Ethics and making a mockery of the Hippocratic Oath

Reading this case of an unprofessional and unethical doctor in Singapore provided me with some food for thought, particularly around the increasing role of ethics and professionalism, particularly in a world of increasing inequality.

It is critical that the vulnerable segments of society are given the appropriate levels of care and support because where unethical and unprofessional behaviours exist, they tend to exacerbate the suffering upon the vulnerable. Kudos also to the Humanitarian Organisation for Migration Economics (HOME) for pursuing this vigorously on behalf of the victim.

The case itself was interesting. Here was a doctor, Dr. David Wong Him Choon, a noted orthopaedic surgeon at Raffles Hospital, who chose to give only two days of medical leave for a foreign worker who had fractured his hand and had undergone surgery. There is increasing concern that there are doctors who are acting in collusion with construction companies to minimise the time off taken by their workers and to also limit their liabilities for compensation.

What is even more interesting/bizarre, is that previously (between June and December 2015) a Disciplinary Tribunal had acquitted Dr Wong of professional misconduct for giving insufficient hospitalisation leave despite the following findings:

  • The tribunal agreed that the appropriate time off (conservatively) for someone with a distal radius fracture was two weeks of medial leave. (Wong had given two days.)
  • The tribunal also agreed that Wong had failed in his duty to discuss with the patient to understand if there were adequate conditions for his rest and rehabilitation.

Despite the above, the Tribunal chose to acquit Wong on the basis of insufficient proof!

This led the Singapore Medical Council (SMC) (to their great credit) to file an appeal to the High Court which subsequently overturned the tribunal’s acquittal of Wong and convicted him of professional misconduct and sentenced him to suspension of medical practice for a period of six months.

Wong’s behaviour is morally reprehensible and runs counter to the Hippocratic Oath which states: “I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”

This raised a few questions for me, namely:

  • What was the composition of the Disciplinary Tribunal that showed such flagrant disregard to evidence, common sense and conventional wisdom and what is their justification for their acquittal of Wong?
  • Whilst Wong has been ordered to pay for the SMC legal and tribunal costs, will Wong also be responsible for the worker’s additional injuries and damages caused as a result of Wong’s unethical and negligent behaviour?
  • Is a six-month suspension/sabbatical a sufficient deterrence? Perhaps in addition to the six-months suspension, there should be a clear statement which suggests he will be struck off permanently for another violation and also be ordered to perform pro-bono activities for migratory workers in Singapore for a period of time. This will be not dissimilar to the Correct Work Orders (CWOs) imposed for a number of other offences in Singapore.
  • In addition to punishment meted out to the doctors, companies and firms, that also are responsible for the prevalence of such despicable practices must also be brought to account and be made an example of.

How a society supports and treats its most vulnerable, its most helpless and its most needy, is an indication of the society’s progress and humanity. A society that is materially wealthy but neglects to look after the concerns of its most helpless is but a poor and miserable one.

 

 

 

 

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The Singapore Budget 2016 in a nutshell

The Singapore Budget 2016 was announced on the 24th of March 2016 by Finance Minister, Heng Swee Keat.

Below is a simple view of the budget (please click here to download high resolution version):

budget 2016
A summary of the Singapore Budget 2016

Some have claimed that this budget represents a ‘game plan for the next 50 years’ but my view is that this is a very functional budget that sets out a 5-year planning approach.

The budget itself can be split across five areas: support for small and medium sized enterprises (SMEs); Economic Transformation; Social support; Infrastructure Investment; and Individual Taxation.

The main focus of the budget has been primarily around partnership (particularly between government and industry), internationalisation (and support for companies that seek to establish Singapore as a trusted brand) and a transformation of the economy, towards greater efficiency and focus on high value drivers.

Theme of the 2016 Budget: Clarity, Consistency and Compassion

The aims of the government seems to be very much around providing clarity to businesses across a number of areas (from finding relevant grants, to addressing their pressing issues and providing them with the right information to ensure their alignment to the government’s wider aims).

There is also significant consistency with previous policies and measures and little deviation to what has already been established. This includes buttressing of existing policies around SkillsFuture or other social policies.

It is the final theme of compassion that strikes me the most. There is a tacit acknowledgement that social mobility is a critical matter that needs to be addressed urgently. The Deputy Finance Minister in a speech has indicated as much.

Looking at the slew of social-focused policies and support pillars designed to help the underprivileged and support social mobility is important as Singapore enters her 51st year.

