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Counseling Ethics: Doctor Susan Lim

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Write about the Counseling Ethics for Doctor Susan Lim.




The moral theories assist a person in making judgment regarding the right or wrong actions. In the recent years, several moral theories have emerged which assist a person in determining whether an action is morally correct or not. In certain situations, moral dilemma arises where taking a specific course of action can result in harm to some other people, whereas taking another course of action can result in harm to some other people. In this regard, a person can take help of moral theories to take ethical decisions. In professional practices, it is important to maintain ethical behavior in order to maintain the integrity of the profession. Several accreditation societies follow stringent have implemented stringent rules in order to maintain the integrity of the profession. In this regard, it is important to take into consideration the moral theories and adopt a specific morality framework so that a person chooses the best action in case of ethical dilemma. In this regard, the present essay evaluates the case of Doctor Susan Lim and her ethical dilemma. Her ethical decision is defended using deontological moral theory. In addition to it, a decision making framework is proposed which can assist the doctor in future decisions.


The Ethical Dilemma of Doctor Susan Lim

Susan Lim is one of the most prominent doctors in Singapore. She handled the case of breast cancer of the sister of Queen of Brunei. The sister was admitted in her hospital and she provided all the care to the patient. Later, the Royal Family of Brunei accused her of charging high fees. When she realized that the Singapore Medical Council and the Brunei royal family are accusing her, Doctor Susan Lim faced the ethical dilemma of whether she should reveal confidential information related to the royal family and their relations with the Brunei government (John Harding, 2011). In order to defend her situation, she needs to reveal sensitive information which can impact adversely on other stakeholders (Broad, 2000).

Different Stakeholders in the Ethical Dilemma

The stakeholders can be identified as all those people who will be affected by the decision of the Doctor. In the below section, the major stakeholders are identified:

Doctor Susan Lim

She is the primary stakeholder of the case. She provided services to the patient and obtained training and facilities so that the patient can be provided with excellent treatment. Later, she charged fees from the patient according relative to the services provided to her. However, she was accused of high fees which resulted in a case against her. In order to present her defense, she needs to reveal information which will damage the repute of her patient’s family. If she will not reveal it, it will make her defense week.

Singapore Medical Council

The Singapore Medical Council (SMC) is a statuary board which regulates the professional conduct and ethics of the medical practitioners. It develops the guidelines for the medical practitioners for ethical conduct (Singapore Medical Council, 2017). Susan Lim overcharged her client which is breach of the ethical guidelines of the organization.


Royal Family of Brunei

In the present case, the victim is the royal family of Brunei. The family was heavily charged. The fees imposed upon the family were very high in comparison to the services offered. Getting influenced by the wealth and affluence of the family, she hikes her service charges. Moreover, when she faced charged for overcharging, she also tried to exploit the vulnerable relations of Brunei government and the royal family.

8-Step Decision Making Model

Ethical decision making is an important part of a professional’s life. While confronted with the ethical dilemma, it is important to follow guidelines so that minimum stakeholders are negatively affected with the ethical dilemma. In this situation, 8-step ethical guide is proposed to assist the doctor in taking the best fit decision.

Gather the Facts:

In this phase, an individual should obtain all the facts and information related to the case. Moreover, it is important that all the possible alternatives and their impact on the stakeholders are examined. The doctor should also examine the extent of impact on different stakeholders for ethical decision-making. In the present case, the stakeholders are Brunei family, Doctor Susan Lim and Singapore Medical Council. If Doctor Lim exposes the vulnerable relations between Brunei Family and government, it will spread bad name for the family and the government. Moreover, this information is not directly linked with the case; therefore, it is not sure that it will be positive for the case.

Definition of the Ethical Issue:

In this phase, an individual or organization needs to define the ethical issue or dilemma. In the present case, the ethical dilemma for the doctor is that whether she should reveal the information related to the vulnerable relations between the Brunei Government and the Royal Family. If she will reveal the sensitive information, it will do potential harm to her past client. It is also against the professional integrity. Moreover, if she does not reveal the information, her chances of getting prosecuted will increase.


Identification of Affected Parties

In the present case, the affected parties are Brunei Family, Singapore Medical Council, and the Brunei Government. If the doctor will reveal the information, it will adversely impact on the Brunei government and the royal family.

Identification of Consequences

In this phase, an individual has to identify all the possible consequences which can occur from a certain action. In this phase, the decision-maker has to evaluate all the alternatives based on their consequences and their impact. In the present case, if the doctor needs to reveal the information to protect herself from accusation. However, it may cause negative impact on the reputation of Brunei Family and the Brunei government.

Identification of Obligations

In the present case, doctor has obligation towards her past client and the Singapore Medical Council. According to the professional ethics of doctor-patient confidentiality, the doctors or the medical practitioners cannot reveal the sensitive information regarding their clients (Miller, 2008). If Doctor Susan Lim reveals the information, it will breach the confidentiality of the patient. Moreover, according to the principles of professional conduct of the Singapore Medical Council, a professional should maintain the professional integrity and should not engage in behavior which causes potential harm to the client.

