Grateful patient philanthropy — donations often made “in response to excellent medical care” — comprises approximately $10 billion in charitable giving to health care centers per year. A report published in JAMA explores the ethical considerations of grateful patient fundraising, particularly with regard to the effect these monetary contributions have on the clinician-patient relationship.

Hospitals across the nation receive charitable donations from past patients who have been treated successfully at their centers, contributions which can help improve the facility’s standard of care for future patients. There is a limited amount of research that explores the ethical considerations involved in grateful patient fundraising, specifically ethical concerns that affect physicians. Some challenges include physician discomfort in discussing philanthropy with their patients who may be “especially vulnerable due to their diseases or conditions” and the conflicts associated with physicians’ “obligations to patient care and a competing obligation to fundraising.”

Currently, it is widely held that grateful patient fundraising should only occur after successful treatment, and not in situations where the patient may still be sick, healing, or in an increased state of vulnerability. According to surveys among oncologists, the majority of physicians in this disease specialty feel they have a duty to participate in fundraising but often feel uncomfortable speaking to their patients regarding this topic. Only 26% of physicians, according to these surveys, have received education on the ethical guidelines for soliciting donations from patient potential donors.

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“Physicians often feel unprepared and uncomfortable discussing financial issues with their patients, in part because physicians rarely receive adequate training to do so. This could undermine successfully establishing a philanthropic relationship with a patient or, even worse, risk compromising the therapeutic patient-physician alliance,” the researchers wrote. “Thus, there is a need for curricula to teach consensus-based, professional standards to development professionals and to clinicians.”


Collins ME, Rum SA, Sugarman J. Navigating the ethical boundaries of grateful patient fundraising. JAMA. 2018;320(10):975-976.