Singapore Medical Council Wong Him Choon

• Jurisdiction: Singapore
• Judge: Sundaresh Menon CJ
• Judgment Date: 25 July 2016
• Neutral Citation: [2016] SGHC 145
• Year: 2016
• Date: 25 July 2016
• Published date: 28 July 2016
• Hearing Date: 10 May 2016
• Plaintiff Counsel: Philip Fong, Shazana Anuar and Sui Yi Siong (Harry Elias Partnership LLP)
• Citation: [2016] SGHC 145
• Defendant Counsel: S Selvaraj, Myint Soe and Edward Leong (MyintSoe & Selvaraj)
• Court: High Court (Singapore)
• Docket Number: Originating Summons No 2 of 2015

Andrew Phang Boon Leong JA (delivering the grounds of decision of the court): Introduction

It is an understatement of the highest order to state that doctors are part of the bedrock of our society. This is so not least because they care for people by helping to heal them, regardless of their situation or station in life. And even in the direst of circumstances, for example, when physical death is at the patient’s doorstep, their kindness and assistance is no less (and may be even more) important. That is why all of us look up to doctors and respect them for the high calling that is rightfully theirs to claim. And that calling is of course embodied in the Hippocratic Oath. As this court observed in Lim Mey Lee Susan v Singapore Medical Council [2013] 3 SLR 900 (“Lim Mey Lee Susan”) (at [39]−[40]): 39 Turning to the medical profession, the idea that the practice of medicine is, above all, a calling of the highest order is a historical cornerstone of the medical profession. It can be traced through the millennia – through countless doctors who have taken, in one form or another, a version of what has oft been hailed as one of the world’s first ethical codes, the Hippocratic Oath (and see also, in this regard, the general definition of a “profession” in the [Oxford English Dictionary] ([30] supra) referred to above at [30]). In Singapore, this oath currently takes the form of the Singapore Medical Council Physician’s Pledge (presently found in the Second Schedule to, read with reg 16(2) of, the Medical Registration Regulations 2010 (S 733/2010)), which is taken by every doctor upon being admitted as a fully registered medical practitioner and which reads as follows:

I solemnly pledge to dedicate my life to the service of humanity; give due respect and gratitude to my teachers; practise my profession with conscience and dignity; make the health of my patient my first consideration; respect the secrets which are confided in me; uphold the honour and noble traditions of the medical profession; respect my colleagues as my professional brothers and sisters; not allow the considerations of race, religion, nationality or social standing to intervene between my duty and my patient; maintain due respect for human life; use my medical knowledge in accordance with the laws of humanity; comply with the provisions of the Singapore Medical Council’s Ethical Code and Ethical Guidelines; and constantly strive to add to my knowledge and skill.

I make these promises solemnly, freely and upon my honour.

[emphasis added in bold italics]

40 This pledge is even more explicit in its reference to ethical obligations and values than the corresponding declaration taken by lawyers (pursuant to r 30 of, read with the First Schedule to, the Legal Profession (Admission) Rules (reproduced above at [32])). In our view, this pledge constitutes no mere rhetoric. Instead, it embodies – as the summary with regard to the legal profession set out above (at [38]) underscores – a calling that seeks, amongst other obligations, to be helpful to others in an important way (here, by curing the sick) and goes beyond mere money-making and the advancement of self-serving interests.

[emphasis in original]

Indeed, the court in Lim Mey Lee Susan proceeded to elaborate upon the above observations thus (at [41]−[42]): 41 Indeed, the proposition that the spirit of public service and the existence of ethical obligations underpin all professional practice applies with equal (and, arguably, even greater) force to medical practitioners, whom we collectively entrust with our health, our well-being and, in certain instances, our lives. In this respect, the medical profession occupies a unique societal position of both great privilege and commensurate responsibility. In this regard, the following observations by the then Governor of the Straits Settlements, Sir John Anderson, in his speech on the occasion of the formal opening of the very first medical school in Singapore on 28 September 1905 are particularly apposite (published in The Straits Times of 29 September 1905 (available at (accessed 24 June 2013)), also quoted (in part) in Transforming Lives: NUS Celebrates 100 Years of University Education in Singapore (Singapore University Press Pte Ltd, 2005) at p 11):

