In a letter published on the Straits Times (ST) forum today (28 February) titled ‘Whistle-blowing not adequately addressed in medical ethical code‘, anaesthesiologist Dr Lim Ee Koon expressed hope that the forthcoming Healthcare Services Act 2020 will address certain issues relating to whistle-blowing in the medical field.

He was responding to an earlier article on ST about whistle-blowing in the medical field by Professor Chong Siow Ann, vice-chairman of the medical board (research) at the Institute of Mental Health. Specifically, Prof Chong touched on China’s late Dr Li Wenliang in Wuhan who was reprimanded by the Chinese government for raising the alarm on the deadly coronavirus outbreak.

In his forum letter, Dr Lim pointed out that the Singapore Medical Council’s Ethical Code and Ethical Guidelines (ECEG) only briefly mentions whistle-blowing, while the Handbook on medical Ethics elaborates the point slightly. Both publication were last amended in 2016.

However, Dr Lim pointed out that the whistle-blowing in the medical field does not have the “extensive rigours” of that in the corporate field, though the eventual outcome here could lead to imminent harm or even death.

Using the example of other fields, Dr Lim pointed out that the Prevention of Corruption Act and the Workplace Safety and Health Act accords whistle-blowers confidentiality even in court proceedings while the Income Tax Act accords whistle-blowers with a small monetary reward for the sum recovered, if any.

Additionally, the Singapore Exchange Regulation (SGX RegCo)’s Listing Rule also addresses corporate malfeasance.

This type of ‘hard-coding’ of rules of whistle-blowing and malfeasance into the medical ethical code “will create more awareness of rights and responsibilities”, said Dr Lim.

He elaborated that whistle-blowers in the medical field tend to worry whether they might be sued by the party they are whistle-blowing against, should investigations into the charges prove them wrong.

As such, Dr Lim suggested that the Healthcare Services Act 2020 – which repeals the older Private Hospitals and Medical Clinics Act – could address some of these issues.

Whistle-blowing is a difficult decision to make

In the earlier article, Prof Chong noted that whistle-blowing wasn’t part of his medical education. Rather, his training and practice as a doctor has been “a process of socialisation into the cloistered culture of medicine” where he learned the social significance of belonging to a professional guild and where a deep sense of “tribal loyalty” was fostered.

He explained that those in the medical field are told to police themselves.

“The Singapore Medical Council’s Ethical Code and Ethical Guidelines tell us that it is our ‘special responsibility’ to report any fellow doctor who poses a potential risk to patients,” he wrote.

However, he pointed out that while it may seem “right and obvious” to blow the whistle on an errant colleague in the abstract, it’s quite different to face that situation in reality.

“To be honest, most of us would baulk at this and fret about naming, and in effect shaming, a professional colleague, and possibly destroying a reputation and livelihood,” Prof Chong explained.

The reason being is that the consequences a whistle-blower might face is tremendous, especially when facing off a major corporate or state organisation, even though it might seem petty in the bigger picture.

“It [these organisations] could respond accordingly with the apparatus at its disposal to isolate and vilify the interloper as someone with a grudge; someone who is incompetent, disloyal and troublesome; and to force him to leave while frightening and alienating other supporters,” noted Prof Chong.

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