Counseling Ethics: A Case Study of Dr. Susan Lim and the Brunei Family

This report discusses the case of Dr. Susan Lim and her association with the Brunei family. The report utilizes the moral theories of teleology and normative realism to justify her moral dilemma, along with an eight step ethical model, for the purpose of her case management.

Running head: COUNSELLING ETHICS
COUNSELLING ETHICS
Name of the Student:
Name of the University:
Author note:

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Introduction
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.

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Case Study
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).
Moral Dilemma
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

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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).
Justification
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

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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.
Limitations
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.
Normative Relativism
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

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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.
Justification
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

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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.
Limitations
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).
8 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).
1. 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

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that the problem needs to be resolved on an immediate basis or else it would tarnish the
professional reputation of the doctor.
2. 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.
3. 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 (Counseling.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.
4. 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 (Counseling.org. 2018, section E, p. 11).
5. 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
(Counseling.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).

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6. 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)
7. 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).
8. 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).
Conclusion:
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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