'Do we allow euthanasia or assisted dying?' asked Mr Khaw Boon Wan when he spoke on challenges in the health-care sector last night to an audience of engineers.

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, he said yesterday, even photocopied a page of letters for him, asking that he legislate euthanasia - 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.

Yesterday, he threw up another example yesterday: '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 benefiting both parties.

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

The current health-care model is 'inadequate' for future needs.

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

He 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 health care, 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 at the the Institution of Engineers' annual dinner and dance.

Himself an engineer by training, he said: 'As engineers, we know the preventive strategy instinctively.'

They know, for example, that servicing a car regularly is cheaper than sending it to a workshop for repairs. But he added: 'The average car owner looks after his car better than his own body.'

Another principle: Making health care more like other sectors, with competition leading to greater choices, higher standards and cheaper services.

Like other industries, innovative business models should be encouraged.

'Hence, my preference for diversity in health-care providers, the more the better.' They will give patients more choice, and create space for mavericks and innovators.

'Not all innovations will succeed, but if there is no opportunity to even experiment, we will be stuck with the status quo,' he added.

salma@sph.com.sg