The Singapore Medical Council's advisory prohibiting fee splitting is better late than never ("Doctors barred from paying agents percentage of fees"; Dec 14).
Fee splitting has been deemed unethical as early as 2000.
A report by the National Medical Ethics Committee in January that year noted that a doctor's first and primary duty is to the patient, and this should not be outweighed by the duty to his employer or whoever pays his patient's medical bills.
It was also observed that "the establishment of a financial arrangement that commits a doctor to give a profit guarantee of practice to a third party... puts the doctor at greater risk of unethical behaviour, as he will be working under financial imperatives imposed by such a financial arrangement".
The American Medical Association's guidelines also state that payment by or to a physician solely for the referral of a patient is fee splitting and is unethical.
Doctors owe their patients a fiduciary duty.
Entering into a fee splitting agreement without their patient's knowledge could potentially breach this fiduciary duty.
Hence, it is better to err on the side of caution and disallow the practice.
Heng Cho Choon