Analysis of Healthcare Ethics and Legal Issues in Singapore

This report provides a comprehensive analysis of the legal and ethical implications within healthcare practice in Singapore, centered around a detailed case study. It examines the complexities of medical negligence, informed consent, and patient autonomy, referencing relevant legislation, professional codes, and case laws such as Bolam v Friern Hospital Management Committee and Hii Chii Kok v Ooi Peng Jin London Lucien. The report delves into the application of bioethics principles, including autonomy, justice, beneficence, and non-maleficence, to the case scenario. The analysis follows a systematic ethical decision-making approach, offering insights into the challenges faced by healthcare professionals. The conclusion summarizes the interplay of legal and ethical dimensions, highlighting the importance of considering both aspects in healthcare decision-making, with the aim to provide a comprehensive understanding of the challenges faced in Singapore's healthcare system.

Running head: HEALTH AND ETHICS
HEALTH AND ETHICS
Name of Student
Name of University
Author Note

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Introduction
In the current essay a detailed analysis has been done on the basis of the legal and ethical
implications in the healthcare practice in Singapore. The analysis of these legal and ethical issues
has been done with relation to a case study mentioned. The discussion has been further supported
with related legislation, professional codes, practice standards and case laws where applicable. In
the given case it was seen that the patient was an 80 year old suffering from diabetes, chronic
venous ulcer and hernia. It is further seen that the patient, Hetty, is pale, lethargic and confused
most of the time and has a slightly elevated temperature. Although she does not remember
anything she consents to her hernia repair surgery to Dr Lin. Even though Hetty did not
remember why she was in the hospital yet Dr Lin was seen to be reassuring Hetty’s husband and
takes her to surgery. Few days after the surgery, Hetty died because of the post-operative
infection and sepsis.
Legal Issues
In the case it can be seen that Dr Lin could be sued for his breach of duty of care towards
Hetty under the law of tort of negligence. Negligence under the common law of torts can be
defined as the legal wrong that a person suffers because of the failure of another person to be
taking proper care in any act or omission which could have been reasonably foreseen (Deakin &
Markesinis, 2019). The elements of negligence include- duty of care, breach of the duty,
causation and harm. For a successful claim in negligence the plaintiff needs to prove the
existence of these 4 elements.

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Medical negligence can be defined as the failure of any healthcare professional for
exercising a standard of care that would be reasonably acceptable in medical skill or knowledge
that results in injury, death, damage or loss (Amirthalingam, 2017). In the case Bolam v Friern
Hospital Management Committee the general rules of the assessment of the proper standards of
reasonable care in indications of negligence that involve medical skills of the professionals have
been laid down. In the case Hii Chii Kok v Ooi Peng Jin London Lucien and another [2017] the
Bolam test, which could be seen to discuss the contentious aspects of medical negligence
categorized in three aspects- diagnosis, advice and treatment, had been rejected for being an
applicable legal test for the adjudication of the standard of care that can be held appropriate for
any medical practitioner. The case is seen as ruling a new 3-stage legal test that is patient-centric.
As per the decision of the court in the Hii Chii Kok v Lonodn Lucien Ooi it can be seen that the
diagnosis and the treatment stated in the Bolam test should be remaining same, however, in the
advice there is a new 3-stage test applicable. In the first stage the medical practitioner is required
to be assessing whether the information provided by the patient is sufficient by the perspective of
the patient. The second stage of the test as per the court is to enquire whether the doctor has in
his possession all the relevant information. The final stage in this test is to assess from the
doctor’s perspective whether information that has been demonstrated by the patient could be
seen as relevant a material and it is the burden of the doctor for justifying the reason for
withholding the information from the patient.
Applying the rules of the cases Bolam v Friern Hospital Management Committee and Hii Chii
Kok v Lonodn Lucien Ooi, can be seen that the standard of proof that Adam, Sue and Brian need
to establish for a successful claim of negligence are- there was a doctor patient relationship
existing between the parties, the Doctor had been negligent of his duties, the injury was caused to

