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ETHICS IS NOT AN IMPEDIMENT 
Welcome address at the 1997 Ethics Convention

This is a historic event. This is, I believe, the first time a full-day medical ethics convention is held in Singapore. Gathered here today are the leaders and representatives of medical bodies and other healthcare organisations. SMA alone cannot decide what ethical standards should be. We need a multi-partite meeting of minds like this to ferment effective consensus.

Ethics is not only about taking pledges. It is also not about making rules about ídos and donítsí. Ethics in practice is about shared values that every doctor and healthcare professional can put into practice. Ethics is about empowering doctors as individuals and as groups, to make decisions when faced with ethical dilemmas; to make sound decisions when professional integrity could be compromised, in the real world of practice.

However, ethics is not cast in stone. Doctors are influenced by the values of society. The healthcare system in Singapore today is increasingly market driven. It is important that we periodically take stock and review our directions. We must also compare ourselves with other professions in Singapore.

The SMA organised an inter-professional ethics seminar two weeks ago in which the national associations of lawyers, accountants, architects, surveyors and engineers also participated. We learnt from the presentations that the medical profession is de facto the only profession in Singapore in which non-professionals are allowed to own and manage professional practices. Legally, architects and engineers are also allowed to have non-professional partners. However, we are told by the President of the Singapore Institute of Architects, that all 30 companies incorporated so far, do not have non-architects or lawyers as equity partners. The other professions including the law profession strictly prohibit non-professional participation. Further, we also learnt in the seminar that the regulations on advertisements by the medical profession are the least restrictive.

The impression of the participants in that inter-disciplinary seminar is that the medical profession is bearing the brunt of the commercial onslaught. This impression was reinforced on 20th October 1997 by an announcement in the Business Times that yet another publicly listed company is going into healthcare. This company openly advertised that it is setting up 5 joint venture companies each with one specialist holding minority equity interest. The arrangement as announced portends another conflict. It imposes on these specialists the responsibility as equity partners to make money for the shareholders. This has to be balanced against his professional responsibility of deciding what is most appropriate and cost-effective to his patients.

We should pause here therefore for a moment to ask two related questions. Firstly, have our ethical values been swept aside by rising commercialisation in Singapore? Or, have we so LOWERED our ethical standards that commercial considerations reign supreme? Or is it a combination of both these scenarios - a vicious cycle where commercialisation begets lowered standards which in turn begets commercialisation. This vicious cycle can only happen in a milieu where the medical profession has no will or way. We must therefore make a stand. Either we all stand up for something or we fall for everything.

I therefore welcome all of you to this convention. This convention is part of an empowerment process that SMA is leading. We hope to empower the healthcare profession to move forward with dignity and integrity.

Finally, to worshippers of the free market who label us as reactionaries, let me make it very clear what is at stake. Ethics is not an impediment to the progress of our healthcare system. Ethics is an impediment ONLY to those who want to make money, to make money out of providing more and more healthcare and not necessarily more health to our people.  

DR CHEONG PAK YEAN