Welcome back, my avid fans/friends and let's kick start the term with something interesting to perk you up.
Recently in Singapore, there was a huge hullabaloo over the Dr Susan Lim controversy. Dr Susan Lim was one of Singapore's most brilliant doctors, and the Brunei royal family had requested her expertise in treating the Sultan of Brunei's sister-in-law. The patient had advanced breast cancer, and was unlikely to survive even with treatment, but was adamant on demanding treatment. For six years, Dr Lim treated the patient. The total bill came to $22.4 million dollars.
The big question: Was it justified? Is it ethical?
There are many different responsed regarding the former question. One must take into account how the doctor scurried around to attend to the extremely demanding patient. According to the accounts of Dr Susan Lim, the patient was very insistent and required her to attend to her personal needs whenever she asked, not even consenting to nurses who took instructions from Dr Lim herself. On one occasion, Dr Lim had just undergone eye surgery, and was having bed rest. However, the patient demanded that Dr Lim attend to her anyway. No matter how people tried to convince her, the patient would not budge in her demands. In the end, Dr Lim had to rely on many other people's help to take an ambulance to the patient's residence, and took a huge medical risk in the fact that she might have lost her eyesight by forgoing bed rest. If that scenario had panned out, she would have been blinded for the rest of her life, just because of one patient's impatience. Also, Dr Lim was the coordinator of many other specialists, such as gyneacologists, psychologists, carcinologists, cardiologists and biologists. There was an entire team of doctors managed by Dr Lim, managing and coordinating their efforts to provide efficient and effective treatment. One can only imagine how torturous the experience must have been.
On the other hand, many assert that the fees charged were simply too high. Even if Dr Lim had been earning a couple million per year, the fees still did not add up to the whopping sum of $22.4 million dollars. Also, it was confirmed after the initial public outburst that she had inflated the bills sent to her by many doctors, by factors of more than twenty. One doctor had sent a bill for $400, which was inflated to above $80,000 by Dr Lim. The Singapore Health Ministry in particular is extremely upset that an offical from Brunei had to come to Singapore personally to make a request on the Sultan's behalf to lower the medical price given by Dr Susan Lim. Additionally, many point out that the patient died despite all the treatment. Worries abound that Singapore's reputation for providing cheap, yet high-quality medical treatment will be tarnished by what has now become a widely publicised affair not only in Singapore, but in surrounding Asia-Pacific countries as well.
This question will remain unanswered for a long time yet.
With regard to the second question, the replies are even more variegated. How ethical is charging high fees? To answer this question, we must ask another one. Why is the public upset over this? Is it because they feel indignant on the patient's behalf? Is it because they fear repercussions on themselves? Is it because they feel ashamed that one of their countrymen has inadvertently tarnished their country's reputation?
From the Government standpoint, I think it is the third reason. The Singapore Health Ministry was and continues to be extremely distraught over what they perceive to be a breach in the code of conduct that all doctors are expected to honour. The message they have been promoting for the past half a century is that Singapore provides cheap, good healthcare. Of course they'd be more than upset, perhaps furious, that a doctor registered in Singapore, a Singaporean, would go so far as to directly contradict them. They fear losing popularity, and while the next general elections are five years off, five years is not a long time. Singapore doctors are expected to provide good, cheap healthcare, and solidify the world perception of Singapore.
From the public standpoint, I think it is the second one. Singaporeans have always been rather selfish, and "kiasu" or afraid to die. Why should they feel for a rich member of the Brunei royal family when they perceive the lives of the rich to be so much better than the lives of the middle class, of the working class, of the poor? I think the majority of Singaporeans are just trying to prevent such an incident from occuring to themselves. Chances are you, the reader who is absorbed in this blog post, are also indignant for this reason. Of course you'll try to cover it up, but what is the real reason for any anger you may be feeling over this incident? You are afraid it's going to affect you and your nice familiar comfortable life.
Back to the question. Is it ethical? The line of ethics is murky. It does not run straight. It curves all over the place, constantly changing along with public expectations. I cannot answer this question yet.
This question is far from answered.
Dear Daniel,
ReplyDeleteI believe that the question about justification has already been answered. As per what I said during the discussion, she has legal rights to profit from her business. Also, the Sultan of Brunei's sister-in-law expressly made out a phrase that she ought not worry about the costs, as "Istana is paying". Now, that clause has culminated in a case of promissory estoppel, which means that the Sultan of Brunei's sister-in-law can no longer insist on her strict legal rights to sue for overcharging. The decisive question to decide the case for justification is whether or not the statement was made in accordance with the Sultan's wishes, and so, whether or not the stopping of legal rights applies to him or not. The ethics question is much harder to answer.
What is ethics? To us, "ethics" as a word does not have an actual meaning at all. Look at the word "ethical". How must something be done to make it ethical? In fact, this question does not have an answer because ethics, like morals and "doing the right thing" are vague, undefined things that are only a part of language simply because they are parts of human nature. It is human nature that defines ethics, and thus because humans are such random and unpredictable animals, ethics is also random and unpredictable. Take this as an example. A rabbit steals your crops like cabbage, carrots and so on. A cockroach and a rat live on your waste scraps. They do not steal from you, hurt you or harm you in any way. The rabbit steals your crops. Yet, it is unethical to kill the rabbit because it has these cute bunny eyes that no one can withstand, and it is ethical to kill the cockroach and the rat because you do not like their face or their smell. Does this not cast ethics into a deep doubt? Let me give another example. It is unethical and criminal to hurt a pet dog, but it is ethical to shove the same breed of dog into a puppy farm and force them to breed so that you can sell the puppies, hurting them in the process. It does seem that using ethics to measure our actions is not unlike rolling a die to get answers in an exam. Ethics, after all, is a spawn of human nature, born out a need to find some reason to criticise another. In fact, whether or not something is ethical is really a question of whether or not it is accepted public practice, i.e., whether or not the majority does it. I am not saying that it is the opiate of the masses, but that it is the "accepted practice of the masses". It gave birth to democracy, and to peer pressure.
Whether or not the doing of Dr Susan Lim was ethical really depends on which way you look at it. She acted in accordance with the business ethics of today. In today's world, you see an opportunity, you take. She saw an opportunity, she took it, and it would have made her for life. In that sense, it is ethical. Does the fact that she is a doctor change that in any way? I am not of the opinion that one's job can dictate one's morals and ethics, as well as what they should be. Her being a doctor ought not affect this case in the least. However, if you look at it from the point of view that it is unaccepted by the majority, and therefore unethical, then yes, it is unethical in a kind of semantical sense.
It is all really dependent on the definition of ethics as you see it. Ethics is not like a chair, you cannot pin it down and say that it is meant for your bum to sit on. However, it is in no respect murky. Changing yes. Curving and twisting yes. But never murky. As long as you have a clear idea of what is acceptable and what is not, the line of ethics will forever be illuminated to you.
Regards,
Yap Jian Shern