Moral Dilemmas in Dr. Lim's Overcharge Case

This article discusses the moral dilemmas in Dr. Lim's case of overcharging a patient for medical treatment and violating professional conduct. It explores the ethical theories and decision-making process involved in resolving the dilemma.

Running head: MORAL DILEMMAS DR. LIM’S OVERCHARGE CASE
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Solving Dr. Susan Lim’s Case
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MORAL DILEMMAS DR. LIM’S OVERCHARGE CASE 2
Solving Dr. Susan Lim’s Case
Introduction
Ethics involves a set of rules or principles that shape morals in an individual or groups.
Ethics determine what choices are to be made based on whether they are morally right or wrong.
In the counseling profession, ethics underpin the course and nature of actions that the counselors
take. Ethics demand that counselors and all other professionals who help clients need to behave
in a manner that is highly ethical (Hanson, 2014). From the nature of counseling profession,
counselors should operate in the best of their clients’ interest, promoting the goals of their clients
and protecting their rights, maximizing the good or right and minimizing the harm. This aspect
broadens based on the inherent power that exists between the counselors and their clients. In this
case, ethics have various principles and ethical codes whose aim is to balance the power of the
profession while ensuring that counselors operate for their good and that of the client. Primarily,
it is the duty of the counselors to care and protect their clients (Dr. Susan Lim, 2016). During the
ethical choice making process, counselors need to consider the organization or agency, the
greater community and profession besides themselves. The counseling does not happen in a
vacuum and thus, it is essential for counselors to acknowledge the various facets in their
profession both externally and internally. The paper targets to evaluate the moral dilemmas in
Dr. Susan Lim’s case.
Case study
The case study involves Doctor Susan Lim who is being investigated for exorbitantly
charging a Brunei patient for the services she rendered to her in a cancer treatment process. The
doctor who is credited for being the first paramedic to conduct a successful liver transplant is

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now facing charges for having overcharged her patient for breast cancer treatment procedure.
The patient is a young sister to the queen of the Brunei royal family and a cousin to the sultan.
She is now about to lose the ability to practice if the allegations directed against her are to go by.
She is claimed to have charged the patient more than £12million which equals $24m Singapore
dollars for a service she rendered for six months in 2007 (Khalik, 2013). In 2012 an investigation
was launched by the SMC (Singapore medical council) after the patient later died and the Brunei
family tabled the case against her. So far Dr. Susan has been found guilty of more than 94 times
and the court gave her a three-month suspension from practicing as a punishment for her moral
misconduct. The court also fined her some £5,000 ($10,000) and forced to sign a commitment
that the felony would not be repeated in the near future (Khalik, 2014). The patient identified as
Pengiran Hajah Damit Anak was brought under the care of doctor Lim in 2001 and died in 2007
of breast cancer. The documents filed against her in court details about the bills she had been
charging the patient from 2004, though those between 2001 and 2004 are not known The (Straits
Times, 2016). These bills show an exaggerated charging for the services and this made the
Brunei family go to court.
Moral dilemmas in the case study
A moral dilemma involves a situation whereby individuals have to make decisions
regarding the best action course to take from various action courses, on the basis or right or
wrong and regardless of which action course is taken, there exist some compromises of moral
principles (Harding, 2011). In the healthcare profession, there exists no direct relationship
between medical healthcare services and profits. However, a reasonable and fair consideration in
exchange for the professional medical care services offered may be totally justifiable. There are
two moral dilemmas in the above Lim’s case study which include the following. One moral

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dilemma is that Dr. Lim can agree and apologize for having overcharged and manipulated the
medical bills against her patient with the key aim of making exorbitant profits (Daily Mail,
2016). The second moral dilemma involves her way of trying to escape the ongoing legal suit
against her misconduct where she threatens to reveal the sensitive information her patient
revealed to her during the treatment process which should be confidential. The dilemma is
whether she can apply this threat to save herself or not.
Moral theories
A moral theory refers to a theory which offers a fair basis of judgment to an individual
regarding a solution to a given problem. Theories help people arrive at a conclusion that tends to
determine whether a give action is morally upright or not. The key objectives in the theory are to
find among given courses of action is the best to take regarding the situation and which one is
wrong. Though all moral theories contradict each other based on some given contexts, they all
try to guide people concerning their personal or professional behaviors (Broad, 2013). Moral
theories have a rigid approach that is conservative whereas ethics have a practical and flexible
approach. The moral dilemma that Lim faces can be solved using a moral theory and a model of
ethical decision making. They tend to shade some light regarding whether the behavior of Lim is
right or wrong (Dreier, 2006). Among the various moral theories include the deontology,
teleology, hard universalism and soft universalism which are useful in professional and personal
contexts.
Teleology moral theory
The teleology theory states that the end result determines the morality of an action. In this
case, when the end result is good, the approach or action applied in getting a good outcome
remains justified (Schmid, 2011). As per the theory, doctor Lim’s action of overcharging her

