Giving Thanks:Giving Thanks:The Law and Ethics of Grateful Patient The Law and Ethics of Grateful Patient

FundraisingFundraising

Stacey Tovino, JD, PhDStacey Tovino, JD, PhD

Lehman Professor of LawLehman Professor of Law

Director, Health Law ProgramDirector, Health Law Program

William S. Boyd School of LawWilliam S. Boyd School of Law

University of Nevada, Las VegasUniversity of Nevada, Las Vegas

Grateful Patient FundraisingGrateful Patient Fundraising

DefinitionDefinition: The solicitation of cash or an in-kind : The solicitation of cash or an in-kind donation from a current or former patient (or a donation from a current or former patient (or a family member or friend of such patient) who is or family member or friend of such patient) who is or may be grateful for the health care given to or may be grateful for the health care given to or received by the patient.received by the patient.

TheoryTheory: Patients who are grateful for the health : Patients who are grateful for the health care they have received may be more willing to care they have received may be more willing to make philanthropic contributions compared to less make philanthropic contributions compared to less satisfied patients as well as individuals who have satisfied patients as well as individuals who have no relationship with the soliciting health care no relationship with the soliciting health care provider or institution. provider or institution.

Explanation of Background and Explanation of Background and InterestInterest

Former hospital outside counsel on HIPAA mattersFormer hospital outside counsel on HIPAA matters

Former student beneficiary of grateful patient Former student beneficiary of grateful patient fundraising at the University of Texas Medical Branch in fundraising at the University of Texas Medical Branch in Galveston, TexasGalveston, Texas

Current health law professor and ethicistCurrent health law professor and ethicist

Recent object of grateful patient fundraisingRecent object of grateful patient fundraising

On January 25, 2013, HHS issued modifications to the On January 25, 2013, HHS issued modifications to the HIPAA Privacy Rule addressing grateful patient HIPAA Privacy Rule addressing grateful patient fundraisingfundraising

Gina Kolata, Gina Kolata, A New Effort Has Doctors Turn A New Effort Has Doctors Turn Patients Into DonorsPatients Into Donors, N.Y. Times, Sept. 29, , N.Y. Times, Sept. 29,

2015, at A12.2015, at A12.

Shoa L. Clarke, Shoa L. Clarke, How Hospitals Coddle the How Hospitals Coddle the Rich,Rich,

N.Y. Times, Oct. 26, 2015, at A21.N.Y. Times, Oct. 26, 2015, at A21.

Jennifer K. Walter et al., Jennifer K. Walter et al., Oncologists’ Experiences Oncologists’ Experiences and Attitudes About Their Role in Philanthropy and and Attitudes About Their Role in Philanthropy and Soliciting Donations from Grateful Patients, Soliciting Donations from Grateful Patients, 33 J. 33 J.

Clin. Oncology 1 (Sept. 28, 2015).Clin. Oncology 1 (Sept. 28, 2015).

Narrow legal questionNarrow legal question: What is the proper : What is the proper balance between encouraging health care balance between encouraging health care philanthropy and maintaining health philanthropy and maintaining health information confidentiality for purposes of information confidentiality for purposes of the HIPAA Privacy Rule?the HIPAA Privacy Rule?

Broader ethical questionBroader ethical question: In addition, what : In addition, what is the proper balance between encouraging is the proper balance between encouraging health care philanthropy and preserving the health care philanthropy and preserving the integrity of the physician-patient integrity of the physician-patient relationship and basic patients’ rights? relationship and basic patients’ rights?

Grateful Patient Fundraising:Grateful Patient Fundraising:Conflicted FeelingsConflicted Feelings

Health care philanthropy is Health care philanthropy is veryvery important.important.

There are There are significantsignificant legal and ethical legal and ethical issues that are implicated by grateful issues that are implicated by grateful patient fundraising and these legal and patient fundraising and these legal and ethical issues must be addressed by ethical issues must be addressed by health care institutions that seek health care institutions that seek philanthropic contributions.philanthropic contributions.

