Lee Wei Ling: Righting a wrong comes from the heart

Lee Wei Ling: Righting a wrong comes from the heart

January 20, 2009

Since young, I have always been upset with myself if I knew something was wrong and I could put it right but didn’t.

Hence, I often find myself on ‘quests’ or ‘missions’, ‘jousting with windmills’. Sometimes, I criticise my friends, saying, perhaps impatiently, ‘you have lost the fire in your belly’.

If there is something wrong that we know of, I believe we should try to set it right whether or not it is our business to do so. Not to do so implies we condone the wrong and hence we would be guilty of committing the wrong too.

The concept of ‘guilty by omission’ is not one that is held commonly here. But it is enshrined in the legal systems of the United States and France.

You can be sued in the US if you do not clear the ice on the sidewalks around your home and as a result, someone slips and fractures a bone. You did not cause the fracture but you would be guilty by virtue of having omitted to clear the ice.

Let me give a concrete example closer to home of the consequences of such omission: A few months ago, a colleague’s mother suffered a heart attack and was rushed by ambulance to Tan Tock Seng Hospital at night.

Horror of horrors, there was no cardiologist there. My friend desperately called one of several private cardiologists she knew personally, being a doctor herself. But what could a layman have done in similar circumstances? Nothing.

Neither Alexandra Hospital nor Tan Tock Seng outside of office hours has the resources to handle acute myocardial infarctions (AMI) or heart attacks.

Thus, they are not in a position to give patients the best chance of surviving heart attacks. Of those who survive, the chance of impaired function of the heart would be higher than for patients treated in hospitals where cardiologists and facilities were available as in the National Heart Centre (NHC) or National University Hospital (NUH).

These problems are beyond my areas of responsibility. But I am a doctor; I know what is wrong; and I know what needs to be done. I would have been guilty by omission if I had not tried to solve this problem.

So I engaged the ambulances which come under the Singapore Civil Defence Force, NHC, NUH and got them all to agree that when their ambulances pick up patients with AMI, they would bypass Alexandra and Tan Tock Seng and go only to NUH or NHC.

I do not believe homo sapiens are necessarily at the top of the evolutionary pyramid. But it is indisputable that we are different from other species in several ways.

Scientists once assured us that we were the only species that possessed language. Then research with gorillas and chimpanzees showed that they too could master sign language. Another distinguishing trait of humans was thought to be our capacity to use tools. But then we learnt otters could smash molluscs with rocks and apes could strip the leaves from twigs to use them to fish for termites.

The one feature that definitely does separate us from other animals is our highly developed sense of morality. We seem to have a primal understanding of good and evil, right and wrong, of what it means to suffer not only our own pain but also the pain of others.

Morality may be a hard concept to grasp, but we acquire it fast. A preschooler, for instance, may learn that it is not all right to eat in class because a teacher says so. If the rule is lifted, the child will happily eat in class. But if the same teacher says it is okay to push another student off a chair, the child would hesitate. He will think: ‘No, the teacher should not say that.’

In both cases, somebody would have taught the child the rules, but the rule against pushing has a stickiness about it. It resists coming unstuck even if someone in authority countenances its breach. That is the difference between a moral imperative and mere social convention. Some psychologists like Michael Schulman believe children can innately intuit the difference.

Of course, the child might on occasion hit some other child and won’t feel particularly bad about it - unless, of course, he is caught. The same is true of people who steal or despots who slaughter their people.

Marc Hauser, professor of psychology at Harvard University, has written: ‘Moral judgment is pretty consistent from person to person - that is, we all know what is right and what is wrong. Moral behaviour, however, is scattered all over the chart.’

The rules we know, even the ones we intuit, are by no means the rules we follow. There are people who have no moral instinct - psychopaths and anti-social people who commit crimes and seem incapable of being reformed. They stand out precisely because their behaviour is so bizarre.

Of the rules that we do follow, it is easier for most people to follow rules that require passively not doing anything wrong. Actively doing something right, especially if that something does not fall within our area of responsibility, is uncommon.

It is good for any country to have an active citizenry. And that is precisely why the concept of ‘guilt by omission’ should be a part of our ethos.

As Singapore climbs the economic ladder, its need for people who would feel guilty if they omitted to do something right - not merely passively do no wrong - will increase.

A rich middle-class society encircled by the material pleasures of life, happily oblivious of social inequities and the suffering of the less fortunate among us, will never become a civil or gracious society.

On the other hand, a country with little financial reserves, a middle class that is not wealthy but is socially active, that tries to lift the lowest common denominator in that society, is one that would be heading in the right direction.