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the patient because of the doctor’s negligence, because of the injury specific damages where
suffered by the patient, the doctor failed to diagnose the illness of the patient, the treatment
provided by the doctor was improper and the doctor failed to wonder patient of the known risks
of the procedure of the treatment that is also known as the duty of informed consent.
Dr Lin, in the case can raise the defence of informed consent. Informed consent is when the
doctor had a conversation with the patient discussing about all the risks known before the
starting of any procedure or treatment and the patient is seen to be e giving consent for the start
of the treatment or the procedure. For an informed consent to be valid there should be four
elements present. The four elements are- the nature of the procedure, traditional alternatives
present for the proposed procedure, the risks benefits of the uncertainty is present for each of the
alternative procedure treatment and the assessment of whether the patient is capable of taking a
voluntary decision regarding the procedure or the treatment. These elements have been discussed
in the case Low Cze Hong v Singapore Medical Council [2008]. Under the common law if
patient is incapable of understanding the nature of the treatment a Healthcare proxy is given the
authority to decide on behalf of the patient. In absence of Healthcare proxy the medical
practitioner is needed to be acting in the best interest of the patient until a proxy is found.
There are two possible outcomes of the given scenario. The first outcome is that Dr Lin would be
held guilty of medical negligence and would be charged subsequently and second outcome is the
Dr Lin would be successful in proving his defence that he had obtained informed consent and he
would be free of all the charges.

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Ethical Issues
In the evaluation of the merits and demerits of the medical procedures the bioethics can often be
seen to be referring to the fore principles of Healthcare ethics. These four principles are-
autonomy, justice, beneficence and non-maleficence (Amer, 2019). This four principles where
seen to be discussed by the empirical ethics theory of Beauchamp and Childress. As per the
words of Beauchamp and Childress the four principles not only specify biomedical ethics but
they are the core elements of common morality (Beauchamp, 2008).
Autonomy- although a medical professional can advise the patient about certain procedures or
treatments however the right to be retaining the control over their body remains only with the
patient. Respect of autonomy means that a medical practitioner cannot persuade or coerce or take
any other action towards the patient even if practitioner is of the belief that the choice would be e
in the patient's best interest.
Justice- in the second principle of Justice it is required for all the medical practitioners to be
taking any decision regarding any medical issue in a just and fair manner.
Beneficence- in the third principle of bioethics medical practitioner is required to be maintaining
a higher level of skill and knowledge for providing maximum amount of benefit towards the
patient in any given situation.
Non-maleficence- medical practitioner should not be taking any decision for the benefit of an
individual patient which would potentially be harmful towards the society or any other person.
In the given scenario principles of bioethics that could be applicable are autonomy and
beneficence. The doctor has the responsibility to be respecting the autonomy of the patient that is

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the patient has the right to the control of their body. Doctor cannot coerce hot force the patient to
be taking any decision. The doctor also has the responsibility for maintaining the highest level of
skill and knowledge to provide maximum benefit to the patient. In the current scenario it can be
seen that the patient had consented to the surgery however it was found that she was disoriented
and could not recognize people. Therefore ethical dilemma would arise in front of the doctor
where he has to choose between respecting the autonomy of the patient ought to be providing
maximum benefit towards the health of the patient.
For the determination of the ethical decisions Kerridge et al., can be seen as to be providing
seventh step systematic approach towards the identification and evaluation of the ethical issues.
These seven steps are- identifying the facts of the case, identifying for the information that is
required, considering the fundamental ethical principles, identifying the ethical conflict present
coma consideration of the law and finally making the ethical decision (Kerridge, Lowe &
Stewart, 2009). Applying the approach to the current case the doctor had to follow a 7 step
systematic approach for determining his ethical decision towards the case.
Conclusion
Thus in conclusion it can be said that there are both legal and ethical issues present in the given
case. The purpose of this study was to discuss in detail all the legal and ethical issues and their
subsequent provisions in relation to the given scenario. In this is essay a detailed analysis has
been done on the basis of the legal and ethical implications in the healthcare practice in
Singapore. The analysis of these legal and ethical issues has been done with relation to a case
study mentioned. The discussion has been further supported with related legislation, professional
codes, practice standards and case laws where applicable.

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Reference
Amer, A. B. (2019). Understanding the Ethical Theories in Medical Practice. Open Journal of
Nursing, 9(02), 188.
Amirthalingam, K. (2017). Medical dispute resolution, patient safety and the doctor-patient
relationship. Singapore medical journal, 58(12), 681.
Beauchamp, T. L. (2008). Beauchamp and Childress Principles of Biomedical Ethics.
Bolam v Friern Hospital Management Committee [1957] 1 WLR 582
Deakin, S., & Markesinis, B. (2019). Markesinis and Deakin's Tort law. Oxford University
Press, USA.
Hii Chii Kok v Ooi Peng Jin London Lucien and another [2017] SGCA 38
Kerridge, I., Lowe, M., & Stewart, C. (2009). Ethics and law for the health professions (p. 225).
Sydney: Federation Press.
Low Cze Hong v SMC [2008] 3 SLR(R) 612