Health Care PhilanthropyHealth Care Philanthropy

Charitable Giving (2014)Charitable Giving (2014)

In In all industries all industries ~ $358.38 billion~ $358.38 billion ($258.51 billion from individuals)($258.51 billion from individuals)

In the In the health care industry health care industry ~ $30.37 billion~ $30.37 billion ($21 billion from individuals)($21 billion from individuals)

Giving USA 2015: The Annual Report on Philanthropy for the 2014 YearGiving USA 2015: The Annual Report on Philanthropy for the 2014 Year

Academic Medical Center SupportAcademic Medical Center Support

Health professional educational programsHealth professional educational programs

Biomedical and behavioral researchBiomedical and behavioral research

Clinical initiativesClinical initiatives

Building, equipment, and other Building, equipment, and other infrastructure supportinfrastructure support

Other Health Care Institution SupportOther Health Care Institution Support

Whole hospitals and other health care institutionsWhole hospitals and other health care institutionsHospital wings, departments, units, wards, and roomsHospital wings, departments, units, wards, and roomsCommunity-based clinics and other organizationsCommunity-based clinics and other organizationsMedical equipment (Medical equipment (e.ge.g., X-ray, CT, MRI, PET, ., X-ray, CT, MRI, PET, SPECT)SPECT)Daily operating expenses (Daily operating expenses (e.ge.g., hospital bed charges)., hospital bed charges)Classes of patients (Classes of patients (e.ge.g., women, children, seniors)., women, children, seniors)Classes of treatments (Classes of treatments (e.ge.g., cleft palate repair, birth ., cleft palate repair, birth defects)defects)

All Medical SpecialtiesAll Medical SpecialtiesBenefit from PhilanthropyBenefit from Philanthropy

Psychiatry Psychiatry NeurologyNeurology GeriatricsGeriatrics Obstetrics and gynecologyObstetrics and gynecology PediatricsPediatrics PlasticsPlastics Rare diseasesRare diseases Etc.Etc.

Methods of Grateful Patient Methods of Grateful Patient FundraisingFundraising

In-person solicitationsIn-person solicitations Current inpatients and outpatientsCurrent inpatients and outpatients Former patients – follow-up visits, fundraising Former patients – follow-up visits, fundraising

events, etc.events, etc.

Solicitation communicationsSolicitation communications Letters mailed to home or work physical addressLetters mailed to home or work physical address Emails sent to home or work email addressEmails sent to home or work email address Phone calls made to home, mobile, or work Phone calls made to home, mobile, or work

telephonestelephones

Patient SelectionPatient Selection

IdealIdeal: Grateful patients who have the : Grateful patients who have the financial means to donate.financial means to donate.

Likely to be unsuccessful or unproductiveLikely to be unsuccessful or unproductive:: Patients with poor health outcomesPatients with poor health outcomes Patients with low income and/or low Patients with low income and/or low

resourcesresources Patients with certain insurance status Patients with certain insurance status

((e.ge.g., Medicaid)., Medicaid)

Patient Wealth ScreeningsPatient Wealth Screenings

Daily (and even hourly) screening of current Daily (and even hourly) screening of current inpatients and outpatients and former patients by inpatients and outpatients and former patients by in-house development officers or third-party data in-house development officers or third-party data connection organizationsconnection organizations

Zip code or street address (Zip code or street address (e.g.e.g., St. Louis Country , St. Louis Country Club)Club)

Property records (Property records (e.ge.g., high-value property)., high-value property) Record of prior givingRecord of prior giving Board affiliationBoard affiliation Asset ownershipAsset ownership

Association for Healthcare Association for Healthcare Philanthropy (“AHP”)Philanthropy (“AHP”)

Provider Involvement inProvider Involvement inGrateful Patient FundraisingGrateful Patient Fundraising

LowLow: Physicians and other providers who : Physicians and other providers who simply sign and mail letters that are drafted simply sign and mail letters that are drafted by development officers requesting donationsby development officers requesting donations

MediumMedium: Physicians and other providers : Physicians and other providers who participate in general conversations who participate in general conversations with patients regarding health care with patients regarding health care philanthropy needsphilanthropy needs

HighHigh: Physicians and other providers who : Physicians and other providers who directly ask patients for donationsdirectly ask patients for donations

High Physician InvolvementHigh Physician Involvement

Jennifer K. Walter et al., Jennifer K. Walter et al., Oncologists’ Experiences Oncologists’ Experiences and Attitudes About Their Role in Philanthropy and and Attitudes About Their Role in Philanthropy and Soliciting Donations from Grateful Patients, Soliciting Donations from Grateful Patients, 33 J. 33 J.

