An Ethical Limit and Medical Singapore

Private doctors will be looking on closely today as the landmark Susan Lim v Singapore Medical Council (SMC) case – which could see an “ethical limit” set to their fees – gets under way at the High Court.

Dr Lim is appealing against an SMC disciplinary committee’s guilty verdict for professional misconduct over the amount she charged a royal patient from Brunei.

The cost of about half a year’s care totalled $24 million before the surgeon halved it to $12.1 million with a discount.

The committee said that notwithstanding any patient-doctor agreement, no doctor should charge more than an “ethical limit”. However, it did not state what that limit should be.

Should the court uphold the SMC’s verdict, it could lead to an immediate overhaul of charges by top private specialists.

Deciding on what such a ceiling might be could lead to great soul-searching as guidelines on medical fees are not allowed because they go against the Competition Act.

Currently, the profession practises in a free market environment with doctors fixing their own fees and some more experienced or popular ones charging several times more than their junior counterparts.

Lawyers for both parties will get 45 minutes each to argue their case before justices Chao Hick Tin, Andrew Phang and V.K. Rajah.

Mr Alvin Yeo of Wong Partnership, acting for the SMC, will maintain that regardless of whether a doctor has an agreement with the patient, the amount charged should not be excessive.

He will argue that patients trust doctors and overcharging would bring dishonour and disrepute to the profession.

He will also uphold the disciplinary committee’s decision that “Dr Lim breached by the widest and clearest margin her ethical obligation to charge fees which were fair and reasonable”.

However, Mr Lee Eng Beng of Rajah & Tann, acting for Dr Lim, will argue that such an ethical limit to what doctors can charge has never been mentioned previously. Therefore, it would not be fair or legal to find a doctor guilty of doing something in breach of an unknown rule.

The recent appeal by aesthetic doctor Low Chai Ling may play a part in this case. She had been found guilty of providing non-evidence-based treatments. This took place before guidelines for aesthetic treatment came out.

In this case, the High Court dismissed the disciplinary committee’s guilty verdict on the grounds that a doctor cannot be found guilty of doing something before guidelines are known.

In his written verdict of the Dr Low case, Justice Rajah also touched on fees.

He said: “While it can be confidently said that no profession should overcharge or be allowed to overcharge... patients who seek aesthetic treatments are usually prepared to pay for such services. The patient’s desires and finances determine the treatment eventually administered.”

Whether the same principle applies to treatments other than those dealing with looking good is what this court will have to decide – and what private doctors are waiting to find out.

Writer: Salma Khalik

Resource From: medical Singapore and Singapore private hospital A&E

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