that this is a list of approved people that you can appoint as professional donees.

The second reason– this is very important– is because in the situation which this Bill is meant to deal with, namely, the single, elderly and those living alone, if there is any case of abuse, for example, they may not be able to take action for themselves and this is because there is a bit of restriction on who can bring actions under the Act.

If we look at section 38 of the MCA, the only people allowed to bring actions under the Act are, I am paraphrasing, the parents of people who are aged below 21 who have lost mental capacity, by the donor or donee of the LPA, by the deputy, by a person named by the order of Court or by the PG.

There is no general provision that allows all and sundry to apply under the Act if they feel that there is abuse. So, for example, the good-natured neighbour, if he were to discover abuse, he may make a report to the PG but he has no right to commence any action in his own name under the Bill.

Others do have a right under section 38(2) of the Act to get permission from the Court to start an application. So, there is a two-step process for them. But this two-step process may take some time. It may also take time for the abuse itself to be uncovered. So, for this reason, the professional deputies must be a very tight list because the reality is that recourse to Court, where there is abuse, is not so straightforward and not so easy.

The other matter is the manner in which the Court will exercise its discretion when deciding whether or not one of the people that is not designated in section 38(1) would have permission to commence action. The MCA very helpfully sets out the criterion which the Court will consider in section 38(3). It says that the Court will look at the applicant's connection to the person, the reasons for the application, the benefit to the person to whom the application relates and whether the benefits can be achieved in any other way. What this means again is that a person who will get no personal benefit from taking an action under this Bill, may have a more limited right to commence action under this Bill.

In this way, the only real recourse for the most egregious cases of abuse may be to make a complaint to the PG and let the PG commence action. The PG has power under section 38(1) itself. But if this is the intended way, meaning that the PG is going to be the main person investigating abuse, then the PG will need more resources to do that. The reality is that many good-natured people who spot abuse will probably not want to commence legal action themselves anyway. And for this reason, I would also support strengthening the capacity of the PG to deal with allegations of abuse under this particular provision of the appointment of deputies.

Mr Deputy Speaker, I definitely speak in support of this Bill and my suggestions are really more on the manner on which this Bill will be implemented but I think it is a good development.

Mr Deputy Speaker: Minister Tan.

6.20 pm

Mr Tan Chuan-Jin: Sir, I thank Members for their participation in today's debate and the very useful considerations and suggestions, especially from Mr Vikram Nair. These are points that we will definitely take into consideration when we look at the regulatory framework. We will also be consulting widely. The inputs today have been quite useful and we do urge Members to continue to provide us with more details should you have other suggestions.

Members have supported the introduction of "professional donees" and "professional deputies". I think we all recognise that given the trends going forward, this is something that we all need. Members have also raised concerns, fair concerns and things that we were also pre-occupied with when preparing these amendments. Let me address them.

First, several Members, including Assoc Prof Fatimah Lateef, Mr Louis Ng, Ms Rahayu Mahzam, Mr Dennis Tan and Ms Jessica Tan highlighted that there must be proper rules and also training for professional donees and deputies. And I fully agree. We need to make sure that not only are they qualified but they are also suitable. I am not sure whether it is easy as Mr Dennis Tan has suggested, in terms of attitudes, to assess that. But those are factors that highlighted the importance of making sure that due diligence is put in place to pick the right donees and deputies.

We do intend to put in place a robust set of criteria for those who wish to register with the OPG as a professional deputy. Our initial thinking is this: that the person must be of sound financial standing, must not have a criminal record; if the person belongs to a professional body, he or she should not have any disciplinary action taken against him; lastly, he or she must have sufficient experience as a deputy or in a related field. And, certainly, what is important is that we are also looking into training programmes to ensure competency. Through that process, through training programmes, possibly, we may also detect if the individuals are not suitable, and we may then not register them accordingly.

