Launch of the inaugural run of the AST course on medical ethics, professionalism and health law

14 Jul 2005

By Dr Balaji Sadasivan, Senior Minister of State for Information, Communications and The Arts and Health

Venue: The Auditorium, MOH

Distinguished Colleagues, friends, ladies and gentlemen

I am happy to launch the Course on Medical Ethics, Professionalism and Health Law for Advanced Specialist and Family Medicine trainees.

I have also been informed that this is a mandatory programme for all our advanced specialty trainees exiting after May 2006.

The programme was mandated by the Specialist Accreditation Board and is organised by SMA and MOH with the support of the Academy of Medicine and the College of Family Physicians. 

There are some who may question the need for such a program.

This course was started because we believe that an extra dose of ethics, professionalism and health law may save some of you from the agony of medical discipline arising from poor ethical and professional decisions, or from disputes arising from offensive or insensitive communication with patients or their relatives.

Medicine is an Art as much as a Science.  While our training often focuses on the science of medicine, the art of medicine must be constantly emphasised. We have heard the oft repeated saying "To cure sometimes, to relieve often, to comfort always - this is our work"

and "Thou shalt treat thy patient as thou wouldst thyself be treated".

Even if these sayings were religiously followed, in an increasingly litigious society, there are many pitfalls that doctors can fall into. 

A course on ethics and law does not provide all the answers to the many contentious medical issues we face, but it will help you see the principles that govern the law, and the ethics that guide our profession. It will help you to navigate a path that is both ethical and lawful.

Medical ethics protects patients. For example, it prevents doctors from exploiting their position and indulging in sexual relations with patients. If we did not have ethical rules we could very easily end up in a situation similar to that at Action for Aids as reported by the newspapers. Apparently, counsellors at Action for Aids had sexual relations with those who approached the organisation for counselling. And apparently, some of the counsellors were HIV positive. At this point in time we are uncertain if any of those who sought help from AFA were exposed to the very disease that AFA was supposed to help prevent.

Without ethics to ensure professionalism, a service that was meant to help the public could itself become a source of danger to the public.  This is a matter of concern.

In developing our HIV control program, we have followed three principles.

The first is "there will be no discrimination."

MOH will take a serious view of any case of discrimination we come across and we will refer the doctor to the Singapore Medical Council.

HIV is not a rare infection and so all doctors should have enough knowledge about the disease to manage common problems found in HIV patients.

Second: There should be no stigmatisation.

The medical profession, by creating special protocols for HIV, may have stigmatised the disease and may have contributed to the fear that the disease generates.

HIV tests will in future be treated like any other test and should be done when indicated.

Third: there will no lowering of the quality of care of HIV patients.

HIV patients are entitled to early diagnosis and proper treatment. Social and financial issues do not justify unprofessional management of a patient.

We do not delay the diagnosis of cancer because cancer drugs are expensive and as you know, there are some cancer drugs that cost more than anti-HIV drugs. So there is no justification for delaying diagnosis.

Oncologists do not delay diagnosis because of fears that the patient may be upset by the diagnosis, or because they think the patient cannot afford the treatment, or because there will be social consequences like being abandoned by their partner.

These should therefore not be reasons for the improper management of HIV patients.

Finally, there may be ethical conflicts in the management of HIV. Doctors have a duty to their patient to maintain confidentiality. They also have a duty to protect the spouse from getting infected.

I have heard physicians passionately argue about their duty to maintain confidentiality and this reminds me of a story that Bertrand Russell referred to in his writings on Ethics.

This is a story about Mencius, the great disciple of Confucius.

One day, the king went to his cook house and he saw a cow being led to slaughter as beef was to be the main course of the dinner. The king saw the frightened appearance of the cow and he was filled with compassion. He ordered the animal to be returned to its shed and he said he would have lamb instead.  A lamb was taken and slaughtered.

All the advisors praised the king for his compassion except Mencius. The king asked Mencius for his opinion and Mencius said

"Sire, you saw the cow but you did not see the lamb".

"What should I have done?" asked the King. 

Mencius replied, "A superior man cannot eat the animals whose dying cries he has heard. So if he wishes to eat, he should keep away from the cook house."

Our ID physicians interact with the patient but not with the spouse and hence their compassion is primarily for the patient.

In future, a HIV Prevention Unit in MOH will deal with these conflicts of duties in an objective manner.

The ID Act will be adhered to and the spouse will be informed.

Where the law requires a physician to act in a specific manner, the physician must follow the law.

No doctor is above the law.

As you can see, ethics is a fascinating subject and I am certain you will enjoy this course.

To conclude, I quote Dr Edmund Pellegrino, a highly respected physician and medical ethicist.

To be a professional "is to accept the trust the patient must place in us as a moral imperative".. people become ill and need to trust others to help them restore health. 

To all of us, doctors whom our patients put their trust in, I wish you a successful lifetime of ethical practice and professionalism.

Thank you.