Counseling Ethics Decision Making Process: Susan Lee Case Study

Discussion

Discuss about the Counseling Ethics Decision Making Process.

A moral or ethical dilemma arises when an individual encounters confusion in choosing between two options, each of which seems to have equally strong grounds to be chosen, and yet the person cannot choose both or more than a single alternative. The healthcare experts often encounter serious ethical moral dilemmas in situations which involve offering an ineffective life-sustaining therapy to a terminally ill person, or applying Euthanasia to a dying patient. However, the case of Susan Lee was indeed an exception. The 57 year old Singaporean surgeon had been making headlines in the newspapers since 2011, as she was accused of having charged an exorbitantly high amount of money while treating the sister of the Brunei Queen. The moral dilemma arising here is that should a doctor charge a hefty amount of $24.8 million simply because she was treating a member of the royal family, or should she charge the exactly same fee for each patient, irrespective of the economic or social differences (Christensen et al., 2014). On the one hand, it can be argued that even if Susan had charged an exorbitant amount of money from the royal family, they had been easily able to afford the huge sum of money, and hence one should not make a big story out of it. On the other hand, the counter-argument here is that a doctor should have an ethical obligation of curing and nursing her patient instead of trying to form a transactional relationship with her. However, the purpose of the essay is to resolve the inherent ethical dilemma that Susan Lim is confronting, and helping her resolve her dilemma with the help of the 8-step ethical decision model (Heyler et al., 2016).

The 8-step ethical decision model is a special model that helps one to resolve any dilemma by breaking down a problem by each step, examining the consequences, assessing the gravity of each consequence on the people involved, and thereby ultimately choosing the most befitting solution. The first step that needs to be concerned in this model is the identification of the problem. As far as the Susan Lim case is concerned, it has been observed that Susan Lim, the Singaporean surgeon is encountering a dilemma between two potential alternatives. On the one hand she deems it perfect to overcharge a patient who belongs to an affluent family, and can pay a lump sum amount of money in lieu of the high quality treatment she will deliver. However, on the other hand, she is aware that as a doctor her primary obligation lies in restoring health to a patient, regardless of the monetary benefits she is likely to receive through the same. Consequently, developing such transactional relation with a patient might not only land Susan in trouble, but she would also have to violate the ethical codes of conduct of her profession.

Identification of the problem

The next step here is the identification of the potential issues involved. The major ethical issue involved in this case is that despite being a healthcare expert who is entrusted with the duty of protecting the life of a patient, Susan is inclined to focus more on the materialistic benefits of her profession, rather than the professional obligation. She believes in overcharging the medical fee from a royal family that is unacceptable. On the other hand, there is no rigid rule as to how much a practitioner can charge from his patient, if he is treating him on a personal basis (Grant-Kel et al., 2016). Hence, the other issue here is who is going to determine the ethicality of the situation, as there is no strict ethical guideline in the healthcare industry as to how much can a physician charge his client for, in lieu of the service he is providing (Anderson & Anderson, 2014). While the professional virtue is an important issue here, the business consideration is equally an important issue. For Susan, offering healthcare service is her vocation, and she makes her living out of that. Hence, the other argument here is that if a business man can charge huge amount of money for the ordinary goods sold by him, is it unethical for Susan to charge huge amount of money from a patient who is capable of paying the same?

The third step here is reviewing the ethical guidelines. As far as the ethical guidelines are concerned, there are little or no guideline is being formulated that can eliminate the commerciality of the health practitioners. Although the Singaporean High Court has twice announced that each health practitioner has a primary obligation towards the well-being of the patient, and thus he should refrain from overcharging a patient, there are no strict laws about the same. The ethical guidelines of the healthcare industry state that a health practitioner will always have a higher ethical duty towards the well-being of his patient, which should always triumph over his materialistic considerations (Jonsen, 2015). 

The next step to consider here is that it is necessary to know the relevant laws and regulations concerned here. Although there is no strict law against overcharging, and it is assumed that a patient would charge minimal amount of out his own accord, if a physician is being continually accused of overcharging the fee, he would be sued for professional misconduct and end up paying a huge amount of money as part of the penalty.

Identification of the potential issues involved

The next step involved in this model, is that consultation has to be obtained from other experts about the ethicality of the decision to be taken (Doval et al., 2015). The Court as well as the Medical Council Board of Singapore has clearly stated that a doctor can never charge a fee higher than the market rate. Even if the patient agrees to the higher medical cost involved, the High Court of Singapore makes it a mandate that the ethical obligations of a patient should under any circumstance get an upper hand over any contractual obligations.

In the next stage, it is important to consider the possible course of action, and act accordingly. Here, Susan is left with two alternatives- either she can consider the option of overcharging the patient, driven by her desire to achieve greater profit in her profession, or she can respect the ethical codes of conduct of her vocation, and charge the market fee, overlooking that the patient belongs to an affluent family.

