Fee limits set by good sense

SINGAPORE - The appellate court judgment on the Susan Lim case is a salutary lesson to doctors on how they should judge ethically for themselves what is fair and reasonable recompense for their training and clinical judgment.

The operative word being "ethical", it is a determination they alone can make, based on the traditions of their profession and the values they have imbibed as practitioners.

It presumes a high degree of professionalism and conscientiousness, in the absence of a schedule of fees for consultation and treatments.

Some doctors are already saying in the light of the appeal finding that the ambiguity inherent in self-regulation troubles them, as it is hard to judge how much is too much.

There would inevitably be calls for a return to some form of fee guidance, which had existed for some years until it was ruled out of order by the Competition Commission.

Exploitative charging is known to occur even among general practitioners, although complaints to the Singapore Medical Council and Health Ministry have concerned specialists.

If fee disputes ever become widespread, the Singapore Medical Association may be compelled to review charging practices, in consultation with the Medical Council. But this for now is not a direction a debate flowing from the finding of the Court of Three Judges ought to take.

What is required of doctors is introspection.

They are asked to reflect on their motivations for choosing medicine over any other rewarding occupation for which they as the cream of their scholastic crop could train for.

Healing the sick is one service to society that intrinsically meets a need, not so much a want. This is itself an ethical distinction which doctors need to be aware of.

As the appeal judges said, the idea that the practice of medicine is a calling of the highest order is "a historical cornerstone" of the profession.

Another professional service that meets a societal need more than it does a want is recourse to justice, through seeking legal advice over lawsuits or to defend charges. There are fee-gouging lawyers just as there are fee-gouging doctors.

The social good should have precedence over industry norms and prior fee agreements with clients, if any, in both of these categories.

This is what the judges meant when saying medical specialists have an ethical obligation, when setting charges, that operates beyond market and contractual confines. To the lay public, it is the dividing line between what is acceptable, even if high, and what is avaricious.

Doctors and lawyers, who also do not have fee guidelines, should develop an ethical culture that rejects overcharging as being harmful to their self-interest and the standing of their professions.


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