Eighteen-year-old Khairul Anuar Salim, who was attacked by hoodlums, succumbed to his wounds because, according to his uncle, a private hospital in Cheras insisted on "Money first then treatment".

That is because the bottom line of private hospitals is profit. They have no intention to treat those who cannot afford to pay. They feel that the government should bear the responsibility for health care of ordinary folks who cannot afford or are unwilling to pay.

That is also why they do not release the deceased's body until they secure payment from the next of kin never mind that the latter are under stress and grieving. In this, they are acting like the banks except that instead of using properties or shares as collateral for payment, they use the dead person's body.

Doctors have taken their Hippocratic oath to uphold the special value of human life above personal profit, to use their medical knowledge to ameliorate suffering and pain and in emergencies, do the best for anyone in medical need regardless of their financial means.

It is sad that more often than not the Hippocratic oath has become the hypocritical oath in the case of doctors in the private hospitals. Many join the private hospitals to make money. By itself, there is nothing wrong in making money except that it is difficult to balance the irreconcilable conflict, which must invariably exist, between the imperatives of profit and those of compassion and care of the Hippocratic Oath.

Administrative staff merely carry out the private hospitals' policies on charges and billings including "No money no treatment" or "No money no body" laid down from above by their directors who may not all be physicians and, if public-listed, have to further account to faceless shareholders to whom profits and share prices should go up for every successive financial year.

Hence patients may be required to pay RM10 for toilet rolls, not to mention thousands of ringgit for surgery or stay in a deluxe room for convalescence. Fast registration, four-star private rooms for recuperation, televisions and toilet rolls are fine but they must be recognised for essentially what they are - mere frills. The main substance of medical attention is proper medical evaluation, correct diagnosis of the problem, advice and treatment including surgery if necessary. This is the raison d'etre of seeking admission in a hospital in the first instance.

What is being asked here is whether this raison d'etre may be subverted by the bottom line monetary policies of private hospitals. I think it may be.

For examples, how could one diagnose an ailment that requires sophisticated medical equipment for detection when the private hospitals' first consideration is how much such equipment would cost how that would increase their operational expenses by leasing payments? And even if such costly equipment may be acquired, could the patient afford to pay for its use (necessary to amortise its costs), and if he cannot, should such equipment be availed to his benefit just because, from the strictly medical point of view, it helps in more accurate and speedy diagnosis?

Doctors in private hospitals may have to pay high rentals for their clinics and they may even be required to meet some kind of budget in terms of billings and collections to contribute to the common weal of sharing expenses (as they do equally for profits) for their practice in such hospitals. Will such doctors purport to do a cursory scan (for purposes of increasing their charges) when neither doctor nor hospital have the proper equipment nor the expertise to do such a scan?

Where for the sake of maximisation of profits a doctor mans several clinics in different locations to which he has to make his rounds, wouldn't he spread himself too thin in terms of attention to any individual patient? Will a general surgeon treat a severed finger by routine suture that ultimately deforms it for the sake of earning the surgery fee when the situation requires a specialist in microsurgery of which he is not?

What happens in the midst of an open abdominal surgery by a surgeon specialising in gastroenterology when the patient develops heart complications will the heart specialist or surgeon (in the context of a private hospital) be ready on standby to assist; or if such a specialist is not around, does that mean the "stomach surgeon" will try to make the best of the situation by trying his hands on the heart as well; and even if the heart specialist is available to be called upon for assistance, will he negotiate and requests for a commitment on payment of his fees first?

I can go on and on with litanies of situations fraught with conflicts of interest between bottom- line profit concerns and the ethical values of the Hippocratic oath. The question for physicians and the medical profession to answer is. 'How do you balance and reconcile these conflicting imperatives?'

And the question for the government to answer is, 'What are you doing in terms of public health care to provide cheaper and more alternatives for those of us who are plain disillusioned with private hospitals and their sickening maximisation of profits?'

At this moment, we have to wait (say) five hours in a government hospital for a blood test to determine if our condition is serious enough to be warded, then join a queue of 400 persons waiting in line for dispensation of medicine and wait up to four months for the earliest available date for surgery.