Clinical Oncology 1 (Sept. 28, 2015).Clinical Oncology 1 (Sept. 28, 2015).

HIPAA Privacy Rule Regulation of HIPAA Privacy Rule Regulation of FundraisingFundraising

November 3, 1999, Proposed RuleNovember 3, 1999, Proposed Rule: Prior written : Prior written authorization would have been required for any and all uses authorization would have been required for any and all uses and disclosures of PHI for fundraising.and disclosures of PHI for fundraising.

December 28, 2000, Final RuleDecember 28, 2000, Final Rule: Authorization not required : Authorization not required for uses and disclosures of for uses and disclosures of demographic information and demographic information and dates of health caredates of health care for fundraising purposes; however, for fundraising purposes; however, authorization is required for all other uses and disclosures.authorization is required for all other uses and disclosures.

January 25, 2013, Final ModificationsJanuary 25, 2013, Final Modifications: Authorization not : Authorization not required for uses and disclosures of required for uses and disclosures of demographic demographic information, dates of health care, treating physician, information, dates of health care, treating physician, department of service, and health outcome information department of service, and health outcome information for for fundraising purposes.fundraising purposes.

45 C.F.R. 164.514(f)(1)45 C.F.R. 164.514(f)(1)

1. Is the HIPAA Privacy Rule1. Is the HIPAA Privacy Rulealigned with patient expectations?aligned with patient expectations?

No authorization needed (45 C.F.R. 164.506, No authorization needed (45 C.F.R. 164.506, 164.512)164.512) TreatmentTreatment InsuranceInsurance LicensingLicensing Public health Public health

Authorization needed (45 C.F.R. 164.508)Authorization needed (45 C.F.R. 164.508) Biomedical and behavioral researchBiomedical and behavioral research Selling patient informationSelling patient information MarketingMarketing

HHS’s Model Notice of Privacy Practices HHS’s Model Notice of Privacy Practices (Sept. 16, 2013)(Sept. 16, 2013)(on page 4 of 8)(on page 4 of 8)

University Medical Center (Las Vegas, University Medical Center (Las Vegas, Nevada)Nevada)

Notice of Privacy Practices (on page 1 Notice of Privacy Practices (on page 1 of 4)of 4)

2. Can a patient’s condition be 2. Can a patient’s condition be revealed?revealed?

An employed development officer, a foundation An employed development officer, a foundation officer, or a third-party commercial fundraiser who officer, or a third-party commercial fundraiser who uses or receives legally permissible patient uses or receives legally permissible patient information to create a targeted fundraising information to create a targeted fundraising communication communication can easily determine the patient’s can easily determine the patient’s general health condition or at least the health care general health condition or at least the health care services requested or received by the patientservices requested or received by the patient. .

Treating physician information (Treating physician information (e.ge.g., Dr. Hsu, Dr. Daulat)., Dr. Hsu, Dr. Daulat) Department or service information (Department or service information (e.g.e.g., Addiction , Addiction

Medicine, Oncology, Behavioral Health, Plastic Surgery)Medicine, Oncology, Behavioral Health, Plastic Surgery)

3. A close examination of the relevant 3. A close examination of the relevant comments received by HHS in response to its comments received by HHS in response to its 2010 proposed rule do not indicate a shift in 2010 proposed rule do not indicate a shift in public attitudes regarding the appropriate public attitudes regarding the appropriate balance of confidentiality and philanthropy. balance of confidentiality and philanthropy.

