“Can I Accept This?” Ethical Dilemmas in Medical Development
In the field of medicine, adherence to ethical principles is critically important. Patients must be able to trust that physicians have their best interests in mind in order to feel ensured that they are receiving the best care possible.
So what happens when a care experience inspires a patient’s desire to express gratitude and give back?
Frequently, physicians fear that accepting patients’ gifts will be a breach of ethics—for any number of reasons. Some fear that it takes advantage of patients in a time of vulnerability. Others fear that it obliges them to provide preferential treatment. Yet others fear that it will change the physician-patient relationship in a way that makes it hard for them to be objective in discussing health matters. And some simply perceive the act of accepting gifts as uncomfortable.
However, patients who make philanthropic contributions tell us that giving can be part of their healing process, and physician involvement in that experience provides an added level of meaning.
The American Medical Association, in its Code of Medical Ethics updated in June of 2016, addresses this topic with the following statement:
Gifts from Patients
Patients offer gifts to a physician for many reasons. Some gifts are offered as an expression of gratitude or a reflection of the patient’s cultural tradition. Accepting gifts offered for these reasons can enhance the patient-physician relationship.
Other gifts may signal psychological needs that require the physician’s attention. Some patients may offer gifts or cash to secure or influence care or to secure preferential treatment. Such gifts can undermine physicians’ obligation to provide services fairly to all patients; accepting them is likely to damage the patient-physician relationship.
The interaction of these factors is complex and physicians should consider them sensitively before accepting or declining a gift.
Physicians to whom a patient offers a gift should:
- Be sensitive to the gift’s value relative to the patient’s or physician’s means. Physicians should decline gifts that are disproportionately or inappropriately large, or when the physician would be uncomfortable to have colleagues know the gift had been accepted.
- Not allow the gift or offer of a gift to influence the patient’s medical care.
- Decline a bequest from a patient if the physician has reason to believe accepting the gift would present an emotional or financial hardship to the patient’s family.
- Physicians may wish to suggest that the patient or family make a charitable contribution in lieu of the bequest, in keeping with ethics guidance.
AMA Principles of Medical Ethics: 1.2.8
Advancement Resources supports and reaffirms this position on the ethics of accepting gifts.
While the size of gifts offered may vary (e.g. a plate of cookies, a trip on a private jet, etc.), these offers are evidence of a desire to give—and perhaps a lack of knowledge about how to do so in a way that makes the greatest impact.
In these sensitive ethical situations, we further recommend that physicians recognize the desire to give a gift as a sign that may indicate the individual wants to engage meaningfully. To ensure that ethical guidelines are followed, physicians who are offered gifts should respond by offering to make a referral to a development professional. This provides the patient or family member with the opportunity to explore what may be possible and identify the way to give that is most impactful and gratifying.
Development’s Important Response
As a final point of equal importance, development professionals should recognize that a philanthropic referral is also a gift. A referral demonstrates the physician’s trust in the development team to care for the patient with the same ethical standards and sensitivity that the physician utilizes. Just as patients who make donations expect a return on that investment, so also do physicians expect—and deserve—a return on their referrals.
If a referral has resulted in a gift, share that information as soon as it is available so that the physician can celebrate the contribution.
Physicians expect certain behaviors as part of “referral etiquette”—learn what these are and adhere to them.
The sacrifices and challenges physicians experience should be acknowledged with professionalism and respect for their time and efforts.
Ultimately, grateful patient and family philanthropy is a reason for everyone to celebrate—and it is incumbent upon development professionals to help their physician colleagues overcome roadblocks and enjoy their important roles in medical development. Development professionals who work with physicians should prove that they understand the ethical dilemma that patient contributions may raise in the physicians’ eyes. Acting as a trusted partner, they can become a valuable resource to their physician colleagues as they confront these complex ethical situations.
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