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Identification of Ethical Issue

Discuss about the Values and Ethics Theory in Counseling.

Ethical decision making is essential in the professional conduct. In order to foster ethical decision making, certain professional organizations have emerged which provides guidelines for the ethical practices. Other than that, there are several moral theories which try to provide framework for determining ethical and non-ethical actions. Some of the common theories are utilitarianism, deontology, virtue ethics and social contract theory. These theories provide framework to evaluate the morality or immorality of certain actions.  Although, these theories have different postulations, the basis of these theories is same. All the theories try to increase the benefits to the society. The moral theories are commonly applied to the situations of ethical dilemma. The ethical dilemma refers to the situations in which taking one course of action can harm to one stakeholder and taking another course of action can cause harm to another stakeholder. In professional practices, ethical dilemmas are common as professionals due to complex business environment. However, taking ethical decisions is important for maintaining the integrity of the profession. In this essence, the present essay evaluates the case of Doctor Susan Lim who was accused of overcharging her patients.

Susan Lim is a prominent doctor in Singapore. She is one of the leading doctors and has acquired international fame. As a result, the sister of Queen of Brunei approached the doctor for the treatment of breast cancer. The doctor was approached in 2001 and the treatment went on till 2006 (Asia One Health, 2016). During this period, the doctor provided all the medical facilities to the patient. She also arranged and bore the expenses of flights of the patient from Singapore to Brunei. In order to provide the best treatment to the patient, he received numerous international training and certificates (Broad, 2000). In regard to all the above expenses, Doctor Susan Lim made a large medical bill. The Brunei family was aggrieved with the manipulated medical expenses. The Singapore Medical Association also critiqued that the fees were astonishingly high and filed a case against the doctor (John Harding, 2011). After the accusation, Doctor Lim threatened the Singapore government that if the case will trialed in the court, she will be required to reveal sensitive information regarding the relations between Brunei government and royal family. In response to the letter of the doctor, the government of Singapore responded severely. It ignored the appeal of the doctor and continued the case (Youtube, 2011).

Decision-Making Framework

In the above case, it can be determined that the doctor was struggling from ethical dilemma regarding whether she should reveal the sensitive information obtained during the treatment of her client. If she would not reveal the information, it will be prosecuted for overcharging her client. It is an ethical dilemma as in both the cases; she will harm the interest of one of the stakeholders. Moreover, there is also an ethical issue regarding the justification of the fees imposed upon the Brunei Family (Jacobs, 2008).

In the present case, the major stakeholders are the doctor, Singapore Medical Council and the Brunei family. It is due to the fact that any course of action by the doctor will impact on one of the stakeholders. If she will reveal the confidential information between Brunei Royal Family and the government, it will compromise the interest and the confidentiality of the past client. Moreover, it is wrong to reveal personal and sensitive information of a specific person. Similarly, if she does not reveal the information; it will adversely impact on her self-interest. The Singapore Medical Council is also stakeholder in the case, as if it is the responsibility of the medical council to maintain the integrity of the medical profession.

In professional conduct, it is important to take ethical decisions so that the integrity of the profession can be maintained. A person should take the decision so that there is minimum negative impact on different stakeholders of the case. In this regard, in the present section, a decision-making framework is suggested which can provide the best solution for the situation. It is 8-step decision making model and each step is crucial in the selection of ethical action (Stuart, 2014).

In the first phase, all the relevant information is obtained regarding the case. The decision-maker should obtain all the possible information from all the available resources. In this phase, the individual should focus on obtaining the information from different stakeholders of the case. With appropriate information, the decision-maker will be able to take the right decision. It will also be helpful in determining the impact on different stakeholders and their extent. In the present case, the doctor should explore all the possible resources to determine the stakeholders of the decision. Moreover, the impact of actions and their extent should also be determined.

In this phase, the decision-maker should define the exact issue and its underlying causes. It will assist in determining the best fit solution for the situation. In the present case, the ethical issue can be defined as the issues regarding whether the doctor should reveal the sensitive information of the patient. Revealing the sensitive information of the patients is also against the professional ethics. However, the professional integrity of the doctor conflicts with her self-interest.

Definition of the Ethical Issue

In this phase, the person should determine all the possible stakeholders and the parties which can be affected by the decision. In the present case, the stakeholders of the decision can be determined as the Royal Family of Brunei, Singapore Medical Council and the doctor.

In this phase, the decision-maker should examine all the possible consequences of the decision. The selection of the best action is dependent upon this phase. In this phase, the decision-maker should examine the possible outcomes of different decisions and based on this decision, the doctor should select the best decision. In the present case, the doctor can opt for two actions; however, both the actions will cause harm to one of the stakeholder. If she reveals the information, it will damage the reputation of the Brunei Family. Moreover, if she chooses to conceal the information, it can harm her self-interest.

