Discuss about the Counseling Ethics for Susan Kim Case.
Dr. Susan Lim is a prominent and renowned surgeon of Singapore. In 2007, after the death of Pengiran Anak Hajah Damit, the sister of the Brunei queen and cuisine of Brunei’ king died, Dr. Lim was accused with overcharging the patient (John Harding, 2011). Dr. Lim treated the patient in the period of 2001 to August 2007 and all the medical procedure made a total bill of 40 million dollars. She was charged with manipulating the bills and charging the patient astonishingly high in comparison to the natural circumstances (Asia one Health, 2016). In 2013, she was prosecuted and found guilty. In this situation, it should be noted that Dr. Susan Lim charged the client in accordance with the services provided to her. She provided client with exceptional services and in several situations she obtained training and paid from her own pocket for the services she provided.
In order to put a hold to the legal proceedings, Dr. Lim claimed that in order to defend herself properly she is required to expose information that will cause unnecessary embarrassment to Brunei upon which a second disciplinary hearing was conducted. It was a threat made to the Singapore government to subvert the legal process. She indicated that she has information regarding the inconsistent relationship between the Ministry of Health, Brunei and the patient’s family or the royal family. In her defense, the doctor also stated that numerous gratuitous demands were asked to her including bearing the cost of a private air transport to send the patient from Singapore to Brunei. As a result, the doctor faced several charges of professional misconduct (Youtube, 2011). The basic prohibition of overcharging comes under the disciplinary offence as it is inherent in the art of being a professional. Specifically, overcharging comes under morally wrong action when a person has conducted deceit or abuse of one’s position. It can be critiqued that was not simply a matter of overcharging but as the fees was astonishingly high and beyond an ethical limit.
In this situation, the major stakeholders were the Brunei royal family, Dr. Susan Lim, SMC (Singapore Medical Council) and the Singapore government.
Dr. Susan Lim was of the viewpoint that she has charged appropriate fees to the customer as she has provided exceptional services, invited foreign professionals for expert views and given special attention to the staff. In addition to it, Dr. Lim also manipulated the bills shown to the family to overcharge them.
The Singapore government stated that a person cannot charge higher than a certain limit. The court was not impressed by the justification of Dr. Lim which stated that due to exceptional care she charged the fees to this extent. While attending the patient, she was able to see other patients and perform other strategies (Chew, 2011).
It can be critically assessed that the Brunei family was exploited in the situation due to their excessive wealth and affluence. Dr. Lim tried to maximize her profits in the situation and tried to obtain as much fees as she can as she knew that her client were capable of paying her. As per the article published in John Harding (2011), Dr. Susan Lim also tried to exploit the vulnerable relations of Brunei and Singapore and thought that the Singapore government will support her to protect the sensitive information of the Brunei royal family. It could be analyzed that in the last, Dr. Kim got desperate in the situation and tried to threaten the foreign ministry regarding an upcoming venture between Singapore and Brunei.
Singapore Medical Council was in dilemma regarding the professional ethics of the doctors. In this situation, Dr. Susan charged excessively to the client in the situation wherein she was required to behave professionally.
The ethical dilemma is defined as the situation in which there are moral conflicts between one or two actions and choosing one action will refute one ethical system whereas choosing another course of action will contest another ethic (Garber, 2008). The situation could be considered as a predicament, as in this situation Dr. Lim is suffering from ethical dilemma whether she should charge her client according to the demands put on her. Furthermore, another ethical dilemma is when she will fight the legal battle she has to reveal sensitive information of her client.
In this situation, the primary ethical dilemma is regarding the charges and the fees that a professional can charge ethically.
In order to arrive at a conclusion whether an action is morally justified or not, several moral theories have emerged. These theories try to provide a systematic method of examining what action is morally right or wrong. The major moral theories are competing in their advocacy and contradict each other’s views. There are certain controversial issues such as suicide wherein each moral theory contradicts. The primary aim of a moral theory is the desire to have certain system to evaluate whether a certain action is right or wrong (Timmons, 2012). There are certain models that assist a person in resolving ethical dilemmas and making ethical decisions. The moral dilemma of Dr. Susan Lim is explored with the help of certain moral theories and ethical decision making model.
In the counsel process, the moral theories can assist Dr. Susan Lin in examining what actions are right and what actions are wrong. A theory encompasses different statements that explain some concept or fact. A moral theory can be defined as a theory that defines the wrong or right conduct. There are several moral theories and they provide the framework to evaluate and examine moral issues or certain action regarding whether they are right or wrong. The major moral theories are hard universalism, soft universalism, teleology and deontology.
