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The 1999 SMA Ethics Convention was held on 28 October 1999 at the College of Medicine Building. The theme of this year’s Convention was “Patient Confidentiality”. The annual Convention aims to equip doctors with knowledge and skills on health law and ethics, especially in this rapidly evolving medical practice. Like previous years, the Convention comprised of 3 events, starting with the Mini Course on Ethics, the 1999 SMA Lecture entitled “Confidence & Confidentiality – Aspects of the Law” by Judicial Commissioner, Mr Choo Han Teck and ending with a Public and Professional Symposium on the same theme.

Mini Course on Medical Ethics
The Chairman, Dr T Thirumoorthy started the Course by explaining the systems that govern human social behaviour. He defined Ethics as a systematic application of values and Medical Ethics is applied ethics concerning medical practice. He went on to outline the principles in Medical Ethics and finally, he reminded doctors their responsibilities with regards to Medical Ethics.

Next, A/Prof Goh Lee Gan touched on the focus of the Course, ie. the issue on Medical Confidentiality. The concept of confidence and confidentiality as well as the 4 principles of confidentiality, ie. (1) in the course of care of the patient (2) with the patient’s consent (3) under statutory compulsion (4) in situations with strongly countervailing public interest were explained. A/Prof Goh proceeded to with pointers on the actual practice of confidentiality in the course of care of patient. Case studies were used to illustrate the different situations where the medical confidentiality could be breached and how doctors could safeguard the patient’s interest in these situations.

We invited A/Prof Chia Kee Seng of the Department of COFM, NUS, Dr Wong Yue Sie of Ministry of Defence, Mr Venu Nair of NTUC Income and Dr David Chan of Department of Philosophy, NUS to present their perspective on medical confidentiality at the panel discussion. The doctors participated actively, some of whom shared their personal experience. The participants went home with much food for thought. So long as the patient confidentiality is not forgotten, we will be on the right track.

1999 SMA Lecture
In line with the theme of the Ethics Convention, Judicial Commissioner Choo Han Teck, the 1999 SMA Lecturer addressed the topic of “Confidence & Confidentiality – Aspects of the Law”. Mr Choo concluded that “the duty of confidentiality may become an enigma in the age of information technology, but so long as law and morals are still central to the application of science and medicine, and are justly and morally administered, the computer will not take over, but function only to serve our needs and enhance the quality of our lives.” The SMA Lecture is published in full on Page 726. Dr Lim Teck Beng gave a citation of the Lecturer, which is printed in N7.

SMA Ethics Essay Award
This is the first SMA Ethics Essay Award. The Award aims to encourage tertiary students in Singapore to research and review important aspects of medical ethics. The Award is open to two categories, medical undergraduates and non-medical undergraduates. Nine entries were received, out of which 7 essays came from the medical category and 2 from the non-medical category. A/Prof Chong Kim Chong, Head of Department of Philosophy, Prof Feng Pao Hsii and Dr John Tambyah were tasked to judge the 9 entries. The winner of the medical category is Mr Tor Phern Chern, a fourth year medical student from NUS. The title of his essay is “New Challenges facing the Doctor-Patient Relationship the next Millenium”. The winner of the other category is Mr Christian Chin Fei Loong, who is currently sitting for the Bar examination wrote on “Medical Ethics”. A/Prof Chong Kim Chong presented the Award in the form of $1000 and a plaque to the winners. The two essays, and other selected ones will be published in subsequent issues of the SMJ.

Public & Professional Symposium on Patient Confidentiality
This symposium focused on patient confidentiality from the lay perspective. Mr Stephen Loke, Chairman of the CASE Consumer Affairs Committee used the word “CONFIDENTIAL” as the acronym for the considerations doctors should observe before “breaching” patient confidentiality. He emphasised the importance of maintaining trust or confidence. He added that “Clearly unless the trust element is created and build up between doctor and patient, there may be little confidential information to speak of to begin with…”

Mr Venu Nair, Underwriting Manager, Group & Health Department of NTUC Income said that “medical information on the insured is usually sensitive and therefore needs to be received in confidence.” He assured that written consent of the insurers is sought before confidential medical information is released. Furthermore, Life Insurance Association (LIA) maintains a LIA Substandard Risk Register which serves as an “alert” to the member company’s underwriter to seek more information regarding the proposed insured. He said that “In this way, insurers are safeguarded to some extent against frauds and anti-selection on the part of the insured which will directly be against the interest of the insurers and indirectly, the interest of the general body of policyholders.”

Finally, A/Prof Cheong Pak Yean reiterated the 4 situations where confidentiality has to be “breached” from the medical practitioner’s point of view. He concluded that doctors and patients need to grapple with the issues of confidentiality in the age the new economics and technologies. The Commentary of this issue is written by A/Prof Cheong based on his presentation at this Symposium. We will feature the full report of the Mini Ethics Course and the Public Symposium on Medical Confidentiality in subsequent issues of SMA News.