MOH-appointed workgroup proposes wide-ranging reforms in healthcare system relating to taking of informed consent and Singapore Medical Council disciplinary process

19 December 2019

The 12-member Workgroup to Review the Taking of Informed Consent and the Singapore Medical Council’s (“SMC”) Disciplinary Process (“Workgroup”), which was appointed by the Ministry of Health (“MOH”) in March 2019, has released a Report on Recommendations (“Report”) dated 28 November 2019 covering mainly the taking of informed consent by doctors and SMC’s disciplinary processes.

In a press release dated 3 December 2019, MOH stated that it has accepted the Workgroup’s recommendations and will take steps to implement the recommendations. MOH will also ensure the proposed reforms remain sustainable and relevant in the long-term. Some recommendations would require legislative changes, whilst some others can be incorporated into the current process and implemented immediately.

By way of background, the Workgroup was appointed in March 2019 to review and make recommendations on two broad issues:

The applicable standard of care when taking informed consent and how that standard is to be judged.
Efficacy of SMC’s regulatory functions and processes to ensure outcomes are fair, independent and consistent.

The Workgroup has made extensive recommendations to address the issues put to them.

Allen & Gledhill Partner Mak Wei Munn is a member of the Workgroup.

Taking of informed consent

Bearing in mind the paramount concern of patient safety and welfare, the Workgroup recommends a clear legal standard for doctors’ duty to advise. The standard will be one that is patient-centric, but ultimately based on the opinion of a responsible body of doctors. The test mandates that the responsible body of doctors must consider whether information that is relevant and material to the patient in the circumstances to allow that patient to make informed treatment decisions, was provided. Under this test, doctors would not be permitted to simply dictate what information patients should receive, without any regard to the individual patient’s need for information, but would need to have regard to patient autonomy and choice in order to satisfy the standard of care. This would mean giving patients an opportunity to ask questions and have their specific concerns addressed.

The Workgroup also recommends revising SMC’s Ethical Code and Ethical Guidelines on informed consent down to basic irreducible principles, with helpful illustrations to guide doctors on how these principles apply. In conjunction, it is also recommended that professional bodies such as the Academy of Medicine, Singapore and public healthcare institutions jointly develop appropriate specialty-specific guidelines to deal with standard commonplace treatments and procedures in each specialty. These guidelines should provide practical guidance to doctors on how they are to comply with their core irreducible duties by illustrating practices that should be adopted in common situations.

SMC’s disciplinary process

Taking reference from the disciplinary process of the Law Society of Singapore and the best practices of medical disciplinary bodies in other Commonwealth jurisdictions, the Workgroup made recommendations in relation to SMC’s disciplinary process that can be broadly grouped into five categories: