Events Details

Ethics In Business - What moves the conscience when mortality is at stake?

Event Date:2013-10-06

Posted by Firoz Abdul Hamid on October 6, 2013

By Firoz Abdul Hamid

Soap operas excite most people. Mostly because it is consoling to know others have imperfect lives too. Soaps ascend many to escape the monotony of life largely, but more importantly people watch these soap operas hoping to relate at some level their lives’ many issues with the imageries on television.

The medical soap series have always been riveting. Doctors clashing with nurses – running to emergency rooms, lives on the brink are resuscitated, doctors confronted by questions of principles and ideologies. Most of us would remember ER, Chicago Hope, SCRUB and then of course Grey’s Anatomy.

But one thing always struck me in the medical business (not least some of these medical series I once watched). Is it a business of saving lives or is it a business, period? You may ask what the difference is. This cannot be better demonstrated by the shutdown in the US last week. How the seemingly most powerful nation in the world that issues global currency is searching its souls on whether healthcare should be free for its people. As imperfect as the systems may be, how can countries like Malaysia and United Kingdom, amongst many others, make healthcare available and accessible for their people yet capitalism curbs this access in some countries in the name of rights and responsibilities?

Whose rights and whose responsibilities do we debate and preserve when it comes to defining and honouring the basics of human dignity like access to education and healthcare for all? What is left of dignity of man without access to either of these services?

The famous Hippocratic Oath which dates back to the Ionic Greek times in the 5th century BC was historically taken by physicians and other healthcare professionals swearing to practice medicine honestly. Although amended and revised over the years, one poignant commitment in this oath is, “That I will not withdraw from my patients in their time of need”.

How does one serving this field reconcile withdrawing from patients in their times of need – when the argument is that there is no budget, no resources. How do physicians reconcile with this oath when their fundamental responsibilities are circumvented by the fundamentals of business and politics? Indeed, can we view clinical ethics in isolation to business ethics when discussing the medical industry? James MacGregor Burns, a US presidential biographer and authority on leadership studies, said that “Divorced from ethics, leadership is reduced to management and politics to mere technique.”

When I started this column in April 2013, I interviewed the managing director of Malaysia’s most successful private medical centre, Excellency Datin Paduka Siti Saadiah. The article then quoted a piece from Huffington Post which read “Doctors need the results of clinical trials to make informed choices, with their patients, about which treatment to use. But the best currently available evidence estimates that half of all clinical trials, for the treatments we use today, have never been published”

Today, there are such questions like: Is force feeding medically ethical? This debate came to the fore during the recent hunger strike by Guantanamo Bay inmates. Is mercy killing unethical? Is surrogate mothering ethical? Who decides this – a faith, a belief, a conviction or how high your stocks may rise for the week? Indeed, what are the determinants to these continued medical ethics debates? Is it a business decision at the end of the day? Or is it a clinical decision? Or a political decision?

When faced with a failing organ, what if your most trusted clergy says transplant is sinful and another says it is not and you are no expert in discernment of the faith’s traditions? What do you go by? Your heart, your instincts, your conscience, your doctor or your clergymen’s contradicting rulings?

How would you react when the doctor tells you that there is this thing called medical \\\\\\\"cannabis\\\\\\\" that will heal you? Cannabis? Yes, weed! What drives your conscience to taking that leap of faith when your only child is facing leukaemia and the only cure (hypothetically) is weed?  What moves your heart when you are told your partner has debilitating illness? Which \\\\\\\"God\\\\\\\" does one ultimately surrender to – the doctor, the system, the business or the industry or the faith itself?

Whom do you listen to when faced with your own mortality?

What do you tell a 10-year-old girl in a war-torn country who has been multiply raped only to find out she is pregnant? When she finds out she may have gotten HIV because of this rape? When she is faced with deep religious taboos and traditions of both rape and abortion? Sitting in the pulpits of judgement is so easy in such instances, yet the reality of raising a child under those circumstances of rape and disease; you wonder what sort of parent one can become. We see parents with such privileges in life struggle to raise well balanced children, what more those who raise a child under these circumstances. The movie We Must Talk About Kevin with Tilda Swinton struck a real chord with me. In such privilege, you find such carnage in a child’s mind. This story is played out in its true form today in some places.