Income disparity and social mobility remain the biggest threat to our social systems and to any country’s progress. Putting into place the pillars to enhance mobility is an important investment to ensure the harmonious development of society and nation.

Climate change

One area that could have been addressed in more detail is the impact of climate change and the government’s wider approach to addressing this important area – particularly given the severe consequences this has on Singapore. In time to come, I suspect, governments around the world will start devoting more of the government budget and resources towards addressing this and report on the developments.

The government touched on tax rebates for companies for CSR practices. I hope over time this extends to wider sustainability measures adopted by companies to reduce their carbon footprint.

Big Data and Planning

Another interesting development is the development of the National Trade Platform (NTP) that seeks to integrate all business and finance data of companies. This is going to support the predictive ability of the government in understanding the various levers of economy and also develop more timely and appropriate interventions to support businesses. If done right, the type of data and the insights gained from this initiative could be hugely  influential and something other nations will sit up and take note of in order to have a better handle on their wider economic affairs.

 

Banks – the regulations that govern them – and what happens when they are not governed.

In addition to my Facebook posting previously on the issues that have been faced in the aluminum markets, banks are generally now increasingly involved in a number of markets from energy to aluminum.

I was reading an excellent article in Bloomberg which very neatly explained the connections. Banks are now subsidized by the government. The Federal Deposit Insurance Corporation and the Federal Reserve (both backed by the taxpayers) provide a subsidy to banks – allowing them to draw on reserves during times of market instability.

 

This means that the banks which are too big to fail (and can cause catastrophic consequences should they go under) are effectively allowed to borrow at low or cheap rates.

 

What this means is that banks who can borrow at a lower rate than most other corporations, start investing in markets such as energy or the metal markets such as the aluminum markets, create stockpiles and cut supply which in turn creates a higher price from which they benefit from when they then sell the commodities in the open market.

In the event they bet wrongly, and the prices of the commodities they are stockpiling drop and lead to financial distress at the banks, then the government (and taxpayers) are obliged to provide emerging funding reserves to tide them through.

This creates similar risk-incentive situations which caused the 2008 financial crisis in the first place.

It will be also useful to learn about some of the existing regulations which are in place or which have been lifted but which may need to be considered to prevent the type of problems we had/have now.

The Dodd-Frank Wall Street Reform and Consumer Protection Act (Link: in full here) –

This is an act that has polarised America with one faction arguing that the Act does little to prevent another financial crisis or stop risky behaviour that will lead to another bailout whilst another faction argued that it was too restrictive and draconian.

The volcker Rule – Within this Act, under the section of “Improvement to Regulation” is the Volcker Rule – which essentially restricts US banks from making a number of speculative investments that do not benefit their customers and only seeks to boost the banks and bonus payouts of senior management at the banks.

With the aim of reducing the amount of speculative investments on large firms’ balance sheets, it limits banking entities to owning no more in a hedge fund or private equity fund than 3% of the total ownership interest.The total of all of the banking entity’s interests in hedge funds or private equity funds cannot exceed 3% of the Tier 1 capital of the banking entity. Furthermore no bank that has a direct or indirect relationship with a hedge fund or private equity fund, “may enter into a transaction with the fund, or with any other hedge fund or private equity fund that is controlled by such fund” without disclosing the full extent of the relationship to the regulating entity, and assuring that there are no conflict of interest

 

Glass-Steagall Act (Link to Act here)

This was an Act that was around from the time of the Great Depression in the 1930s until the Clinton Administration repealed it at the turn of the century.

Established as a part of President Franklin D. Roosevelt’s New Deal following the Great Depression, the Glass-Steagall Act actually refers to a handful of provisions sponsored by Sen. Carter Glass and Rep. Henry B. Steagall, which were a part of the larger Banking Act of 1933.

These provisions accomplished a number of things, but most notably prohibited commercial banks from participating in investment banking; this includes activities such as underwriting securities (except for certain treasuries), providing services by brokers or dealers in transactions in the secondary market, as well as facilitating mergers, acquisitions and other forms of restructuring. Investment banks were likewise prohibited from accepting deposits.

The ending of Glass-Steagall removed the distinction between investment banks and commercial banks, leading to a scenario where banks started making risky investments with government-guaranteed deposits.

However, in the last few months, a bipartisan group of senators put forward a proposal for new Glass-Steagall legislation that would restore a strict separation between commercial banks and speculative trading. It is argued that this will inhibit the excessively risky behaviours demonstrated by a number of banks and help prevent the next financial catastrophe.