Some things cannot be legislated but must come spontaneously from the heart. The desires to right wrongs and help others are examples.

Singapore is a great place for social experiments to improve both the country and the individual.

Lee Wei Ling

# The writer is director of the National Neuroscience Institute.

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Lee Wei Ling: My house is shabby, but it is comfortable

Lee Wei Ling: My house is shabby, but it is comfortable

Written by Lee Wei Ling, for the Sunday Times, 04 Jan 2009

In 2007, in an end-of-year message to the staff of the National Neuroscience Institute, I wrote: ‘Whilst boom time in the public sector is never as booming as in the private sector, let us not forget that boom time is eventually followed by slump time. Slump time in the public sector is always less painful compared to the private sector.’

Slump time has arrived with a bang.

While I worry about the poorer Singaporeans who will be hit hard, perhaps this recession has come at an opportune time for many of us. It will give us an incentive to reconsider our priorities in life.

Decades of the good life have made us soft. The wealthy especially, but also the middle class in Singapore, have had it so good for so long, what they once considered luxuries, they now think of as necessities.

A mobile phone, for instance, is now a statement about who you are, not just a piece of equipment for communication. Hence many people buy the latest model though their existing mobile phones are still in perfect working order.

A Mercedes-Benz is no longer adequate as a status symbol. For millionaires who wish to show the world they have taste, a Ferrari or a Porsche is deemed more appropriate.

The same attitude influences the choice of attire and accessories. I still find it hard to believe that there are people carrying handbags that cost more than thrice the monthly income of a bus driver, and many more times that of the foreign worker labouring in the hot sun, risking his life to construct luxury condominiums he will never have a chance to live in.

The media encourages and amplifies this ostentatious consumption. Perhaps it is good to encourage people to spend more because this will prevent the recession from getting worse. I am not an economist, but wasn’t that the root cause of the current crisis - Americans spending more than they could afford to?

I am not a particularly spiritual person. I don’t believe in the supernatural and I don’t think I have a soul that will survive my death. But as I view the crass materialism around me, I am reminded of what my mother once told me: ‘Suffering and deprivation is good for the soul.’

My family is not poor, but we have been brought up to be frugal. My parents and I live in the same house that my paternal grandparents and their children moved into after World War II in 1945. It is a big house by today’s standards, but it is simple - in fact, almost to the point of being shabby.

Those who see it for the first time are astonished that Minister Mentor Lee Kuan Yew’s home is so humble. But it is a comfortable house, a home we have got used to. Though it does look shabby compared to the new mansions on our street, we are not bothered by the comparison.

Most of the world and much of Singapore will lament the economic downturn. We have been told to tighten our belts. There will undoubtedly be suffering, which we must try our best to ameliorate.

But I personally think the hard times will hold a timely lesson for many Singaporeans, especially those born after 1970 who have never lived through difficult times.

No matter how poor you are in Singapore, the authorities and social groups do try to ensure you have shelter and food. Nobody starves in Singapore.

Many of those who are currently living in mansions and enjoying a luxurious lifestyle will probably still be able to do so, even if they might have to downgrade from wines costing $20,000 a bottle to $10,000 a bottle. They would hardly notice the difference.

Being wealthy is not a sin. It cannot be in a capitalist market economy. Enjoying the fruits of one’s own labour is one’s prerogative and I have no right to chastise those who choose to live luxuriously.

But if one is blinded by materialism, there would be no end to wanting and hankering. After the Ferrari, what next? An Aston Martin? After the Hermes Birkin handbag, what can one upgrade to?

Neither an Aston Martin nor an Hermes Birkin can make us truly happy or contented. They are like dust, a fog obscuring the true meaning of life, and can be blown away in the twinkling of an eye.

When the end approaches and we look back on our lives, will we regret the latest mobile phone or luxury car that we did not acquire? Or would we prefer to die at peace with ourselves, knowing that we have lived lives filled with love, friendship and goodwill, that we have helped some of our fellow voyagers along the way and that we have tried our best to leave this world a slightly better place than how we found it?

We know which is the correct choice - and it is within our power to make that choice.

In this new year, burdened as it is with the problems of the year that has just ended, let us again try to choose wisely.

To a considerable degree, our happiness is within our own control, and we should not follow the herd blindly.

Lee Wei Ling

The writer is director of the National Neuroscience Institute.

