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Counseling Ethics Case Of Susan Lim

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Discuss about the Counseling Ethics Case of Susan Lim.


Susan Lim is a prominent surgeon in Singapore who has performed several complex surgeries throughout her career.  Due to her exceptional capabilities, she is famous all across the globe. She was head surgeon in the first liver transplant in Singapore, became the youngest person and first Singaporean to become the fellow of Trinity College, Melbourne. In 2001, she undertook the case of Pengiran Anak Hajah Damit, the sister of Brunei queen. In 2007, the patient died a d Dr. Susan Lim was accused of overcharging the patient with a very high charge. According to the media reports, Dr. Susan Lim was accused of making a bill of 40 million dollars during the period of 2001 to August 2007 (Asia One Health, 2016). In the later investigations, it was found that the bills constructed were astonishingly high than the normal circumstances. In 2013, doctor was prosecuted and found guilty. Singapore National Council filed a case against the Susan Lim and won the case eventually. The doctor was found guilty. During the judgment, the doctor presented her side by stating that she charged the patients in accordance to the services provided to them. She stated that although the prices were very high, but they were in accordance to the services. In order to excellent services to her client, she received training from all across the globe. In several instances, she herself paid for the services provided to her client such as sending the patient from Singapore to Brunei; therefore, she was only asking them from the client (John Harding, 2011).

Moreover, her professional conduct can be scrutinized from the fact that in order to halt the legal processioning, she threatened the Singapore Medical Council that she can bring into light several unnecessary and embarrassing facts which can bring shame to the government and the royal family of Singapore. She stated that she knows the inconsistent relationship between Ministry of Health, Government of Brunei and the royal family of Brunei. The threat brought her a second disciplinary action.


Identification of Ethical Dilemma

The code of medical ethics regulation state that the doctors should not overcharge their patients. According to the professional ethics, doctors should charge their patient according to the services provided by them. However, same is not the case of Doctor Susan Lim. Moreover, overcharging is against the professional practices, as it refers to deceit and abuse of one’s position. It can be critiqued that there was another moral issue wherein that the doctor tried to threaten the government to drop the accusations.

Major Stakeholders of the Case:

Upon the review of the ethical issue, the major stakeholders can be identifies as Brunei Royal Family, Singapore Medical Council, Singapore government and the doctor herself.

Susan Lim

Susan Lim was the primary stakeholder in the ethical issue. She was the performing doctor who took case of the patient for six years. She was of the viewpoint that she provided exceptional services to the patients, invited the foreign professionals and received training which made it acceptable for her to overly charge her patients (Youtube, 2011).

Singapore Medical Council (SMC)

Singapore Medical Council was also a major stakeholder in the case, as it is the responsibility of the organization to maintain the professional integrity among the healthcare professionals and doctors in the Singapore. Any breach of duty is against is breach of guidelines of the Singapore Medical Council. In the present situation, Dr. Susan Lim breached the guidelines of Singapore Medical Council and the organization should try to impose justified penalty for the unethical behavior (Broad, 2000).

Brunei Family

Brunei family is the victim in the present situation. The doctor exploited the family due to their excessive wealth and influence. The doctor tried to obtain as much fees as she possibly could as she knew that her client was capable of paying higher fees. When she faced trial, Susan Lim also tried to exploit the vulnerable relations between Brunei government and Royal family as she was aware of their relations (Timmons, 2012).

Singapore Government

It is the responsibility of the government to protect the society from any type of criminal or civil offence.  The professional medical society of Singapore has made code of conduct for the healthcare professionals so that they work ethically. In the present case, the Singapore government is a stakeholder as it is its responsibility to maintain law and order in the country.

Ethical Dilemma

The ethical dilemma can be defined as a situation in which a person is conflicted between different courses of actions in which taking one action will result in transgressing some other moral imperative. In the present situation, the ethical dilemma of overcharging the patient has been identified. The doctor calculated the fees according to her perspective and presumed that the exceptional services provided to the client justify the fees imposed upon them. She singularly treated one patient and kept all her focus to the sister of the royal queen of Brunei (Garber, (2008). Therefore, in her perspective, the fees imposed upon the client were justified. However, the royal family of Brunei was displeased with the doctor’s fees as they were exceptionally high. They presumed that the doctor was charging them with high fees die to their wealth.


Moral Theories

In the recent years, a large number of moral theories have emerged to examine whether certain actions are morally fit or not. These theories try to provide a systematic method to evaluate whether certain actions are morally right or wrong. However, different moral theories are dependent upon different perspectives and several times contradict each other. In the present section, the ethical dilemma of Doctor Susan Lim is examined under different ethical frameworks.


Utilitarianism is the most popular and common ethical theory which states that the all those actions are ethical which have better outcomes for the society. The utilitarianism is a version of consequentialism and states that only the result of certain actions can be categorized as right or wrong. In this framework, the interest of all the stakeholders is considered equally. There are certain benefits and disadvantages of utilitarianism (Dreier, 2009). The advantages of utilitarianism are that it promotes equality and happiness of all the people in the world and assist the people in taking tough decisions. In most of the complex and tough decisions, the emotions and the desire of the people become predominant; however, adopting utilitarianism approach assist the people in thinking rationally and taking the right decision (Jacobs, 2008).  