Mr Louis Ng wished to clarify if all professional donees must register with the PG. The short answer is no. But this is not to say they will not be regulated. We envisage two categories of professional donees. The first comprises persons who have been registered with the PG as professional deputies. The second comprises persons who fall under a prescribed class. We intend to keep this class very narrow and, for now, we are contemplating only licensed trust companies. Simply, they can already act as donees and deputies under the MCA today. They are tightly regulated by the Monetary Authority of Singapore(MAS) under the Trust Companies Act. As such, professional donees will be regulated, either by the PG, as they are also professional deputies, or by the MAS, for licensed trust companies.

Assoc Prof Fatimah Lateef and Mr Louis Ng asked if nursing homes and VWOs can serve as deputies to their clients. We prefer that they do not do so. Doing so could create a potential conflict of interest where they can decide to procure and charge for their own services. It would really be better if an independent professional deputy was appointed, if needed.

Second, several Members, in fact, a number of Members, have expressed concern about the fees professional donees and deputies may charge. In fact, this is one area I was concerned about as well. I want to assure Members that my Ministry will work with partners to ensure that pro bono, low-cost services or financial assistance are readily available for the low-income, for those who need it but are not able to afford it.

We think that controlling fees right at the onset might not be the best way to keep prices affordable. A fee cap could remove the incentive for service providers to charge competitive rates and stunt the growth of services for differing needs and circumstances. As Members realise, every individual comes with a very different context and there might be different types of services required, thereby, requiring different charges. It may also deter competent service providers from entering if the fee cap is set wrongly, especially. Moreover, with regard to Mr Dennis Tan's question, the remuneration a professional deputy may claim also depends on what the Court deems fit in his case. So, the Court will also have to apply itself to assess whether the remuneration is appropriate or not.

Mr Vikram Nair asked if there will be standardised LPA forms and fee guidelines for professional donees. As the donor may wish to give specific powers to the donee, we are not sure if it is advisable to have standardised forms. The donor and the donee should also be free to decide on the fee arrangements. After all, this is when the donor has his full mental faculties and he should be able to decide for himself what he is prepared to pay and what are the arrangements he would like to put in place with the donee.

Third, Ms Joan Pereira asked how the Court would decide on which professional deputy to appoint. When a professional deputy applies to Court, the Court would have to evaluate, based on the circumstances of the case, whether it is appropriate to appoint that professional as the person's deputy. Minimally, the professional deputy must be registered with the PG and unrelated to the person who lacks mental capacity. In addition, as Ms Rahayu Mahzam noted, the Court could also appoint a professional deputy if it is satisfied that the significant others are unwilling, unable or unsuitable to act, especially if there are family disputes. And as we all know, that happens.

On a related point on safeguards, Assoc Prof Fatimah Lateef also asked if an Independent Mental Capacity Advocate – or the IMCA – service could be considered in Singapore. This is an advocacy service provided in the UK to those without deputies, donees and family support.

We did consider this quite carefully when we first introduced the MCA. We believed then and we still do now, that we have sufficiently protected mentally incapacitated persons. Section 7 of the MCA allows for professionals, such as doctors and caregivers, to act in the best interest of the incapacitated person. They can consult those who know the mentally-incapacitated persons to better understand their wishes. In this way, we enable professionals and caregivers to care for the incapacitated confidently, while avoiding unnecessary costs and complexity. Where it is really necessary, professional deputies may be appointed.

The passing of these amendments is the first step towards regulating the professional deputy and donee sector. We will consult stakeholders and relevant professional bodies extensively before finalising the details, which will be promulgated in subsidiary legislation.

Members supported the amendments to enable pre-emptive action to protect individuals from abuse by their proxy decision-makers, but had some concerns. I will address the concerns, but let me first reiterate that the fundamental principle of the MCA is to respect the decisions of a person who has mental capacity, and this is something that Ms Jessica Tan had also highlighted. It is important for us to remember that we may not always agree with the decision, we may think the decision is unwise, but if they still retain their full mental faculties, that is something that we have to respect. It is the same way as they make wills, individuals who make wills out of different individuals and we have to respect them.

Ms Joan Pereira and Assoc Prof Fatimah Lateef asked about how and how long it would take to suspend an unsuitable donee or deputy. The process involves preparing an application that is supported by sworn statements from the witnesses, to prove that it is necessary for the Court to suspend the donee's or deputy's powers. The duration of this process will largely depend on the complexity and evidence provided.

