Skip to main content
SpringerLink
Log in

Ethical Pricing: a Confucian Perspective

  • Original Paper
  • Published:
Asian Bioethics Review Aims and scope Submit manuscript

Abstract

Based on an analysis of a landmark case Lim Mey Lee Susan v Singapore Medical Council in Singapore where a doctor was professionally disciplined for over-charging a wealthy patient, a judgement upheld by the Singapore High Court, this paper will discuss the notion of an ‘ethical price’ (EP) and its determination with respect to the provision of healthcare services. It will first examine the limitations of a legal approach for setting an ethical limit to pricing. From there, it will argue that Confucian philosophy provides a useful ethical framework to explore EP, with focus on the context of Singapore. The following question is addressed: What is an ethical pricing standard for medical practice from a Confucian perspective? The strengths and limitations of a Confucian value base as regards the determination of an objective EP will be analysed through an examination of the shortcomings of the doctor’s behaviour in the Susan Lim case as well as other case scenarios. The paper will conclude with some practical suggestions on how Confucian-based ideas can be applied to decision-making on pricing and the importance of this for medical professionalism and ethics teaching.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. Such attempts were construed as price-fixing, because the Singapore Medical Association, comprising medical professionals, was involved in the fee guidelines, resulting in conflict of interest. Members of the profession may thus attempt to exploit their position to set fees higher than the current market rate, increasing profit at the expense of consumers.

  2. Excessive government involvement in financial matters may lead to a slippery slope and possibly central planning. With the state having significant control over economic affairs, there is the risk of abuse of power, potentially escalating to a tyrannical government.

  3. Hence, the philosopher Xunzi argued that individuals need to be restrained by law and punishment (see Chatterjee 2011)

References

  • Amaya, Amalia, and Hock Lai Ho. 2012. Law, virtue and justice. London: Bloomsbury Publishing.

    Google Scholar 

  • Ames, Roger T. 2003. Li 禮 and the A-theistic religiousness of classical Confucianism. In Confucian Spirituality, edited by Wei-ming Tu and Mary Evelyn Tucker. New York, NY: Crossroads Press.

  • Anandarajah, Kala, and Joshua Seet. 2017. Medical fee guidelines - a case of full circle? Straits Times, 15 December 2017. https://www.straitstimes.com/opinion/medical-fee-guidelines-a-case-of-full-circle. Accessed 4 June 2018.

  • Brennan Jr, J. 1976. US Supreme Court.

  • Chan, Joseph. 1999. A Confucian Perspective on Human Rights for Contemporary China. In The East Asian Challenge for Human Rights, edited by Joanne R. Bauer and Daniel A. Bell, 212–237. Cambridge: Cambridge University Press.

  • Chatterjee, Deen K. 2011. Encyclopedia of global justice: A-I. Berlin: Springer Science & Business Media.

    Book  Google Scholar 

  • Chen, Albert H. Y. 2001. Mediation, litigation and justice: Confucian reflections in a modern liberal society. 現代法學 [Modern Law Science] 2001 (3). http://en.cnki.com.cn/Article_en/CJFDTotal-XDFX200103000.htm. Accessed 10 October 2020.

  • Cheng, Chung-ying. 1972. On yi as a universal principle of specific application in Confucian morality. Philosophy East and West 22 (3): 269–280.

    Article  Google Scholar 

  • Chew, Rebecca. 2013. Doctor’s fees after Susan Lim’s case–implications for the medical profession. SMA News 45 (11): 24–27. https://www.sma.org.sg/UploadedImg/files/Publications%20-%20SMA%20News/4511/Insight.pdf. Accessed 9 October 2020.

  • Ci, Jiwei. 1999. The Confucian relation concept of the person and its modern predicament. In Personhood and health care, edited by David C. Thomasma, David N. Weisstub, and Christian Hervé, 149–164. Berlin: Springer.

  • De Bary, William Theodore. 2009. The trouble with Confucianism. Cambridge: Harvard University Press.

    Google Scholar 

  • Deng, Feng. 2013. Corrective justice in the Confucian legal tradition: a nonexistent concept. Cornell Law School Clarke Program, conference paper.

  • Fingarette, Herbert. 1972. Confucius: the sacred as secular. New York, NY: Harper Torchbook.

  • Frederickson, H. George. 2002. Confucius and the moral basis of bureaucracy. Administration & Society 33 (6): 610–628.

  • Gensler, Harry J. 2013. Ethics and the golden rule. Abingdon: Routledge.

    Book  Google Scholar 

  • Hayek, Friedrich A. 2014. The road to serfdom: text and documents: the definitive edition. Volume 2 of the Collected Works of F.A. Hayek, edited by Bruce Caldwell. Abingdon: Routledge.

