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Discuss about the duties of the Counselors. 

Dr. Susan Lim's Case

Ethics are considered to be moral principles or rules of conduct designated for any individual or group. However, in case of counseling, ethics plays significant role in underpinning the nature and course of actions taken by the counselor (LUM, 2018). Therefore, in case of counseling ethics, it is the duty of the counselors to behave in an ethical manner.

Susan Lim is one of the reputed surgeons in Singapore. In the year 2016, she received her fellowship in surgery from the Royal College of Surgeons Edinburgh. The present case is involved with the death of Pengiran Anak Hajah Damit belonging to the Brunei family who was suffering from breast cancer for a long time since the beginning of 2001 and ultimately died in 2007. Dr. Susan Lim was treating the patient during that time and has overcharged the patient in regard to the medical treatment provided to her. The total medical bill charged was an amount of £12million which is much more compared to the professional fees charged in such circumstances (Lum 2018). The overcharging of medical fees directly questioner her professional ethical practices. It is evident that, in the year 2012, an enquiry was launched against her by the Singapore Medical Council in regard to her unethical behavior and was held to be guilty. However, it was found that the services provided by her were extraordinary and exceptional and there are no complaints in regard to the medical facilities provided by her. 


The case of Dr. Susan Lim is related to misconduct in medical practice. In this case, Dr. Susan Lim was convicted of professional misconduct as she overcharged one of her patient, the sister of Queen Brunei in the year 2012 (LUM, 2018). In this regard, Dr. Lim was suspended from practice and was fined with $10,000 SGD. In the later part, Dr. Lim was allowed to continue her medical career when she appealed her sentence. It is worthwhile to refer here that, the case of Susan Lim Mey Lee v Singapore Medical Council [2013] SGHC 122 has been considered to have utmost significance as it successfully pointed out the fact that medical practitioners in Singapore are bound by high ethical duties (Vijayan, 2018). Dr. Susan was acting as the principal physician of the royal family of Brunei. In spite of all these, she charged an amount of $24 million as a part of her medical charges.

Moral theories are those theories that has been providing fair basis to individuals in regard to the judgment involving ethical issues. Moral theories have proved to be beneficial in arriving at a reasonable conclusion that whether the solution provided is morally correct or not. Each moral theory contradicts each other’s views however; they still plays significant role in shaping the personal and professional behavior of individuals (Rodríguez & Juri?i?, (2018). Therefore, the ethical dilemma faced by Dr. Susan Lim can be resolved by the application of the moral theories. The moral theories can be emphasized as Hard Universalism, soft universalism, deontology and teleology. In the present case study, it can be observed that Dr. Lim has charged excessive fees from one of her patients. The nature of the disease was such that it was not easier to cure however; it is unethical to charge excessive fees from a patient. The act on the part of Dr. Lim was such that it was declared to be unethical and in violation of the professional codes of conduct.

Moral Theories and Their Limitations

Deontology is the study of moral duty that falls under the branch of normative ethics (Holyoak& Powell, 2016). Under deontology theory, an act is only considered to be ethical only if it adheres to the assigned duty. However the authority is totally independent upon the given situation and the possible outcomes.

The concept of deontological ethics is purely based on the subject-matter of non-consequentiality. In this regard, the views and moral decision of the people are taken into consideration. The word “deontology” is a Greek word which means “duty”. The concept of deontology emphasizes on the part that, the actions on the part of the individuals are not justified by the consequences (Barnard, 2017). However, factors involving good outcomes may in some cases determine the effectiveness of the actions. It is worthwhile to refer here that, from the very beginning, the concept of deontology emphasizes upon the set of rules which distinguishes the concept of right and wrong (Bowen & Prescott, 2015). The concept of deontology ethical theory is such that it is easier to apply.

There are certain limitations of the deontological theory as well. The major limitation is that deontologists need to develop non-consequentiality model of rationality of their own (Holyoak& Powell, 2016).  Secondly, it is important on the part of the deontologists to deal with the areas of conflicts that have been in existence between certain rights and duties over the years (Uhlmann, Pizarro &Diermeier, 2015). Therefore, the most important limitation is the conflicting of moral duties where an individual gets confused regarding what to decide between the two duties and rights. Thirdly, the theory of deontology creates paradox (Kinsella et al., 2015). The welfare of the society has been forbidden as a result of this. For instance, the act of killing someone in order to save a person is not considered to be just and fair under deontology however; it is not allowing the person to die. Therefore, there comes a confusion regarding whether to prevent the action or let the individual kill someone. Fourthly, the concept of self-defense has been ignored. In deontology, the concept of violence is considered to be wrong (Paquette, Sommerfeldt& Kent, 2015).   