… What I want you to remember is that the course of study you are about to enter upon is not merely a course of study which is intended to enable you to earn a living, but … a passport to membership of a very great profession, a profession in many instances of unselfish devotion and splendid achievement, a profession with very lofty ideals and one which calls for all the best qualities, mental and moral, which a man can give. It demands not only freshness and vigour of body, but steadiness and skill in hand and eye. It wants infinite patience and keenest sympathy, and to all these qualities there has to be added unfaltering courage. …

[emphasis added in italics and bold italics]

As also articulated by this court in Low Cze Hong v Singapore Medical Council [2008] 3 SLR(R) 612 (“Low Cze Hong”) at [36]: … The importance of maintaining the highest level of professionalism and ethical conduct has been duly acknowledged by the [Singapore Medical Council] in the Introduction section of the [Singapore Medical Council] Ethical Code (at p 1): The medical profession has always been held in the highest esteem by the public, who look to their doctors for the relief of suffering and ailments. In modern medical practice, patients and society at large expect doctors to be responsible both to individual patients’ needs as well as to the needs of the larger community. Much trust is therefore endowed upon doctors to do their best by both. This trust is contingent on the profession maintaining the highest standards of professional practice and conduct. …

[High Court’s emphasis in Low Cze Hong in italics; emphasis added in bold italics]

42 We would like to emphasise, in the circumstances, that fostering a culture of ethics and striving to achieve the ideals embodied within the practice of medicine as a whole represent the only meaningful way to approach the questions that matter in this profession. It is with this in mind that we now turn to Issue 1 proper, namely, whether there exists, on the part of all doctors who practise medicine in Singapore, an ethical obligation to charge a fair and reasonable fee for their services. In our view, any engagement with this issue must take place in the full context of the professional status of doctors and the unique situation which they occupy in society, coupled with the ethical considerations which necessarily attach to both these weighty positions (and which are embodied in the pledge reproduced above at [39]).

[emphasis in original]

It is important to emphasise right at the outset what the nature – as well as ideals – of the medical profession are simply because of their woeful neglect in the context of the present case. In fairness to the doctor concerned, we note that there was neither an allegation nor a finding of dishonesty as such. However, as we shall elaborate upon below, his conduct in the entire case fell far short of the ideals set out above and is (simultaneously) a reminder to all concerned that doctors ought never to lose sight of them.

This case also – as we shall also elaborate upon below – concerns the important issue of perspective. In particular, the doctor must also be cognisant of the patient’s position and welfare. And this entails placing himself or herself in the shoes of the patient, so to speak. In this regard, the following oft-cited advice from a father to his daughter in a famous novel ought to be noted (see Harper Lee, To Kill A Mockingbird (William Heinemann Ltd, 1960; reprinted in the New Windmill Series, 1966) at p 35):

First of all, … if you can learn a simple trick, Scout, you’ll get along a lot better with all kinds of folks. You never really understand a person until you consider things from his point of view – … until you climb into his skin and walk around in it.

In many ways, the wisdom contained in the above quotation is, in point of fact, an integral part of the doctor’s duty which we have set out above. The underlying thread is one of care and common humanity.

With these broad principles in mind, we now turn to the specific facts and issues of the present case, which is an appeal by the Singapore Medical Council (“the SMC”) against the decision of the Disciplinary Tribunal (“the DT”) appointed by it for the disciplinary inquiry in relation to the respondent, Dr Wong Him Choon (“Dr Wong”). The DT found that Dr Wong was not guilty of professional misconduct under s 53(1)(d) of the Medical Registration Act (Cap 174, 2014 Rev Ed) (“MRA”). We allowed the appeal and now give the detailed grounds for our decision.

Background facts

On 3 September 2011, at or about 10.35pm, Mr Fan Mao Bing (“the Patient”), a Chinese national and construction worker, visited the Accident and Emergency Department (“A&E”) of Raffles Hospital (“RH”) after having fallen off “monkey stairs” from a height of about three metres at a construction site managed by a construction company called Kajima Overseas Asia Pte Ltd (“Kajima”). The Patient was an employee of Tai Ping Yang Jian Gong Pte Ltd (“TPY”), a sub-contractor of Kajima. The Patient fell on his right (master) hand. He was brought to RH by a safety supervisor of TPY and safety officer from Kajima.

Dr Wong was at the material time a consultant orthopaedic surgeon at Raffles Orthopaedic Centre, RH. He attended to the Patient. Before treating the Patient, he asked to view the Patient’s Work Permit where he learned that the Patient’s Work Permit would expire in November 2011. The relevance of this piece of information is discussed below at [107]. At about 1am on 4 September 2011, Dr Wong performed surgery involving the...