It is important to identify the obligation towards different stakeholders to take the best decision in the situation. In ethical decision-making, a person should identify his obligations towards different stakeholders try to address them. In the present case, the doctor has obligations towards her patient and the Singapore Medical Council. Doctor Susan Lim was provided the license by the medical council on the basis that she will follow the ethical and professional guidelines of the organization. Therefore, if the doctor will reveal sensitive information regarding the patient, she will breach the confidentiality norms of the organization. Moreover, doctor also has duty towards her patients. It is important to maintain confidentiality and integrity in the professional conduct. Therefore, the doctor has obligation towards the Singapore Medical Council (SMC) and the patient and her family (Levitt & Moorhead, 2013).

The character and the virtue of a person impact his decision-making.  Every person develops certain beliefs and virtues during his lifetime. All his decisions are based on these basic principles. It is important that the doctor take the decision which aligns with his personal values.

In ethical decision-making, it is important that a person should identify different alternatives which can be used to address the situation. In the present case, the doctor can take two different actions of either disclosing the information or concealing it from the public.

In this phase, the doctor should choose to conceal the sensitive information of the patient. According to the ethical decision making, this is the best decision for the doctor.

Stakeholder Analysis

Ethical theories have been developed to assist in the decision-making process because it represents the viewpoints which can be used to take decisions. There are four broad categories of ethical theories, namely, deontology, utilitarianism, rights, and virtues (Timmons, 2012). The deontological ethical theory states that the people should adhere to their obligations and duties. It states that a person should follow his or her obligations as upholding one’s duty is considered as ethically correct (Hinman, 2012).  According to this theory, a person must follow the rules or his or her obligations to society because upholding one’s duty is ethically correct (Sher, 2012). The deontologists keep their promises and follow ethically correct decisions. A person following deontological principles will produce consistent results which are based on the individual’s set of duties.

According to this theory, the doctor should follow his duties to conceal the confidential information between her and the patient. Moreover, it should also follow the professional guidelines of the Singapore Medical Council. However, it can be scrutinized that there are certain limitations of this theory, for instance, there is no rational or logical basis for determining the ethical duties of a person. Second shortcoming of this theory is that sometimes the duties of a person may be in conflict.

Utilitarianism is another popular ethical theory. It is based on consequentialism and states that the goodness of a decision is based on the consequences of that action. If the consequences of an action are good on different stakeholders, it is considered as morally correct action. In contrast to it, the consequences of an action are bad for the society then it would be categorized a morally incorrect action (Barrow, 2015). Utilitarianism is based on utility theory which states that the morality of an action can be determined based on its overall consequences on different stakeholders. When a person adopts utilitarianism perspective, he needs to consider the interest of all the stakeholders involved in the case rather than considering own self-interest (Mill, 2006). Accordingly, if this theory is applied to the case of Doctor Susan Lim, it can be proposed that doctor should look at the greater good for the society. If she reveals the personal information of her client, it will negatively impact on the complete medical community.  People will start distrusting the doctors with their personal information. Moreover, it can be examined that revealing the personal information of the customers can negatively impact on the reputation of the customer. The patients will be skeptical in trusting their personal information with the doctors in the future. Therefore, it is important that the doctor choose to conceal the personal information of her client.

Consequentialist Perspective on the Case

Conclusion

Susan Lim is one of prominent lawyers in Singapore. In 2001, she undertook the case of the sister of Brunei queen who was suffering from breast cancer. She took care of the medical condition of the patient till the time of her death. She took care of all the medical expenses and the transportation of the patient from Singapore to Brunei. However, later when the doctor asked for her fees, the Royal family considered that the fees were very high in comparison to the services provided. They filed a case against the doctor for the exponentially high fees. However, in order to present her justification in the court, the doctor will need to reveal personal information regarding the Brunei family and government, which can bring dishonour to them.

In the present situation, the doctor is suffering from the ethical dilemma regarding whether she should reveal the personal information of her client. An 8 step decision making model is proposed to assist the doctor in ethical decision making. The decision is based on different ethical theories or framework. The utilitarianism ethical theory state that any action which has better consequences on the society is morally justified. According to this theory, a person should consider the self-interest of all the stakeholders. In contrast to it, the deontological theory states that an action could be morally justified if it follows the rules and ethical obligations towards the society.

References

Asia One Health. (2016). Surgeon billed Brunei patient $40m over 4 years. Retrieved May 3, 2017 from https://health.asiaone.com/health/health-news/surgeon-billed-brunei-patient-40m-over-4-years

Barrow, R. (2015). Utilitarianism: A Contemporary Statement. Routledge.

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 May 3, 2017 from https://www.sma.org.sg/UploadedImg/files/Publications%20-%20SMA%20News/4511/Insight.pdf

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

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 May 5, 2017 from https://johnharding.com/2011/03/dr-susan-lims-threatening-letter-to-foreign-minister-george-yeo/

Levitt, H., & Moorhead, H. (2013). Values and Ethics in Counseling: Real-Life Ethical Decision Making. Routledge.

Mill, J.S. (2006). Utilitarianism. ReadHowYouWant.com.

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

Stuart, G.W. (2014). Principles and Practice of Psychiatric Nursing - E-Book. Elsevier Health Sciences.

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

Youtube. (2011). Singapore Top surgeon 'threatened' MFA - 28Mar2011. Retrieved May 5, 2017 from https://www.youtube.com/watch?v=xWuWLuSZ95Y

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