Background

The case discusses about Dr. Susan Lim who is a very renowned and reputed surgeon, practicing and based in Singapore. She has completed her graduation in medicine from Monash University and further received her fellowship and a gold medal from Royal College of surgeons, Edinburgh. She has a medical license to practice from General Medical Council, London. Her contribution in the medical field has been very remarkable as she performed the first cadaveric liver transplant in Singapore (Dr. Susan Lim, 2016). She came into the light of controversy after the death of the queen’s sister in the year 2007. Due to her exemplary medical career, she was chosen to treat the sister of the queen of Brunei Pengiran Anak Hajah Damit who was suffering from breast cancer. Dr. Lim was treating the royal patient since 2001. She was accused of overcharging her patient for the cancer treatment given by her. During an investigation launched by the Singapore Medical Council, it was found out that she charged £12million for the treatment given during a six month period just before she died. It was found that medical bill was overstated as compared to the bill charged in usual circumstances. She was charged of professional misconduct and found guilty on 94 charges against the queen’s sister. The fees charged by Dr. Lim were not reasonable and disproportionate (SingaporeLaw.sg, 2015). Also, the professional fees of other doctors who were involved in treatment were inflated by Dr. Lim so that she could fulfill her commercial interest (Lum, 2017).

She argued on the fact that the fees charged was according to the medical services provided to the Queen’s sister. She undertook training to provide her client with the best diagnosis possible and sometimes paid from her own pocket to ensure that there is no compromise in the treatment provided under her supervision (Harding, 2011). Medical profession is conceived as noble profession which prioritizes human life over anything but in Dr. Lim case, her commercial interest was important. Dr. Lim not only exploited her patient and her family financially but mentally too. In order to defend her case she indirectly threatened the royal family that she will have to reveal the sensitive information which may embarrass the royal family and it may affect the relationship between Brunei and Singapore. This was a threat to the Singapore Government so that they can stop the legal proceedings against her. In her letter to the foreign minister of the Singapore, George Yeo she stated that if her case did not reach the settlement, she will have to disclose some sensitive information about the Brunei Royal Family and the queen’s sister (Vijayan, 2016).

Ethical Dilemmas

The legal battle between Dr. Susan Lim and Singapore Medical Council has affected Dr. Lim, Singapore Medical Council, Brunei Government and Brunei Royal family.

1. Susan Lim: The ongoing legal battle and serious charges of professional misconduct have raised questions on the medical profession of Dr. Lim. She issued several public statements in which she claimed that the fees charged by her were justified according to the treatment provided. She also agreed to offer a discount and withdraw some of her invoices so as to reduce the financial burden in the royal Family. This case has questioned her professional ethics (Vijayan, 2016).
2. Singapore Medical Council: The case has raised several questions on the doctors practicing in Singapore that whether they are charging reasonable fees and Singapore Medical council is answerable for this. SMC criticized the unprofessional behavior of Dr. Lim and imposed a fine of $10,000 along with a three year suspension for violating professional and ethical code of conduct (Lee, 2014).
3. Brunei Government: The matter of overcharging first came into the light of Brunei High Commission and then they informed Ministry of Health, Brunei. They thoroughly reviewed the bills and found it unreasonable. Also the statement issued by Dr. Lim regarding disclosing the secrets of the royal family may affect the relations between Brunei and Singapore.
4. The Brunei Royal Family: Dr. Lim provided the queen’s sister with the best of the care as per the expectations of the royal family but she crossed her ethical limits by charging unreasonably high. The total bill charged was $24m but after giving discounts it amounted to $12.6m which was still high. Dr. Lim should have charged the family reasonably for like any other patient irrespective of the status of the family and their family reputation may also get affected if Dr. Susan disclosed any of their family secrets (Glanfield, 2016).

Ethical dilemma refers to a situation where an individual is required to choose the best course of action and every course of action involves compromises of ethics, morals and principles so therefore whatever course of action an individual chooses to follows, their ethics will be compromised and there is no perfect or right way to act ethically (Allen, n.d.).

Medical practice involves certain ethical issues related to the financial aspect of the profession. The interest and well-being of the patient should be given priority rather than emphasizing on personal financial gain. The ethical dilemma faced by Dr. Lim is overcharging and violating professional code of conduct to fulfill her commercial interest. She has to make a choice of charging her client reasonably and forget her financial motive. Another ethical dilemma in her case is that in order to fight her case she has to reveal some sensitive information of the royal family which may be not in their best interest (SAMJ, 2011).