With these looming debates, I went back to the first interviewee, Datin Paduka Siti Saadiah, who has since retired as the Managing Director of KPJ Healthcare and is now its Corporate Advisor, to confront her with some of these questions. Amidst her enviable energy and passion to serve, Saadiah exudes such humility that is exemplary and rare for a leader of her caliber and accomplishment in these times. Excellency Saadiah has also recently launched her biography which details her journey to building Malaysia’s largest private medical center. Under her tenure, KPJ Healthcare grew to become the country’s largest private healthcare group, operating 23 hospitals locally with two hospitals in Indonesia and a retirement and age-care resort in Australia. As the author of her biography, Rokiah Talib, wrote, “This is an inspiring story of a woman who defied all norms and theories on the role of women in society.”

In his acclaimed book, The Nicomachean Ethics, Aristotle wrote “For the things we have to learn before we can do them, we learn by doing them.”  One cannot continue to debate clinical ethics without seeing it in the realms of business ethics. Everything we do today is a business for someone somewhere. Everything we claim to do in the name of ethics is confronted by detractors who also claim to be doing so in the name of their conscience. Yet we struggle to find the line between right and wrong, black and white when faced with our own mortality. Only when faced with the fragility of our own lives do we stand down from the benches of judgement and censures to the fields of mortality that would serve and save our own lives.

Professor Tariq Ramadan of the University of Oxford wrote a piece on medical ethics in his book The Radical Reform, saying \\\\\\\"It has appeared, however, as it grew more specialised, reflection sometimes became technical and formal, losing touch with the complexity of the world and of day-to-day realities. It is as if, while gaining effective specificity, legal councils had lost ground in terms of global vision and social, political and economic consideration. As if, once again, medicine – whose specific complexity has been acknowledged – was practiced abstracted from the complexity of societies and economic issues.\\\\\\\"

This is perhaps why Jalaluddin Rumi said, “Beyond right and wrong, there is a field. I will meet you there”

Finally, for the first time, KPJ Healthcare in its annual medical convention will be debating the subject of clinical ethics from the sphere of business ethics. I hope to be moderating this exciting session which comprise both medical and non medical panelists.

 PadukaDatin Paduka Siti Saadiah Bakir

 â€œNobody can take the fact that a billion-ringgit company was created from scratch” – Siti Saadiah

1. You recently launched your biography. Congratulations. What would you say your greatest legacy has been in and for the medical industry?

On a professional basis, my legacy would be KPJ’s strong growth since the opening of our first hospital in 1981 until today. Within three decades, we have been able to grow the organisation from one hospital into 23 existing hospitals in the country, two in Indonesia and one in Thailand, as well as an aged care facility in Australia.

Another legacy is KPJ’s achievements and milestones, which are recognised at both the national and international levels including :

2007: >RM1 billion turnover @ RM1.11 billion
2008: >RM100 million profit before tax @ RM114.1 million
2009: >RM1 billion market capitalisation @ RM1.37 billion and the listing as one of Bursa Malaysia’s Top 100 public limited companies, i.e. at rank 91
2010: >RM2 billion market capitalisation @ RM2.08 billion, and with that KPJ’s ranking on Bursa Malaysia’s Top 100 list had risen to rank 85
2011: KPJ’s ranking on Bursa Malaysia’s Top 100 list had risen to rank 75 as market capitalisation reached RM2.7 billion
2012: Successfully achieved >RM2 billion turnover @ RM2.11 billion and reached rank 66 on Bursa Malaysia’s Top 100 list with a market capitalisation of RM3.7 billion.
On a personal basis, I am delighted that my own contributions have been recognised both at the industry and national levels. Among the major awards I have received to date is the CEO of The Year 2009 by The New Straits Time Press and American Express – and I remain the only woman having achieved this milestone to date.