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patient's high fees is morally upright and justified. She does not have to plead guilty and
apologize since the reason is that her primary focus in the course of offering treatment to the
patient was targeting her well-being and recovery from the breast cancer she suffered from.
Thus, regardless of the overcharged fee, the doctor wanted her good health to be restored.
According to her, she claims that all the bills she table for the patient was out of the interest of
the patient’s well-being and not for self-gain as many can attest. On the other side, since the
patient later died, it is not easy to know whether Lim was seriously treating her patient or was
just after her money. She may be held accountable for moral misconduct. The main limitations of
the theory are; that the end outcome or the consequence is not certain and that the course of
action that has been taken may not justify the results that are expected (Schmid, 2011). The other
limitation is that the behavior that is meant to achieve a good outcome may not be morally
supported.
Normative relative theory
This theory claims that there is no one or universal moral code of conduct or standard
applicable to all people in the world since every culture has what it considers good or bad and
which may be good or bad to another culture (Quintelier, & Fessler, 2012). In this case, one
action is right for this country or culture and is at the same time bad in another culture of a
country. So applying some laws against action in one country may be wrong since it all depends
on whether the action is considered wrong in this area. According to Lim’s case, what the Brunei
family culture may consider morally wrong from the case may not be wrong in Susan’s culture.
This means that she may be justified in charging any fee to her patients. However, the degree of
wrongness depends on whether the law is against this behavior. The main limitations of this
theory are; that it may justify actions that are morally wrong based on culture and area. Again,

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the theory lacks any back up from cultural anthropologists and the evidence about this theory is
against it (Quintelier, & Fessler, 2012). It is thus important to evaluate what the law in Singapore
or GMC (general medical council) in London or SMC (Singapore medical council) say about the
habit of overcharging. It is clear that they are against disclosure of confidential information
among medical professionals (Chong, Quah, Yang, Menon, & Krishna, 2015).
Moral Decision-Making Process
The professional and personal life, involves various situations which leave them obliged
to decide from some course of actions. Whatever the case is, the decisions taken need to be
morally upright. Professionals may consider using a model for making moral decisions. This
process of decision making is subdivided into eight simple steps. I have a key responsibility as a
counselor, to try and help Dr. Lim so that she may take the right decisions while observing ethics
and morals which are acceptable to both her professional and personal life.
1. The first stage involves defining the problem which focuses on the problem, the problem
root causes and solutions to the identified problem (Linder, 2013). Doctor Susan Lim’s
case is faced with a problem of charging unreasonably one patient related to the royal
family in Brunei, in the name of the medical services she exceptionally offers to the
client. However, the royal family has a strong belief that the doctor saw a golden chance
to rip huge sums of money from her patient’s medical health.
2. The second stage involves acquiring relevant information from available sources on how
to charge for similar services rendered. Susan should also obtain data regarding the
services she gave to the client, from the other doctors having enough experience so that
she forms a charge limit for her patients in a professionally, fair and reasonable manner.
She also needs to consult the GMC (general medical council) or the medical council of

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Singapore. The two moral principles are reasonable charging for services and
withholding confidential patient information.
3. The next step involves judging by the best alternative Linder, 2013). The best alternative
that Dr. Lim needs to follow in her case involves using the charge rates for consultation
that other medical professionals like her use. At the same time, she can consider lowering
her fee she charges the patients so that she may try to retain back the original public faith
and professional reputation for her practice. She needs to evaluate the ACA (American
counseling association) and SMC (Singapore medical council) code of ethics and what
they say about charging for services rendered in healthcare (Asia One Health, 2016).
4. The fourth step in the model involves an analysis of the best alternative chosen among
the many that are available. She ought to analyze all the given alternatives identified in
the above step and try getting the one that best applies to her own case. She needs to
evaluate Singapore law and regulation concerning the profession in the country. The law
is against overcharging for services rendered (Bergmann, & Brough, 2013).
5. Step five involves selecting the best of the alternatives by consulting experienced
professionals. In Lim’s case, the best alternative that seems to suit her is to reduce her
professional charges for her services so that she retains back her original faith patients
and the general public had on her regarding her medical practice so that she may try to
convince them that the services she offers are of great importance than making money.
6. The next step involves implementing the identified probable course of action. The
possible solution involves Dr. Lim preparing a medical bill for her patients keeping in
mind the fair and reasonable fee to charge. She also needs to give the clients some