Moral theories acts as guiding philosophies for the individual in deciding what actions are morally right and wrong. It provides right basis to solve the ethical problems. Moral theories provide a systematic approach to deal with ethical issues (Laird, 2014). The major drawbacks of these theories are that arguments and thought provided in each theory contradicts the other. They have their own set of limitations but still they can be used to deal with ethical dilemma.

The ethical dilemma of Dr. Susan Lim can be addressed and resolved with the help of moral theories and ethical decision making model. The theories like hard universalism, soft universalism, teleology and deontology. There is no theory which surpasses the other one; each theory has its set of applications in different situations. These theories can provide practical guideline to Dr. Susan Lim in analyzing the morally right and wrong behavior.

The teleology theory of morality or consequentialist theory argues that only the consequences of the action matters. The actions whether are morally correct or not is totally based on the nature of the consequences. The decision of an individual is justified if they result into positive end results. The act of Dr. Susan Lim is justified by the theory. The fees charged by Dr. Lim from her patient were justified as her intention was to provide her with best medical care. She also claimed that the overcharged fees was in consideration to the training and other professional medical help she undertook to leave no stone unturned in her treatment (Wood, 2011). So at the end the patient’s health matters and the unethical action of charging fees is justified.

Limitations

1. The consequences are uncertain. It is not always necessary that the actions and decisions of an individual will bear positive results. In this case context Dr. Susan’s action did not assure that the queen’s sister will recover from this disease.
2. The course of actions which are chosen to achieve a positive outcome may not be morally justified. It also encourages an individual to choose whatever path that leads to a good end result. Dr. Susan’s treatment does not defend her unethical actions. It is her professional duty to provide her best treatment without seeking any personal benefit.

Moral Theories and Ethical Decision Making

The deontology theory critically opposes the teleology theory. Unlike the teleology theory which only focuses on the end action, this theory considers the intention or motive of an individual as the only benchmark to judge the end action (Broad, 2000). An individual have certain obligation and duty that justifies the morality of the chosen course of actions. This theory criticizes the behavior of Dr. Lim. The fees to charge for the treatment is not mentioned anywhere but she has an ethical obligation to charge reasonably and provide her patient with the best care and services. Also the aim of Dr. Lim was to earn profits, which is not justified in the medical profession. In the place of the queen’s sister if there was any other patient she did not have charged them this much. This was highly unprofessional.

1. This theory is not flexible; it focuses on following a rigid course of action, rules and morals that cannot be applied in practical situations. In the case context Dr. Susan Lim must have taken extra care in her treatment as the patient was queen sister. The patient’s family must have asked the doctor to provide expensive treatment.
2. This theory is subjective, which means it does not consider the background and situation of an individual. It is not individualistic. The extra training and other doctor advices taken by her in order to provide the best treatment was not considered in her fees.

Ethical decision making refers to the framework of evaluating and analyzing the best course of action where the ethics and values of the individuals are not compromised. The best ethical alternative is chosen. As a counselor, the problem of Dr. Lim will be identified and the best ethical solution is suggested (Ford & Woodrow, 2013).

Stage 1: The first stage revolves around identifying the problem. The patient may hesitate in discussing the problem with the counselor. As a counselor it is my responsibility to build a relationship of trust and integrity so that the client can discuss the problem openly. In this case, Dr. Lim has been proven guilty of overcharging her client and violating professional code of conduct. She gave many arguments, justifying her consideration as reasonable in exchange of the services provided by her to the client. The problem should be solved immediately because it is affecting the professional and personal life of Dr. Susan Lim.

Stage 2: In the second step, the relevant information should be collected that can form the strong basis for defending the client and problem to the solution. She should analyze the professional fees to be charged from various doctors in Singapore. The cost of treatment and other expenses should be calculated on reasonable grounds by taking the help of doctors having same qualifications and other judicial laws.

Stage 3: The third step involves analyzing the different possible alternatives to the problem of Dr. Lim. For the counselor in giving advice the client’s welfare is must but it should also keep in mind the welfare of all the related parties in this case (ACA, 2017). One alternative can be charging her medical fees on the basis of the fees charged by other professionals in this same situation. The alternative can be reducing her professional fees so that her medical practice cannot be questioned as a way to earn money. She can also publically apologies for the unethical behavior towards the royal family of Brunei and the medical fraternity of Singapore.

Conclusion

Stage 4: In the fourth step Dr. Lim is advised to choose the best alternative possible by keeping aside her own personal interest. The best alternative is evaluated which do not have any unethical implications and in line with her professional ethics.

Stage 5: The fifth step involves selecting the best alternative to solve the problem. As a counselor I would advise Dr. Susan Lim to charge her professional fees on reasonable grounds and also apologies to the royal family for threatening them to disclose their secrets as the relationship between the patient and the doctor is of utmost good faith and she has violated this rule.