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Lee Wei Ling: Medicine is not just a career, but a calling

Medicine is not just a career, but a calling

By Lee Wei Ling

I have always felt keenly the suffering of animals. Since I was a child, I had wanted to be a vet. My parents persuaded me to abandon that idea by using the example of a vet whose university education was funded by the Public Service Commission. When he returned to Singapore, he was posted to serve his bond at the abattoirs. That was enough to persuade me to select my second career choice - a doctor. I have never regretted that decision.

There are still many diseases for which medical science has no cure, and this is especially true of neurological diseases because nerve cells in the brain and spinal cord do not usually regenerate. Hence, a significant percentage of patients seeing neurologists, of which I am one, cannot be cured. But as in all areas of medicine, we still try our best for the patient, 'to cure, sometimes; to relieve, often; to comfort, always'.

An example is a 70-year-old woman who sees me for her epilepsy. Her husband has taken a China mistress whom he has brought back to his marital home. He wants my patient to sell her 50 per cent ownership of their HDB flat and move out. Her children side with the husband because he is the one with the money and assets to will to them.

When this patient comes, I always greet her with a big smile and compliment her on her cheongsam. She will tell me she sewed it herself, and I will praise her for her skill. Then I ask her whether she has had any seizures since the last time she saw me. She sees me at yearly intervals, and usually, she will have had none.

Next, I ask her how she is coping at home. She would say she just ignores her husband and his mistress. I would give her a thumbs-up in reply, then ask her whether she still goes to watch Chinese operas. She would say yes.

By then, I would have prepared her prescription. I hand it to her, pat her on her back and she would walk out with a smile on her face, back straight and a spring in her step.

It takes me only five minutes to do the above. I can control but not cure her epilepsy. But I have cheered her up for the day.

One very special patient, Jac, has idiopathic severe generalised torsion dystonia. By the age of 11, she was as twisted as a pretzel and barely able to speak intelligibly. She did well in the Primary School Leaving Examination, but was a few points short of the score needed for an external student to be accepted by Methodist Girls' School (MGS).

I had done fund-raising for MGS prior to this and knew the principal. I phoned her and explained Jac's disease as well as her determination and diligence.

I told the principal that the nurturing environment of MGS would be good for Jac, and that it would be a good lesson for the other students in MGS to learn to interact with a peer with disability.

At the end of Secondary 2, Jac mailed me a book and a typed letter. The book was a collection of Chinese essays by students in MGS.

There were two essays by Jac. In addition, she had topped the entire Secondary 1 and, subsequently, Secondary 2 in Chinese. She was second in the entire Secondary 2 for Chemistry. She was happy at MGS, and her peers accepted her and helped wheel her around in her wheelchair.

Medication merely gave Jac some degree of pain relief from her dystonia. Being admitted to MGS gave her the opportunity to enjoy school and thrive in it.

I was walking on clouds for the next few hours after I received the book and letter. Jac showed that an indomitable human spirit can triumph over a severe physical disability. As a doctor, I am not just handling a medical problem but the entire patient, including her education and social life.

I have been practising medicine for 30 years now. Over this period, medical science has advanced tremendously, but the values held by the medical community seem to have changed for the worse.

Yearning and working for money is more widely and openly practised; and sometimes this is perceived as acceptable behaviour, though our moral instinct tells us otherwise.

Most normal humans have a moral instinct that can clearly distinguish between right and wrong. But we are more likely to excuse our own wrongdoing if there are others who are doing the same and getting away with it.

These doctors who profit unfairly from their patients know they are doing wrong. But if A, B and C are doing wrong - and X, Y and Z too - then I need not be ashamed of doing the same. Medical students who see this behaviour being tacitly condoned will tend to lower their own moral standards. Instead of putting patients' welfare first, they will enrich themselves first.

The most important trait a doctor needs is empathy. If we can feel our patient's pain and suffering, we would certainly do our best by our patients and their welfare would override everything else.

Medicine is not just a prestigious, profitable career - it is a calling. Being a doctor will guarantee almost anyone a decent standard of living. How much money we need for a decent standard of living varies from individual to individual.

My needs are simple and I live a spartan life. I choose to practise in the public sector because I want to serve all patients without needing to consider whether they can pay my fees.

I try not to judge others who demand an expensive lifestyle and treat patients mainly as a source of income. But when the greed is too overwhelming, I cannot help but point out that such behaviour is unethical.

The biggest challenge facing medicine in Singapore today is the struggle between two incentives that drive doctors in opposite directions: the humanitarian, ethical, compassionate drive to do the best by all patients versus the cold, calculating attitude that seeks to profit from as many patients as possible. Hopefully, the first will triumph.

