The American College of Physicians recently published a paper: “Ethical Guidance for Physicians and Health Care Institutions on Grateful Patient Fundraising: A Position Paper From the American College of Physicians.”

The paper outlines three positions:

1) Physicians should prioritize patients’ best interests and not solicit donations, redirecting any charitable discussions to institution administrators.

2) Physicians must uphold patient privacy and not use their information for fundraising, and consent is required for any referrals to development.

3) Physicians shouldn’t be compelled or incentivized to solicit donations from patients.

Advancement Resources agrees with these three positions as they are fully in alignment with practicing medical philanthropy in the ethical and patient-centric way we have been advocating for twenty years.

Unfortunately, not all medical philanthropy is conducted in this way. We have long been uncomfortable with “grateful patient fundraising” for that reason. Instead, we advocate using referral-based medical philanthropy. This approach trains clinicians to accept gratitude from patients in a way that brings both parties joy and limits the clinicians’ role to referring patients who express interest in philanthropy to the appropriate development partners.

How to Respond if Clinicians/Faculty Have Questions

If physicians/faculty/administration have any questions about this paper, respond positively—not defensively—in a way that increases trust. It is entirely proper and commendable that the American College of Physicians is seeking to uphold and maintain the integrity of medical clinicians and institutions by addressing this important ethical issue. However, rather than offering your own counter arguments or referring to Advancement Resources (or any other industry expert that has undeniable inherent bias in favor of development), we recommend pointing out that they are not the only thought-leaders to “explore these issues and offer guidance.”

The following are a few sources that have also explored these issues. While they uncovered very similar findings, they differ in their subjective interpretation and subsequent guidance in favor of clinicians’ limited and ethical participation in philanthropy.

APM (The Association of Professors of Medicine) Perspectives: Success in Grateful Patient Philanthropy: Insights from Experienced Physicians

https://www.amjmed.com/article/S0002-9343(11)00752-2/pdf

Rosalyn Stewart, MD, MS, MBA,a,b; Leah Wolfe, MD,a,c; John Flynn, MD, MBA,a,b; Joseph Carrese, MD, MPH,a,c; Scott M. Wright, MD

This study, conducted by Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, and Johns Hopkins University School of Medicine, was based on in-depth qualitative interviews of their physicians and features numerous direct quotes. In the opening to the “Discussion” section in which they conclude their findings, they state:

Even for physicians who are not interested in or are uncomfortable about pursuing philanthropy, the strategies used by the informants, such as connecting meaningfully with patients, listening to patient cues, and being prepared to articulate your vision, should be helpful tips for any physician striving to achieve excellence in communication and interpersonal skills.

Caring for “Very Important Patients” – Ethical Dilemmas and Suggestions for Practical Management

https://pubmed.ncbi.nlm.nih.gov/26522793/

David Alfandre, MD, MSPH; Sarah Clever, MD; Neil J. Farber, MD, FACP; Mark T. Hughes, MD, MA; Paul Redstone, MD; Lisa Soleymani Lehmann, MD, PhD, MSc.

This paper explores ethical issues using a series of vignettes to demonstrate how VIPs’ behavior and status has the potential to influence a clinician’s judgment or actions. One of the vignettes is “The Philanthropist” which includes the following:

Health care philanthropy benefits patients, physicians, and health care institutions…to maintain the patient’s trust in their physician, the development office and the physician should emphasize that the patient’s health care needs will always come first and that any development activity will be done apart from their clinical care.

Ethical Issues and Recommendations in Grateful Patient Fundraising and Philanthropy

https://dukespace.lib.duke.edu/dspace/handle/10161/20595

Megan E. Collins, MD, MPH; Steven Rum, MPA; Jane Wheeler, MSPH; Karen Antman, MD; Henry Brem, MD; Joseph Carrese, MD, MPH; Michelle Glennon, JD; Jeffrey Kahn, PhD, MPH; E. Magnus Ohman, MD; Reshma Jagsi, MD, DPhil; Sara Konrath, PhD; Stacey Tovino, JD, PhD; Scott Wright, MD; and Jeremy Sugarman, MD, MPH, MA; for the Participants in the Summit on the Ethics of Grateful Patient Fundraising.