On the other hand, using violence in order to prevent attack is also prohibited. Due to this reason, it has been difficult for individuals to stay ethically right in deontology. Fifthly, the essentials of emotion and sympathy have been removed by Kant from ethics. In such process, the moral worth from ethics has been removed. Authors have argued that, deontology provided a narrow view of the concept of duty (Ten Have, 2016). The concept of duty under deontology has facilitated the formation of a closed system where individuals do not enquire into the reasons behind their actions (Rodríguez &Juri?i?, 2018). In this way, the theory of deontology has lead to moral fanaticism.

Application of the Eight-Step Decision-Making Model

Normative theory is concerned about the moral concepts of right and wrong. There are three sub-divisions under normative ethics. These are virtue ethics, deontology and consequentialism (Paquette, Sommerfeldt& Kent, 2015). These sub-divisions of ethics mainly emphasized upon the nature of moral character and action which are closely related or are concerned with the course of action on the part of normative ethics. As normative ethics is the study of ethical frameworks, there is an attempt to develop guidelines that do not necessarily list ethical actions however; can judge the nature of the action. There are certain limitations of normative theory as well. Firstly, normative theories cannot be applied in real world because real world is full of complexity. Secondly, the nature of these normative theories is such that it can be considered to be overly academic. Thirdly, the normative ethical theory emphasizes much upon prescriptive approaches. In this regard, most of the decision is made by applying the set of moral principles and rules. However, in real world, the decision making process involves the judgment and discretion of individuals.

Dr Susan came to visit me for seeking advice regarding the ethical dilemmas faced by her. In her medical career she is facing ethical dilemma regarding charging of excessive fees from one of her patients. She seeks advice regarding the fact that whether charging of excessive fees was ethical or was it necessary for the sake of the medical facilities she offered to the patient. It is noteworthy to refer here that, situations may occur in the life of a medical professional which involves taking moral and ethical decisions. As a counselor, I would like to apply the 8-steps decision making model in order to solve the ethical dilemmas faced by her. In this case, Section A of the SMC 2016 Ethical Code can be applied which deals with Good clinal care. According to Section A1, it is important to provide competent and relevant care to the patients.

In the first stage, the identification of the problem or dilemma takes place. In case of Dr. Lim, the problem involved is regarding overcharging one of her patients (VIJAYAN, 2018). In this regard, assumption can be made on the part that from the very beginning, Dr. Lim has provided extraordinary services to that patient that in general were not provided to other patients. However, her patient’s family felt that they were charged excessively for the services provided and were treated unfairly. 

Conclusion


In the second step, the potential issues involved needs to be identified. In this step, it is important on the part of Dr. Lim to gather relevant information from all possible sources. In such process, she should take the advice of other medical practitioners having similar experiences in regard to the charges that needs to be imposed (VIJAYAN, 2018). In this regard, she is free to consult the Singapore Medical Council as well.

In the third step, it is important for Dr. Lim to judge the underlying alternatives. The alternatives are concerned with the imposition of different fees for consultation and treatment. In this context, the major alternative available is lowering the charges for the medical services.

In the fourth step, the evaluation of the alternatives takes place however; after proper examination of the alternatives, the appropriate solution needs to be opted (Uhlmann, Pizarro & Diermeier, 2015). After obtaining the appropriate solution in the fifth step which is concerned with charging fees according to the guidelines provided in the professional code of conduct.

In the sixth step, there is an implementation of appropriate solution in which Dr. Lim should implement the solution by charging appropriate fees from the Brunei family. However, in this regard, before implementing the solution, Dr. Susan must take into consideration possible and probable courses of action in relation to the case. In this case, she should charge reasonable fees from her clients and should not charge them excessively.

In the seventh step, there is monitoring of result and the Brunei family is charged reasonably and fairly (Rowe, 2017). In this step, Dr Susan should consult her supervisor and colleges before taking any reasonable decision.

In the eighth step, the solution needs to be measured in relation to its performance in order to ensure whether the solution is justifiable or not. Therefore, in this step, it is important to measure the effectiveness of the solution. In this regard, when the Brunei family will receive the appropriate bill amount; there is a possibility on their part to withdraw the suit that has been filed. 

The major stakeholders involved were Dr. Susan Lim, the members of the Brunei family, Singapore Medical Council (SMC) and the Singapore Association for Counseling (SAC).

