In this Bioethics Update we consider the question: 


Is it OK to accept gifts from our patients?

Professional Societies
The American Medical Association's statement on accepting gifts notes that: "Gifts from patients may be an important means for some patients or their family caregivers to express gratitude for the care a physician has provided. However, physicians should be aware that gifts may be offered for many different reasons, and that acceptance of certain gifts may compromise the patient-physician relationship."

The American Nurses Association's Code of Ethics section on Professional Boundaries states: "When acting within one's role as a professional, the nurse recognizes and maintains boundaries that establish appropriate limits to relationships."
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The BWH Center for Bioethics is a resource for staff with questions about clinical and research ethics.


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Gifts from Patients
We know that as health care providers at BWH we are not permitted to accept gifts from industry representatives such as pharmaceutical companies; but can we accept gifts from our patients or their families? Is it inappropriate to accept a box of chocolates or a box of homemade cookies from a patient? Is it OK to accept tickets to a Celtics game from a patient? Here are a few points to consider when thinking through the challenging question of whether to accept, and how to "reject," gifts from patients.
The Dilemma  
When treating patients we frequently intertwine what we might consider social and professional behaviors. We may share personal details about our lives or share pictures of our family - both examples of generally positive social interactions that happen every day between patients and health care providers. Concerns arise when there is a blurring of boundaries between social and professional behavior that may compromise the patient-provider relationship, as it might when a patient offers us a gift. It may be helpful to remember that the primary consideration should always be how acceptance or refusal of the gift will ultimately affect your relationship with your patient.
The Provider's Perspective
It is important to consider the value of a gift. A small token of appreciation should be treated differently than an extravagant or expensive gift. As you think through your own motivations and concerns it may be helpful to ask yourself the following questions:
  • Will the patient be offended or feel rejected by my refusal to accept the gift?
  • Will I feel obliged to treat the patient differently in the future, as a result of having accepted the gift?
  • Is this patient presenting a small, personal gift as simple gesture of appreciation; or might this gift mask underlying vested interests? 
  • Can I graciously accept the gift on behalf of my team or practice?
  • Can I express my gratitude and still not accept the gift?
  • Are there peers or mentors whom I can consult for advice?
Understanding the Patient's Perspective
A patient's motivations may be conscious or unconscious. It may be helpful to consider the following questions:
  • What motivated the patient to give the gift?
  • What does the offer of the gift mean to the patient?
  • Is it a small token of warmth and appreciation or a presumed attempt to manipulate or influence care?
  • Is the patient trying to "buy" more attention?
  • Is it an attempt to transform the professional relationship into a more personal or intimate one?
  • Is this patient from a culture in which gift-giving is the only means to ensure quality health care?
  • Is the patient from a culture in which gift-giving is a commonly accepted way in which people show respect?

Refusing a Gift 
no gift
Gifts of substantial value should not be accepted by health
care providers. As a rule, we should never accept money for our personal use. Refusing a gift can be a delicate situation. You do not want your patient to feel rejected or disrespected. The following suggestions may be helpful:
  • Always express gratitude, even when you cannot accept a gift.
  • Clarify that you have a general rule not to accept gifts.
  • Stress that you don't want other patients to feel like they have to give gifts.
  • If you do accept a gift of small value, you might clarify that the gift will be shared with staff.
  • If a patient wants to make a monetary donation to the hospital they should be encouraged to contact the BWH development office

Center for Bioethics, Brigham and Women's Hospital
75 Francis Street  Boston, MA 02115

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