Patient philanthropy may result in ethical dilemmas for physicians

Physicians associated with "patient philanthropy" - financial donations from grateful patients to a medical institution - are concerned with how these contributions might affect their own behavior and attitudes, and how they might impact the doctor-patient relationship. A new study by Scott Wright, MD and Joseph A. Carrese, MD, MPH of Johns Hopkins University, and colleagues, explores this topic. The paper considers the perspectives of internal medicine physicians working in an academic medical center who have had experiences with these situations. Their findings appear in the Journal of General Internal Medicine, published by Springer.

The researchers conducted in-depth interviews with 20 physicians in the Department of Medicine at Johns Hopkins University. All of those interviewed had relationships with several patients who had made philanthropic contributions. They asked the doctors to describe their thoughts about ethical considerations that could be associated with grateful patient philanthropy. The analysis of the physicians' responses identified several ethical issues.

The number one ethical consideration was that many physicians felt as if their relationship with the patient had been transformed as a result of the philanthropic gift. Physicians were concerned that the purity of the physician-patient bond might be tainted or that patient expectations could change. The second most frequently-cited concern was the notion that physicians often feel unprepared, and even uncomfortable, in discussing financial support, even when the subject is broached by the patient.

Physicians also said that they may feel pressure to treat philanthropic patients differently than other patients as a way of demonstrating appreciation for the grateful patient's generosity. This was a noted source of discomfort for doctors. Several doctors also expressed concern about accepting gifts from sick patients, because although patients sincerely want to give, by virtue of their illness they may be in a vulnerable state.

Interestingly, despite the fact that these ethical concerns were raised, a majority of the physicians interviewed said that ultimately there were no ethical issues involved with the facilitation of grateful patient philanthropy since, at the end of the day, the decision to give lies with the patient.

The authors note that despite the ethical concerns reported in the paper, academic medical centers and their faculty are likely to increasingly pursue patient philanthropy. Accordingly, the authors conclude, "Institutions may wish to consider the issues described by our doctors to ensure that front line physicians are supported in these efforts, in ways that allow them to maintain their commitments to high ethical and professional standards."