Ethics in counseling, serve as standards and guideline which aim to dictate the need for moral considerations, by professionals practicing their respective fields of expertise. As stated by Har and Jusoh (2015), ‘Counseling Ethics’ imply the usage of ethical standards for the provision of guidance in order to enhance the quality of teaching disseminated to counselors, the quality of services exhibited by them as well as enhancement of the quality of duty, counselors are responsible for, during handling of their clients. As opined by Trahan and Lemberger (2014), counseling ethics can also be defined as a set of standards which aim to state the guidelines of conduct, which ought to adhered to, by professionals. As researched by Sivis-Cetinkaya (2015), counseling ethics can be defined as standards which dictate the structure of services disseminated by counselors and the provision of boundaries in duties and description of professionalism. The emerging importance of professionalism and provision of humanitarian services, has necessitated the need for professionals to adhere to legal and ethical consideration during their provision of services to the client (David, 2015).
The following report discusses the case of Dr. Susan Lim and her association with the Brunei family. In this report, I will work in favor of Dr. Susan Lim and defend her in her situation of ethical and moral dilemma. The usage of moral theories aims to justify and reason the underlying causes of actions and their state of righteousness. Hence, for the purpose of defending Dr. Lim, the moral theories of teleology and normative realism have been utilized to justify her moral dilemma, along with an eight step ethical model, for the purpose of her case management.
Dr. Susan Lim irecognition as a surgeon high skill, was acquired during her successful conduction of one of the first liver transplantations in Singapore. Her situation of ethical dilemma and associated conflict emerged upon the death of the younger sister of the Queen of Brunei, Pengiran Anak Hajah Damit (Khalik, 2014). The patient belonging to this royal family was receiving treatment for breast cancer since the year 2001 and succumbed to her condition in the year 2007. The conflict arose when it was uncovered that Dr. Lim charged a medical bill of £ 12 million, which was extremely expensive in comparison to the standard salary. During 2012, the Singapore Medical Council found her guilty for overpricing and manipulating medical expenses of the patient, resulting in her violation of professional ethical behavior (Glanfield, 2016). It is however worthwhile to mention that Dr. Susan Lim provided services of high quality to the Brunei family, acquiring help from various individuals of expertise, in accordance to the best of her abilities and professional information. The situation further escalated to alarming levels, when Dr. Lim engaged in writing a letter to George Yeo, Singapore’s foreign minister, stating that she may be compelled to leak confidential information about Brunei’s royal family and the patient, if the legal proceedings did not reach a conclusion, which will not only shame the royal family but will also severely hinder Brunei’s and Singapore’s cordial relationship (The Independent, 2016).
As stated by Lamiani, Borghi and Argentero (2017), moral and ethical dilemma highlights a conflict where an individual must undertake a decision, which he or she assumes would yield the best outcomes after assessment of several alternative outcomes, which may however, hinder moral and ethical considerations. The profession of medical and clinical practice is not devoid of such dilemma and often practitioners are faced with such conflict, which is justified considering the resultant positive health outcome which they are providing.
In the case of Dr. Susan Lim, a key moral dilemma is her overpricing and distortion of medical bills, which goes against the ethics of her professional conduct. The other moral dilemma which I could identify as her counselor, was her threat to release confidential patient information of the royal family, in an attempt to save herself legally, which violates the ethical considerations of patient privacy, confidentiality and unanimity.
Moral Theory: Teleology
In ethics, as stated by Nicholson and Kurucz (2017), moral theories are frameworks upon which the actions of individuals can undergo discussion, evaluation and justification, on their rightness or wrongness. For the case of Dr. Susan Lim, I will be utilizing the moral theory of Teleology, as an attempt to defend her stand. In accordance to the teleological theory of morality, the end result or outcome achieved after the conductance of certain actions, is the determining factor of morality. Hence, as stated by this theory, the action of an individual is morally correct, if the results lead to beneficial outcomes (Padin et al., 2015).
Hence, the teleological theory of morality can be used to justify the moral dilemmas faced by Dr. Susan Lim. Hence, according to this theory, Dr. Susan Lim’s action of charging high prices for the medical field was reasonable and justified, since the initial purpose of her action was to result in the betterment of the younger sister of the Queen of Brunei. Despite the alarmingly high charged which indirectly would lead to profit, Dr. Susan Lim’s primary aim was to result in the rapid recovery of the Queen’s sister, through the provision of high quality treatment which utilized professionals of multiple expertise, in accordance to the best of her in capabilities. Hence, her action justifies her claims of charging high amounts for the purpose of positive health outcomes in the patient.
Despite the justifications, the moral theory of teleology is subject to several limitations (Padin & Svensson, 2017):
- The resultant implications of such actions are unpredictable and may not be justified by the methods of such actions. Hence, despite the provision of overpriced treatment procedures by Dr. Lim for the purpose of patient recovery, they were still not justified since the result was the uncertain outcome of death of the queen’s sister.
- The nature of behaviors undertaken with the intent to result in positive outcomes, may still be morally incorrect. Hence, despite the provision of best quality treatment, Dr. Lim’s prices were still high in comparison to standard expenses by other renowned professionals, which hindered the ethical consideration of provision of services in accordance to the consent and capability of the patient’s family.
