ACP addresses ethics of physician fundraising from ‘grateful patients'

Physicians should not engage in, or be asked or expected to participate in, fundraising through solicitation of their patients or patients' families, ACP stated in a new position paper.

Having physicians participate in fundraising activities by asking patients or families for financial contributions affects relationships, creating conflict between the roles of caregiver and fundraiser, and potentially undermines the trust at the heart of the doctor-patient relationship, the College said. The position paper was developed by ACP's Ethics, Professionalism and Human Rights Committee and published Sept. 26 by Annals of Internal Medicine.

Additional ethical concerns include potential expectations of donor patients for treatment that is not indicated or preferential care; justice and fairness issues; disclosure and use of confidential patient information for nontreatment purposes; and conflicts of interest, the paper said. Development and administrative officials might see physicians as strong potential fundraisers because of their relationship with patients and knowledge of their medical history and clinical status, personal information, and financial circumstances, but use of this information is among the reasons why physician involvement is ethically problematic, the position paper stated.

The College suggests the following:

• Participation by physicians in health care fundraising should be guided by the best interests of patients and by the need to establish and maintain trust in the patient-physician relationship. Patients or family members inquiring about charitable donations should be directed to the institution's administrators. Other activities that do not involve payments by their patients but constitute fundraising, including speaking at events, attending galas, giving public talks related to the physician's area of expertise or research, and encouraging philanthropy by colleagues, can be ethically acceptable.
• Physicians have a duty to protect patient privacy and confidentiality and should not reveal or use patient information for fundraising purposes. Maintaining confidentiality and respecting patient privacy are core ethical responsibilities for physicians. The Health Insurance Portability and Accountability Act Privacy Rule was modified in 2013 to expand access to and use of protected health information (PHI) by health care fundraisers. ACP opposes the use and disclosure of PHI for fundraising purposes under the modification.
• Physicians should not be asked or expected to participate in fundraising solicitation of their patients or patients' families as a condition of employment or as part of an incentive program.

“Philanthropic goals in health care can be pursued in various ways, but [grateful patient fundraising] by physicians is ethically problematic,” the position paper concluded. “In addition, patient expression of concern about this practice emphasizes the potential for erosion of patient and public trust in institutions and the profession—another red flag, and an intuition that should be heeded, lest this practice ultimately harm both patient care and ethically appropriate philanthropic efforts.”