Health Law and Medical Ethics in Singapore

Gary Chan Kok Yew

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000296778
• Edition: 1
• Topic: Law
• Subtopic: Medical Law
• Index: Law

This book encompasses two inter-related disciplines of health law and medical ethics applicable to Singapore. Apart from Singapore legal materials, it draws upon relevant case precedents and statutory developments from other common law countries and incorporates recommendations and reports by health-related bodies, agencies and committees.

The book is written in an accessible manner suitable for tertiary students. It should also serve as a useful resource for medico-legal practitioners, academics and healthcare professionals who wish to keep abreast of the evolving legal and ethical developments concerning health and medicine.

1 Introduction to the healthcare system, health laws and regulations

1.1 Introduction

By global standards, Singapore has been performing well on certain key health barometers. Life expectancy has increased significantly over the last few decades standing at 85.7 and 81.4 years for females and males, respectively, as at 2019.¹ The average span of living in good health was 74.2 years based on 2017 figures.² The newborn mortality rate per 1,000 live births in Singapore and the infant mortality rate (the probability of dying in the first year per 1,000 live births) have declined, whilst cancer survival rates have increased since the 1970s (Haseltine 2013, at chapter 2). In the Bloomberg Global Health Index 2019, Singapore was amongst the ten healthiest countries in the world based on a number of factors including health risks (tobacco use, high blood pressure, obesity), availability of clean water, life expectancy, malnutrition and causes of death.³

In the early years post independence, the focus was on public health programmes (such as proper sanitation procedures and control of infectious diseases through vaccinations against measles and polio). Public health issues continue to be paramount in Singapore in the new millennium with major outbreaks of the Severe Acute Respiratory Syndrome (SARS) in 2003, the Influenza (H1N1) or Swine Flu in 2009⁴ and virus SARS-CoV-2 in 2019 (COVID-19). In recent decades, more attention has been paid to health promotion and healthy lifestyles in view of the increased incidence of chronic illnesses, diabetes and hypertension amongst Singaporeans as well as severe dementia in an ageing population. The ageing demographic is exacerbated by declining total fertility rates (with the birth rate of about 1.2 well below the replacement level of 2.1)⁵ as parents are postponing giving birth and choosing to have fewer children.

This chapter gives an overview of the general state of the healthcare system in Singapore with a focus on health costs, insurance, medical education, training and research. This is followed by a range of health law and regulatory issues relating to the registration and supervision of healthcare professionals, the establishment and operations of medical clinics and hospitals, public health, health products and medical institutions and bodies in Singapore, the regulation of medical practitioners through the Singapore Medical Council’s (SMC) disciplinary processes as well as civil and criminal law sanctions against errant medical practitioners.

¹ https://www.singstat.gov.sg/find-data/search-by-theme/population/death-and-life-expectancy/latest-data.

² https://www.todayonline.com/singapore/singaporeans-living-longer-spending-greater-proportion-time-ill-health-study.

³ https://worldpopulationreview.com/countries/healthiest-countries/.

⁴ Lim (2010, at pp. 857–861).

⁵ The total fertility rate was 1.14 as of 2019: https://www.singstat.gov.sg/modules/infographics/total-fertility-rate.

1.2 Meaning and scope of health, disease and well-being

Before we discuss Singapore’s healthcare system, let us begin with some brief thoughts about some fundamental terms and concepts. What is the meaning of “health” in the first place? Does it refer to “well-being” or merely an absence of illness or disease? What counts as a “disease”, “illness” or positive well-being?

The World Health Organization (WHO) – a specialised agency of the United Nations concerned with global health – defined ‘health’ broadly as a state of complete physical, mental, and social well‐being and not merely the absence of disease or infirmity.⁶ This expansive definition of “health” would encompass not only treatments for common diseases such as cancer and diabetes but also certain health services such as aesthetic surgery and traditional and complementary medicine.⁷ It may, however, surprise some to learn that infertility has been classified by the WHO as a disease – specifically “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse”.⁸

Reiss and Ankeny (2016) noted that the term “disease” generally refers to “any condition that literally causes ‘dis-ease’ or ‘lack of ease’ in an area of the body or the body as a whole”. On the other hand, “illness” typically describes the “more non-objective features of a condition, such as subjective feelings of pain and discomfort”, and the “behavioral changes which are judged as undesirable and unwanted within a particular culture, and hence lead members of that culture to seek help” from health professionals. Illness may also relieve a person from certain social responsibilities (eg, to take time off work or to avoid family responsibilities) – the social aspect of illness.

The naturalist basis for disease involves the abnormal functioning of system(s) of the human body. It is an objectivist empirical assessment as to what is biologically natural and normal functioning for human beings. For Boorse (2007), a disease is either an impairment of normal functional ability (which is based on biostatistical theory) or a limitation of functional ability caused by environmental agents; thus, health is the absence of disease.

An alternative view is constructivism which emphasises the human interests and values involved in assessing whether a disease exists. This theory is normative in nature.⁹ For example, Nordenfelt (2007) regarded health for a person as the ability, given standard circumstances, to reach his or her vital goals. Thus, according to this value-laden approach, a disease represents a divergence from social norms and depends on culture that varies according to place and time. For example, homosexuality was at one time considered a disease due to the social mores against the practice of homosexuality. One problem, however, in constructivism is that it may not be capable of distinguishing between what is socially undesirable (eg, alcoholism) and a disease (Reiss and Ankeny 2016).

A hybrid approach is to consider a disease as comprising two features: (i) the abnormal functioning of some bodily system and (ii) the resulting abnormality is harmful. Thus, the existence of a biological dysfunction is not sufficient; it must manifest in tangible harm to the person as a member of society. One proponent of this hybrid approach is Wakefield (2007) who, in relation to the assessment of psychiatric condition, regarded mental disorders as “harmful” dysfunctions.

Instead of a binary categorisation between health/disease and absence of health/disease, it is plausible to regard the concept of “health” as one that lies in a continuum from illness to wellness. Under this approach, health is an aspirational goal of positive well-being. This is consistent with the WHO definition of “health” in 1948 and the idea of health promotion for members of public who may not suffer from any biological diseases. This approach also raises the problem of the subjectivity in the measurement of this expanded scope of health to the extent that the related assessment of well-being is dependent on a person’s socio-economic conditions, upbringing, spirituality and outlook and not merely concerned with a biological dysfunction. Where do we draw the line between health and concepts such as happiness or life-satisfaction? Yet the adoption of a purely biological account of health runs the risk of divorcing health assessment from reality. For the individual person or patient, he would probably wish to know how his ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Table of cases
• Table of legislation
• Preface
• Acknowledgements
• 1 Introduction to the healthcare system, health laws and regulations
• 2 Introduction to medical ethics
• 3 Medical negligence (part 1)
• 4 Medical negligence (part 2)
• 5 Consent to treatment
• 6 Mental health
• 7 Confidentiality
• 8 Complementary and alternative medicine
• 9 Reproduction
• 10 End of life
• 11 Human organs, tissues and biological materials
• 12 Human biomedical research, medical innovations and information technologies in healthcare
• Index