Consideration of Personal Character and Integrity

In this phase, the decision maker has to evaluate his personal character and values. Every person grows with a specific set of beliefs and virtues. The doctor should consider self-evaluation and adopt the practices which align with his personal character. According to the case-study, it can be identified that the Doctor has been successful in his career and brought several technologies in Singapore. She has contributed a lot for the welfare of the Singaporean society. Therefore, it can be critiqued that the moral standards of the person are high (Jacob, Decker & Hartshorne, 2010).

Identifying Different Alternatives

In good decision-making, it is important that the person should identify different alternatives and their impact on the stakeholders. In the present case, the primary stakeholders of the company are Brunei government and the doctor. There are two alternatives to the situation, either the doctor can opt to reveal the sensitive information regarding the vulnerable relations between Brunei government and the royal family or choose to conceal it.

Taking the Final Action

In this phase, it is correct action is taken after the evaluation of all the alternatives. Accordingly, it is proposed that the Doctor should opt to conceal the information regarding the sensitive relation between Brunei government and royal family.


Justification with the Ethical Theories

In the recent years, a large number of moral theories have emerged which tries to develop a framework through which the righteousness of the actions could be determined (Sher, 2012). The most common moral theories are utilitarianism and deontology. The utilitarianism is the most common and popular theory which states that an action could be categorized as right or wrong based on its consequences. According to this theory, if an action has positive outcomes on the stakeholders then it is a morally correct action. In contrast to it, if the consequences of the action are bad for the society or the stakeholders, then that action will be considered as an immoral action. The utilitarianism is based on the utility theory which states that the best action is one which has maximum utility. In this moral theory, the utility is defined as the sum of all the benefits derived from an action and subtracting from it the sufferings imposed from the action. According to this theory, the utility of action is the only determinant of the possibility of an action. The theory dictates that a person should consider the interest of all the stakeholders involved rather than considering only self-interest. This theory states that the interest of all the stakeholders should be considered equally (Dreier, 2009). When this theory is applied on the case of Doctor Susan Lim, it can be evaluated that the doctor should decide to conceal the facts known to her. She should consider the interest of patient, her family and the Brunei government. It can be analyzed that there are certain shortcomings of this theory. For instance, nobody can determine the future consequences of a certain action. If the doctor chooses to conceal the information regarding the relations between Brunei government and the Royal family, it can have negative impact on the society or in the filed case. In the application of this theory, it can be critiqued that favoritism influences the decisions. In utilitarian decision making, the basic instincts of a person take over and a person takes a decision in personal favor (Jacobs, 2008).

The deontological theory is a normative ethical theory. It states that the ethical position of an action could be determined according to certain rules. It is different from utilitarianism in which the focus is on consequences rather than the action itself. However, deontological theory emphasizes on the morality of the actions. In the context of the professional ethics, there are certain ethical codes which need to be followed for integral and ethical conduct (Waluvhow, 2003). According to this theory, the doctor should not deviate from rules, in spite of the consequences. The professional Code of Conduct developed by Singapore Medical Council (SMC) states that all the medical professionals should follow ethical conduct in their medical practices (Haidt, 2012). It includes charging he client in proportion to the services provided to them. Moreover, all the medical professionals should follow the basic integrity and confidentiality principles. It means that the doctors or the healthcare professionals should not reveal sensitive information which can cause potential harm to the clients. The deontological theory has certain shortcomings. It can be evaluated by the application of the deontological principles on the case study that a person cannot deviate from the rules in order to prevent future disasters. They can also not breach duty to prevent violations caused by other people. In essence, when a person follows the deontological principles he cannot deviate from the principles even in complex situations.


It can be concluded that Susan Lim should decide to not reveal the sensitive information related to the Brunei family and the government. The decision is reached by the application of 8 step decision making model. According to the utilitarianism theory, a person should consider the benefit of all the stakeholders rather than self-interest. Therefore, according to this theory, the action is justified.  The deontological theory states that a person should abide by certain rules and regulations in any situation. According to this theory, the decision of concealing the information is morally correct. 



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. May 3, 2017 from

Haidt, J. (2012). The Righteous Mind: Why Good People are Divided by Politics and Religion. Penguin UK.

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

Jacob, S., Decker, D.M., & Hartshorne, T.S. (2010). Ethics and Law for School Psychologists. John Wiley & Sons.

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

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

Miller, T.W. (2008). School Violence and Primary Prevention. Springer Science & Business Media.

Sher, G. (2012).Ethics: Essential Readings in Moral Theory. Routledge.

Singapore Medical Council. (2017). About SMC. Retrieved 4 May 2017 from

Waluvhow, W.J. (2003). The Dimensions of Ethics: An Introduction to Ethical Theory. Broadview Press.


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