Thursday, November 8, 2012

Silence is golden, NUS? I am disappointed.

Sometimes I wonder if the National University of Singapore (NUS) values good press above doing the right thing. I understand that managing the corporate profile is important, and that for a school such as the NUS that relentlessly chases the rankings, avoiding bad press is important. But there are other ways of managing your reputation than just avoiding difficult issues.

Here the imposed silence on student blogger Alvin Tan's punishment says a lot about NUS character and maturity. I am not interested in the sordid details about what the blogger did, but the consequences of what he did especially while he was a scholarship holder. Whatever NUS's disciplinary decision was, there are important lessons for everyone. Transparency in dealing with such a difficult issue will show to the world the heart and soul of the university. We need to know what value systems, the NUS stands for. If the disciplinary action was fair and honest, why is there a reluctance to make it known? There are lessons for everyone.  As a world class university aspirant, the NUS should not fear engaging in public discussions and debate, even about its own corporate decisions.

But I am disappointed. Because it seems clear that the NUS has opted to hide behind zipped lips and walls of silence rather than bravely engaging the public. This has been how the NUS has chosen to manage previous incidents - from research malpractices to spectacular lab accidents. To date, the public remains in the dark about what mistakes were made and what actions taken. Valuable opportunities to learn from these incidences have been lost. This over-reliance on the strategy of retreating behind walls of silence is very damning, and I believe in the longer term, will stunt the intellectual growth of the university. Perhaps some timely advice from the managing editor of the SPH who sits on the NUS Board of Trustees is appropriate here.

It's time the NUS grew up.

The patient-doctor relationship - a relationship between unequals

Today's Straits Times carried an interesting report of  contest in a coroner's court between a mother who is a nurse, and a surgeon. The mother, who had lost her daughter in a liver transplant contended the surgeon provided sub-standard care because she had a spat with the surgeon earlier.

She did not convince the coroner. However, the case highlighted the inherently unequal relationship that exists between a patient (and relatives) and the doctor. Here, every patient is in essentially a subordinated position, and generally hesitant to offend the attending physician/surgeon. This is generally the case, unless the relationship is based on a completely elective and unnecessary procedure, when a more commercial/contractual relationship may apply.

This is why I am concerned about how the physician/surgeon goes about taking consent for procedures. Often the consent is taken by the care giver. In this case, the patient is often afraid of offending the doctor. This unequal relationship very clearly does not create the circumstance when a truly voluntary consent can be obtained. This ethical lapse, also applies to the situation when consent is being sought for participation in a experimental procedure or clinical trial when the researcher or care giver is himself/herself the one administering the informed consent.

The more academic hospitals compound the problem further by expecting patients on admission to consent to giving up rights to tissues and genetic material for research purposes. This consent is often taken at most inappropriate times when the patient and his/her relatives are most dependent and submissive.

The hospital ethics committees applying their very utilitarian logic, obviously do not disapprove of these ethical lapses.