  • Hu, Eric. 2014. When doctors overcharge, what price do they pay? Singapore Law Review 5. http://www.singaporelawreview.com/juris-illuminae-entries/2015/when-doctors-overcharge-what-price-do-they-pay. Accessed 9 October 2020.

  • Huang, Yongchang [黄永昌]. 1991. 陈实功与医德规范 [Chen Shigong and Medical Ethical Standards]. 中医杂志 [Journal of Traditional Chinese Medicine] 2: 042.

  • Hui, Edwin C. 2003. Personhood and Bioethics: a Chinese Perspective. In Bioethics: Asian Perspectives: A Quest for Moral Diversity, edited by Renzong Qiu, 29–43. Berlin: Springer.

  • Ivanhoe, Philip J. 1991. Character consequentialism: an early Confucian contribution to contemporary ethical theory. Journal of Religious Ethics 19 (1): 55–70.

  • Ivanhoe, Philip J. 2002. Ethics in the Confucian tradition: the thought of Mengzi and Wang Yangming. Indianapolis, IN: Hackett Publishing.

  • Ivanhoe, Philip J., David S. Nivison, Bryan W. Van Norden, R. P. Peerenboom, and Henry Rosemont. 2000. Ethics in the Confucian tradition: the thought of Mencius and Wang Yangming. Journal of Religious Ethics 28 (3): 449-470.

  • Li, Jian-guo. 2007. Culture of the rites of the Zhou dynasty and primitive Confucius. Journal of Xinyang Normal University (Philosophy and Social Sciences Edition) 2007 (1). https://en.cnki.com.cn/Article_en/CJFDTotal-XYSZ200701000.htm. Accessed 10 October 2020.

  • Johnson, Carl M. 2009. Freedom and Confucianism. International Journal of the Asian Philosophical Association 1 (2): 52–61.

  • Kim, Terri. 2009. Confucianism, modernities and knowledge: China, South Korea and Japan. In International Handbook of Comparative Education, edited by Robert Cowen and Andreas M. Kazamias, 857–872. Dordrecht: Springer.

  • Lam, Kit-Chun Joanna. 2003. Confucian business ethics and the economy. Journal of Business Ethics 43 (1–2): 153–162. https://doi.org/10.1023/A:1022935820655

  • Lau, Dim Cheuk. 2003. Mencius. Hong Kong: Chinese University Press.

    Google Scholar 

  • Lim, Meng-Kim. 2005. Transforming Singapore health care: public-private partnership. Annals, Academy of Medicine, Singapore 34 (7): 461-467.

  • Liu, Yunzhang. 2014. 從儒家傳統論中醫職業精神的形成機制 [On the formation mechanism of traditional Chinese medicine professionalism from Confucian tradition]. 中外醫學哲學 [International Journal of Chinese & Comparative Philosophy of Medicine] 12 (1): 6.

  • Loewe, Michael, and Edward L. Shaughnessy, eds. 1999. The Cambridge history of ancient China: From the Origins of Civilization to 221 BC. Cambridge: Cambridge University Press. https://doi.org/10.1017/CHOL9780521470308

  • Lufrano, Richard John. 1997. Honorable merchants: commerce and self-cultivation in late imperial China. Honolulu, HI: University of Hawaii Press.

  • Mill, John Stuart. 1966. On liberty. In A selection of his works, 1–147. Berlin: Springer.

    Chapter  Google Scholar 

  • Oxnam, Robert, and Irene Bloom. 2009. Three Confucian values.

  • Qu, Fan [曲凡], and Liyu Wang [王丽宇]. 2010. 论儒家 “五常” 思想与医生职业精神之契合 [On the Application of the Confucian Concept of the “Five Constants” to Doctors’ Professionalism]. 中国医学伦理学 [Chinese Medical Ethics] 23 (2): 39–40.

  • Renda, Andrea, Lorna Schrefler, Giacomo Luchetta, and Roberto Zavatta. 2013. Assessing the costs and benefits of regulation. Brussels: Centre for European Policy Studies. http://ec.europa.eu/smartregulation/impact/commission_guidelines/docs/131210_cba_study_sg_final.pdf. Accessed 1 June 2014.

  • Riegel, Jeffrey. 2002. Confucius. In Stanford Encyclopedia of Philosophy. Fall 2002 Edition. https://plato.stanford.edu/archives/fall2002/entries/confucius/. Accessed 10 October 2020.

  • Shils, Edward. 1996. Reflections on civil society and civility in the Chinese intellectual tradition. Confucian traditions in East Asian modernity: Moral education and economic culture in Japan and the four mini-dragons, edited byWeiming Tu, 38–71. Cambridge: Harvard University Press.

