Friday, July 24, 2009

Singapore's doctor bashing continues - and is a test of our medical ethics

The spate of doctor bashing that started with the publication of the Tan Tock Seng Hospital study continues in today's Straits Times.

While I have some reservations about the methodology of the study and conclusions drawn, I don't necessarily disagree with the overall impression that ethics and professionalism has become somewhat lax. Nevertheless, I do feel the doctor bashing is somewhat unfortunate and unfair because I think this phenomenon is really a function of the general decline in ethics and professionalism across much of Singapore society. It is quite unfair to just single out the medical profession. I mean, the lawyers, engineers, accountants, businessmen are probably as bad, if not worse. But perhaps this is only because the issues of ethics and professionalism is most visible for the medical profession. And it is easy to bash doctors.

The degeneration in our value systems, is a societal one, and which begins in early development - at homes and in schools. To finger the medical school as being responsible somehow for this decline is probably quite misguided.

There is also a facile and wrong perspective that this can be corrected by giving 'x' numbers of ethics lectures in the school. This does nothing but comfort the educators that they are doing something....or at least can appear to the public to be doing something. In the Singapore culture, we have become quite good at 'talking ethics'. Oh yes, we have ethics committees and we publish guidelines, and can satisfy all the accrediting authorities that we are an ethical nation. But I seriously question if we are truly an ethical people, or just a simulate of an ethical people.

This is not an unimportant issue because we have many medical challenges on the horizon that will test the very core of our ethics. And we need to be ready. Human experimentation is already upon us. And so is experimentation on the embryo. The balloons for organ trading and euthanasia have already been floated by the Minister of Health. Is our ethics environment ready for these? Or will we be apathetically lulled into thinking everything is ok because all we need is to simulate being ethical?

We need our society to start practicing ethics, and stop being so pragmatic. I was going to say we should stop just discussing ethics as if it were an academic subject, but the truth is that we aren't even doing that. Where are all our wonderful ethicists? Why aren't they in the public domain, discussing and educating us? Why do they just hide in the comfort of committees, only to periodically issue politically correct position papers?

We desperately need a serious cultural reboot.

See previous post: 'Are we an ethical society?'


angry doc said...

I don't think the public and the medical profession have the same definition of 'ethics' - laymen tend to see 'doctor didn't give me what I want' as something 'unethical', while doctors see 'giving patients what he wanted when not indicated' as 'unethical'', for example.

To continue my laymen-bashing, I will say that most laymen don't really think about ethics from 'the ground up', like looking at what are the principles we should base our ethical system upon, but merely accept norms, or even if they do, expect exceptions to be made for them when their own health is at stake.

As for doctors, we tend to have our ethics 'handed down' to us, since there is much overlap between what is ethical and what is legal - does organ trading become ethical now that it is legal? Is it ethical to exercise conscientious objection and refuse to participate in a transplant involving a bought kidney? Does it really matter because it is inconceivable in the local context to have the SMC disagree with the law (i.e. the SMC will never consider it 'conduct unbecoming of the profession' for a doctor to participate in a transplant of a bought kidney once it becomes legal)?

And regarding your ealier post, I have an interesting anecdote to share: a colleague once managed to convince a patient to his decision with not "it's the ethical thing to do", but "it's my quota" - he said he got no argument from the patient. We are a pragmatic society indeed.

gigamole said...

I'm not so sure I agree with your generalization about:
"laymen tend to see 'doctor didn't give me what I want' as something 'unethical', while doctors see 'giving patients what he wanted when not indicated' as 'unethical'',.."

Admittedly there is some truth in that, and there are indeed quite a few shallow demanding patients out there, but by and large I think the public does have expectations about doctor's ethics that is not incompatible with ours.

The points in the Physician's Pledge that are worth considering are:
dedicate my life to the service of humanity;make the health of my patient my first consideration;not allow the considerations of race, religion, nationality or social
standing to intervene between my duty and my patient;
maintain due respect for human life;
use my medical knowledge in accordance with the laws of humanity;...

Interestingly, there is nothing in the Pledge about having good bedside manners. But medical ethics isn't really about having good bedside manners, no matter how popular that might make a doctor.

People also forget that the physicians also vow to:
uphold the honour and noble traditions of the medical profession;respect my colleagues as my professional brothers and sisters.

with respect to your point:
"As for doctors, we tend to have our ethics 'handed down' to us, since there is much overlap between what is ethical and what is legal - does organ trading become ethical now that it is legal?"...

I think that applies for as much as we allow it to dictate to us. I believe we are expected to live and practice in accordance with our conscience. After all, we did pledge to "practise my profession with conscience and dignity".