Stage 6: The sixth step involves the implementation of chosen alternative so that the Dr. Lim’s problem can be resolved ethically. Also the solution provided to her by the counselor should serve the best interest of all the stakeholders in this case.

Stage 7: In this step the alternative that has been implemented is reviewed and monitored in the real world. This solution if implemented effectively will result into retaining back the lost reputation of Dr. Susan Lim and the ongoing case may be withdrawn by the Royal Family.

Stage 8: The last step involve the review the previous steps and ensure that no important information is ignored also the effectiveness of the solution is also measured (Linder, 2013).

Conclusion

The above essay concludes on a note that any problem can be solved ethically. The case of Dr. Lim involved serious violation professional ethics. In order to fulfill her personal motive she took undue advantage of her client’s health. Not only this she violated to the rule of utmost good faith in which she is required to keep all the important information she found out during the course of treatment to herself. She was charged by Singapore medical council due to her unprofessional behavior. The teleology theory justifies the actions of Dr. Susan Lim whereas the deontological theory criticizes it. As a counselor the, with the help of ethical decision model the best alternative has been chosen to solve her moral dilemma.

References

ACA. (2017). Code of Ethics. Retrieved from https://www.counseling.org/Resources/aca-code-of-ethics.pdf on 24 April 2017.

Broad, C.D. (2000). Five Types of Ethical Theory. Psychology Press.Chew, R. (2011). DOCTORS’ FEES AFTER SUSAN LIM’S CASE – Implications for the Medical Profession. Retrieved https://www.sma.org.sg/UploadedImg/files/Publications%20-%20SMA%20News/4511/Insight.pdf on 24 April 2017.

Dr Susan Lim. (2016). About Dr Susan Lim. Retrieved from https://www.drsusanlim.com/about on 24 April 2017.

Ford, R. C., & Richardson, W. D. (2013). Ethical decision making: A review of the empirical literature. In Citation classics from the Journal of Business Ethics (pp. 19-44). Springer Netherlands.

Glanfield, E. (2016). Top surgeon who performed the world’s first liver transplant faces being struck off for ‘charging the Queen of Brunei’s sister £12million for breast cancer treatment. Retrieved from https://www.dailymail.co.uk/news/article-3421059/Top-doctor-performed-world-s-liver-transplant-faces-struck-charging-Queen-Brunei-s-sister-12million-breast-cancer-treatment.html on 24 April 2017.
Allen, K. (n.d.). What Is an Ethical Dilemma? Retrieved from https://www.socialworker.com/feature-articles/ethics-articles/What_Is_an_Ethical_Dilemma%3F/ on 24 April 2017.

Harding, J. (2011). Dr Susan Lim’s threatening letter to Foreign Minister George Yeo. Retrieved from https://johnharding.com/2011/03/dr-susan-lims-threatening-letter-to-foreign-minister-george-yeo/ on 24 April 2017.

Laird, J., 2014. A Study in Moral Theory (Routledge Revivals). Routledge.

Lee, H. (2014). Singapore Medical Council overcharged Susan Lim: Courts. Retrieved from https://www.theonlinecitizen.com/2014/10/03/singapore-medical-council-overcharged-susan-lim-courts/ on 24 April 2017.

Linder, K. (2013). Crunch Time: 8 Steps for Making the Right Life Decisions at the Right Times. Austin: Greenleaf Book Group.

Lum, S. (2017). Susan Lim saga: Husband appeals against High Court ruling. Retrieved from https://www.straitstimes.com/singapore/susan-lim-saga-husband-appeals-against-high-court-ruling on 24 April 2017.

SAMJ. (2011). Medical ethics and the payment of fees before treatment. The South African Medical Journal. Retrieved from https://www.samj.org.za/index.php/samj/article/view/5221/3664 on 24 April 2017.

SingaporeLaw.sg. (2015). Singapore Medical Council v Lim Mey Lee Susan  [2015] SGHC 129.  Retrieved from https://www.singaporelaw.sg/sglaw/laws-of-singapore/case-law/free-law/high-court-judgments/18038-singapore-medical-council-v-lim-mey-lee-susan-2015-sghc-129 on 24 April 2017.

Vijayan, K.C. (2016). Surgeon Susan Lim loses UK case over notice of suspension. Retrieved from https://www.straitstimes.com/singapore/surgeon-susan-lim-loses-uk-case-over-notice-of-suspension on 24 April 2017.

Wood, G. (2011). “Teleological business ethics: formative, rationalist and transformative – illustrations and analogies”, EsicMarket, Vol. 138, pp. 35-61.