My personal legacy would primarily be centered on three aspects:

a) Visionary and Transformational Leadership (TL): I have been a visionary leader in tandem with the principles of Transformational Leadership, which I embrace. I focus on TL’s principle that \\\\\\\"leaders and followers engage in a mutual process of ‘raising one another to higher levels of morality and motivation’\\\\\\\" (Burns, 1978).  As a Transformational Leader, I consistently raise the bar by appealing to my team members’ higher ideals and values. In doing so, they embrace and ultimately model the values themselves to others around them.

b) Building a Winning Team: My team has grown significantly – as professionals and as leaders.  I would like to think that I have helped create many opportunities for people within the group to move ahead as Malaysian professionals, including many women leaders and professionals in the healthcare industry.

c) Motivating Malaysians to achieve greater heights: I have tried to reach out to many cross sections of the market, through the presentation of papers and interviews on general management issues, women’s managerial matters and healthcare management. This has been my personal contribution in helping to build the community and nation as a whole.

Launch Book with Datuk edit2. What would you have liked to have achieved given more time and opportunity?

I still play an active role today in my capacity as a Non-Executive Director and Corporate Advisor for KPJ since January 1, 2013. As the Corporate Advisor, I am directly involved in development of several key business areas which are:

a) Reviewing and monitoring the KPJ Group’s new hospitals and new expansion projects

With more than 30 years’ experience in hands-on management and development of projects in the private healthcare industry, I can contribute and facilitate all in-depth analysis of KPJ’s new projects. Among the projects being monitored are six new hospitals which are listed on the national Economic Transformation Project (ETP) under the healthcare NKEA. When completed, the six hospitals will generate a Gross National Income of approximately RM1.3 billion and create more than 3,000 new jobs.

b) Chairmanship of KPJ Sabah Specialist Hospital

I maintain the chairmanship of the 250-bed hospital to ensure that the new hospital development is fully completed as detailed and will fully achieve all benchmarks as targeted by the board. This is especially crucial as KPJ Sabah will be the first purpose-built hospital in Kota Kinabalu, Sabah, undertaken by KPJ.

c) Healthcare education – KPJ University College

I am the Chairman and Pro-Chancellor of the KPJ Healthcare University College (KPJUC), and my role is to actively provide the strategic direction of the University College focusing on healthcare programmes en route in order to become a full-fledged university by 2015. It is my aspiration that KPJUC will ultimately the preferred provider of world-class healthcare education. The University College is already achieving tremendous milestones and was the first to be given the license to train diploma-level nurses since 1991. For the past 20 years, KPJUC has trained more than 4,500 nurses and 800 allied health professionals. Some of these graduates work abroad, in the Middle East, Singapore and Australia.

KPJUC today offers 27 programmes ranging from foundation to postgraduate courses in nursing, pharmacy and allied services. Since 2012, KPJUC was also given the license to run medical programmes started with Masters in Otorhinolaryngology (head and neck surgery) and Paediatrics. Several more programmes are currently being reviewed for approval. These include Masters in Surgery, Masters in Orthopedic and Masters of Radiology.

Apart from the medical programmes, KPJUC is awaiting approval for other allied health sciences programmes especially at degree level. Among the newly approved ones are Bachelor in Medical Imaging, Bachelor of Pharmaceutical Sciences with Health Sciences and Bachelor of Pharmacy. Two other bachelor degrees, Nursing and Physiotherapy, are also in the pipeline for approval. All the degree level programmes will commence by September 2013.

To cater to the increase in student intake, the university places significant emphasis on its human capital development. Its staff force has grown by 15 per cent year-on-year, with more than half of the staff members being qualified and experienced lecturers in order to achieve a balanced student-lecturer ratio.

d) Aged care services

I am also looking into KPJ’s Aged Care business as we believe there is tremendous potential for the long term. In doing so, KPJ has already completed several undertakings:

a) Jeta Gardens Waterford Trust (JGWT): On September 23, 2010, KPJ completed the acquisition of a 51 per cent interest in Jeta Gardens Waterford Trust (JGWT). Through JGWT, KPJ owns and operate Jeta Gardens, Australia’s first retirement village and aged care resort based on Eastern values located on a 64-acre property in Brisbane, Queensland, Australia. KPJ provides the capital as well as operational and intellectual resources for Jeta Gardens. The results have been very positive as Jeta’s 2012 revenue was RM30.8 million, a 367 per cent increase compared to the revenue of RM6.6 million in 2011.

