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September 29, 2015; Cancer Therapy Advisor

This one is a new issue to us, but perhaps NPQ Newswire readers were already aware of this practice. An article in the Journal of Clinical Oncology assesses how physicians feel about asking for philanthropic contributions from “grateful patients.” The author of the article apparently contacted 771 oncologists, getting responses from 405. According to the Cancer Therapy Advisor summary of the Journal article, 71 percent of the respondents had had “previous exposure” to the fundraising or development staff of the institutions where they worked, and nearly half of those doctors had been “taught to determine potentially good donors.” One-fourth of the doctors had been provided “ethical guideline information,” though this brief summary doesn’t explain what the guidelines contained.

Somehow, the notion that the oncologist treating a patient’s cancer might also be contemplating the patient’s potential charitable donations is a little off-putting. One hopes that a doctor is treating all patients equally and not thinking about which might be so grateful to life-saving treatment that they might be motivated to make a hefty donation once they get out of the recovery room. However, with the costs of running and sustaining hospitals, particularly in this case expensive cancer hospitals, the idea that doctors might be thinking about their grateful patients’ charitable contributions or even be encouraged by hospital fundraising staff to ask them for donations probably isn’t all that surprising.

Like us, this practice makes some doctors uncomfortable. About one-third of the respondents said that they had been asked, presumably by their institutions, to discuss the potential for donations with their patients. Apparently, half of the doctors who were asked to talk to their patients about donations declined to do so. The report suggests that three-fourths of the doctors felt that asking for donations “may interfere with their relationships with patients” and a little over half noted the possibility of conflicts of interest.

The New York Times described the work of the author of the Journal study, Dr. Reshma Jagsi, a radiation oncologist and ethicist at the University of Michigan. According to NYT reporter Gina Kolata, Dr. Jagsi had actually participated in workshops on how to identify good prospects for donations and how to ask them to donate. Kolata writes that Jagsi “was uncomfortable with the idea, but she also knew some patients want to donate and are grateful for guidance on how to do it…What was the ethical way for doctors to help, she wondered? Or should they stay out of the donation business completely?” She found just about nothing in the medical literature on the topic and decided to conduct her own research.

Jagsi’s article has received much positive feedback. Lauding the paper, Arthur L. Caplan, head of the division of medical ethics at NYU Langone Medical Center, expressed the hope that Jagsi’s research would start important public discussion, addressing issues that he raised about the power imbalance between the successful, life-saving doctor and the grateful patient. “Patients may be emotionally vulnerable; doctors have very close ties to their patients, which can strain asking on both sides; and the fact that incentives to ask sometimes skew toward the doctor’s own program rather than the most needy areas of the hospital,” Caplan said, pointing out some of the troubling possibilities of doctors soliciting their patients for donations.

For all the research about nonprofits and charity that appears to regurgitate information that we all know, Dr. Reshma Jagsi’s research examines questions and generates new data on an issue that needs public airing and probably occurs much more than anyone might ever suspect. This is new and important research, not more of the same-old, same-old. Moreover, as a practicing oncologist, Jagsi is demonstrating the importance of practitioners conducting research themselves.  More nonprofit practitioners should be thinking like Jagsi that they are both practitioners and researchers.—Rick Cohen