University Health Law and Ethics Case Study: Legal & Ethical Issues

This assignment presents a detailed case study concerning health law and ethics. It analyzes a scenario involving a patient, Hetty, and Dr. Lin, focusing on issues such as medical negligence, informed consent, and ethical considerations. The case examines the legal implications of Dr. Lin's actions, specifically whether he violated the Singapore Code and Ethical Guidelines and the Medical Registration Act. It explores the validity of Hetty's consent given her mental condition, and the ethical dilemmas surrounding autonomy and justice in medical practice. The analysis considers the standards of care, the importance of diagnosis, treatment, and communication with patients and their families. The document explores the importance of medical confidentiality, and the potential charges of misrepresentation and malpractice against the doctor. It concludes that medical practitioners are bound to adhere to their code of conduct and regulations. The assignment also references relevant legal precedents and legislation from Australia and Singapore, including the Health Practitioner Regulation National Law Act and the Medical Registration Act, and explores the relationship between legal and ethical principles in healthcare.

Running Head: HEALTH LAW AND ETHICS
HEALTH REGULATIONS AND CODE OF CONDUCT
Name Of the Student
Name Of the University
Author’s Note

1HEALTH LAW AND ETHICS
Table of Contents
INTRODUCTION:..........................................................................................................................2
LEGAL ISSUES:.............................................................................................................................2
ETHICAL ISSUES:.........................................................................................................................5
CONCLUSION:..............................................................................................................................7
REFERENCES:...............................................................................................................................8

2HEALTH LAW AND ETHICS
INTRODUCTION:
According to John (2008), medical practice is a self-regulatory profession. Australia and
Singapore legislations may vary in the scope of their formal enactment. However, the crux
remains the same that is to provide health care services to people are sick. In Australia, Health
Practitioner Regulation National Law Act 2009 is the national legislation which governs the
practices of health practitioners including doctors and nurses. In addition to this there have been
many other laws like Aged Care Act 1997 which regulates the health care provider and its
services to aged people who need it.
In Singapore, Medical Registration Act has explicitly laid down the provision that the
Court shall not interfere in the findings and decisions of the tribunal convened by the Singapore
Medical Council. The Council extends its jurisdiction to the provisions of Medical Registration
Act, Medical Registration Regulations and the relevant guidelines. Owing to the highest esteem
of profession conferred upon the health practitioners, the Council has laid down a set of rules and
regulations including the Code of Conduct for these professionals to abide by for the protection
of the public and integrity of their profession.
LEGAL ISSUES:
The legal issue in the case from Dr. Lin has resulted in trespass of person is whether the
medical negligence and the same can be determined by the legal analysis of whether the action of
Dr. Lin has resulted in the violation of Singapore Code and Ethical Guidelines and Chapter 174
of Medical Registration Act. The provision of the Act has expressly laid down that the medical
professionals should uphold the integrity of the profession and maintain public trust and

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confidence while practicing the profession. on the other hand the Singapore Medical Council
Code and Ethical Conduct expressly states that the failure to maintain the standard of care in the
medical skill or knowledge of the practitioner resulting in the injury, damage or loss to the
patients shall amount to medical negligence or malpractice related to medical profession. In
2007, one woman was given thousand times the dose of radioactive iodine in a procedure. As a
result of which she suffered from lymphoma and thyroid gland disorder. The practitioner was
charged with malpractice or medical negligence by the doctor which injecting the medicine.
However, the woman and the hospital had an out of court settlement for compensation.
In case of such situations, the complaint should be registered with the Singapore Medical
Council. They will provide help related to guidelines and the jurisdiction. The Council may
address three systems for dispute resolution. They are:
 Mediation: the Complaints Committee shall present the case to the Singapore Mediation
Centre for the process of dispute resolution, which shall be free of cost. However if the
parties themselves refer the case to mediation, they may be charged with some minimal
fee for the initiation of the process.
 Formal Inquiry: the Complaints Committee of the Council has the power to initiate a
disciplinary proceeding against the accused in case it feels the necessity for a formal
inquiry to look deeper into the course of events and analyse the application of legal
provisions.
 Health Inquiry: In extreme cases, if the Complaints Committee deems fir to analyse and
evaluate the physical and mental fitness of the medical practitioner to assess whether he
or she is fit to continue the practice or not, then the Committee shall refer the case for the
Health Inquiry of the practitioner.

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In order to evaluate the elements for the test of medical negligence or malpractice of the
practitioners, then following grounds should be testified:
 Diagnosis is accurate and related to the identification of the cause of the ailment.
 Investigations were carried out within appropriate time, not causing any delay.
 Treatment was safe and secure.
 The practitioner has fully and clearly explained the disease and its treatment to the patient
and its family members.
 The relationship between the patient and its practitioner should be completely based on
consents received for the treatment.
 Any reference to any specific department for core check-up should be timely done.
 The practitioner shall appropriately respond as and when he or she has been called gto
attend the patient.
 Medical confidentiality is the essence of medical profession and it should be strictly
maintained.
Trespass to person shall amount when the consent is obtained in the condition of
unconsciousness or inability to give consent due to other physical and mental disabilities, and if
such cases need the treatment in accordance with the best interest and clinical judgment
(Oxbridge.co.uk 2019). In the given scenario, Hetty was under the mental ailment of
forgetfulness and hence, the consent given by her is not admissible as a valid consent.
In Hii Chii Kok vs. Ooi Peng Jin London Lucein and another (2017), it has been held by the
court that standard of care applicable to determine medical; negligence shall be assessed under
two broad headings namely; medical advice and cases related to diagnosis and treatment. The

