“Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course”. The Hippocratic Oath has been recited by newly graduated physicians across centuries. There are other such declarations too, but a common denominator is that these always place emphasis on several common ethical principles, which include nonmaleficence, justice, beneficence, respect for patient autonomy and confidentiality.

In the Singapore context, the need for medical treatment for both chronic and general illnesses such as cancer, pneumonia and ischaemic heart diseases have been on the rise. The more cases there are, the more ethical dilemmas are bound to arise, which leads to more constant questions about whether the Hippocratic oath can sometimes be bypassed for practical purposes, in order to suit the population’s needs. 

There are many factors that spark debate as to whether Singapore’s medical system must balance ethical practices and practical decisions.

Ageing population

Between 1965 and 2015, it was found that Singapore’s population had grown from 1.9 million to 5.5 million. However, the group of citizens aged 65 and above is increasing rapidly, doubling from 220,000 in 2000 to 440,000 in 2015. This was despite the fact that population growth overall in the country had slowed down. It is projected that this group of citizens is expected to increase to 900,000 by 2030.

This has caused strain on Singapore’s healthcare system, where policymakers now have to make decisions regarding social services, hospitals and manpower. Even then, the benefits of implementing the right measures and policies may not come to fruition until several years later.

More importantly, one of the consequences of population ageing in Singapore is whether the healthcare system should place heavy emphasis on meeting the medical needs of the elderly, or young patients who are chronically ill. The Ministry of Health has implemented measures to increase the capacity of Singapore’s healthcare system; however, it is currently strained, with the ageing population being one of the dominant causes.

Financial and moral support

Treatment for any chronic illness comes at a steep price. In 2015, it was found that Singapore’s medical inflation rate was at 15%, which was considerably high as compared to the global 10%. In order to alleviate costs, it is common for patients and their family members to dip into savings, slowly eroding their financial base especially when it comes to paying for the treatment of long-drawn illnesses.

Similarly, moral support goes a long way in battling illness – if patients are not provided with the necessary financial and moral support, they may lose heart and give up fighting towards recovery.

The fact that medical inflation rate is considerably high in Singapore has posed the question – Should the government do more to subsidise healthcare in the country, or should this be invested into other areas that would benefit the country on a broader basis? Finance Minister Tharman Shanmugaratnam has highlighted that healthcare financing will be a key fiscal challenge for Singapore – the government’s projected healthcare spending is expected to triple to S$12 billion a year by 2020, up from S$4 billion in 2011. 

The right to die

Many a time, diseases such as terminal cancer can take a huge toll on the patient’s psychological health. This may cause them to consider the prospect of ending their life, or wishing for an immediate death as release.

In Singapore, euthanasia (also known as assisted suicide) is illegal. However, the Advance Medical Directive (AMD) allows individuals to state in advance that they do not want any extraordinary life-sustaining measures when they are or have become terminally ill. Physician-assisted suicide has also been increasingly legalised in the United States, Europe and Canada, leading to reflections about whether the legalising of euthanasia should be be considered locally as well.

Chief Justice Sundaresh Menon once raised this topic during a lecture, emphasising that Parliament, not the courts, should be the party to decide on whether euthanasia should be legalised. He also urged public discussion on the issue.

In a world where there is bound to be change, health has become a major concern for people of all ages. A doctor now plays multiple roles – he is a healthcare professional, a friend and a guide to his patients. Ethical practices now need to be fused with practical decisions, as this is necessary for the future of healthcare in Singapore, and worldwide too. MIMS

Read more:
Private and public hospitals in Singapore: Doctors working together for better healthcare services
A look at healthcare systems across Asia
Top 7 Singapore healthcare stories of 2016
Singapore retains Asian lead in Global Pension Index