Wednesday, July 1, 2015

Ethical Concerns Related to Grateful Patient Philanthropy: The Physician’s Perspective

John Flynn, MD, MEd
Johns Hopkins University

Background: Philanthropic contributions to academic medical centers from grateful patients allow for progress and innovation. The goal of this study was to identify the ethical concerns associated with philanthropic gifts from grateful patients.

Methods: A qualitative study design was selected. Data collection took place between March 1 and May 31, 2009. Investigators conducted in-depth semi-structured interviews with 20 Department of Medicine physicians at Johns Hopkins who were identified by Development Office staff as experienced and successful in this realm; those having relationships with multiple patients who have made philanthropic contributions to the institution. Interview transcripts were independently coded by two investigators and compared for agreement. Content analysis identified several themes related to ethical concerns associated with physicians and patient donors.

Results: Eighteen informants (90%) were Associate Professors or Professors, 2 (10%) were females, and a wide range of internal medicine specialities were represented. The mean percent effort spent in clinical care by the physicians was 31%. Four thematic domains emerged related to ethical concerns associated with philanthropy from grateful patients: (i) impact of gift on the doctor-patient relationship, (ii) gift acquisition considered beyond the physician’s professional role, (iii) justice and fairness, and (iv) vulnerability of patients. Despite acknowledging at least one of the aforementioned concerns, eleven physician informants (55%) expressed the view that there were no ethical issues involved with grateful patient philanthropy.

Conclusions: Philanthropic contributions from grateful patients represent a valuable revenue source that allows for creativity and innovation at academic institutions. Recognition and thoughtful consideration of ethical concerns that may arise in the context of grateful patient philanthropy may assist faculty by better preparing them for the challenges that may accompany these gifts. Further, awareness and careful review of these issues might help faculty maintain expected professional and ethical standards when accepting grateful patient philanthropy.