Getting a Valuable Gift From Patients: Tempting but Wrong?

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at the NYU Grossman School of Medicine.

I'm going to talk to you about a case drawn out of my clinical case ethics experience. This was really a surprise, and it was very interesting. I think there may be diversity of opinion about this case. It's not about medical intervention, but a situation that was presented to me by a physician friend. He said it was hypothetical. I think it was real.

It was a famous artist who was undergoing treatment. We'll call him Pablo. He was undergoing deep brain stimulation, where you put a needle into the brain and stimulate an area of the brain for tremors. He had parkinsonism and it had kept him, as it got worse, from being able to paint for the past few years.

This newer intervention, the so-called deep brain stimulation, which is being made available in many hospitals around the world now, helped stop his tremors, and indeed, he began to return to painting and returning to his art. He was very grateful for this. He had been just despondent that he couldn't pursue his art.

Pablo painted a little picture and said, "I want to give it to you, the doctor, as a gift. It's just out of my gratitude. You know, I was even thinking about committing suicide if I couldn't paint anymore. Now, I'm back and my gratitude really knows no bounds."

Well, one problem that the doctor faced is that Pablo's paintings go for millions of dollars. They don't cost the artist anything, and there's no value in that sense when he gives the little gift to the doctor. But there is a market, and Pablo's work really was out there as something that could be resold and used to make a huge profit.

Now, this isn't quite getting brownies from a grateful patient, which I know goes on and I don't have any heartburn about, but ethically, many institutions say you cannot accept gifts from grateful patients. The doctor said, "Yeah, but this painting isn't really valuable unless I resell it."

My own attitude was that you have to think hard about how it's going to be viewed in terms of its value. Its value is not whether you intend to try and resell it and make the money. Its value is what it is on the open market, and I think you just got a gift that you shouldn't take because it is worth millions of dollars.

Is that it? He can't accept the little painting? My suggestion might be that instead of making that as a gift to the doctor who did the treatment that got rid of the tremors and let Pablo come back to the world of the art of painting, maybe the gift could be made to the department, the medical school, or the hospital. It could become part of their ownership, and they can handle the tax implications or whatever else there might be, but it would not be a violation of the idea that grateful patients should not be expected, allowed, or permitted to give individual doctors huge gifts.

I know that fundraising often goes on where a doctor asks a patient who's had a good experience if they'd be willing to contribute money to research to support activities at the hospital. I think the little painting falls into this category.

It's something that, ethically, you want to use its value to bolster more access to people who might benefit from neurosurgical interventions; more access to doctors, postdocs, fellows, and residents who can get trained in doing improved versions of deep brain stimulation within your department; or just to help the hospital or medical center overall.

I think that's acceptable. I think we all understand that gift-giving is part of philanthropy. No to the individual doctor taking the little painting. Yes to taking that little painting and putting it to use under the aegis or ownership of the department or the institution.

I'm Art Caplan at the Division of Medical Ethics at NYU Grossman School of Medicine. Thanks for watching.

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