While current earnings from this venture are relatively small, KPJ has been able to gain valuable insight and experience from the undertaking, setting the foundation for a business model which KPJ can replicate locally – which was the main purpose of acquisition.

With this knowledge and experience, KPJ can innovatively introduce an organised aged care living service to the growing Malaysian market. Unlike the traditional old folks homes, KPJ’s future retirement homes will have various modern safety and living facilities, all meeting the needs of our niche market. Medical and health services complement the residents who can either live independently or those who need assisted living.

b) Sibu Geriatric Health & Nursing Center SdnBhd (SgHnC): On January 18, 2011, KPJ acquired Sibu Medical Centre Corporation SdnBhd (SMCC) and Sibu Geriatric Health & Nursing Centre SdnBhd (SgHnC)  – further extending our reach in both Sabah and Sarawak

c) Tawakal Health Center: This houses KPJ Group’s Senior Living Care and is scheduled to open in December 2013. The Senior Living initiative will offer professional  care and support for senior citizens in the capitol city.

d) Other developments : Ongoing discussions to collaborate with developers to take off Aged Care Services in Johor and Selangor.

Launch Book sign3. What is your understanding of ethics in the medical industry?

There are many definitions of medical ethics, but they fundamentally focus on the same thing – doing the right thing as allowed by medical regulations and by-laws in order to achieve the best possible outcome for every patient. Basically, good ethics are based on integrity, of “doing the right thing, even when no one is watching”, or as some say “doing the right thing, even if it hurts”. Having good ethics is not self-serving, instead it is undertaking something for the benefit of others, without compromise.

Ethics in the medical aspect of service falls under strict clinical governance guidelines, and needs to be harmoniously balanced with the business aspect, which is under the corporate governance framework. Both aspects need to be synchronised and work in tandem – so that providers can always ensure patient safety, internationally-accepted service standards and professionalism, at all times.

4. Since you did our first interview on ethics in business, the column has progressed quite considerably into various sectors. In your view, what are the key areas of ethics in business that leaders haven’t grasped yet but need to?

Congratulations to you on the success of the column. In response to the question, I would like to say leaders should embrace honesty and integrity as part of their own lives, walk the talk.

I think leaders should showcase that it is not only about the enriching of our personal selves, the society or our economy. It is really about doing the right things, and being transparent whilst doing it. Our words and actions must be in sync and reflect our sincerity in serving.

To me, personally, the pursuit of wealth is never wrong but it is HOW you pursue it that matters more. If I were to give you an example, I could cite you two extreme cases – one which is completely the opposite of the other. The good example would be leaders who encourage the creation of shared wealth, for the benefit of the community as a whole – and these are people like Tunku Abdul Rahman (the Founding Father) or Tun Ismail, the former Deputy Prime Minister. They created value for the people.

The opposites would be people like Robin Hood or Botak Chin who wanted to \\\\\\\"rob the rich and give to the poor\\\\\\\". Though their intentions were noble, their methods were not and caused great disruption and distress.

5. What is the role of education in delivering ethics in business and how can this be achieved in a country like Malaysia and also globally in the medical industry?

I would like to say that the government, its ministries and agencies have indeed been very clear about the need for adherence to ethical guidelines and frameworks. All this is complements the overall national transformation into a hub for excellence in commerce, education, healthcare as well as other sectors of the economy.

Education plays a crucial role in further extending this understanding about \\\\\\\"ethics\\\\\\\" both at the highest levels such at corporate leadership programmes, and in university and schools where we train our future leaders.