Doctors do have families to support. Needing and wanting money is not wrong. But doctors must never allow greed to determine their actions.

I think if a fair system of pricing medical fees - such that doctors can earn what they deserve but not profit too much from patients - can be implemented, this problem will be much reduced. The Guideline of Fees, which previously was in effect, was dropped last year. I am trying to revive it as soon as possible.

The writer is director of the National Neuroscience Institute.

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Lee Wei Ling: Doing what's right without fear or favour

Doing what's right without fear or favour
Lee Wei Ling
30 July 2008,Straits Times

I WAS born and bred in Singapore. This is my home, to which I am tied by family and friends. Yet many Singaporeans find me eccentric, though most are too polite to verbalise it. I only realised how eccentric I am when one friend pointed out to me why I could not use my own yardstick to judge others.

I dislike intensely the elitist attitude of some in our upper socio-economic class. I have been accused of reverse snobbery because I tend to avoid the wealthy who flaunt their wealth ostentatiously or do not help the less fortunate members of our society.

I treat all people I meet as equals, be it a truck driver friend or a patient and friend who belongs to the richest family in Singapore.

I appraise people not by their usefulness to me but by their character. I favour those with integrity, compassion and courage. I feel too many among us place inordinate emphasis on academic performance, job status, appearance and presentation.

I am a doctor and director of the smallest public sector hospital in Singapore, the National Neuroscience Institute (NNI). I have 300 staff, of whom 100 are doctors. I emphasise to my doctors that they must do their best for every patient regardless of paying status. I also appraise my doctors on how well they care for our patients, not by how much money they bring in for NNI.

My doctors know I have friends who are likely to come in as subsidised patients. I warn them that if I find them not treating any subsidised patient well, their appraisal - and hence bonus and annual salary increments - would be negatively affected. My doctors know I will do as I say.

I remind them that the purpose of our existence and the measure of our success is how well we care for all our patients - and that this is the morally correct way to behave and should be the reason why we are doctors. In NNI, almost all patients are given the best possible treatment regardless of their paying status.

My preference for egalitarianism extends to how I interact with my staff. I am director because the organisation needs a reporting structure. But my staff are encouraged to speak out when they disagree with me. This tends to be a rarity in several institutions in Singapore. The fear that one's career path may be negatively affected is what prevents many people from speaking out.

This reflects poorly on leadership. In many organisations, superiors do not like to be contradicted by those who work under them. Intellectual arrogance is a deplorable attitude.

'Listen to others, even the dull and ignorant; they too have their story,' the Desiderata tells us. It is advice we should all heed - especially leaders, especially doctors.

I speak out when I see something wrong that no one appears to be trying to correct. Not infrequently, I try to right the wrong. In doing so, I have stepped on the sensitive toes of quite a few members of the establishment. As a result, I have been labelled 'anti-establishment'. Less kind comments include: 'She dares to do so because she has a godfather'.

I am indifferent to these untrue criticisms; I report to my conscience; and I would not be able to face myself if I knew that there was a wrong that I could have righted but failed to do so.

I have no protective godfather. My father, Minister Mentor Lee Kuan Yew, would not interfere with any disciplinary measures that might be meted out to me.

And I am not anti-establishment. I am proud of what Singapore has achieved. But I am not a mouthpiece of the government. I am capable of independent thought and I can view problems or issues from a perspective that others may have overlooked.

A few months ago, I gave a talk on medical ethics to students of our Graduate Medical School. They sent me a thank-you card with a message written by each student. One wrote: 'You are a maverick, yet you are certainly not anti-establishment. You obey the moral law.' Another wrote: 'Thank you for sharing your perspective with us and being the voice that not many dare to take.'

It would be better for Singapore's medical fraternity if the young can feel this way about all of us in positions of authority.

After the Sars epidemic in 2003, the Government began to transform Singapore into a vibrant city with arts and cultural festivals, and soon, integrated resorts and night F1. But can we claim to be a civilised first world country if we do not treat all members of our society with equal care and dignity?

There are other first world countries where the disparity between the different socio- economic classes is much more extreme and social snobbery is even worse than in Singapore. But that is no excuse for Singaporeans not to try harder to treat each other with dignity and care.

After all, both the Bible and Confucius tell us not to treat others in a way that we ourselves would not want to be treated. That is a moral precept that many societies accept in theory, but do not carry out in practice.

I wish Singapore could be an exception in this as it has been in many other areas where we have surprised others with our success.

The writer is director of the National Neuroscience Institute.

Think-Tank is a weekly column rotated among eight heads of research and tertiary institutions.

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