~61 comments discussed the fundraising issue~61 comments discussed the fundraising issue• ~55 of these comments were authored by health care ~55 of these comments were authored by health care

providers, etc.providers, etc.• ~6 of these comments were authored by privacy ~6 of these comments were authored by privacy

advocates, etc.advocates, etc.

Health care philanthropy and health Health care philanthropy and health information confidentiality should be information confidentiality should be balanced through a balanced through a more express more express notification of fundraising activities notification of fundraising activities and a prior authorization and a prior authorization requirementrequirement, as is required by the , as is required by the HIPAA Privacy Rule for research, HIPAA Privacy Rule for research, marketing, the sale of PHI, etc. marketing, the sale of PHI, etc.

Narrow legal questionNarrow legal question: What is the proper : What is the proper balance between encouraging health care balance between encouraging health care philanthropy and maintaining health philanthropy and maintaining health information confidentiality for purposes of information confidentiality for purposes of the HIPAA Privacy Rule?the HIPAA Privacy Rule?

Broader ethical questionBroader ethical question: In addition, what : In addition, what is the proper balance between encouraging is the proper balance between encouraging health care philanthropy and preserving the health care philanthropy and preserving the integrity of the physician-patient integrity of the physician-patient relationship and basic patients’ rights? relationship and basic patients’ rights?

Ethical Implications ofEthical Implications ofGrateful Patient FundraisingGrateful Patient Fundraising

Grateful patient fundraising risks Grateful patient fundraising risks distorting the distorting the physician-patient physician-patient relationshiprelationship through possible: through possible:

Conflicted decision makingConflicted decision making Health care resource allocation Health care resource allocation

injusticesinjustices Financial exploitationFinancial exploitation Breach of privacyBreach of privacy

1. Conflicted Decision Making1. Conflicted Decision Making

Conflicted Physician (and Hospital)Conflicted Physician (and Hospital)Decision MakingDecision Making

““[The physician] acts [The physician] acts primarily to protect primarily to protect and promote the and promote the interests of the patient interests of the patient and keeps self interest and keeps self interest systematically systematically secondary …”secondary …”

Laurence McCullough, A Laurence McCullough, A Primer on Bioethics Primer on Bioethics 7 (27 (2ndnd ed. 2006).ed. 2006).

The physician’s The physician’s professional self interest professional self interest in in raising funds;raising funds;

The physician’s/hospital’s The physician’s/hospital’s interest in raising funds for interest in raising funds for the the clinical benefit of clinical benefit of future patientsfuture patients; and; and

The hospital’s interest in The hospital’s interest in raising funds for the raising funds for the hospital’s own financial hospital’s own financial benefitbenefit..

Typical HypotheticalTypical Hypothetical

A hospital re-schedules a potential grateful patient’s A hospital re-schedules a potential grateful patient’s elective or non-emergency procedure to an earlier date elective or non-emergency procedure to an earlier date (earlier compared to other patients who are now pushed (earlier compared to other patients who are now pushed back) to back) to induceinduce the wealthy patient to make a the wealthy patient to make a philanthropic donation.philanthropic donation.

Or, a hospital re-schedules a past donor’s elective or non-Or, a hospital re-schedules a past donor’s elective or non-emergency procedure to an earlier date (earlier compared emergency procedure to an earlier date (earlier compared to other patients who are now pushed back) to to other patients who are now pushed back) to thankthank the the donor for her earlier donation (and/or perhaps to donor for her earlier donation (and/or perhaps to encourage a second donationencourage a second donation). ).

Note regarding the distortion of several physician-patient Note regarding the distortion of several physician-patient relationships and the distortion of the “normal” timing of relationships and the distortion of the “normal” timing of health care.health care.

Scott M. Wright et al., Scott M. Wright et al., Ethical Concerns Related to Ethical Concerns Related to Grateful Patient Philanthropy: The Physician’s Grateful Patient Philanthropy: The Physician’s

Perspective,Perspective,28(6) J. Gen. Int. Med. 645 (2012).28(6) J. Gen. Int. Med. 645 (2012).