The theory of normative realism states that there are no universally valid principles. The theory suggests that the moral righteousness or wrongness in one’s action varies from one society to other (West, 2016). It should also be noted in this regard that the theory build up upon the fact that there are no universal standards of ethics or morality that all men bind to at all times. The concept of ethics varies from one individual to other (Wong, 2013). Further, it has also been stated that the set of moral values are set by different communities on the basis of their culture and traditional values. In addition to this, it should further be stated that the theory considers the concept of normative relativity to be subjective and highly variable. In this regard, it should also be mentioned that the diverse ethnic and cultural background of the people would never permit to establish a universal set of ethical guidelines that would be observed by every individual across the globe. The theory also mentions that the ethical principles of a specific community reflects the nature of the authoritative leaders who hold power in their hands and their thought process. It is therefore, obvious that each culture would follow a distinct source of ethical guidelines and any attempt to adopt a universal set of guidelines would lead to a political turmoil or an assertion of an extrinsic power. However, it is crucial to note here that the theory has remained restricted to a philosophical notion and is not accepted by cultural anthropologists and scientists. The diverse ethical considerations of each culture has been critiqued by the researchers and has been compared to calculation of gain and loss.
On closely evaluating the case study of Dr. Susan Lim it can be mentioned that the Normative relativism theory holds true. Dr. Lim was aware of the fact that she was surcharging the patient for the treatment from the time-period 2001 to 2007. She kept overcharging the patient on the basis of her royal background and also testified during the hearing that she had informed the patient previously that special care would involve an amount of approximately $100,000 to $200,000 per day. The patient had agreed and also mentioned that the fees incurred was nominal. It can be mentioned here that Dr. Lim had been a high-profile practitioner and had entered into the profession being aware of the ethical code of conduct. The incidence of disrespecting the moral obligation of the profession clearly reflects her separate belief in a diverse set of ethical principles that is built up upon the misuse of her authoritative power.
However, it is crucial to note here that the theory has remained restricted to a philosophical notion and is not accepted by cultural anthropologists and scientists. The diverse ethical considerations of each culture has been critiqued by the researchers and has been compared to calculation of gain and loss (Wong, 2013).
Step Ethical Model
The eight step ethical model is used by professionals to make ethically sound decisions when they encounter an episode of moral dilemma (Counseling.org, 2018). In order to assist Dr. Lim, as a professional counsellor, the 8-step ethical model would be used to help her in the decision-making process. The eight stages of the decision making model constitute eight stages that include, defining the issue, collecting appropriate information, explore the issue applying different perspectives, brainstorm and make use of contrasting approaches, stringent evaluation of the available alternatives, selection of the appropriate alternative and take a decision and evaluate the subsequent outcome (Herlihy & Corey, 2014).
- The first step that includes the definition of the problem is extremely important. This stage comprises of identifying the major issue and identifying the root cause of the issue and a possible solution to the issue. On relating it to the case study, it can be said that the Dr. Lim has provided exceptional service to her client who belongs to the royal family. However, the patient’s family is not happy with the service provide and allegedly claims that the cost of the treatment had been unreasonably high. It should be mentioned here that the problem needs to be resolved on an immediate basis or else it would tarnish the professional reputation of the doctor.
- The second stage includes, the collection of relevant and appropriate information that are linked to the case. Dr. Lim must collect all relevant information that are aligned with the patient’s case. In addition to this, she must consult other doctors that whether or not the charges charged by her are economically feasible. Also, she should investigate and analyse the judicial norms that whether or not the charges imposed by her are permitted by the law.
- The third step would require Dr. Lim to consider wavering and lowering her fees. She could also consider lowering and segregating the prices charged for different services provided to the patient (org. 2018, section C, p. 8). At this moment the appropriate solution to the problem would be to comply with the professional standard of practice and charge reasonable fees.
- The fourth step on the other hand would require Dr. Lim to thoroughly evaluate all the legal laws and regulations that would be incurred upon her by the SMC for violating the professional code of ethics (org. 2018, section E, p. 11).
- The fifth step would require DR. Lim to obtain legal consultation. This would require her to discuss the issue with other professionals and consider the options available to her (org. 2018, section D, p. 10). In this context, it should be mentioned that the best option available to Dr. Lim is revising the treatment price that was incurred by her to the Brunei family. Over pricing the patient irrespective of their background is considered a violation of the professional code of conduct (Counseling.org 2018).
- The sixth step would require Dr. Lim to consider the probable courses of action. This refers to considering the legal procedure that she has to undergo in order to implement the best recommendation available (Counselling.org 2018)
- Consequently, the seventh step would involve exploring the consequences of various decisions. It can be expected that on wavering the fees, the Brunei family would be satisfied with the solution and the SMC would also approve the stance taken by DR. Lim (Counseling.org, 2018).
- The eighth step includes deciding on the course of action and evaluating the result of the efficacy of the outcome in the long run and deciding whether or not the implemented strategy had been successful in solving the problem and justified the stance of the stakeholders. (Counseling.org, 2018); (Shapiro & Stefkovich, 2016).
Hence, to conclude it can be said that the case of Dr. Lim and the Brunei family was a complicated one that involved conflict of professional ethics. While the Brunei family was not satisfied with the overpriced treatment, Dr. Lim argued that the surcharge was justified as she had rendered the best quality service to the patient. The stance of Dr. Lim proved to be justified and compliant with the Normative Relativism theory, and the teleological theory code of ethics. However, she had mislead the patient according to the judicial review committee. The theory of 8-ethical model could be used to assist Dr. Lim in taking an effective decision and lower the price charged to the patient in order to comply with the code of ethics associated with the profession.
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