Where Should Clinicians Draw the Line on ‘Grateful Patient’ Donations?
There are physicians who solicit “grateful patient” donations, but plenty of people disagree with common practices used at hospitals, according to the authors of a recent study.1
“Hospitals and health centers have long relied on donations from patients and families grateful for the care they have received,” says Reshma Jagsi, MD, DPhil, the study’s lead author and director of the University of Michigan Center for Bioethics and Social Sciences in Medicine.
Development professionals identify potential donors, solicit gifts, and acknowledge donations in various ways. “Ethical concerns have been raised,” Jagsi notes.
These include conflicts of interest, erosion of trust, problems with the physician-patient relationship, privacy, and confidentiality. There also are ethical concerns that providing certain gestures of thanks to donors, or incentives to potential donors, could lead to unfairness in the delivery of clinical care.
Researchers asked 513 people to share opinions about some of the practices used to raise funds from grateful patients. “The vast majority of the public found unacceptable certain approaches that are both legal and described as common in the literature of healthcare philanthropy,” Jagsi reports.
Wealth screening and spontaneous discussions of donations raised by physicians were two of these problematic practices. Forty-seven percent responded that doctors giving patient names to hospital fundraising staff, after asking patients’ permission to do so, was “definitely or probably” acceptable. In contrast, just 8.5% endorsed this practice if the doctor did not ask permission from the patient. Most (79.5%) agreed it was OK for physicians to talk about donating if the patient brought it up first. This percentage dropped to 14.2% if it was the physician who raised the topic.
Most participants (83.2%) agreed or strongly agreed that if doctors talk with patients about donating, it could interfere with the patient/physician relationship. Participants also listened to a hypothetical scenario in which a patient donates $1 million to a hospital. Half of respondents said it would be acceptable for the donor to be provided with nicer hospital rooms, 26% said that expedited appointments would be acceptable, and 19.8% thought giving the donor the doctors’ cellphone numbers would be acceptable.
The study’s findings supported the idea that giving is good for the mental and physical health of those who give. Most of the respondents (85.2%) agreed patients feel good when they donate to the hospital. “Patients should have opportunities to give if they desire. However, these opportunities should be offered in ways that are ethically acceptable to them,” says Sara Konrath, PhD, one of the study’s authors and associate professor of philanthropic studies at the Indiana University Lilly Family School of Philanthropy.
Healthcare philanthropy is an essential activity, but approaches to encourage donations must be mindful of ethical considerations and public attitudes, according to Jagsi.2 “Public trust is important for its own sake, and also essential if organizations are to succeed in delivering on their missions,” Jagsi adds.
- Jagsi R, Griffith KA, Carrese JA, et al. Public attitudes regarding hospitals and physicians encouraging donations from grateful patients. JAMA 2020;324:270-278.
- Collins ME, Rum S, Wheeler J, et al. Ethical issues and recommendations in grateful patient fundraising and philanthropy. Acad Med 2018;93:1631-1637.
Healthcare philanthropy is an essential activity, but approaches to encourage donations must be mindful of ethical considerations and public attitudes.
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