This paper presents the findings from a summit on Grateful Patient Fundraising (GPFR) and offers specific advice across multiple issues on what can be done to mitigate ethical issues associated with GPFR, as well as suggesting important next steps, including conducting research. Regarding physician-initiated discussions about philanthropy, they specifically recommend:

Physicians should exercise considerable caution in initiating discussions with patients about philanthropy and proceed only when: a: The physician ascertains that the physician–patient relationship is well established, there is substantial reason to believe the patient wants to contribute philanthropically, and other factors, such as timing, the patient’s health, and cognitive status, suggest that the conversation is appropriate. b: The physician has been trained regarding appropriate ways to broach the topic and manage the conversation. c: A physician should initiate discussions with a patient about philanthropy only following the clinical encounter with awareness of the potential risks of raising the topic, including diminishing the patient’s trust and damaging the therapeutic relationship.

Giving Thanks: The Ethics of Grateful Patient Fundraising

https://scholars.law.unlv.edu/facpub/927/

Stacey A. Tovino, University of Nevada, Las Vegas – William S. Boyd School of Law.

This comprehensive legal analysis of the ethics of grateful patient fundraising from the Kentucky Law Journal looks at the main risks of conflicted healthcare decision making; potential resource allocation injustices; financial exploitation; and breach of privacy. The conclusion does not argue against physician involvement in philanthropy but states:

Philanthropy plays an important role in the American health care system and should be encouraged. One problem with health care philanthropy, especially grateful patient fundraising that relies on significant physician involvement, is that it can risk distortion of the physician-patient relationship, conflicted health care decision making, health care resource allocation injustices, financial exploitation, and breach of privacy. These ethical concerns can be lessened through proper guidance of the physician-patient relationship. To this end, this Article offers new ethical guidelines governing physician involvement in grateful patient fundraising. Designed to work alongside proposed corrections to federal health information confidentiality regulations, these guidelines will support the physician-patient relationship and basic patient rights in the context of grateful patient fundraising.

Physicians as Fundraisers: Medical Philanthropy and the Doctor-Patient Relationship

https://pubmed.ncbi.nlm.nih.gov/24523665/

Julian J. Z. Prokopetz, Yale Law School; Lisa Soleymani Lehmann, Department of Medicine, Brigham and Women’s Hospital, Boston, Division of Medical Ethics, Harvard Medical School.

This article recognizes that the practice of physicians being involved in fundraising has three main areas of concern which it states as: “(1) undue pressure on patients to contribute, (2) possible expectations of preferential treatment from donors, and (3) concerns about patient confidentiality and trust.” It recommends the adoption of new policies to guide clinician involvement:

We propose that institutions voluntarily adopt development policies that mitigate these risks. Specifically, we recommend that patient consent be secured before development staff access patient information or physicians refer patients to the development office. We also recommend that physicians not directly solicit donations from their own patients.

Instituting and Teaching Ethical Standards for Grateful Patient Fundraising

https://ascopubs.org/doi/10.1200/JCO.2015.65.3394

Steven A. Rum and Jane L. Wheeler, Johns Hopkins Medicine, Baltimore, MD; Scott M. Wright, Johns Hopkins Bayview Medical Center, Baltimore, MD

This short response, published in the Journal of Clinical Oncology, advocated for the use of research and best practice standards for development offices and clinicians in order to maintain and grow medical philanthropy as it is critical to the medical profession. As the MD’s eloquently state:

Philanthropy offers a lifeline to vital support. Major gifts support centers, research programs, professorships, and fellowships, thus underwriting medical research, education, and patient care. In our experience, philanthropy also benefits patients. It offers them a way to give back, from which many gain a valid sense of meaning, contribution, and fulfillment. Large-scale philanthropic gifts often not only benefit the physician and institution but also serve higher purposes such as advancing medical knowledge and increasing the well-being of patient populations.

 

We hope you find this information helpful in your discussions and invite you to reach out to us for further assistance.