FOR the second time this week, Health Minister Khaw Boon Wan has surfaced euthanasia as an ethical dilemma that Singapore would have to confront.

'Do we allow euthanasia or assisted dying?' asked Mr Khaw Boon Wan when he spoke on challenges in the healthcare sector on Friday night at the Institution of Engineers' annual dinner and dance.

As he did on Wednesday, he noted that the Chinese daily Lianhe Zaobao has published several letters from readers on 'this complicated but pertinent issue'.

One man even photocopied a page of letters for him, asking that he legislate euthansia - a message the man conveyed in red ink.

End-of-life issues are expected to be on his ministry's agenda next year, but it appears that he wants more debate on other ethical dilemmas that ageing and developed countries are grappling with.

He referred to the recent debate on organ trading, a divisive issue sparked by the recent nabbing of a case here.

It is expected to be raised again when the planned changes to the Human Organ Transplant Act to increase the supply of cadaveric kidneys come up for debate soon.

On Friday, Mr Khaw threw up another example.

'Should we allow surrogate pregnancy?'

India has legalised this but critics say the poor are being exploited by the rich who can afford to 'rent a womb', he noted. Others, however, see it as a normal commercial transaction benefitting both parties.

Besides confronting ethical issues, another challenge is deciding how much to spend on healthcare, given a rapidly ageing population, rising expectations and escalating costs.

The current healthcare model is 'inadequate' for future needs, said Mr Khaw.

So long as someone else pays - be it the government, employer or insurer - demand for medical treatments will be high, including some that are unecessary.

The minister asked: 'Imagine that your TV is paid for by your Government or employer, as a gift.'

'Would you just settle for a 20-inch ordinary TV, or would you go for the top-end home cinema system, complete with karaoke and flat screen LED monitor?'

But this is what is happening in healthcare, he said, adding that 'gross abuses and over consumption will have to be paid for, by all citizens, through higher taxes'.

This is further fuelled by unrealistic expectations. He said: 'In times of grief, family members often do not accept the limits of medical science. Many seem to forget that we are all mortals.'

Whatever the solution, some basic principles should be maintained, such as focusing on prevention rather than cure, said Mr Khaw.