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Abstract

I remember discussing the topic of gift-giving by patients in a small group session in medical school. When asked whether it’s ethical for medical professionals to accept gifts from patients, I responded, “It depends on the value of the gifts.” If the gifts were of appropriate value and given purely out of appreciation, they serve to strengthen the physician-patient relationship. However, what I failed to realize was the difficulty in determining the value and intention of a gift. My personal experience of receiving gifts from a patient made me aware of such ethical ambiguities.

At the community clinic where I volunteer, I took care of an undocumented immigrant who did not speak English and was unable to work due to a disability. Because of his complicated medical and social needs, he had been a frequent visitor. He was one of the most appreciative people I had ever met – he remembered the names of everyone who had helped him and said thank you to them on his way out. As his primary provider, I wasn’t surprised when I received a text message from him stating that he wanted to give me something in return. Despite my repeated refusals, he brought the gifts to the hospital one day, asking if I could meet him briefly during my lunch break. The gifts, consisting of food donated to him by the community, were packaged neatly in grocery bags, with plastic rope wrapped around them for ease of carrying. Knowing it wasn’t easy for him to carry these bags all the way there with his disability, I accepted them with deep gratitude.

He reached out a few more times trying to hand me similar gifts. I felt conflicted about accepting them but struggled to decline more sternly, fearing it would damage our relationship. The American Medical Association Code of Medical Ethics suggests that one should be sensitive to the gift’s value relative to the patient’s or physician’s means and not allow the gift or offer of a gift to influence the patient’s medical care.1 On one hand, these gifts weren’t of excessive value. On the other hand, the patient has no income, making these community donations his only source of food security. Is it justifiable to believe that they are of the same value to me as they are to him? While I could assume that these gifts were well-intended as a sign of gratitude, would he have the same expectations for our patient-physician relationship? Furthermore, accepting them would create a slippery slope situation where it could be more difficult for me to reject them in the future. Among the numerous considerations, I couldn’t decide on the appropriateness of accepting these gifts.

I eventually donated the nonperishable items to local food drives. And thankfully, my patient expressed understanding and agreed not to bring any more gifts after my clinic supervisor offered to speak to him on my behalf. The experience of ethical uncertainty reminds me to always approach these situations with ethical scrutiny, as the social power of a gift to influence decisions can often be underappreciated. While ethical guidelines should be consulted, accepting gifts from patients should be steered by one’s internal moral compass built with professionalism and humanity.

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