Friday, October 16, 2009

Medical ethics - Prof Satku's blogpost

Let me be among the first to congratulate Prof Satku, Director of Medical Services, on his blog comments on Dr Martin Huang's recent escapades with animal stem cells.

Well said, Sir!

I hope Prof Satku's public comments on topics pertaining doctor's professionalism and ethics will not be a one-off event. There is much out there that requires a re-boot. Ethics and professionalism has been fast tracking down the wrong road as the medical market place develops. Sometimes legislation is required. But often it is just the regular and consistent articulation of what is acceptable and what not that puts peer pressures on doctors to 'conform' to best practices. I believe most doctors want to do their best, but if things are left unsaid, errancy can fast become the norm.

I firmly urge our medical professional leaders to take up more visible, clear and vocal positions about medical ethics and professionalism. Not just generic statements, but targeted specific comments about issues. This includes not just the Ministry of Health but also the Medical Council and the Medical Association.

It's time to stop the rot.


angry doc said...

Wow, the man blogs.

It's good to know that is how he stands on the subject of unproven therapy.

I think most of these misdeeds performed by doctors, although being done in their capacity as doctors, is not merely a matter of medical ethics but 'general' ethics.

If a merchant sold a service or product that does not do what it says on the bottle, it is fraud and viewed and punished as such. For doctors, it is an 'unproven therapy' - well, so is the magic stone!

If a merchant sold a product that can harm the buyer, they can be charged in the sub court and fined or imprisoned. For doctors, it is merely 'conduct unbecoming' to be handled internally.

A drug dealer gets a death penalty, a doctor gets no more than $10,000 in fine.

Why should things which, when performed by laymen, are plainly wrong, not be viewed in the same manner when performed by doctors?

The question is, if a non-doctor (an "unlicensed medical practitioner", if you will) injected animal foetal cells into people claiming it is a form of anti-ageing treatment, will he be tried in a "court" of unlicensed medical practitioners, or in a general court? Will the penalty he receives be more or less than a fine of $5000?

I have always argued for self-regulation, but if self-regulation results in doctors receiving less severe penalty than laymen committing the similar offence, even when their peers have judged them to be at fault, then something is wrong with our system. We certainly have the head to tell right from wrong, but do we have the heart to pronounce it, and the teeth to exact penalty?

gigamole said...

I think we need to be clear about the difference between breaking laws and contravening guidleines.

When a merchant or a doctor breaks a law, then the full weight of the law kicks in. But when he contravenes a particular guideline such as one found in professional ethical codes, then it becomes a bit more grey. If he is clearly in breach then he can potentially be struck off the register. But if it is a relatively minor infringement, often it is a little more than a slap on the wrist.

In the case of MH, he did not actually break a law. What he did was to breach Para 4.1.4, which is to offer upproven therapies. Therein lie the difficulties in disciplining him. How many doctors violate Para4.1.4 in offering 'unproven therapies'? MH is not the first but merely among the most gross of such unethical practices.

The question we must all ask is why was the animal cell based product legally allowed to be imported for such use in the first place? Is the 'license to import' a tacit approval of such use of the product?

This is what we must ask MOH and the HSA.