  • Susan Lim was of the perspective that the fees charged by her in regard to the services provided by her were appropriate. This is due to the reason that she provided exceptional services and also invited foreign medical professionals in order to provide extraordinary services.
  • It was emphasized by the Singapore Association for Counseling that, any medical practitioner cannot charge bills higher than the considerable limit ("Mission & Values – Singapore Association for Counselling", 2018).However, the Court did not agree with such justification on the part of the Dr. Lim as she stated that as a result of exceptional care the higher fees were charged. This is because; the nature of the service was such that she could attend other patients as well.
  • After proper evaluation, it can be observed that the Brunei family has been exploited due to the presence of excessive wealth. In this regard, by taking advantage of the situation, Dr. Lim intended to maximize her profits by obtaining large amount of fees from the Brunei family. The vulnerable relations with the Brunei family have been exploited to the large extent and have a perception that the Singapore government will support her in this case ("About SMC | SMC", 2018). Lastly, it can be analyzed that, Dr. Kim got very desperate in her actions and in such process tried to threaten the foreign ministry in regard to the upcoming venture between the Singapore government and Brunei family.
  • There was a dilemma on the part of the Singapore Medical Council in regard to the code of professional ethics of the medical practitioners ("About SMC | SMC", 2018). In this situation the ethical dilemma was that whether Dr. Susan Lim acted professionally by charging excessive fees or not.

Conclusion:

In the conclusion, it can be stated that ethical behavior depends on many things. However, the final decision shall depend upon the individual i.e. Dr Susan, the underlying circumstances and the morality or the intensity of the situation. The behavior of Dr. Susan was morally correct as emphasized by deontology theory however; the normative theory addresses such behavior to be unethical. For the purpose of taking the right decision, it advised to Dr. Lim that she should follow the eight steps ethical decision making model for preventing her professional career from further damage. 

References:

"Code Of Ethics – Singapore Association For Counselling." Sacsingapore.org. N.p., 2018. Web. 23 July 2018.

About SMC | SMC. (2018). Retrieved from https://www.healthprofessionals.gov.sg/content/hprof/smc/en/topnav/about_smc.htm.

Barnard, A. (2017). Values and ethics for professionals. In Developing Professional Practice in Health and Social Care(pp. 80-92). Routledge.

Bowen, S. A., & Prescott, P. (2015). Kant’s contribution to the ethics of communication. Ethical Space: The International Journal of Communication Ethics, 12, 38-44.

Capraro, V., Sippel, J., Zhao, B., Hornischer, L., Savary, M., Terzopoulou, Z., ... & Griffioen, S. (2017). Are Kantians better social partners? People making deontological judgments are perceived to be more prosocial than they actually are.

Cook, T., Mavroudis, C. D., Jacobs, J. P., & Mavroudis, C. (2015). Respect for patient autonomy as a medical virtue. Cardiology in the Young, 25(8), 1615-1620.

Holyoak, K. J., & Powell, D. (2016). Deontological coherence: A framework for commonsense moral reasoning. Psychological Bulletin, 142(11), 1179.

Kinsella, E. A., Phelan, S. K., Lala, A. P., & Mom, V. (2015). An investigation of students’ perceptions of ethical practice: engaging a reflective dialogue about ethics education in the health professions. Advances in health sciences education, 20(3), 781-801.

LUM, S. (2018). Court of Appeal upholds decision that Susan Lim must pay $235,000 in fees to legal assessor. Retrieved from https://www.straitstimes.com/singapore/courts-crime/court-of-appeal-upholds-decision-that-susan-lim-must-pay-235000-in-fees-to.

Paquette, M., Sommerfeldt, E. J., & Kent, M. L. (2015). Do the ends justify the means? Dialogue, development communication, and deontological ethics. Public Relations Review, 41(1), 30-39.

Rodríguez, J. V., & Juri?i?, Ž. (2018). Perceptions and attitudes of community pharmacists toward professional ethics and ethical dilemmas in the workplace. Research in Social and Administrative Pharmacy, 14(5), 441-450.

Rowe, G. (2017). VALUES AND ETHICAL FRAMEWORKS IN HEALTH AND SOCIAL CARE. The Handbook for Nurse Associates and Assistant Practitioners, 20.

SMC Ethical Code and Ethical Guidelines (2002 and 2016 editions) and Handbook on Medical Ethics (2016 edition) | SMC. (2018). Retrieved from https://www.healthprofessionals.gov.sg/content/hprof/smc/en/topnav/guidelines/ethical_code_and_ethical_guidelines.html.

Ten Have, H. (2016). From medical ethics to bioethics. In Global Bioethics (pp. 31-42). Routledge.

Uhlmann, E. L., Pizarro, D. A., & Diermeier, D. (2015). A person-centered approach to moral judgment. Perspectives on Psychological Science, 10(1), 72-81.

VIJAYAN, K. (2018). Surgeon Susan Lim loses UK case over notice of suspension. Retrieved from https://www.straitstimes.com/singapore/surgeon-susan-lim-loses-uk-case-over-notice-of-suspensi

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