SPEECH BY PROFESSOR KENNETH MAK, DIRECTOR-GENERAL OF HEALTH, MOH, AT THE OFFICIAL LAUNCH OF THE BIOETHICS ADVISORY COMMITTEE MEDICO-LEGAL CASEBOOK

Emeritus Professor Lee Eng Hin, Chair of the Bioethics Advisory Committee

Professor Julian Savulescu, Head, and Dr Sumytra Menon, Director of the NUS Centre for Biomedical Ethics

Distinguished delegates of the Asian Bioethics Network (ABN) Conference 2025

Esteemed clinicians, researchers, bioethicists, and colleagues

Ladies and gentlemen

1.         A very good morning to all of you. As both a practicing physician and Singapore's Director-General of Health, I have witnessed firsthand how the practice and standards of medicine have evolved over time. This is to reflect the evolving societal norms and expectations. Today, I am honoured to launch the Singapore Bioethics Advisory Committee’s new publication, Biomedical Ethics in Singapore: Cases and Commentary. This Casebook chronicles how law and medicine have developed together to serve our profession, our institutions and more importantly, our patients.

The Genesis and Significance of This Casebook

2.            Over the past few decades, Singapore's courts have had to address fundamental and challenging questions that every healthcare professional faces: How much information must we share with our patients? What constitutes professional misconduct or medical negligence? How do we balance individual patient rights with public health needs?

3.            The Bioethics Advisory Committee recognised that these important court rulings, often dispersed across legal texts and journals, would serve the profession more powerfully if consolidated into a single reference volume. The Casebook is the result.

4.            In total, the Casebook highlights 42 unique medico-legal cases, each with its own set of medical, legal and ethical considerations. To give you a flavour of the Casebook’s contents, let me highlight two landmark cases that have shaped medical practice in Singapore today.

Landmark Cases That Shaped Practice

5.            The first is the case of one Hii Chii Kok from 2017. This landmark medical negligence case involved a patient who had suffered complications from a major pancreatic surgery that was based on a concern about the possible presence of a malignancy, which turned out not to be so. The patient subsequently alleged that he had not been provided with sufficient information and medical advice to allow him to give proper informed consent before the surgery. The Court of Appeal applied a patient-centric test for medical advice – a doctor’s duty to advise a patient is discharged when sufficient information has been provided to the patient from the patient’s perspective. In doing so, Hii Chii Kok updated Singapore’s approach to doctor-patient communications to embody the ethical principle of patient autonomy, reflecting the patient's right to make informed choices and aligning our laws with countries such as Australia and the United Kingdom.

6.            The second would be the 2008 case of Low Cze Hong v Singapore Medical Council. In this case, the doctor was found guilty of professional misconduct, the Court clarified that an oversight by a medical practitioner does not automatically amount to professional misconduct – there has to be serious negligence that it objectively constitutes as an abuse of the privileges which accompany registration as a medical practitioner. This provided reassurance to many doctors that they would not be sanctioned for minor mistakes, whilst clarifying that ethical obligations to uphold professional integrity remain in place.

Evolution of Medical Practice Standards

7.            The two landmark cases I’ve just highlighted reflect an evolution in medical practice over the past decades. We have witnessed the transformation from a paternalistic model of healthcare – where doctors made and justified decisions for patients primarily based on our clinical judgment and peer professional opinion – to a patient-centred approach, which emphasises patient autonomy and shared decision-making.

8.            This evolution continues today. We need to maintain the timeless core principles of patient welfare and professional integrity, as we grapple with new challenges: various technologies – digital health technologies included, personalised or precision medicine, and also dealing with better-informed patients.

9.            Understanding this evolution is crucial for healthcare professionals, policymakers, and legal practitioners alike. It shows how medical practice adapts to societal changes while preserving and upholding essential ethical principles, and how the law can both reflect and guide this transformation.

The Casebook's Analytical Approach

10.         To navigate the evolving medical landscape effectively, healthcare professionals need resources that translate hard legal requirements into practical ethical guidance. This is where the Casebook's unique value proposition becomes clear. While the original court judgments focused on legal standards, the Casebook carefully analyses each case to identify the underlying ethical principles and their practical implications for healthcare professionals. Each chapter includes dedicated sections examining the ethical dimensions of the cases and their relevance to contemporary medical practice.

11.         Beyond setting out facts and holdings, each chapter provides a thoughtful commentary on the relevant ethical issues raised, contributed by members of the Bioethics Advisory Committee and the National Medical Ethics Committee. This marries expertise from both bioethics research and clinical practice. The Singapore Medical Council's Ethical Code and Ethical Guidelines (ECEG), which provide critical guidance on best clinical practices, have also been referenced throughout the Casebook to provide illustrations on how the ECEG applies in practice. This collaborative approach ensures that the Casebook is properly informed by both theoretical ethical frameworks and practical clinical realities.

12.         Medical practice is varied and wide-ranging. In the same vein, the Casebook endeavours to transform legal precedents into practical guidance across diverse healthcare settings – from conventional medicine to Traditional Chinese Medicine, from emergency departments to specialist clinics, from patient safety to patient data, and from private procedures to public health.

A Resource for All

13.         For clinicians, the Casebook offers practical guidance to navigate legal and ethical obligations. For policymakers, it illustrates how the underlying ethical tenets have evolved to reflect and meet societal changes. For the public, it provides insights into how Singapore’s healthcare system protects patient rights and safeguards against unethical medical practices.

14.         For me, the Casebook demonstrates that medico-legal guidance enhances rather than constrains good medical practice. Clear legal standards and ethical principles work together to protect both patients and practitioners, creating the trust and clarity essential for our healthcare system's effective functioning.

Closing

15.         I congratulate the Bioethics Advisory Committee, particularly the editors, both Mr Charles Lim and Mr Tan Sze Yao, for producing this comprehensive and valuable resource. The meticulous analysis and thoughtful commentary throughout the Casebook reflect the Bioethics Advisory Committee's commitment to advancing ethical practice in healthcare and supporting practitioners across all medical disciplines.

16.         This Casebook also builds on the strong foundation that has laid by the Bioethics Advisory Committee and National Medical Ethics Committee, whose vital roles have been formally recognised by Singapore’s High Court. For example, in the case of Pang Ah San of 2014, the Court endorsed the Bioethics Advisory Committee’s ethical guidelines and frequently adopted their positions in its rulings, demonstrating the integration of ethical and legal standards in our healthcare system and how ethical guidance and legal frameworks work together to advance medical practice.

17.         To our international colleagues here at the ABN Conference 2025: the Casebook represents Singapore's contribution to understanding how legal frameworks and ethical principles work together to safeguard and advance medical practice. I hope that the Casebook will be of some use to you in assessing and strengthening the ethical frameworks in your own regional or national healthcare systems.

18.         Thank you very much for your attention. Again, I wish all of you well, and congratulations to both the Bioethics Advisory Committee, the National Medical Ethics Committee, and in particular, the two editors, Charles and Sze Yao. Thank you.