Upholding Catholic Moral Principles

1. Upholding Catholic Moral Principles Managing a Private Hospital D Fang

2. Jesus’ Healing Mission • Beyond caring for and curing physical and mental affliction • Touched the people at deepest level of their existence • Provided for their physical, mental, and spiritual healing • “He came so that they may have life and have it more abundantly.” John 10:10

3. Mission Statement of SPH • To provide loving care to the sick and needy • Depends on not only the dedication of the clinical team and advanced technology, but personal loving care “I made myself all things to all men” (1 Cor. 9:22)

4. Apply the Paulinian spirit of caring to all people, regardless of age, colour, race or creed and social status in the provision of our healthcare service. Provide a peaceful and comfortable healing environment as promulgated by the Sisters of St. Paul de Chartres for our clients. Maintain a high standard of service in the promotion and restoration of health for all people. Mission Statement of SPH

5. WHO Definition of Health State of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity

6. Healthcare Professionals • Moral duty to save life, heal the sick, promote Health • Traditional code of ethics puts moral duty above self interest • Duty invokes charity, humanity, compassion, sacrifice, professional integrity • Duty to update knowledge, and skills, necessitates lifelong learning

7. St. Paul’s Hospital The Future The present

8. Clinical Governance • Systematic approach to maintaining & improving quality of care within the Hospital • Framework thru which an organization is accountable for continuously safeguarding and improving high standards of clinical care • Patient safety is first & foremost

9. SPH organizational structure (organizational chart as attached)

10. Management framework of SPH • Hospital Governing Committee • Oversees management and set directions for the Hospital • Hospital Management Committee • Develop, monitor and implement operational policies • Clinical and Advisory Committees • Advise on clinical and other practice in the Hospital • Approve and advise new procedures and audits • Visiting experts/ consultants as members

11. Clinical Governance Independent non-interested members of HGC Specialist & academic advisors on medical and professional committees Clinical audit Education & training Research & development (good clinical practice) Risk management External accreditation

12. Transparency and Accountability • Clinical governance • Financial : accounts, fees & charges • Tender procedure • HR management

13. Is Conservatism within the Church hindering Clinical Governance? Openness Collective decision Tendering Recruitment Staff appraisal Project management Avoidance of scandal

14. Fee for Service vs Charity Catholic healthcare should not only provide charity care for the poor; it should also work for universal coverage, care based on need rather than on ability to pay for it. Jennings, Bradford H. Gray, Virginia A. Sharpe, Linda Weiss, Alan R. Fleischman; The Hastings Center Report, Vol. 32, 2002

15. Fee for Service and Charity Fees waiver system Outreach projects Voluntary service Control of professional fees Reinvesting any profit in hospital development

16. Pastoral Care Provision for the sacraments Appointed priests approved by Cardinal Sisters of St Paul de Chartre Lay Catholic staff Very frequent visits

17. Ethics Committee Membership Terms of reference: all ethical issues relating to patient & health service, audits, clinical research, new technology, information, resuscitation, consent, etc. Guidelines: Religious Directives for Catholic Healthcare Services. Conduct of meetings Case consultation

18. Ethics Committee Terms of Reference • Consider and advise hospital on ethical issues of healthcare policy, provision, and outcomes. • Consider, approve, and monitor new technology and clinical research. • Provide urgent individual case consultation.

19. What Doctors May Not Do • Contraceptive devices & interventions other than medically necessary • Scientifically assisted reproduction (IVF) • Abortion • Certain research e.g. Embryonic stem cells • Euthanasia (illegal) • Unethical organ transplant (illegal)

20. On Abortion Thou shalt not kill. 5th Commandment Abortion is murder in the womb. A child is a gift of God. If you do not want him, give him to me. Mother Teresa

21. Medically Necessary Abortion Intervention or medication for the direct treatment of a proportionately serious pathological condition of a pregnant woman when such cannot be safely postponed, even if such results in the death of the unborn foetus.

