Patient autonomy in audits: MOH replies

MOH's Reply

The Straits Times,18 June 2015

Patient autonomy in audits: MOH replies

THE Ministry of Health (MOH) thanks the Singapore Medical Association (SMA) for its feedback ("Patient autonomy key part of medical ethics"; June 4).

As SMA president Wong Tien Hua said, MOH has powers under the Private Hospitals and Medical Clinics Act to audit any patient's clinical outcomes, should the need arise.

Our medical audits enable MOH to monitor and uphold the high quality of care and safety of aesthetic procedures performed in Singapore.

Our intent in including this information in the consent template for medical practitioners and healthcare institutions is to give patients the opportunity to be informed of and to agree to participate in MOH's medical audits before they undergo aesthetic procedures.

In this way, situations whereby patients are surprised when they are contacted after undergoing the procedure are avoided.

Dr Wong's letter might have given the impression that the patient must consent to participate in the audit for the treatment to proceed. This is not so. The patient's autonomy is not compromised in this process: Should the patient not agree to participate in any future audit of his aesthetic procedure, neither the patient nor the doctor is prohibited from undergoing or performing the procedure, respectively.

Before they undergo any aesthetic procedure, we urge the public to exercise due caution by ascertaining that the medical practitioners and healthcare institutions consulted are properly licensed and accredited to perform the desired procedures and treatments.

When in doubt, they should seek a second opinion from their regular family physician or other qualified medical practitioners.

Lim Bee Khim (Ms)
Director
Corporate Communications
Ministry of Health

Forum Letter

The Straits Times, 4 June 2015

Patient autonomy key part of medical ethics

IN THE article on May 27 ("Just had liposuction? MOH may be calling you soon"), it was revealed that those who want to undergo liposuction to improve their looks must also agree to be interviewed by the Ministry of Health (MOH) on the outcome of the procedure.

The four fundamental tenets of medical ethics are patient autonomy, beneficence (to do good), non-maleficence (to do no harm) and social justice.

Patient autonomy includes the patient's rights to give or withhold consent for treatment, privacy and confidentiality.

These tenets should not be violated or significantly compromised except in the most serious circumstances, and backed by the force of legislation. For example, the Infectious Diseases Act can over-ride certain patients' rights to privacy and confidentiality in the interest of public health and safety.

Similarly, the Private Hospitals and Medical Clinics Act already empowers the MOH to access patient records for audit purposes without a patient's consent, in the interest of improving patient safety and clinical quality.

Giving consent for an aesthetic procedure is different from giving consent to be contacted and interviewed by MOH officers post-procedure.

The two are separate and independent events that entail separate and independent decisions by the patient. A patient's autonomy is compromised when the two decisions are bundled together in one consent form.

We hope the MOH can clarify and explain how it is empowered by legislation to do so and why it has chosen this path of significantly diminishing patient autonomy in its effort to regulate aesthetic procedures.

Wong Tien Hua (Dr)
President
Singapore Medical Association