About one-third of oncologists (32%) had been asked to directly solicit a donation from their patients for their institutions, according to a recent study.1 Half declined to do so.

Researchers surveyed 405 medical oncologists affiliated with the 40 National Cancer Institute-designated comprehensive cancer centers about participation in philanthropy at their institutions. Other key findings include the following:

  • The majority of oncologists (71%) reported that they had been exposed to their institution’s fundraising/development staff. Of those, 48% reported being taught how to identify patients who might be good donors, but only 26% received information about ethical guidelines for soliciting donations from their patients.
  • About half (52%) of oncologists believed that soliciting donations could interfere with the physician-patient relationship.

“Our hope in doing this study was to stimulate a broad discussion about how to encourage the vital activity of philanthropy while also respecting important ethical principles,” says lead author Reshma Jagsi, MD, DPhil. Jagsi is deputy chair of the Department of Radiation Oncology and a research investigator at the Center for Bioethics and Social Sciences in Medicine at University of Michigan Health System in Ann Arbor.

Jagsi acknowledges the “tremendous potential” for philanthropy to help cancer centers pursue clinical, educational, and research missions, and the benefits such philanthropy can have for individual patients. “We often hear how empowering it can be to have the chance to become partners in the fight against a disease that has afflicted them or their loved ones,” she says.

Conflicts of interest are a central ethical concern if physicians solicit donations from their own patients, however. “Little research has evaluated the ways physicians are being asked to participate in development activities or how they feel about it,” says Jagsi. “That motivated us to conduct our survey.”

Many respondents expressed concerns about conflicts of interest and how this could interfere with patient relationships. Jagsi says the study’s findings signal a need to address existing guidelines on this practice.

Ira Byock, MD, executive director/chief medical officer at the Torrance, CA-based Institute for Human Caring, Providence Health and Services, is concerned about academic health systems asking practicing physicians to not merely be on the lookout for grateful patients, but also to approach them for philanthropic contributions. “While it may seem like an attractive approach, this increasingly common practice clearly violates some ethical boundaries,” he says.

Underpinning this is the unequal power relationship between physicians and patients. “There’s really no way for a physician to request financial support from a patient while avoiding the potential for that patient to feel somehow manipulated or beholden to the physician,” says Byock.

The American Medical Association’s Council on Ethical and Judicial Affairs recommends that “physicians should avoid directly soliciting their own patients, especially at the time of a clinical encounter.”2

Clearly, institutions welcome financial support from individuals who are grateful for the care they or a loved one has received. “However, the practice of providing care and solicitation of philanthropic donations need to be separated,” says Byock. “In fact, that’s one of the reasons institutions created development departments.” Hospital fundraising staff can act as “buffers,” he explains, allowing patients to express their gratitude without compromising the physician/patient relationship.

Byock urges bioethicists to “step up” to protect patients from inappropriate philanthropic practices at their institutions. “Philanthropy belongs in the realm of the development offices and their staff, not in the clinical realm,” he says. “We are here to serve patients and their families. They are not here to serve us.”

REFERENCES

  1. Walter JK, Griffith KA, Jagsi R. Oncologists’ experiences and attitudes about their role in philanthropy and soliciting donations from grateful patients. J Clin Oncol 2015; 33(32):3796-3801.
  2. American Medical Association. CEJA Report 7-A-04. Physician participation in soliciting contributions from patients. 2004.

SOURCES

  • Ira Byock, MD, Executive Director/Chief Medical Officer, Institute for Human Caring, Providence Health and Services, Torrance, CA. Phone: (310) 543-3424. Email: ira.byock@providence.org. Web: www.irabyock.org.
  • Reshma Jagsi, Deputy Chair/Department of Radiation Oncology, University of Michigan, Ann Arbor, MI. Phone: (734) 936-7810. Fax: (734) 763-7370. Email: rjagsi@med.umich.edu.