KPJ and KPJUC have always stressed on serving honestly, with dedicated focus on sincerely serving our patients and customers. We understand that healthcare is not just the hardware but also the software. In my biography, I talk about us serving with integrity – working hard and honestly, fulfilling your obligations.

Having said that, I must also say that that leaders and educators are only the second-line enforcers in our lives. The key lessons about integrity and honesty must be taught at home, where parents lead through example. I think that only by having a strong culture of integrity and good ethical behaviour right from the family builds our principles in our business life and in the medical school.

Launch Book speech 16. The medical industry straddles between pharmaceutical lobbies, conventional medicinal practices and alternative medicine. More and more “enlightened patients” are looking to alternative medicine. There are countries that are now speaking to alternative practitioners to imbue certain practices in conventional offering. Malaysia hasn’t this far. Why is that?

Malaysians are increasingly aware of alternative treatment methods. In KPJ, we offer evidence-based, scientifically-researched treatment approaches that center around proven clinical trials.

Nevertheless, we are open to exploring possible alternative medicine. These methods  – if offered – could perhaps be offered under a different set-up, separate from our hospital service.

7. We know too much antibiotic is bad for you. Enough studies have proven chemotherapy kills healthy cells. Yet these are being offered in conventional medicine. Conventional medicine seems to focus on curing the symptom not cause. Can this change and if so how?

I believe in achieving a balance in life between the conventional and the alternative medicine. In days gone by, communities depended heavily on traditional medicine, which was based primarily on natural or organic resources. We then moved on to embrace modern pharmaceuticals or chemical based Western medication, which was evidence-based.

However, continued usage of some chemical-based Western products did cause health defects and were highly toxic; for example in the plantation sector, continued exposure to weedkillers had hurt workers’ legs. Hence a better option would be to use organic fertilisers, e.g. those made from the palm tree husks.

This therefore means patients get the best of Western medicine as well as complementary organic/nature based treatment.

At KPJ, we also have a wellness programme and healthy lifestyle campaigns, which offer services to prevent diseases. Our hospitals also carry out awareness programmes for communities and KPJ’s medical consultants give health talks or write in newspapers and magazines on health issues, but cannot allow complementary practice as it is prohibited by the Private Hospital Act 2006. Hence, KPJ can do it outside the hospitals.

8. What role, in your view, ethics will play in local and global medical ethics?

As I highlighted before, ethics is serving with integrity. Ethics is giving patients what they really need, without making them pay for unneeded treatment. Having said that, however, I believe we must look at the patients’ bigger picture in ensuring that the patients’ welfare is protected – not only caring for one aspect of treatment but essentially giving holistic care.

Datin Paduka Siti Sa’diah Sheikh Bakir_KPJ HealthcareDatin Paduka Siti Sa’diah Sheikh Bakir is Corporate Advisor to the Managing Director of KPJ Healthcare Berhad after she served herself as Managing Director of KPJ Healthcare since March 1, 1993. She graduated with a Bachelor of Economics from University of Malaya and holds an MBA from Henley Management College, University Reading, London. Committed to promoting excellence in healthcare, Datin Paduka also is the President of the Malaysian Society for Quality in Health, elected since its inception in 1997 to date. She is a member of the Malaysia Productivity Council (MPC) Consultative Panel on Healthcare since 2001 and a member of the National Patient Safety Council, Ministry of Health since 2003. In 2009, she was appointed as a member of the Malaysian Healthcare Travel Council, Ministry of Health.

Datin Paduka was a Board member of MATRADE from 1999 to 2010 and was an Independent Non-Executive Director of Bursa Malaysia from 2004 to April 2012.

In 2010, Datin Paduka was named the ‘CEO of The Year 2009′ by The New Straits Times Press and American Express. In 2011, Datin Paduka achieved three more awards, namely the ‘Asia Leading Woman CEO of The Year’ at the Women in Leadership (WIL) Forum Asia, the ‘Masterclass Woman CEO of The Year’ by the Global Leadership Awards and the ‘BrandLaureate Transformational Corporate Leader Brand ICON Leadership Awards 2011′ from The Asia Pacific Brands Foundation.