Ethics And Justice: What Can We Do When Ethics Don’t Produce Justice As Its Final Outcome?

I am emotional. But I am emotional about principles and facts. I know,  I cannot always behave like “it’s either my way or the highway.” But some things are so obviously wrong and when people defend it, I go ballistic. 

But I flip out when people don’t get their priorities and their facts right. In that sense, I might be a bit autistic. It feels like my world come tumbling down when things don’t go according to the principles I know to be correct and facts I know to be true. It irritates me. In that sense, I can also be a bit offensively manic in my irritation.

If someone says that the world is flat, and since it is his opinion that the world is flat and I should respect it, I will totally go insane with anger. 

***

I attended a course one day. One of the speaker works in the management side of the MOH. He talked about documentation and medicolegal issues. 

At the end of his talk, I asked him (I have forgotten the exact words I used, but the gist of it were as such) “What can MOH do to help clearing up the reputation of a doctor in the case where a patient goes to the social media with wrong accusation against the doctor? For example,  there was a case where a patient who had an allergic reaction to a medication went to tabloids and viral it in the social media that the doctor had given him the wrong prescription? The patient had already broken his own confidentiality, so can the doctor correct the facts in the same social media to regain his reputation?”

He basically said that obviously, the doctor cannot correct the facts in the social media because the doctor is bound by the ethics of confidentiality. Basically in his own words “we can only stay silent. Malaysians are forgetful, anyway. The hype will go away”

“So, KKM won’t help to clear up the doctor’s name?” I was getting warmed up, hahah. (See? I can be really annoying)

“What can we do? What’s your suggestion?” the speaker asked.

“Well, we can do health promotion. We can issue a statement that in the case of such and such, investigation has been done and we have since found out that the allegation towards the doctor is false. We have to viral the statement that we issued to the same extent that the accusation was viralled against us.  Otherwise, the public will never learn the truth of the matter and there will be more unfair accusations being viralled.”

The speaker said “But when you respond to such accusations, sometimes you are giving more weight to the matter. Silence is golden in this case.”

(The word “silence is golden” grates my nerve endings)

“If the doctor wants to counter-sue the patient, will KKM help?” I asked

Again, the answer is disappointing.

I ended my interrogation with “So, there’s no solution.” Then I passed back the microphone to other audience.

I don’t blame the speaker. It was not his fault. He was only representing our own mindset in MOH and our general conduct in our passive culture. I am sure, he himself would be frustrated if he were in other doctors’ shoes. But sometimes it’s hard not to blame the messenger.

***

I am grieved by injustice. Not just against me, but against anyone. 

We Muslims, used to have better standards in how we expect other people to conduct themselves.

I hate it when people said things like “We have to look at the management point of view. Even though your point of view is correct, the management also has their own take on this matter. They have to do a lot of damage control, money that can be spent elsewhere have to be spent for legal fees etc etc. ”

Okay, let’s look at EVERYBODY freaking point of view. And then what?? 

What is the bottom line?

The bottom line for MOST people is “We have to look at the management point of view. And since we have now looked and understood the management point of view, we can follow what THEY decide.”

Sure sounds diplomatic. Management love people like this. Kudos! 

People like this want to please everybody. They will say everybody’s point of view is correct, but then they will give MORE WEIGHT to the management point of view and follow whatever unfair decision made by the management. They think they are being less rigid, more holistic just by saying ‘everybody is right’ but at the end of the day, they will go with the management. 

If that’s how you want to think, then next time, just cut the diplomatic act short, by just saying the management is right.

That’s why I get irritated with diplomatic people. The only diplomacy I display is with my depressed patients because it is therapeutic and that diplomacy serve a good purpose. (unless the patient is like me and can tell bullshits apart) But in my day-to-day dealings with people, I am direct and some people have interpreted that to be rude. Because in my day-to-day dealing with people, diplomacy does not serve any better than simple straightforward talk does.

And in my experience, diplomacy can sometimes be another form of dishonesty. Some management people are good at that. 

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***

The point of ethics is to serve justice. You shouldn’t stick to ethics just for the sake of ethics, without serving the real purpose of justice.

Not just for patients, but also for doctors!