In-depth interviews with 20 JHSOM physician In-depth interviews with 20 JHSOM physician fundraisers representing a diverse range of medical fundraisers representing a diverse range of medical specialties. Ninety percent (90%) of the physicians specialties. Ninety percent (90%) of the physicians surveyed identified surveyed identified the impact of gift-giving on the the impact of gift-giving on the physician-patient relationship as the most significant physician-patient relationship as the most significant ethical concern associated with grateful patient ethical concern associated with grateful patient fundraisingfundraising..

““[GPF] taints the physician-patient relationship.”[GPF] taints the physician-patient relationship.” ““[GPF] changes the relationship from one focused entirely on [GPF] changes the relationship from one focused entirely on

patient well-being to one that also focused on philanthropy.”patient well-being to one that also focused on philanthropy.” ““I recognize that the philanthropic aspect of the relationship I recognize that the philanthropic aspect of the relationship

can conflict with the patient care aspect of the relationship.”can conflict with the patient care aspect of the relationship.” ““I try not to compromise patient care when I am disappointed I try not to compromise patient care when I am disappointed

by a patient’s decision not to donate.”by a patient’s decision not to donate.”

Physician (Dis)comfortPhysician (Dis)comfort

ComfortComfort: “[Grateful patient fundraising] is a : “[Grateful patient fundraising] is a positive opportunity for me to help raise money positive opportunity for me to help raise money from current patients to help future patients. It’s from current patients to help future patients. It’s like helping a grateful patient pay it forward.”like helping a grateful patient pay it forward.”

DiscomfortDiscomfort:: ““It’s unseemly.”It’s unseemly.” ““This is not why I went to medical school.”This is not why I went to medical school.” ““I don’t want to appear to be pandering.”I don’t want to appear to be pandering.” ““I’m not in sales, that’s what the development I’m not in sales, that’s what the development

staff is for …”staff is for …” ““It’s unethical.” It’s unethical.” ““It’s illegal.” It’s illegal.”

Jennifer K. Walter et al., Jennifer K. Walter et al., Oncologists’ Experiences Oncologists’ Experiences and Attitudes About Their Role in Philanthropy and and Attitudes About Their Role in Philanthropy and Soliciting Donations from Grateful Patients, Soliciting Donations from Grateful Patients, 33 J. 33 J.

Clin. Oncology 1 (Sept. 28, 2015).Clin. Oncology 1 (Sept. 28, 2015).

2. Health Care Resource Allocation 2. Health Care Resource Allocation InjusticesInjustices(Justice)(Justice)

A second major concern associated with A second major concern associated with grateful patient fundraising relates to grateful patient fundraising relates to justice. That is, individual and justice. That is, individual and institutional health care providers may institutional health care providers may prefer donors over non-donors and prefer donors over non-donors and health health care resources may be consciously or care resources may be consciously or subconsciously allocated towards donorssubconsciously allocated towards donors, , thus improving the diagnosis, treatment, thus improving the diagnosis, treatment, and health outcome of donors vis-and health outcome of donors vis-àà-vis -vis non-donors.non-donors.

Justice HypotheticalJustice Hypothetical

If a well-resourced patient makes a donation to a If a well-resourced patient makes a donation to a hospital, is it ethically permissible for the donor to be hospital, is it ethically permissible for the donor to be preferred in a way such that another non-donating preferred in a way such that another non-donating patient is not? patient is not?

What about What about scheduling a donor’s elective procedure scheduling a donor’s elective procedure before a non-donor’s emergency procedurebefore a non-donor’s emergency procedure??

What about giving other perks to the donor, such as What about giving other perks to the donor, such as in-room courtesy visits, laptops or iPads for personal in-room courtesy visits, laptops or iPads for personal use while in the hospital, other gift items, use while in the hospital, other gift items, priority priority access to private roomsaccess to private rooms, staff escorts, personal , staff escorts, personal notes, or notes, or expedited follow-up appointmentsexpedited follow-up appointments??