22. On Contraception • No contraceptive interventions that either in anticipation of the marital act, or in its accomplishment, or in the development of its natural consequences, have the purpose, whether as an end or a means, to render procreation impossible • Such violate the inseparable connection between the unitive and procreative purposes of the conjugal act

23. Medically indicated contraception or sterilization Interventions that result in contraception or sterilization with the specific purpose of cure or alleviation of a present and serious pathologies where simpler options are not available. e.g. Hysterectomy to remove a malignant tumour

24. On Assisted Reproduction • Reproductive technologies that substitute for the marriage act are not consistent with human dignity. E.g. extracorporeal fertilization, heterologous fertilization, conception • Assistance which does not separate the unitive and procreative ends of the act allowed to help married couples conceive

25. Doctor Patient Relationship • Trust essential to the healing process • Respect for human dignity and rights, privacy and confidentiality • Respect for advance directives • Doctor and patient making decisions together

26. Surgical Consent • Who should sign • Interpreter • General and specific risks • Treatment options • Separate anaethetic considerations • Under no stress, premedication or misrepresentation • Properly witnessed

27. Care for the Dying • Death is a beginning for the Catholic health ministry • Relief of pain & suffering • Care for human dignity, support for family • Avoidance of meaningless insistence on life sustaining technology • Avoidance of withdrawal of life support with intention of causing death

28. Problems Peculiar to HK Private Hospitals • Great majority are visiting doctors • Organization differs vastly from HA • Adequacy of medical documentation • Absence of credentialing process • Maternity services for Mainland patients • Emergency specialist backup lacking

29. Ability to deal with emergencies Complex surgical interventions Obstetric services, neonatology Intensive care 24-hr OPD

30. Renewal of Admission Privileges • 3-yearly exercise • CME requirement • Credentialing for invasive new technology • Mandatory clinical audit • Full professional indemnity • Medical Council disciplinary orders

31. Professional Indemnity • Exponential rise in MPS fees • Dislocation of certain specialist services • Each specialty different risk premium • No cap on damages • 30% legal fees for civil litigation • 100% legal fees for alleged professional misconduct

32. Prevention the Best Cure • Improved communication with patients • Audits, alerts, and accreditation • Continuous professional development • Certification of skills • Clinical protocols and guidelines • Professional integrity and courtesy • Do not test the Medical Council

33. Avoidance of Scandal • Increasing complaint culture • Compensation common objective • Threat to invoke media • Proper handling by designated staff essential • To what extent must hospitals give in?

34. Compensation Act 2006, U.K. An apology, an offer of treatment or other redress, shall not of itself amount to an admission of negligence or breach of statutory duty.

35. Apology Act, B.C., Canada • An apology made by or on behalf of a person in connection with any matter • does not constitute an express or implied admission of fault or liability by the person in connection with that matter.

36. Mediation - as the way forward

37. Mediation • Non-adversarial process in which a neutral 3rd party assists in resolving a conflict between two or more other parties. Mediator facilitates communication between the parties, helps them focus on the real issues, and develops options that meet their common interests and needs.

38. Mediating Medical Disputes • On 15 January 2006, the first medical negligence dispute case was successfully co-mediated by Mr. Roy CHENG, a professional mediator from the HKIAC and Dr James Chiu. • Case resolved in 4 hours with monetary settlement.

39. Mediation in Singapore • A dispute resolution protocol for doctors and patients, introduced by the Singapore Subordinate Courts, became effective on 2 January 2007.

40. Chief Justice’s Working Party on Civil Justice Reform March 2004 To promote court-related mediation. Legal Aid Department to limit its initial funding of persons who qualify for legal aid to the funding of mediation Court should have power, after taking into account all relevant circumstances, to make adverse costs orders in cases where mediation has been unreasonably refused

41. Chief Justice on Mediation 2007 • suggested 4 ways to help in the development in mediation: • the different mediation bodies should consider ways of co-operation and collaboration, and indeed even merge together. • the accreditation process should have the benefit of external assessment and advice to maintain international standards. • public awareness of the benefits of mediation must be generally raised. • there should be broad access to mediation, with the help of Legal Aid and pro bono work.

42. Altruistic Healthcare Workers and Providers Not necessarily religious, but respect those with faith. Do not have Christian vision or motive. Achieve humane goals without expecting afterlife. May hold beliefs contrary to Catholic Moral Principles.

43. Partnerships & other institutions • Morally licit • Avoidance of scandal • Religious organizations

44. Catholic Healthcare service • Response to the challenge of Jesus to do as he did • Not only to restore and maintain health • Spiritual service testifying to final healing transcending life on earth

45. Thank you