Where there is an urgent need for protection, the OPG will expedite the filing of the Court application and ask the Court to hear their application on an urgent basis. The order will then continue until the donee or deputy applies to set it aside, or until a further Court order, whichever is earlier.

If there is a suspension order, the Court may also place limits on what can be withdrawn by the donee or deputy for the day-to-day living and medical expenses of the person without capacity. In this same way, the same level of care can be provided as before the suspension order.

Mr Vikram Nair asked if the OPG is resourced to investigate complaints and about access to Courts. We will certainly be monitoring the volume of complaints and resource the OPG appropriately. We are also amending the MCA to introduce an Assistant PG and allow the PG to engage auditors to assist with investigations. As to access to Court, apart from PG, concerned others can apply to Court. While permission is required for non-family members, the process is similar to that for PG.

Ms Joan Pereira also asked how members of the public will know whether a donee or deputy has been suspended. The information on suspended or revoked LPAs is available on OPG's website after the information is received from the Family Justice Courts. It would also be prudent to request to search Court records for the latest status on the validity of a Court order appointing a deputy.

Ms Denise Phua, Ms Sylvia Lim and Ms Joan Pereira asked if OPG can do more to check LPA applications, particularly for "high-risk" cases. Ms Sylvia Lim asked if the option to notify main persons could be reinserted into the standard LPA form. The option was there previously, as highlighted by Ms Sylvia Lim. It was taken out in large part as less than 1% of the donors use this option. Paradoxically, I fully understand and I agree with the concern, that if the intent of the option was really to protect against undue influence, a donor who is unduly influenced, is very unlikely to notify anyone. Even if he or she did, he or she probably would not be notifying the correct persons.

What we hope to do is, in terms of the prompt, to advise them to speak to their family, brief them on their LPA arrangements so that, at least, they can understand. This is no guarantee that they would do it, but that is something that we are putting in place. OPG checks LPA applications to ensure that they comply with the legal requirements set out in the MCA and Regulations.

As I have highlighted, OPG typically does not question the donor's choice of donee – whether the donee is a family member, as in most cases, or a professional – because the donor is deemed to have mental capacity. The donor must also get a certificate issuer to certify that the donor understands the purpose of the LPA and the scope of the authority conferred on donees in the LPA and that no fraud or undue pressure was used to induce the donor to make the LPA.

As I have shared earlier, each case has its unique circumstances. We do not believe it is appropriate for the PG to raise red flags just because the donee is a foreigner or not a relative. The PG should not, I believe, act as an arbiter of another's choices. Again, just to reiterate, the core principle of the MCA is to respect the choice of a person who has mental capacity. The registry of the LPAs is a confidential registry, similar to the Wills Registry. It would be inappropriate for PG to share information about the donor's LPA with the donor's family members.

What we can do is to encourage the donor himself to share the information with his family members. What we can do and have done is this: to encourage them not just to talk to the family members and, hopefully, in the process, to choose a donee wisely. The PG will only step in and, rightly so, when the donee is not acting in the donor's best interests and has no one else to intervene. The MCA also provides for whistle-blower protection to those who report potential abuse.

We want to assure Members that we fully understand the dilemmas that you have brought to bear and because of many of the cases that Members have seen. In the vast majority of cases, we do not face the problem but, obviously, these cases, when they do surface, can be quite dramatic and they seize the public imagination. But it is a fine balance to strike. On the one hand, it is important to respect the individual; on the other hand, we also need to be sufficiently rigorous to protect the individual as well.

Ms Denise Phua expressed concern about the retiring of the PG Board, although the Chairman of the PG Board had made this recommendation. Ms Sylvia Lim also asked why the Ministry has done away with the requirements for an annual report. I want to assure Members that we have considered this very carefully before deciding to make this move and I have explained earlier in my opening speech.