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concession that would apply as a gesture for the problem the Brunei family faced which
is the probable action (Muller, 2008).
7. The seventh step after the implementation stage involves monitoring and enumeration of
the consequences of various decisions. When the Brunei family gets to see the corrected
bill and the proposal to compensate them for the overcharged amount, they may consider
withdrawing the case from the court and makeup with Dr. Lim.
8. The last step in the decision-making model involves deliberation and making a decision
by measuring the effectiveness of the solution so far obtained by finding out whether it
was the one fit for the given case or situation or there could have been a better one. In
case, another one is identified at this stage, one is advised to repeat the evaluation process
again from step six.
Conclusion
The case above serves as a moral or professional misconduct involving Doctor Susan
Lim. The paramedic had overcharged a patient for medical treatment and violated the
professional conduct code when she threatens to reveal confidential information concerning the
client and her immediate family. Based on her unacceptable actions she had to face several legal
proceedings in a court of law. Doctor Lim’s behavior was morally corrected from the support of
the teleology theory. Additionally, the normative relativism theory seems to find ways of bailing
Lim out of what she did, based on the fact that there may not be universal moral standards that
seem to bind people across the world. In this case, the eight-step decision-making model needs to
apply in the case and try to fix Lim’s reputation in her profession and avoid future damages.

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References
Asia One Health. (2016). Surgeon billed Brunei patient $40m over 4 years. Retrieved from
https://health.asiaone.com/health/health-news/surgeon-billed-brunei-patient-40m-over-4-
years
Bergmann, S., & Brough, J. (2013). Reducing the Risk, Increasing the Promise: Strategies for
Student Success. London: Routledge.
Broad, C.D. (2013). Five Types of Ethical Theory. Retrieved from
https://books.google.co.in/books?
hl=en&lr=&id=o2K4AwAAQBAJ&oi=fnd&pg=PP1&dq=teleological+theory&ots=BO
Kj84lT1l&sig=MiZf1REWsmTAUBcRXbzGMMre-jI#v=onepage&q=teleological
%20theory&f=false
Chong, J. A., Quah, Y. L., Yang, G. M., Menon, S., & Krishna, L. K. R. (2015). Patient and
family involvement in decision making for management of cancer patients at a centre in
Singapore. BMJ supportive & palliative care, 5(4), 420-426.
Daily Mail. (2016). Top surgeon who performed the world's first liver transplant faces being
struck off for 'charging the Queen of Brunei's sister £12million for breast cancer
treatment. Retrieved from https://www.dailymail.co.uk/news/article-3421059/Top-
doctor-performed-world-s-liver-transplant-faces-struck-charging-Queen-Brunei-s-sister-
12million-breast-cancer-treatment.html
Dr Susan Lim. (2016). About Dr Susan Lim. Retrieved from https://www.drsusanlim.com/about

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Dreier, J. (2006). Contemporary Debates in Moral Theory. Retrieved from
https://www.psicosocial.net/grupo-accion-comunitaria/centro-de-documentacion-gac/
filosofia-y-teoria-comparada/etica/866-contemporary-debates-on-moral-theory/file
Hanson, O.K. (2014). The Six Ethical Dilemmas Every Professional Faces. Retrieved from
https://www.bentley.edu/sites/www.bentley.edu.centers/files/2014/10/22/Hanson
%20VERIZON%20Monograph_2014-10%20Final%20(1).pdf
Harding, J. (2011). Dr Susan Lim’s threatening letter to Foreign Minister George Yeo. Retrieved
from https://johnharding.com/2011/03/dr-susan-lims-threatening-letter-to-foreign-
minister-george-yeo/
Khalik, S. (2013). Susan Lim case: SMC's lawyer says Brunei govt found fees exorbitant,
unjustified. Retrieved from https://www.straitstimes.com/singapore/susan-lim-case-smcs-
lawyer-says-brunei-govt-found-fees-exorbitant-unjustified
Khalik, S. (2014). Brunei health ministry wants a "fair" bill, not discount from Dr Susan Lim.
Retrieved from https://www.straitstimes.com/singapore/health/brunei-health-ministry-
wants-a-fair-bill-not-discount-from-dr-susan-lim
Linder, K. (2013). Crunch Time: 8 Steps for Making the Right Life Decisions at the Right
Times. Austin: Greenleaf Book Group.
Muller, S.S. (2008). In defense of soft universalism. Retrieved from
https://dialnet.unirioja.es/descarga/articulo/3684833.pdf
Quintelier, K. J., & Fessler, D. M. (2012). Varying versions of moral relativism: the philosophy
and psychology of normative relativism. Biology & Philosophy, 27(1), 95-113.

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Schmid, S. (2011). Teleology and the Dispositional Theory of Causation in Thomas
Aquinas. Logical Analysis & History of Philosophy/Philosophiegeschichte und Logische
Analyse, 14.
The Straits Times. (2016). 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-suspension