If a patient has spread in the social media about his/her own disease and then wrongly accuse the doctor of not treating her well, then the doctor should no longer be bound by the ‘confidentiality’ clause. Why? Because, justice will fail to be served. That’s why. And therefore, the ethic lost its purpose of being adhered to, in the first place. 

The confidentiality clause was made with ‘protection of patient’s rights’ in mind. But when the patient himself/herself breaks it (in the social media where it spread like bushfire), then the purpose of the confidentiality clause is already gone. There is no confidentiality anymore!  Therefore, the doctor should no longer be bound to it when he has to defend himself. 

But see, some doctors don’t think that way. They think conventionally and cannot analyse beyond the point of what they have already known.  There are so many others who cannot think flexibly and still said “Patient can break his own confidentiality but the doctor still can’t.” (and ironically, I was the one being accused of inflexibility. I am flexible. Believe me I am SO flexible, that I can be a rule breaker when I don’t agree with the rule. Just because I stick with my principles for justice doesn’t mean I am inflexible. People who cannot change their ethical reasoning when presented with different scenarios…they are THE ONES WHO ARE INFLEXIBLE!)

Yes, in general, patient can go around telling anyone about her own disease and the doctor cannot tell others about the patient’s disease. “Suka hati aku laa aku nak habaq kat sapa pun aku sakit apa. Doctor yang  tak boleh pi habaq kat orang lain”.

Okay, setuju!

But when you ADD IN another factor where the patient ACCUSES the doctor of misconduct in the freaking social media, the purpose of ethics to serve justice cannot be realised if the doctor is STILL BOUND by confidentiality. This sort of ethic is an ethic that has lost its soul (justice)

And if you CANNOT think this way, then there’s something wrong with your justice reasoning.

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***

I am all for justice. Not just for the patient but also for the doctor.

My suggestion is:

-Investigate each accusation in the social media that has been viralled.

-Come up with a fair conclusion after that investigation

-And viral the outcome of the investigation in the social media, regardless of whether the accusation was true or false.

If the accusations is true, issue a statement saying, “With regards to the case of A accusing Dr. B of so and so, our investigation showed that, Dr. B was guilty of so and so. We have asked Dr. B to apologise and compensation will be awarded to patient A.”

If the accusation is false, issue the statement, “With regards to the case of A accusing Dr. B of so and so, our investigation showed that A had an allergic reaction which could not have reasonably been expected for Dr. B to know that A would develop such reaction. We hope, patient A will apologise to Dr. B and correct the impression he has given against Dr. B in  the social media.We in MOH fully support Dr. B should he decide to pursue legal action against patient A if patient A fail to extend his apology.”

The statement, especially if the accusation is false, should be viralled SO THAT the reputation of Dr. B can be regained which is only the fair thing to happen. 

But what usually transpires is, the accusation was viralled throughout Malaysia. But the outcome of the investigation that clears up the doctor’s name was not viralled to the same extent as those of the accusation. So the public will still be under the misapprehension that the doctor is wrong. In this case, AGAIN justice is not served. What is the point of investigating an accusation if people don’t know the outcome of it? 

Viralling the outcome of the investigation is also good for these purposes:

-For public education and health promotion about diseases, in general

-serve as a lesson for the public not to viral the things that they don’t know before they clarify with their doctor or complain to the right channel. 

-serve as a lesson to doctors not to repeat the mistakes of other doctors.

So, I am not suggesting this just to ‘hentam pesakit’ because I am fully aware that I might be a patient too one day. I want justice to be served for everybody; doctors and patients both. Because I also believe that we should not hide misconduct done by doctors.

Fair is fair, is fair, is fair.

Fighting for justice is human instinct. But we have dulled our instinct when we douse our instinct in diplomacy and fear of hierarchy.

diplomacy-and-virtue-do-not-make-easy-companions

***

“O you who believe!  Stand out firmly for justice, as witnesses to Allah, even if it be against yourselves, your parents, and your relatives, or whether it is against the rich or the poor…” (Quran 4:135)

“God commands justice and fair dealing…” (Quran 16:90)

“O you who believe, be upright for God, and (be) bearers of witness with justice!…” (Quran 5:8)

“…If you judge, judge between them with justice…” (Quran 5:42)

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