The PG Board was established to scrutinise and to review the way in which the PG's functions were discharged when the MCA was a relatively new piece of legislation. With the Board's help, we have improved various internal processes and guidelines for OPG to operate effectively. The Board also assisted OPG in establishing links, which Members have rightly pointed out, is really important, not only with key stakeholders like the Law Society and College of Family Physicians, but also at the customer front-ends, such as the CPF, the grassroots and many other stakeholders.

Based on these improvements, the Chairman himself felt that they have achieved the objectives and could be dissolved. After examining their proposal thoroughly, I have agreed with the recommendation.

What we are doing is to reconstitute the PG Board into an Advisory Panel that does not compromise checks and balances. That remains important. Individuals who suspect that the PG had not discharged his functions in good faith and with reasonable care can make this known to the Minister. The annual report was submitted by the PG Board to the Minister. It accounted primarily for the initiatives and the review of the OPG's activities in the year concerned. With this amendment, the PG is directly accountable through the Minister and will continue to make available relevant information, such as key initiatives and statistics, on its website. Appeals against certain administrative decisions made by the PG can also be made to the Minister. Lastly, the judicial review and appeal through the Courts remain an option.

Some may feel that it is better to retain the PG Board so that it can provide constructive feedback. However, the idea is that the Advisory Panel, which we are forming, will continue to comprise various respected professionals in the medical, legal, finance and social work sectors. I am very sure that they will provide independent and constructive feedback, as they have done so previously when they were a Board.

Members asked how to increase public awareness and accessibility of the LPA and how to reduce the cost in making an LPA or a deputyship order.

Ms Rahayu Mahzam, Assoc Prof Fatimah Lateef and Ms Jessica Tan believe that more need to be educated about the LPA and the implications of the appointment and choice of donees. Ms Joan Pereira, Assoc Prof Fatimah Lateef, Mr Louis Ng and Mr Dennis Tan have suggested various ways to raise the awareness and accessibility of the LPA and, especially, in keeping the process simple, which we agree. And I fully agree with these areas of concerns that Members have raised and their suggestions.

We need more to spread the word. OPG has to play its part. We are producing more collaterals and guide books in the four official languages. OPG conducts monthly LPA talks at Raffles Place, for example, and will hold talks in mother tongues later this year. The talks cover the technical aspects of how to make an LPA, the types of powers donees may be given and also the importance of choosing trusted persons to act as donees. These talks are open to the public.

OPG has also recently produced two videos; one, on the need for an LPA, specifically targeting the elderly; and, the other, on how exactly to apply for the LPA itself. These videos have been subtitled in the four languages and would soon be posted on OPG's website and further disseminated. The OPG's helpline can also handle calls and enquiries in the four official languages.

Basically, the idea is that we will do whatever we can to raise awareness as much as possible, and we do ask Members of this House to support us and assist us in that process.

On Ms Joan Pereira's and Mr Louis Ng's point that PGAs can play a role – that is something we can definitely consider. Feedback from the public and the Pioneer Generation Office has been positive. They are, indeed, a good resource base that we can draw on, especially to encourage those without family members, to make an LPA. While they may appoint close and trusted friends to be their donees, some may also consider appointing a professional donee when the regulatory framework is up. As for getting registered medical practitioners to put up signs indicating that they can certify LPAs, we can explore if that is feasible as well.

To increase accessibility, OPG has simplified the LPA Form 1 which meets the needs of most Singaporeans. We have also waived the LPA application fee for Form 1 for Singaporeans in September 2014 for a two-year period. Applications to register an LPA can now be made by post. We have also waived the postage charge for a similar two-year period.

We are working closely with the Family Courts to keep the process simple. That is something many Members have raised and we fully agree with that. We welcome suggestions and specific ideas about how we can make it simple because that is really where we should go. But, again, I just want to flag out that we do need to find a balance. Because on the one hand – and I think Ms Rahayu Mahzam raised the point – we want ease and accessibility and, of course, with that, lower cost. But at the same time, we do need rigour, because this is an important process and we need to get it right. So, these two considerations remain important and we need to find that balance, and Members' inputs would be tremendously helpful on that front.

