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Introduction to SMA Committees - Ethics Committee

The SMA Ethics Committee has been a committee of the SMA Council since 1966. It started off as "a committee formed with an advisorial function and no definite terms of reference"(1). In recent years, its nature of work has become more defined and in the last two years, has also been more proactive.

It is a committee; I am told, customarily chaired by the President to indicate its importance in the hierarchy of SMA activities. I can see the activities of the Committee being classifiable into four types: operational, consultative and liaison, policy, and educational.

Operational activities

The key operational activity is to handle complaints from the public. The natures of complaints are wide ranging. Some figures and details may help to give the reader a picture of what reaches the Committee’s attention.

In the space of four months since the new SMA Council took office in May 1999, the Ethics Committee has received 87 complaints against the 5000 doctors practising in Singapore. The institutions complained against by unhappy patients ranges from clinics to both private and restructured hospitals. There have also been complaints from the public against whom they see to be charlatans, trying to advertise themselves purporting the ability to cure medical problems like blood pressure.

The top reasons for complaints by patients against their doctors are alleged negligence (36 complaints) which include dissatisfaction of outcome of treatment (5 out of the 36 complaints); fees (22 complaints); communication problems and rudeness (5 complaints); failure to attend, alleged outrage of modesty, medical certificates (3 complaints each); long waiting time, prescription problems (2 complaints each); clinic environment, confidentiality, advertising (1 complaint each).

We also receive complaints from professionals. Two doctors complained against their colleagues about unethical practice.

The modus operandi of the Committee in handling the complaints has been published in the July 1997 issue of the SMA News. First of all, the letter of complaint is screened. There are three kinds of cases that we will not handle: cases in which police reports have been made or which are the subject of court proceedings; cases in which medical ethical issues are not involved; cases in which the doctors or complainants have confirmed that legal proceedings are being instituted.

For the rest, we will forward the letter from the complainant to the doctor(s) complained against and ask for their comments. The letters received from the doctor and the complainant are then studied by Committee members and action is taken. A letter from the Committee on its view of the matter, together with the doctor’s letter of reply is then sent to the complainant. Very often the underlying causes of the complaints are miscommunication and differing expectations. Where the complaint and answer from the doctor looked like the doctor may be a potential defendant, we will advise the doctor to seek medico-legal opinion, tell the complainant that the matter is outside the purview of the Committee and direct him or her to alternative avenues to take up the matter.

The Ethics Committee also has a consultative and liaison function. Discussions on ethical policy matters are sometimes carried out with the Ministry, lawyers and doctors as well as with overseas medical institutions, marketing agencies and also the mass media. The Best Doctor International is one recent example.

This is an important function. In a world of uncertain values, there is a need for balanced policy decisions. In this context, we liaise with the Ministry of Health and other relevant medical and ethical organisations world-wide in drawing up policy decision statements on ethical matters.

The Ethics Committee has issued the following advisory statements for members:

1. Advisory on Advertising

2. Advisory on breast and chest examination of female patients and,

3. Advisory to radiologists who wish to perform radiological investigations arising from requests from other than SMC -registered medical practitioners.

In 1997, the Ethical Issues and Policy Review Committee was formed with the following Terms of Reference of this Committee:

"1. As ethical standards evolve with time, there is a need to study the norm and evaluate the profession’s stand on pertinent issues. The Committee may decide from time to time to conduct research (through collating feedback from the general membership or other means) or initiate discussion with a view to produce or update position papers, principles and guidelines for the guidance of the professional, or even for updating of the SMA Ethical Code.

"2. The Committee may make recommendations to the SMA Council on the topics to consider for SMA Lecture, SMA Medical Convention or other talks, seminars, workshops to be organised."

This Committee has worked with SAPI and produced a joint paper on "The Medical Profession & The Pharmaceutical Industry" in 1998. This paper spells out the common ethical principles and practices in the relationship between the medical profession and the pharmaceutical industry, and establishes the working guidelines for the two organisations in resolving ethical conflicts which may arise from time to time.

The SMA Ethics Committee, through the Ethical Issues and Policy Review Committee, has organised several continuing educational activities on medical ethics.

In 1997 an Ethics Convention with the theme "The Medical Profession and the Industry" was organised. The highlights were a keynote address on the medical profession and the industry, a symposium on the medical profession and the pharmaceutical industry, and a symposium on managed care.

The Committee organised its first Mini Course on Medical Ethics in the 1998 Ethics and Practice Convention. This course which was held on a Sunday morning was very well attended by about 100 doctors. The topics covered in the course included the pillars of medical ethics and its relevance to medical practice, what is ethics, the sanctorum of medical ethics and the doctor-patient relationship. A series of case studies introduced the real world into the classroom.

The 1999 Ethics and Practice Convention will be held on Sunday, 28 November. Another Mini Course on Medical Ethics will be held. The lecture topics covered will be the pillars of medical ethics, and patient confidentiality. There will be a panel discussion and case studies on patient confidentiality. There will be the SMA Lecture 1999 on Medical Ethics to be delivered by Mr Choo Han Teck, Judicial Commissioner. There will also be a public symposium on patient confidentiality with speakers from SMA, CASE, SNEF and NTUC (see N6 for details and registration form).

The plan in the near future is to launch a Centre for Ethics and Professionalism as the forum for defining, documenting and disseminating information on what is ethical medical practice.

The SMA Ethics Committee is a Committee that works to acquaint members and the public on the professional values that doctors uphold. The public has an avenue of redress should they feel the need to take up issues with their doctors on the services they have received. We believe that timely feedback is important.

A/PROF GOH LEE GAN
Chairman, SMA Ethics Committee

1. SMA Annual Report 1966

2. SMA Guidelines on Case Management by SMA Ethics Committee, SMA News, Vol 39 No. 3, N 4.