Private Room ExamplePrivate Room Example

Philanthropy expertsPhilanthropy experts have no difficulty have no difficulty recommending the move of the donor to therecommending the move of the donor to the large, large, private room with large windows and plenty of private room with large windows and plenty of sunlight under the theory that both patients will sunlight under the theory that both patients will continue to receive the “same level of health continue to receive the “same level of health care”; it’s just the “perks” that are different.care”; it’s just the “perks” that are different.

EthicistsEthicists worry that unequal perks could turn into worry that unequal perks could turn into unequal care. That is, there are studies that unequal care. That is, there are studies that associate perks with patient satisfaction and/or associate perks with patient satisfaction and/or better health outcomes. better health outcomes.

Expedited Appointment Scheduling Expedited Appointment Scheduling ExampleExample

If there are no medical issues requiring follow-up care, If there are no medical issues requiring follow-up care, the level of care (in theory) will stay the same. If there the level of care (in theory) will stay the same. If there are medical issues requiring follow-up care, diagnosis and are medical issues requiring follow-up care, diagnosis and treatment could occur later in time for the non-donor. treatment could occur later in time for the non-donor.

Some ethicistsSome ethicists are very uncomfortable with expedited are very uncomfortable with expedited appointment scheduling for donors, reasoning that non-appointment scheduling for donors, reasoning that non-donors will be given a “second level of care.”donors will be given a “second level of care.”

Philanthropy expertsPhilanthropy experts continue to refer to expedited continue to refer to expedited appointment scheduling as a “harmless amenity [or appointment scheduling as a “harmless amenity [or perk].” perk].”

Scott M. Wright et al., Scott M. Wright et al., Ethical Concerns Related to Ethical Concerns Related to Grateful Patient Philanthropy: The Physician’s Grateful Patient Philanthropy: The Physician’s Perspective,Perspective, 28(6) J. Gen. Int. Med. 645 (2012). 28(6) J. Gen. Int. Med. 645 (2012).

““I do not like treating patients differently from an I do not like treating patients differently from an egalitarian perspective, but from a practical point of view I egalitarian perspective, but from a practical point of view I recognize the generosity of donors and the fact that recognize the generosity of donors and the fact that they they are used to a different level of attention, so I give it to are used to a different level of attention, so I give it to themthem.”.”

““I might be late to a meeting to call back a donor, where I might be late to a meeting to call back a donor, where I I might call a non-donor back after my meetingmight call a non-donor back after my meeting [even [even though they] … both have the same patient care need.”though they] … both have the same patient care need.”

““It just gives me an uncomfortable feeling … I’m more It just gives me an uncomfortable feeling … I’m more aware of when they come to the clinic, and I may be trying aware of when they come to the clinic, and I may be trying harder to be a better doctor, do my job better. I don’t like harder to be a better doctor, do my job better. I don’t like that part; that part; I feel that I’m cheating on my other patientsI feel that I’m cheating on my other patients.”.”

3. Financial Exploitation3. Financial Exploitation(Beneficence/Non-maleficence)(Beneficence/Non-maleficence)

ConcernConcern

A third major concern associated with A third major concern associated with grateful patient fundraising relates to the grateful patient fundraising relates to the financial well-being of the patient. That financial well-being of the patient. That is, is, some grateful patients are vulnerable some grateful patients are vulnerable and could be financially exploited during and could be financially exploited during the fundraising process.the fundraising process.

Illustrative ExamplesIllustrative Examples

Consider an elderly patient who is in the early stages Consider an elderly patient who is in the early stages of of dementia dementia and who has limited financial acumen.and who has limited financial acumen.

Or, consider a stage-III or -IV cancer patient who Or, consider a stage-III or -IV cancer patient who wishes to make a donation that is wishes to make a donation that is more generous more generous than the patient/family really can affordthan the patient/family really can afford..

Or, consider a young adult patient with severe Or, consider a young adult patient with severe bipolar disorder who, bipolar disorder who, during a manic phase, wishes during a manic phase, wishes to donate money to the hospital where she received to donate money to the hospital where she received inpatient psychiatric treatment even though the inpatient psychiatric treatment even though the money could be better* spent on a college education.money could be better* spent on a college education.