The teleology theory of morality states that morality depends on what can be achieved in the end. It denotes that if a person can achieve good in situation by applying a specific course of action, then the course of action is justified. In the present situation, the course of action undertaken by Dr. Susan Lim can be justified by the teleology moral theory as according to this theory, in spite of the fact that Dr. Lim charged excessively to her client, her main intent was to take care of the patient. She was enthusiastic to provide all the necessary and other services that can prove beneficial to the treatment of the patient. She also undertook training and took advice from other experts to treat the patient. However, the teleological theory has several disadvantages:
Another theory that can be used to justify the situation of Dr. Lim is deontological ethics theory. As per this theory, the morality of the action of a person can be judged according to his or her adherence to certain rules. In the situation of Dr. Lim, there were no certain professional rules or legislations that stop a medical professional from charging excessively. However, this moral theory also has certain disadvantages:
In the daily life of a professional, several situations occur, where it is required to take morally correct and ethical situations. Decision-making is a key skill and a professional can get help of different decision making models to take the correct decision. The most commonly used decision-making model is eight step decision making process in which the decision-making process is divided into eight stages. As a counselor, it is important to assist Dr. Susan Lim in taking a morally justified and correct decision. In this regard, the eight step decision-making model is taken to counsel her in ethical decision making process. The eight stages of ethical decision making models are: defining the problem, gathering all the relevant information, explores different alternatives that can assist in the situation, brainstorm and examine different choices, evaluating the alternatives, selection of best alternative, take decision and evaluate the results (Bergmann & Brough, 2013).
In the first step, the problem is defined, wherein it is examined what exactly is the problem, what the root cause of the problem, and how it can be solved. In the situation of Dr. Susann Li, the major issue is overcharging the client. The underlying assumption in the situation is that Dr. Susan Lim has provided exceptional and extraordinary services to the client and those services are not provided to other people. Her client, the Brunei royal family is unhappy with the excessive charges and feels unfairly treated. The problem should be solved as it will create and tarnish the image of the doctor and will result in dissatisfaction and discontent among the clients.
The second stage is gathering information from all the possible sources. In this step, Dr. Susan Lim is required to collect the information from different sources, for example she should consult other doctors with similar qualification and experience regarding the charges that she should impose, check the judicial guidelines for the service providers regarding their fees and examine the total cost incurred by her before imposing the fees. She can also take guidance from Singapore Medical council.
In the third step, she should judge the alternatives, in this situation; the alternatives include imposing different fees for the consultation and the treatment. Another option is increasing or lowering the fees according to her judgment regarding the services provided.
Then after in the fourth step, different alternatives in the situation should be evaluated. Dr. Lim should examine these alternatives and select the best possible solution.
In the fifth step, the most appropriate solution is obtained. In the present case, most appropriate alternative is to charge fees as per the professional ethics. As the medical profession is considered human service, charging patients exceedingly and working as a business is not appropriate.
In the sixth step, the solution is implemented. In the present case, Dr. Lim should implement the justified solution of charging Brunei family according to the professional ethics.
In the seventh step, the implemented solution is monitored for its results. When the Brunei family is charged fairly, they will not file any case and the reputation of the doctor remains intact.
In the concluding step, the solution is measured for its performance. As it is the best-fit solution, the performance of the solution will be appropriate (Linder, 2013).
Conclusion
Conclusively, it can be stated that situation of Dr. Susan Lim was quite complex. She was suffering from moral dilemma regarding excessive charge of fees from her client. In her perception, the charges were justified as she provided exceptional services to the patient who was a family member of the royal family of Brunei. In this regard, a lawsuit was imposed upon her as she was charging excessively from the client. The situation of Lim can be explored from one of the moral theories which have been formed to distinguish right actions from wrong. The actions of doctor are justified from teleological moral theory wherein the actions are justified by their consequences. In addition to it, the deontological ethic also states that the moral position of a person can be justified from his or her adherence to the rules. However, both of these theories suffer from several limitations. In the counseling process, Dr Lim has been assisted in taking the right course of action by using the eight-step decision making model. According to this model, it has been evaluated that charging the client less will be the most appropriate course of action in this situation.
References
Asia One Health. 2016. Surgeon billed Brunei patient $40m over 4 years. Retrieved December 10, 2016 https://health.asiaone.com/health/health-news/surgeon-billed-brunei-patient-40m-over-4-years
Bergmann, S., & Brough, J. (2013). Reducing the Risk, Increasing the Promise: Strategies for Student Success. London: Routledge.
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 December 10, 2016 https://www.sma.org.sg/UploadedImg/files/Publications%20-%20SMA%20News/4511/Insight.pdf
Garber, P.R. (2008). The Ethical Dilemma. Human Resource Development.
JohnHarding. (2011). Dr Susan Lim’s threatening letter to Foreign Minister George Yeo. Retrieved December 10, 2016 https://johnharding.com/2011/03/dr-susan-lims-threatening-letter-to-foreign-minister-george-yeo/
Linder, K. (2013). Crunch Time!: 8 Steps for Making the Right Life Decisions at the Right Times. Austin: Greenleaf Book Group.
Rawls, J. (2009). A Theory of Justice. Harvard University Press.
Timmons, M. (2012). Moral Theory: An Introduction. Plymouth: Rowman & Littlefield.
Youtube. (2011). Singapore Top surgeon ‘threatened’ MFA – 28Mar2011. Retrieved December 10, 2016 https://www.youtube.com/watch?v=xWuWLuSZ95Y
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