Q: I have a patient who was struck by a car, suffering multiple severe injuries requiring numerous operations. He is pleased with the outcome (“You saved my legs, Doc”) and expects a large settlement from a lawsuit he filed against the driver. He says he will give me a portion of that money. Can I ethically accept such a gift?
Anonymous, New Jersey
A: Enjoy it in good health – if the case is settled without your testimony and the gift is not too large. The American Medical Association says that a physician not only may accept a patient’s gift but sometimes also should. The next edition of its Code of Medical Ethics will include this guideline: “Gifts that patients offer to physicians are often an expression of appreciation and gratitude or a reflection of cultural tradition and can enhance the patient-physician relationship.”
This is a reasonable policy. Even a nonphysician like me can see how a gift could “enhance” a relationship – like that between reader and writer. (Incidentally, my suit size is 40 regular.) The AMA Code will warn that not all gifts are benign and urge physicians to demur if a patient is using them to influence care or secure preferential treatment. I would add that you should also be wary of implying to patients that gifts are expected or are necessary to secure proper care. One other consideration: If you are called upon to testify on your patient’s behalf either in court or in pretrial discussions, the fact that you have a stake in the outcome of his case could cause participants to discount your comments.
Update: The case was settled for more than $1 million. But Anonymous says in an e-mail message: “I (alas) was offered nary a penny. The patient, however, has a new house.”
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Q: I am an education researcher studying papers written by a group of university students. I promised them confidentiality and that they would face “no forseeable risks.” I discovered that one paper had been plagiarized. May I inform the instructor and cite the source from which the student stole if I do not name the student?
Someone at the office of my institution’s research review board suggested I drop this paper from my study; then I’m no longer bound by my confidentiality agreement. Is that OK?
Anonymous, Kentucky
A: Your contemplated backdoor promise-breaking is not OK. Leading the instructor to the plagiarist even indirectly – has brown hair, a Boston accent, loves cheesecake – subverts your pledge to the participants. This would not only offend ethics but also damage your profession by inhibiting future student participation.
There are circumstances when you should break your word – to prevent imminent serious harm to another person, say. If a paper revealed a student’s determination to shoot one of his classmates, you would have to come forward. But you may not do so to rectify this past misconduct. What you may do is contact the student, reassure her that you will not disclose her name and read her the riot act.
Your colleague’s letter-of-the-law solution is both bad ethics and a betrayal. Now the question is, Do you report him to his supervisors? Presumably he would say yes – but indirectly, maybe by re-creating your conversation in charades.
Write to Universal Press Syndicate 4250 Main St., Kansas City, MO 64111, or e-mail ethicist@nytimes.com.
