When Patients Give

As he nearedthe end of hislife, former BeatleGeorge Harrisonsigned a guitar as agift for his physician'sson. Was it gratitude on Harrison's part or coercionon the part of the doctor? In Harrison's case, thequestion may be resolved by a multimillion-dollarlawsuit recently filed by his estate. Gifts frompatients remain a thorny ethical thicket for manydoctors. At the AMA's Web site (www.ama-assn.org), there's a brief section covering patient gifts,noting that such gifts can enhance the doctor–patient relationship, but also may be a patient's wayof trying to get special treatment. And when thepatient is famous, as in the case involving Harrison,both doctors and hospitals run special risks when apatient offers a gift.

While receiving gifts may seem ethically acceptable,going too far can be seen as exploiting thepatient's fame and vulnerability, especially if thepatient's illness is severe or fatal. Like deathbedwills, gifts from dying patients can be subject toclaims of coercion. Another pitfall doctors and hospitalsthat care for famous patients face is the possibilitythat the amount of free publicity that a well-knowncelebrity offers may influence care decisions.Some doctors and hospitals may be reluctant torefer a patient who represents an enormous measureof free advertising and donations, even if thepatient might receive better care and more specializedtreatment elsewhere.