New paper addresses ethical issues in physician fundraising from 'grateful patients'

In a new position paper, the American College of Physicians (ACP) addresses the question of "grateful patient" fundraising, stating that physicians should not engage in or be asked or expected to participate in fundraising solicitation of their patients or patient families. The position paper is published in Annals of Internal Medicine.

Philanthropic support remains very important to the financial health and implementation of the mission of hospitals and health systems in the U.S. A newer approach to fundraising, often called "grateful patient" fundraising, however, raises ethical concerns when physicians and their patients (or patient families) are involved.

Questions have been raised about the physician's role in such activities and whether physicians should be asking patients or families for financial contributions and whether involvement by physicians affects relationships, creating "tension between their roles as caregiver and fundraiser, potentially undermining the trust at the heart of the doctor-patient relationship."

Additional ethical concerns include pressure on patients to donate and the effects of this on the patient-physician relationship; potential expectations of donor patients for treatment that is not indicated or to receive preferential care; justice and fairness issues; disclosure and use of confidential patient information for nontreatment purposes; and conflicts of interest.

Using the patient-physician relationship and knowledge of the patient's medical history and clinical status, personal information, and financial circumstances are some of the reasons development and administrative officials might see physicians as strong potential fundraisers; but use of this information is among the reasons why physician involvement is ethically problematic.

Developed by ACP's Ethics, Professionalism and Human Rights Committee, ACP believes physicians should not engage in or be asked to participate in fundraising or financial solicitation of their patients and suggests that:

• 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 include speaking at events, attending galas, giving public talks related to the physician's area of expertise or research, encouraging philanthropy by colleagues, which 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 (HIPAA) 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 patient families as a condition of employment, or a part of an incentive program. Employed physicians may be expected to lend their professional reputation to promote campaigns without control over usage, for example perpetual use of their photograph taken for a promotional campaign.