The New Medical Code: What Has Changed?

By Professor Alastair V. Campbell,

Emeritus Director, Centre for Biomedical Ethics

On January 1, 2017, the latest version of the Singapore Medical Council’s Ethical Code and Ethical Guidelines (2016 ECEG) came into force, and accompanying it is a comprehensive Handbook of Medical Ethics, which is designed to provide more detail on best practice in following the Code and Guidelines. The previous version of the ECEG was published in 2002, since which a great deal of change has occurred in medicine and in the delivery of health care. The process of producing these new documents took more than five years, since it entailed a series of drafts with multiple rounds of consultation with, and feedback from, the medical community. The overall aim was to produce guidance that would ensure the full protection of patients and the public, while being fair to doctors, by not making unreasonable demands that could lead to unjustified medical litigation. The drafts were produced by a small working committee of nine members, chaired by Dr Tan Chi Chiu, the Chairman of the Medical Ethics Committee of the SMC. I was a member of the working committee, as were three other colleagues from our Medical School, Professor Lee Eng Hin, Professor Chew Chin Hin and Associate Professor Roy Joseph.

So what has changed since 2002? Actually quite a lot, but in this short article I will mention only a few significant changes.

Firstly, we live in the age of the internet and social media. This means that patients are much better informed (though also in danger of getting false or misleading information), and that doctors can use a variety of modes of communication with patients, with the public and with colleagues. So the new code gives detailed guidance on how to share information in these different contexts appropriately, as well as how to ensure fully informed consent. There is also a major new section on telemedicine, and advice on the use - and dangers - of social media.

Secondly, there has been a massive increase in aesthetic practice, including in primary care settings. The new Code lays down clear requirements for adequate consent and for a cooling off period before any major procedures are carried out.

Thirdly, there is an increasing awareness of the need to respect the wishes of young people, even although they may be legally under the age of consent. This is reflected in a whole new section detailing the requirements for consent from both minors and persons with diminished capacity. The emphasis here is on respect for these patients’ choices within the limits of their competence.

Finally, there is now a much more open and honest approach than there was in the past to the care of patients at the end of their lives. The new Code stresses the need to respect and enhance the autonomy of the dying patient, through good and honest communication, by respecting the decisions of patients who wish no further treatment, and by avoiding non-beneficial or harmful interventions in the terminal stages of their illness.

There are many more parts of this comprehensive document that I cannot deal with here. I strongly recommend downloading all of the ECEG and the Handbook from the SMC website to use as a reference when you have uncertainty about the right thing to do in your professional life. It is true, of course, that Ethical Codes do not ensure ethical behaviour – that depends on the genuine ethical commitment of each individual practitioner. But these new documents point out very clearly the best route to such good medical practice, and they provide a rich educational resource to help to stay on that route despite the realities and pressures of modern clinical practice.