- Legal Commentary
Doctors hold the well-being and interests of their patients in their hands. The matter of their continuing fitness to practise is therefore an important one. The manner in which the Singapore Medical Council (SMC) Ethical Code and Ethical Guidelines (ECEG) addresses this issue is to focus on the best interests of the doctors concerned as well as that of their patients.
Article 4.7.1 of the ECEG states that doctors who become aware that they are suffering from a condition that renders them unfit to practise should seek appropriate medical treatment. Essentially doctors are being reminded that there is a need to take care of their own health and well-being. It is possible that with proper treatment the doctor’s condition may improve and allow him to resume his practice. Article 4.7.2 then goes on to state that the doctor also has an ethical duty to disclose the nature of his medical condition to the SMC, either because the medical condition is a serious one that can be transmitted to a patient, or his condition would significantly impair his professional competence as a doctor. This underscores the importance of ensuring that the doctor’s medical condition is brought to the attention of the regulator, so that there can be independent and objective consideration of whether it would be in the interests of the doctor’s patients that he be allowed to continue to practise. Since the doctor can only be expected to report his condition to the SMC if in the first place he is able to appreciate and understand his illness and its ramifications, Article 4.7.2 goes on to clarify that this is a duty that is imposed on a doctor “if he is of sound mind”.
In the present case, Dr. G appears to lack insight into his own condition. He probably does not see that [End Page 242] there is anything to report to the SMC, because he does not even realise and accept that he is ill. He has flatly denied that he has a psychotic disorder. He has refused medication and does not appear to acknowledge that he even requires any treatment. He certainly appears to lack comprehension of how his professional competence as a practising family physician may be compromised in any way. This being the case, the ethical duty to report his condition to the SMC, with likely repercussions on his continuing right to practise, is not so much thrust upon Dr. G himself but upon the doctors who are treating him and who may have diagnosed him with a condition that renders him unfit to practice.
Article 4.7.3 of the ECEG states:
Doctors must protect patients from risk of potential harm posed by another doctor’s conduct, performance or health. Where a doctor has grounds to believe that another doctor may be putting patients at risk, he must inform the SMC.
A doctor who treats another doctor for a condition that renders him unfit to practise has a special responsibility to alert the SMC.
It seems clear that Dr. G is currently unfit to practise, unless and until such time as he is successfully treated for his condition. This is the reasonable conclusion that one reaches, not simply because Dr. G has admitted to hearing voices and receiving instructions from God and hearing the voice of the Devil, and not even because he appears convinced that he has the gift of healing by the laying of hands. Based on this alone, some may argue that Dr. G is simply a very religious man with certain beliefs, and we should be slow to declare a doctor unfit simply because he has eccentric ideas. However, in Dr. G’s case, the voices he has been hearing and his conviction in his ability to heal patients by laying hands and without resorting to the use of conventional medical treatment such as medication, has clearly significantly altered his view of what treatments he would prescribe or administer to his patients. If he believes that conventional medical therapies are from the Devil, he will obviously withhold such treatments from his patients, even...