September 2020

New Study Raises Questions About Ethics When Doctors Fundraise From Wealthy Patients

Donations from grateful former patients are a significant source of funding for hospitals. In order to solicit donations, some hospitals approach wealthy patients, either directly or through physicians. Nearly half of cancer specialists have been taught to identify wealthy patients on behalf of hospital fundraising offices, and a third of physicians have been asked to directly solicit donations from wealthy patients. Ethical guidelines from the American Medical Association suggest this practice is acceptable. 

Before Dr. Reshma Jagsi’s recent research, supported by a Spring 2018 Making a Difference grant from The Greenwall Foundation, there were little data on how physician fundraising impacts patient experiences. Through her Greenwall-funded project, Dr. Jagsi discovered that patients are uncomfortable with many hospital fundraising practices. In particular, patients worry that conversations about donations will strain their relationships with medical providers. Dr. Jagsi’s research showed that 91.5% of patients surveyed disapprove of medical professionals soliciting donations from patients unprompted; 83.2% of patients agreed that having physicians solicit donations could harm patient-physician relationships; and only 47% of patients surveyed were comfortable with medical professionals soliciting donations from patients who expressed an interest in donating to the hospital.  

Dr. Jagsi’s research suggests that a large number of patients are uncomfortable with medical professionals soliciting donations from them. This finding frames a novel bioethical dilemma: Although it is important for hospitals to have sufficient funds in order to operate, it is also important to maintain strong patient-physician relationships in order to provide quality medical care. Physician solicitation of patient donations helps hospitals fundraise but, according to this research, places patient-physician relationships at risk. Dr. Jagsi seeks to provide hospitals with the resources to navigate this tension. 

“Philanthropic development is essential to support the worthy missions pursued by hospitals and medical centers, said Dr. Jagsi. “Our research suggests, however, that many practices that the law permits may nevertheless be important to reconsider so that these institutions do not jeopardize the trust of the public that is also essential for them to succeed in pursuing their missions.” 

Dr. Jagsi’s research has been featured in the New York Times and other publications, and health systems leaders are taking her findings seriously. Marschall Runge, dean of the University of Michigan medical school and chief executive of its health system, told the New York Times that, while donations are important for medical centers, the patient attitudes that Dr. Jagsi uncovered worry him. As a result of her research, the University of Michigan Medical School has formed a committee to determine best practices in fundraising in light of patient discomfort with physician fundraising.  

Dr. Jagsi’s full article in JAMA can be found here.