Regarding the fees that certificate issuers charge, such fees, I believe, are warranted, because of the important role in the LPA-making process and they carry serious, significant legal implications. Having said that, we will continue to see how best to reduce the cost of making the LPA.

On the matter of deputyship applications, we agree with Ms Rahayu Mahzam that deputyship is a serious matter and we need to bear this in mind, even as we work with various groups to make the process easier for them to apply for deputyship.

This is also why, for Mr Louis Ng's question on whether parents with children with intellectual disability can be made "natural deputies", we think that a judicial process is needed. The Court needs to evaluate the specific matters in which the individual with intellectual disability lacks capability and whether the proposed deputy is suitable to act, even if it is the parent. There are also instances where parents may be unsuitable – for instance, parents who are abusive or who have serious illnesses that may impair their own mental capacity.

Ms Denise Phua asked if the deputyship process can be made easier and more accessible, especially for individuals with special needs. We are certainly making progress in the pilot project with MINDS, which has been completed. With the help of the NUS Law Faculty, volunteers and MINDS itself, the average cost that each of the three families incurred was around $300, comprising mainly Court fees. This is compared to the average of $5,000 if lawyers and other professional services are involved.

As for the next steps, which Ms Denise Phua, Ms Sylvia Lim and Assoc Prof Fatimah Lateef asked about, we have, as I have mentioned, completed a project and are now working with MINDS to scale up and cover the graduating cohort of MINDS students. We will also be covering those who have already left school and also those with other forms of intellectual disabilities and autism. Basically, we are confident and have found it useful and successful and do intend to scale up. It will take some time, but we intend to expand it.

We will look into Ms Denise Phua's suggestions to encourage healthcare professionals to act under section 7 of the MCA in the best interest of their patients, without the need for formally-appointed deputies. At the same time, we will also look into familiarising healthcare professionals with the medical report required for deputyship and encourage them to set reasonable fees.

In response to Mr Dennis Tan and also Ms Sylvia Lim, we have completed work with the Family Justice Courts. We continue to work very closely with them in fact, it has been a very constructive relationship between both parties, because of a lot of inputs that we have been able to gather from both sides. We are in the process of further simplification of forms and some processes, and this has been implemented in the MINDS pilot. However, do continue to give us your suggestions. What Members have highlighted has been most useful. We will certainly make sure that the points have been registered. We hope to also achieve further cost savings and a more user-friendly process for other families who need deputyship, once the IT system which the Family Justice Courts is developing is up and running in a couple of years.

Finally, let me address Members' questions on how the MCA relates to other legislation. Assoc Prof Fatimah Lateef asked whether a person with severe mental health disorder can be covered under the MCA. Ms Denise Phua also highlighted that there are others with other conditions that may impair their ability to make decisions for themselves.

The answer is yes, if the severe mental disorder results in mental incapacity. Someone is considered to lack mental capacity to make a decision if he or she is unable to (a) understand the relevant information; (b) retain the information; (c) weigh the information as part of the decision-making process; or (d) communicate his or her decision. If a severe mental disorder or any other condition results in the inability to do one or more of these things, the person would be covered by the MCA. There may be cases of fluctuating capacity among those with severe mental health disorders. In these cases, a report from a medical practitioner would be needed.

I would like to assure Assoc Prof Fatimah Lateef that the MCA does not affect any Advance Medical Directive made. Donees and deputies are not permitted to make or revoke an AMD on behalf of persons without mental capacity.

In conclusion, I mentioned earlier that the MCA reflects how we desire to live a dignified life, regardless of whether we have mental capacity or not. As individuals, we really ought to plan ahead, for our own sake, but I think also for our families' sake, to make clear our wishes should we lose our capacity. And as a country, we need to come together, as a society, to protect those who are incapacitated and to ensure that they live in dignity.

The amendments to the MCA are a step in that direction and we call on everyone to play a part. Once again, thank you very much for all your valuable inputs. Inputs will continue to be sought, especially in terms of coming up with the regulatory framework. We do encourage Members to continue to provide us with suggestions, ideas and feedback from the public. With that, thank you very much.

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 Tan Chuan-Jin.]

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