Offering and acceptance of illegal advantages
A doctor owes an obligation of fidelity to his patients and, at the same time, should demonstrate loyalty to the organisation he is working for. The offering and acceptance of illegal advantages in the course of clinical practice can compromise the doctor's professional judgement, erode patients' trust and impair the interest of his employer. It is thus of great importance that doctors should comply with the legal and the conduct requirements governing corruption.
Scenario 1 | Enlistment of medicine in drug formulary
Dr A is a consultant of a public hospital. His assessment of the effectiveness of medicine will have a strong bearing on the final selection of the drug for enlistment in the hospital and Hospital Authority (HA) drug formulary which would also mean major business for the supplier. On one occasion, Dr A attended an annual ball hosted by a pharmaceutical company on behalf of the hospital and came to know its CEO, Andy. They then maintained close ties and Andy always treated Dr A by way of lunches and dinners to share the latest information and development of new drugs. Lately, Andy called Dr A for dinner in a private club where he disclosed that his company had successfully developed a new antibiotic and requested for Dr A's assistance in recommending the drug for enlistment in his hospital and HA. Andy even suggested to offer shares of his company to Dr A if he agreed to help. Should Dr A accept Andy's offer?
In this case, Dr A is a public servant. He would not be granted permission by the Hospital Authority to accept Andy's offer. He and Andy would thus violate Section 4 of the Prevention of Bribery Ordinance (POBO) if Dr A accepts an advantage from Andy (in the form of company shares) for recommending the new drug to his hospital or HA.
Doctors are expected to choose the drug that best serves the medical interests of their patients. Dr A is subject to disciplinary action of the Medical Council of Hong Kong (MCHK) for breaching the Code of Professional Conduct of MCHK (Oct 2022), which prohibits doctors from accepting any inducement from commercial firms within the pharmaceutical and allied industries as such acceptance may compromise, or may be regarded by others as likely to compromise the independent exercise of their professional judgement in matters pertaining to patients' well-being.
Generally speaking, entertainment, which refers to the provision of food or drink for consumption on the occasion when it is provided, and of any other entertainment connected with such provisions, is a form of social behaviour and does not constitute an advantage under the POBO. However, Dr A should not accept frequent or lavish entertainment from Andy as such acceptance of entertainment would impose an obligation on himself to do Andy a favour, bring himself or the hospital into disrepute or lead to conflict of interest.
Dr A should not accept Andy's offer and should report to appropriate authority if corruption is suspected.
Scenario 2 | Gratitude from patient
Dr B was the attending doctor of Barry who was hospitalised in a public hospital after an accidental fall and later diagnosed with osteoarthritis. Upon the advice of Dr B, Barry underwent a joint replacement surgery to fix the problem in the long run. Before Barry was discharged from the hospital, he offered Dr B two complimentary coupons for dinner buffet at a luxurious hotel as a token of thanks for taking care of him during his hospitalisation. Barry said it was just a small gift to show his gratitude to Dr B and insisted that he would not take it back despite Dr B's refusal to accept it. What should Dr B do?
Dr B should refuse the complimentary coupons as far as possible.
The complimentary buffet coupons are considered a kind of advantage regardless of its value. Dr B and Barry might breach Section 4 of the Prevention of Bribery Ordinance (POBO) if Dr B accepts the complimentary buffet coupons from Barry as the coupons are offered to him on account of his official capacity as a public doctor.
Dr B might also violate the Hospital Authority's guidelines on acceptance of advantage for accepting the complimentary buffet coupons from Barry.
Where the complimentary coupons are offered out of a genuine courtesy motive and cannot be declined owing to protocol reasons or the need to avoid causing offence or embarrassment, Dr B should report the receipt of the coupons and seek direction on its disposal in accordance with the relevant circulars / guidelines set out by his employer.
Understand the law and the professional code of conduct
The best solution is to have full understanding of the Prevention of Bribery Ordinance and the conduct requirements on integrity stipulated in the Code of Professional Conduct of the Medical Council of Hong Kong (Oct 2022) to avoid accepting advantages that will lead to loss of objectivity and honesty in the course of clinical practice.
Follow the organisation policy
Whether doctors are employed by the government, the Hospital Authority (HA) or private medical institutions, they should always seek guidance from the organisations concerned in the matter of acceptance of advantages. Public servants should not accept advantages offered to them by virtue of their official position. Gifts offered/presented to public doctors in their official capacity should be dealt with in accordance with respective rules and regulations of the government and the HA. HA employees should not solicit or accept, directly or indirectly, any advantage or gift which would, or might reasonably be seen to, compromise their integrity or judgment or influence the discharge or non-discharge of their duties and responsibilities. As in the private sector, the recipients should clarify with their respective employers whether they can accept advantages from patients or business associates in the discharge of their official duties.
Avoid the "sweetener"
Many ICAC cases reflect that corruption always begins with a "sweetening up" process instead of a direct bribe at the outset. It usually starts with the offering of entertainment which appear not to be related to the recipient's official duties at the time of offer. Hence, the recipient would easily be trapped in an embarrassing or compromising situation when being asked to return a favour later on. Therefore, doctors should not accept entertainment from persons with whom they have official dealings if it is:
Corruption should be reported to the management of the organisations concerned and the ICAC as soon as possible. One may risk being suspected of conspiring to commit corruption if he, even without being involved in the scam, delays blowing the whistle or turns a blind eye to the crime.
Any party may lodge a complaint or make an enquiry with the ICAC through the various channels.