Informed Consent Obligation Expanded in Singapore Doctors’ Updated Ethical Handbook

Featured image for the "Informed Consent Obligation Expanded in Singapore Doctors' Updated Ethical Handbook" article. It features a doctor smiling as he discusses a matter with an elderly patient.

The Singapore Medical Council’s Ethical Code and Ethical Guidelines (ECEG) was created as a guide for doctors in Singapore, setting ethical standards for their practice and conduct as doctors.

The ECEG had previously last been revised in 2002. It has since been updated to a 2016 revised edition which entered into force on 1 January 2017.

The latest edition of the ECEG reflects, generally, increased recognition of patient autonomy. As it explains,

“an important part of patient autonomy involves ensuring that patients give their valid consent…to any treatment or procedure prior to undergoing such treatment or procedure. This involves patients making voluntary decisions on their medical care after having known and understood the benefits and risks involved”.

While the ECEG does not have the force of law, contravention of any of its guidelines may form the basis for a case of professional misconduct or negligence.

Informed Consent

The 2002 edition of the ECEG had previously addressed the issue of informed consent in just 1 paragraph:

 “It is a doctor’s responsibility to ensure that a patient under his care is adequately informed about his medical condition and options for treatment so that he is able to participate in decisions about his treatment. If a procedure needs to be performed, the patient shall be made aware of the benefits, risks and possible complications of the procedure and any alternatives available to him. If the patient is a minor, or of diminished ability to give consent, this information shall be explained to his parent, guardian or person responsible for him for the purpose of his consent on behalf of the patient.”

In contrast, the 2016 edition of the ECEG’s discussion on the same issue spans a total of 20 guidelines.

These 20 guidelines attempt to consider various clinical situations which doctors will need to obtain their patients’ prior consent for. They also state the necessary steps doctors have to take to ensure that their patients understand and validly consent to treatment, in such situations.

For example, the ECEG requires doctors to, as far as possible:

  • Obtain consent for all aspects of medical care. This is regardless of whether the medical intervention is minor with low risk, or major with substantial risk.
  • Emphasise to patients that their consent to treatment can be withdrawn or modified at any time. These decisions must also be respected unless the doctor has reason to believe that the patient’s judgment has been impaired.
  • Ensure that patients understand the information given for the purposes of consent. For example, doctors faced with language barriers are required to use interpreters.

The latest version of the ECEG is a welcome addition for patients who would prefer to make informed decisions regarding their treatment, rather than passively relying on their doctors’ recommendations.

For more information on the rights of patients relating to informed consent, you can consult Guideline C6 of the 2016 edition of the ECEG here.

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