When this theory is applied to the case of Doctor Susan Kim, it can be evaluated that the action is morally justified. The overcharging of fees was ethically wrong as it was only beneficial for the doctor. The client was wronged as the fees were astonishingly high and determined according to his affluence. Moreover, the action will be a bad influence on the society as it is a breach of the moral code of conduct of the healthcare professionals.



The teleology theory of morality states that the morality of the actions depends on the expected outcomes of the actions. Teleology theory states that if a person is following a certain course of action to achieve good from the situation, then that action is justified (Hinman, 2012). The teleology theory has certain disadvantages like it allows immoral actions on the pretext of better consequences. The consequences of most of the actions are quite uncertain; however, it allows the people to take morally unjustified actions (Alexandra & Miller, 2009).

According to this theory, the actions of Susan Lim are morally wrong as she was not focused on the treatment of the patient rather than increasing the probability of charging her client in the maximum possible manner. Although she provided exceptional services to the patients, pricing her client highly was always in her mind.

Counseling Process

Doctor Susan Lim should be provided counseling on the moral justifications of her action. Adopting a morality framework and examining the actions through it can assist the doctor in taking morally right actions.


Decision-Making Process

In the daily life of professionals, it is important that the people should take morally correct and ethical decisions. In order to take morally correct and right decisions, the professionals need a decision making framework. In the present section, an eight-step decision making model is proposed which can assist doctor in ethical decisions in the near future. According to this model, the decision making process has eight phases.

Phase 1:

In this phase, the problem is defined. In good decision-making, the problem definition is very important. It assist person in establishing clarity on the actual problem and examining various viewpoint of different stakeholders. In this phase, the root or the underlying causes of certain problems is identified. In addition to it, in this phase the limiting assumptions, system and the interface boundaries and the stakeholder issues are identified (McKee, Kemp & Spenxce, 2012).

Phase 2:

In the second phase of the model, the requirements for the acceptable solution are identified. The Acceptable solution must meet certain requirements and address the underlying problem. The requirements define what the solution must be capable of doing.

Phase 3:

In the third phase, goals and objectives are defined which can be achieved by the solution. It refers to the broad statements of intent and value with the decision.

Phase 4:

In the fourth phase, the person should ponder on different alternatives which can be used to address the problem statement. In good decision making, it is important to evaluate different alternatives according to their effective outcomes. In most of the cases, the alternatives are evaluated according to their ability to meet the requirements and goals of the organization.

Phase 5:

In the fifth phase, different criterions are defined according to which the alternatives to the solution are evaluated. It is important to define discriminating criterion which determines how well each goal is able to achieve the result.

Phase 6:

In the sixth phase, a decision making tool must be developed which is able to select the best route for the solution. The decision-making tool should be based on the complexity of the problem (Mowen, Hansen & Heitger, 2016).

Phase 7:

In this phase, the selected alternative is implemented to achieve the solution. The person should also monitor the solution for its results.

Phase 8:

In the last phase, the implemented solution is measured for its performance. After the evaluation, the person can make amendments in the decision so that the desired outcomes can be achieved (Mowen, Hansen & Heitger, 2016).


It can be concluded that the course of action taken by Doctor Susan Lim is unethical and immoral. It is due to the fact the doctor overcharged her patient excessively. The moral dilemma of Susan Lim has been evaluated according in utilitarianism and the teleological moral framework. According to the utilitiarism theory, all the actions are justified which have better outcomes for the society. In addition to it, the teleological moral theory states that if the intentions of the people are good then the actions are justified. The action can be categorized as immoral according to both theories.

Upon the evaluation of situation, it has been determined that the action was immoral. The doctor can be provided counseling with the help of decision making framework. The eight step decision making framework has been suggested will be beneficial in the future decision making process of the organization.



Asia One Health. 2016. Surgeon billed Brunei patient $40m over 4 years. Retrieved December 10, 2016

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

John Harding. (2011). Dr Susan Lim’s threatening letter to Foreign Minister George Yeo. Retrieved December 10, 2016

Youtube. (2011). Singapore Top surgeon 'threatened' MFA - 28Mar2011. Retrieved December 10, 2016

Garber, P.R. (2008). The Ethical Dilemma. Human Resource Development.

Timmons, M. (2012). Moral Theory: An Introduction. Rowman & Littlefield Publishers.

Jacobs, J. (2008). Dimensions of Moral Theory: An Introduction to Metaethics and Moral Psychology. John Wiley & Sons.

Alexandra, A., & Miller, S. (2009). Ethics in Practice: Moral Theory and the Professions. UNSW Press.

McKee, A., Kemp, T., & Spenxce, G. (2012). Management: A Focus on Leaders. Pearson Higher Education AU.

Mowen, M.M., Hansen, D.R., & Heitger, D.L. (2016). Managerial Accounting: The Cornerstone of Business Decision-Making. Cengage Learning.

Dreier, J. (2009). Contemporary Debates in Moral Theory. John Wiley & Sons.

Hinman, L.M. (2012). Ethics: A Pluralistic Approach to Moral Theory. Cengage Learning.


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