Vulnerable Adult/Vulnerable Adult/Financial Exploitation StatutesFinancial Exploitation Statutes

E.g.E.g., The Washington Abuse of Vulnerable , The Washington Abuse of Vulnerable Adults Act, Wash. Rev. Code § 74.34.020(6)(a) Adults Act, Wash. Rev. Code § 74.34.020(6)(a) (2015).(2015).

““The use of deception, intimidation, or The use of deception, intimidation, or undue undue influence influence by a person or entity by a person or entity in a position of in a position of trust and confidencetrust and confidence with a vulnerable adult with a vulnerable adult to obtain or use the property, income, to obtain or use the property, income, resourcesresources, or trust funds of the vulnerable , or trust funds of the vulnerable adult for the benefit of a person or entity adult for the benefit of a person or entity other than the vulnerable adult.”other than the vulnerable adult.”

Scott M. Wright et al., Scott M. Wright et al., Ethical Concerns Related to Ethical Concerns Related to Grateful Patient Philanthropy: The Physician’s Grateful Patient Philanthropy: The Physician’s PerspectivePerspective, 28(6) J. Gen. Int. Med. 645 (2012)., 28(6) J. Gen. Int. Med. 645 (2012).

““DementiaDementia is such a devastating disease, is such a devastating disease, and that’s why I have a big ethical and that’s why I have a big ethical concern about that, concern about that, I feel there is I feel there is financial and other vulnerability therefinancial and other vulnerability there.”.”

Financial Exploitation ConclusionsFinancial Exploitation Conclusions

A vulnerable patient may worry that her current or future A vulnerable patient may worry that her current or future care depends on the making of a donation and may be care depends on the making of a donation and may be pressured into making a donation even when the donation pressured into making a donation even when the donation is beyond the patient’s financial means (financial is beyond the patient’s financial means (financial exploitation) or when the donation is otherwise against exploitation) or when the donation is otherwise against the patient’s wishes (lack of respect for autonomy). the patient’s wishes (lack of respect for autonomy).

The principle of respect for autonomy includes not only The principle of respect for autonomy includes not only the requirement to acknowledge autonomy (the requirement to acknowledge autonomy (e.g.e.g., , including respecting a competent patient’s autonomous including respecting a competent patient’s autonomous donation decision) but also the requirement to protect donation decision) but also the requirement to protect those with diminished autonomy (those with diminished autonomy (e.g.e.g., protecting a , protecting a vulnerable individual from making a donation beyond her vulnerable individual from making a donation beyond her financial means or against her wishes).financial means or against her wishes).

4. Breach of Privacy4. Breach of Privacy

Privacy ConcernsPrivacy Concerns

A fourth major area of concern associated with A fourth major area of concern associated with grateful patient fundraising is that fundraising that grateful patient fundraising is that fundraising that relies on wealth and other unknown (from the relies on wealth and other unknown (from the patient’s perspective) and unauthorized types of patient’s perspective) and unauthorized types of screenings can raise privacy concerns.screenings can raise privacy concerns.

That is, privacy issues arise when hospital That is, privacy issues arise when hospital development officers, institutionally-related development officers, institutionally-related foundation officers, and other business associates foundation officers, and other business associates gather information about patients, without such gather information about patients, without such patients’ knowledge, in an attempt to determine or patients’ knowledge, in an attempt to determine or estimate patient wealth, giving capacity, past estimate patient wealth, giving capacity, past donations, and other relevant informationdonations, and other relevant information..

Privacy ConcernsPrivacy Concerns

AMA Code of Medical Ethics, Opinion AMA Code of Medical Ethics, Opinion 5.059.5.059.

Giving Thanks:Giving Thanks:The Law and Ethics of Grateful Patient The Law and Ethics of Grateful Patient

FundraisingFundraising

Stacey Tovino, JD, PhDStacey Tovino, JD, PhD

Lehman Professor of LawLehman Professor of Law

Director, Health Law ProgramDirector, Health Law Program

William S. Boyd School of LawWilliam S. Boyd School of Law

University of Nevada, Las VegasUniversity of Nevada, Las Vegas