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 tragedy of the Sinti and Roma

I have been reflecting over the last few months over the persecution and murders of defenceless Yazidis and Christians in ISIS-controlled territory; over the rising intolerance towards minorities in India; Islamophobic political commentary being delivered by far right segments of the political spectrum, be they in Europe or in North America. The age of immediate transmission of wanton murders, genocide and hateful rhetoric has a multiplier effect in terms of how the news is consumed and acted upon.

I was in Berlin last week and as I made my way towards the Reichstag (or the German Parliament) from the Brandenburg Gate, I walked past an unassuming little garden with a small plaque that read, “Memorial to the Sinti and Roma of Europe murdered under the National Socialist (Nazi) regime.”

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Entrance to the Memorial to the Sinta and Roma of Europe at Tiergarten, Berlin.

Against the backdrop of a haunting violin music played by Romeo Franz, a German Sinti, I learnt about the fate of the Sinti and the Roma people, who were part of the “gypsy” community that was systematically murdered by the Nazis.

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A reflection of the German Reichstag upon the Memorial pool.

A brief history of the Sinta and Roma.

The Sinti and Roma people have lived in Europe for over six hundred years and are believed to have travelled from India through Iran. Their languages are rooted in Sanskrit but have lived a nomadic lifestyle in Europe and were commonly referred to as gypsies. They also generally had slightly darker coloured skin, hair and eyes.

The gypsies identified themselves by the various groups they belonged to, including the Sinti, Roma, Lallere, Lovari or Manouche. The Sinti and Roma were the largest groups and numbered in the hundreds of thousands.

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Roma boys in the Warsaw ghetto (1941)

The Sinta and Roma people were indeed persecuted even before the National Socialists took over. They were singled out and discriminated by not only the Germans, but indeed across Europe for centuries.

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The triangular stone in the centre of the pool symbolises the badges that were work by the concentration camp prisoners. The stone is retractable and fresh flowers are placed upon it daily.

 

 The Nazi atrocities

The Nazis however took the persecution to a horrific level and it was a very steep descent into hell for the Sinti and the Roma.

As part of their racist and puritan ideologies, they sought the active annihilation of these minorities as they were considered racially inferior. These poor and defenceless people were first subject to internment, then forced sterilisation and were all subject to forced labour. Men, women and children were seized and taken away or murdered in their hometowns, ghettos or concentration camps or killing centres.

A decree was issued in 1936, as part of the Nuremberg laws on race and citizenship, where the gypsies and Jewish people were formally defined as “Alien Races” and were forbidden to marry, have children and excluded from most professions and jobs.

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Senta and Sonja Birkenfelder, deported from Ludwigshafen to Poland in 1940 with other Sinta and Roma children (Photo probably taken in the Radom Ghetto in 1941)

Two years later, over 2000 Sinti and Roma people were taken away to various concentration camps across the country as the Chief of the German Police, Heinrich Himmler, sought the “final solution to the Gypsy question.”  In 1940, entire families were deported from Germany to occupied Poland and to various other concentration camps. In the camps, they were all required to wear an armband bearing the letter, ‘Z’ which stood for ‘Zigeuner’ or ‘gypsy’ in German.

 

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Lodz Ghetto 1941/42: Assembly point at Krawiecka Street. Waiting for transport, probably to the Chelmno (Kulmhof) extermination camp. (Photo from the Jewish Memorial in Berlin)

The systematic mass murder of the Roma started in occupied Soviet Union in 1942 by a mobile killing unit (or ‘Einsatzgruppe’of the Security Police and Security Services of the SS). More were gassed to death in specially equipped vans at the Kulmhof killing centres.

More forced mass deportations of the gypsies from across Europe to the Auschwitz-Birkenau concentration camp. Thousands died due to hunger, disease or horrific cruelty by the Nazis.

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Warsaw Ghetto, August 1941 (Photo from the Jewish Memorial, Berlin)

It is estimated that as many as 500,000 people identified as ‘gypsies’ were murdered under the Nazi regime. There is no way of ever determining the final number.

Reflections

The memorial site was a source of immense pain, solitude and remembrance.

As I reflected on the atrocities meted out to these poor people, whose only crimes were that they were born into a different creed and caste, I thought about the people of our times going through the same horrors. A truly strong society looks after its most vulnerable and helpless, not oppress them further.

Particularly over the last couple of years, I have been getting increasingly worried about the rise of far-right extremism across the spectrum. The savagery exhibited by terrorist death cults such as the IS is well-known. However, to see politicians such as Donald Trump voice out hateful ideology is frightening. In Singapore, an ex-nominated member of parliament, Calvin Cheng, suggested all children of terrorists ought to be killed along with their parents, as a preventative measure.

It is already terrible that there has always remained within the fringes of society, a segment that feeds off hate and rancour. These groups of lunatics have either been outlawed or are regularly derided. To see this same hate and extremism enter its ugly head into the mainstream is tragic and has the potential to rupture the very delicate fabric of our society.

Humanity as a whole cannot afford to let this state of affairs continue. Lest we think that it is improbable that the world will witness another genocidal event, it is worth remembering the words of Primo Levi, a Holocaust survivor:

Each and every one of us, whether we be Christians, Muslims, Jewish, Hindus Buddhist, Bahais or atheists, has a responsibility for the safety, fair-treatment and dignity y our fellow women, men and children, regardless of their beliefs, customs or creed.

I pray that the light of our collective humanity overcomes the darkness of hate that some attempt to it hit on us all.

Below is a poem by an Italian Roma, Santino Spinelli at this most poignant of memorials which conveys more eloquently than I ever could, the sentiments I felt at the memorial.

 

 

Sunken in face

extinguished eyes

cold lips

silence

a torn heart

without breath

without words

no tears

 

 

 

A random musing on society and the elderly…

I am currently sitting at the airport lounge in Terminal 3 in Singapore. I look around the lounge and all I see are elderly people (some of whom do not look in the best of health) working as support staff, clearing plates and glasses in the lounge and slowly doing the rounds around the entire lounge and I am left pondering…
What is the purpose or point of all of this economic progress and development when we are unable (or unwilling?) to provide a social support or safety net to the vulnerable and elderly within our society?
My view is that a society cannot truly call itself advanced if its elderly and vulnerable are not supported and they are in a position where they are made to work to support themselves. The advancement of our society rests on our ability to protect those who need our help the most.