5HEALTH LAW AND ETHICS
Montgomery case determines the tests for the standards of care for medical advice whereas the
Bolitho inquiry has laid down the principle tests for the assessment of standard of care for
diagnosis and treatment. However, instances of waiver, emergency treatment, therapeutic
privilege and others are few of the non-exhaustive list of instances where the doctor or any other
medical practitioner may be excluded from the provisions of medical negligence and malpractice
of the profession.
ETHICAL ISSUES:
There are two ethical issues that arise from the given situation:
 Autonomy (Duty to inform)
 Justice
The above mentioned issues can be observed by following situational analysis:
 whether Dr. Lin is autonomous and just in his medical practice while treating
Hetty?
 whether Dr. Lin diagnosed and threated Hetty appropriately.
 whether the consent of Adam for the performance of the hernia surgery was free.
 whether the consent given by a woman who is facing problems of forgetfulness is
valid.
In the given scenario, it can be observed that Dr. Lin had an obligation for appropriate
diagnosis and treatment of Hetty. However, he neglected the mental condition of hetty
which may result in further complications. In addition, the reason behind the connection
of mental forgetfulness and hernia surgery was not explained by Dr. Lin. On the contrary,

6HEALTH LAW AND ETHICS
it can be argued by Dr. Lin that hernia has got nothing to do with ,mental sickness. Even
after the surgery, she could have been referred to a psychiatrist. Therefore, for the second
issue, Dr. Lin was responsible to explain in detail about the connection of mental illness
with hernia surgery.
In the given scenario, the consent of Adam was not free. It can be explained from the fact
that he was not confirmed about the operation to be conducted during Hetty’s disturbed
mental condition. However, the doctor chose to avoid Adam’s confusion and confirmed
to him that the forgetfulness is because of hernia problem. Thus, Dr. Lin can be charged
for misrepresentation of facts and misleading the patients leading to malpractice.
However, the doctor may argue that he honestly believed that the cause of forgetfulness
is the delay of hernia surgery and hence, he proceeded with the surgery. Thus, the doctor
can plead defence under therapeutic privilege.
In the given scenario, it can be observed that people with disturbed state of mind cannot
enter into a valid contract and hence, Hetty had a problem of forgetfulness thus, her
consent is not valid. However, it can be argued by the doctor Hetty’s forgetfulness has
not been diagnosed medically with a registered practitioner and therefore, Hetty is holds
the same designation as Adam as a natural fit person whose consent is valid.
From the above situational analysis, it can be explained that the doctor is liable for
medical negligence or malpractice. The doctor had the obligation to be autonomous
which means that he had a duty to inform. In Rosenberg case, it was held that the duty to
inform extends to the principles of Human Rights and recognition of human dignity. the
same been recently applied to Tok Seok May Joanne vs. Yau Hok Man Gordon (2013).

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However, the courts have taken a liberal interpretation and have decided that the doctor
in the given scenario, acted in a haste manner rushing and forcing his decision of surgery
without understanding the reason behind such denial. Thus, the action of the doctor was
not autonomous and justified to the terms of his profession and its expectation as a
registered medical practitioner.
CONCLUSION:
It can be concluded that medical practice is the profession of highest epitome and the
practitioners are bound to adhere to their code of conduct and its regulations during all the span
of their practice. However, the Code of Conduct by the Singapore Medical Council is not a set of
law but acts as a guidelines to the practitioners to abide by such principles. However, if there is a
conflict between the existing law like the Medical Practitioner’s Act and Regulations, and the set
of Code of Conduct then the provision shall be construed in accordance with the language of the
legislation to bring out the complete objective of the legislation. Legislation holds a superior
position for interpretation than the regulation of the code of conduct. Nevertheless, whatever
may be the position, both the code of conduct and the legislation is adopted at par to regulate the
practice of the medical practitioners and regulate their conduct in the best interest of the public
and their confidence. Public interest and their confidence or trust is the highest priority in such
service industry.

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REFERENCES:
(ACT), H. (2019). Health Practitioner Regulation National Law (ACT) | Acts. Retrieved 7
August 2019, from https://www.legislation.act.gov.au/a/db_39269/
Bolitho inquiry [1998] A.C. 232
Hii Chii Kok vs. Ooi Peng Jin London Lucein and another [2017]SGCA 38
John M Law, “Regulation and the Legal Profession” (2008) 45 Alta L Rev 255 at p 255
Montgomery Case [2015] UKSC 11
Rosenberg vs. Percival (202) 205 CLR 434 at 145
Oxbridgenotes.co.uk. (2019). Consent To Treatment And Trespass | Oxbridge Notes the United
Kingdom. [online] Available at: https://www.oxbridgenotes.co.uk/revision_notes/law-
medical-law/samples/consent-to-treatment-and-trespass [Accessed 9 Aug. 2019].
to Tok Seok May Joanne vs. Yau Hok Man Gordon (2013) 2 SLR 18
Aged Care Act 1997. (2019). Retrieved 7 August 2019, from
https://www.legislation.gov.au/Details/C2019C00199
Medical Registration Act. (2019). Retrieved 7 August 2019, from
https://www.healthprofessionals.gov.sg/smc/medical-registration-act