  • Shun, Kwong-loi. 1993. Jen and Li in the “Analects”. Philosophy East and West 43 (3): 457–479. https://doi.org/10.2307/1399578

  • Singapore Medical Association. 2014. Singapore Medical Association – Guidelines on Fees. https://www.cccs.gov.sg/public-register-and-consultation/public-consultation-items/singapore-medical-association%2D%2Dguidelines-on-fees. Accessed 27 May 2018.

  • Singapore Medical Council. 2012. Singapore Medical Council Disciplinary Committee inquiry for Dr Susan Lim Mey Lee held on 21, 22, 23 May, 21 June and 17 July 2012. https://web.archive.org/web/20150526070110/. http://www.healthprofessionals.gov.sg/content/dam/hprof/smc/docs/grounds_of_decision/Dr%20Lim%20Mey%20Lee%20Susan.pdf. Accessed 13 April 2017.

  • Sommerlad, Hilary. 2010. Some reflections on the amorality of the market: correspondent’s report from the United Kingdom. Legal Ethics 13 (1): 93–96. https://doi.org/10.5235/146072810791655206

  • Stern, David Thomas. 2006. Measuring medical professionalism. Oxford: Oxford University Press.

    Google Scholar 

  • Swick, Herbert M., Philip Szenas, Deborah Danoff, and Michael E. Whitcomb. 1999. Teaching professionalism in undergraduate medical education. JAMA 282 (9): 830–832. https://doi.org/10.1001/jama.282.9.830

  • Tan, Chi Chiu. 2013. Doctor’s fees: what has changed after the Susan Lim case? SMA News 45 (9): 25–28. https://www.sma.org.sg/UploadedImg/files/Publications%20-%20SMA%20News/4509/Insight.pdf. Accessed 9 October 2020.

  • Tan, Hwee Hoon, and Dave Chee. 2005. Understanding interpersonal trust in a Confucian-influenced society: an exploratory study. International Journal of Cross Cultural Management 5 (2): 197–212. https://doi.org/10.1177/1470595805054493

  • Tsai, Daniel Fu-Chang. 1999. Ancient Chinese medical ethics and the four principles of biomedical ethics. Journal of medical ethics 25 (4): 315–321.

  • Tsai, Daniel Fu-Chang. 2005. The bioethical principles and Confucius’ moral philosophy. Journal of medical ethics 31 (3): 159–163. https://doi.org/10.1136/jme.2002.002113

  • Tsai, Daniel Fu-Chang. 2008. Personhood and autonomy in multicultural health care settings. Virtual Mentor 10 (3): 171–176. https://doi.org/10.1001/virtualmentor.2008.10.3.msoc1-0803.

  • Vallentyne, Peter. 2014. Robert Nozick: anarchy, state, and utopia. In Twentieth Century: Quine and After, Volume 5 of Central Works of Philosophy, edited by John Shand, 108-125. Abingdon: Routledge. https://doi.org/10.1017/UPO9781844653621

  • Van Norden, Bryan W. 2014a. Wang Yangming. In Stanford Encyclopedia of Philosophy Archive. Fall 2014 Edition. https://plato.stanford.edu/archives/fall2014/entries/wang-yangming/. Accessed 24 June 2018.

  • Van Norden, Bryan W. 2014b. Mencius. In Stanford Encyclopedia of Philosophy. Spring 2017 Edition. https://plato.stanford.edu/archives/spr2017/entries/mencius/. Accessed 24 June 2018.

  • Wattles, Jeffrey. 1996. The golden rule. Oxford: Oxford University Press.

    Google Scholar 

  • Wong, David B. 2018. Chinese Ethics. In Stanford Encyclopedia of Philosophy. https://plato.stanford.edu/entries/ethics-chinese/. Accessed 9 October 2020.

  • Yin, Yong-ming, and Hui Xiao. 2008. Zhu Xi’s thoughts on rites of the Zhou dynasty. Journal of Hunan University (Social Sciences) 2008 (1): 006. https://en.cnki.com.cn/Article_en/CJFDTotal-HDXB200801006.htm. Accessed 10 October 2020.

Download references

Acknowledgements

The author would like to acknowledge the efforts of Dr Voo Teck Chuan from the Centre for Biomedical Ethics, National University of Singapore; Associate Professor Loy Hui Chieh from the Department of Philosophy, National University of Singapore; and Dr Philip Yap and Dr Lawrence Tan from Khoo Teck Puat Hospital for proofreading the draft and giving kind feedback.

Author information

Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore

    Gabriel Hong Zhe Wong

Authors
  1. Gabriel Hong Zhe Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gabriel Hong Zhe Wong.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wong, G.H.Z. Ethical Pricing: a Confucian Perspective. ABR 12, 419–433 (2020). https://doi.org/10.1007/s41649-020-00146-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41649-020-00146-y

Keywords

Search

Navigation