The seventh step to consider here is to weigh and assess the consequence of each possible course of action. As far as the first course of action is concerned, it is being observed that the patient’s family can accuse Susan of having overcharged the medical fee, and that is likely to ruin the reputation of the doctor, and can also mar the public attitude towards the ethical integrity of the doctors. Besides, the first alternative has a high probability of landing him amidst legal troubles as well (Chattopadhyay, 2015). On the other hand, if the second alternative is to be chosen, that is if Susan is prevented from choosing the option of overcharging her patient, the patient’s family would not accuse her or her family of anything wrong, and she would not have to encounter any legal penalty for having breached the moral codes of medical ethics. She would be able to remain true to her professional obligations as well.

After considering and assessing the possible consequences of each action, it has been observed that Susan has two possible alternatives to act on, and given the choice to choose the right one, she should always choose the second alternative. The reason behind choosing the second alternative lies in the fact that Susan would face undesirable legal issues on overcharging a patient. The Singaporean government has mandated that a doctor should only charge fair and reasonable fees from his patients, and he should not prioritize his commercial benefits over ethical responsibility towards a patient. Although there is no ethical limit, as to what fee should be charged, if the patient’s family accuses the doctor of overcharging, she might end up paying $10000 in the form of penalty. Besides, if Susan would be legally sued, this might have a negative impact on her career prospects as well. Considering this, she should choose not to overcharge her patient, and even if she intends to charge high considering her expertise, the amount should be moderately high (Weaver, 2016).

Reviewing the ethical guidelines

Susan Lim’s action of overcharging a patient, violating her ethical obligations towards a patient cannot be justified to be ethically a right alternative at all. However, if one has to defend her action, and comprehend the reason why she chose the option, the theory of Moral Subjectivism should be chosen. According to the theory of Moral Subjectivism, an action can be regarded to be morally right or wrong in accordance with what the subject, or the perpetrator of the action considers to be right or wrong. Thus, no action, according to this theory is intrinsically right or wrong, and if the subject deems his action to be ethically right, the action is right, regardless of what the social norms claim. As far as Susan Lim is concerned, she overcharges the medical fee, that is considered to be wrong as it is violating the ethical codes of conduct a medical expert is expected to follow. Susan Lim herself was well-aware that she was not charging an exorbitant amount of money from an impoverished or financially insolvent person, but rather she was charging a hefty amount from a member of the Royal family. The patient or her family, according to Susan, were financially powerful enough to afford the medical bill, without any difficulty (Barker, 2013). Another majo reason as to why Susan might have done this, or undergone the moral dilemma is that the dctor was one of the most recognized surgeons of Singapore, and hence she deemed it perfectly right to charge high, considering her higher skills and more acknowledged expertise. Susan herself might argue as well that despite being involved in a vocation that serves the welfare of the public, she just like any other person intends to earn penny through her profession. Thus, while a private tutor might sell his service at a higher fee, or a business man might sell his cookies at a higher price, she also wanted to sell her service in lieu of a higher amount. The theory of moral subjectivism claims that the rightness of an action solely depends on the thoughts and opinions of the perpetrator. Consequently, if one looks at Susan, one can find that Susan’s argument can well justify her position and the reason of her action. According to this moral theory, it is vain to criticize and judge the actions of other people, sa not only every one acts in their own interests, but each man works in accordance with what he feels to be a right action. Susan herself thought that her medical profession was the only source of income for her, and resultantly she chose to hike her fee, considering the expertise nad recognition she has earned over the years.

Knowing the relevant laws and regulations concerned

Although in this way, with the help of the above theory, one may easily justify the moral position of Susan Lim, it is important to have a look at the limitations of this theory as well. As far as the theory is concerned, the rightness of an action is determined I terms of what the subject deemed to be right. Hwever, the major limitation of the theory lies in the fact that to each perpetrator of an action, his own perspective is right. Very few people suffer from a sense of repentence and accept that his action was wrong. Now, if one has to consider the rightness of an action in terms of the perspective of the doer, almost every action, including the wrong ones, have to be deemed to be right. Each action as such would have to be considered to be just. The thief stealing someone else’s property must be justified if one has to consider that his perspective was right, as he wanted to bring money to his home at the expense of the hard work of other people (Tan, 2016). Hence in justifying the case of Susan Lim with the help of this theory lies in the fact that Susan Lim was wrong in her choice, and yet she thought that her action was right according to her perspectives. However, it is important to use one’s own judgment and discretion, and object to an action, that is considered to be morally objectionable, regardless of what the subject thinks.

Conclusion:

To conclude, it should be noted that overcharging a patient is not legally or ethically acceptable. It should be noted that Susan or doctors like her often face an ethical dilemma, as they want to charge high and yet understand that the same is not an ethical option. However, it is important to resolve the ethical dilemma, and Susan should remember that she should comply by the ethical obligations of her profession, or else she might face penalty or imprisonment of 3 years. Considering this, Susan is being advised to refrain from overcharging the patient.

Reference List:

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Barker, K. (2013). The Island Has Its Reasons: Moral Subjectivism in Fiction.

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