A Response on

Accepting gifts in an Organisational Structure

Giving gift to anyone is a way to show appreciation, gratitude, to show interest or sometimes
strengthen bond with others. But is it ethical to accept gifts in an organisation, even in case of
a noble profession like Medicine? The act gift giving is practiced from ancient times. But
when these gifts are offered to the doctors from their patients, the doctor’s tend to face ethical
dilemma.

In my opinion, when one is working in an organisation it is unethical to accept gifts from

customer’s, clients, or people associated with the organisation with some or the other reason.
Accepting gifts may be considered as a favour given to the person giving the gift over the
other customer’s or clients. Also, the person giving the gifts may take for granted the person
accepting the gifts and may expect extra help of favour. Such expectations may lead to
disobeying the organization’s code of conduct and can also bring the person accepting the gift
in very tricky situation where even his/her job can be held on risk. Also the reputation of the
organization can be affected. Talking specifically about doctors, as performing surgeries and
giving necessary treatment is a part of their job and patients are their clients. The doctors
charge fees for the treatment provided and hence accepting gifts other tan fees is totally
unethical to the profession.

According to previous studies, about 20% of the physicians receive gifts. The most common
of them includes: Chocolates, Baked items, Alcohol, expensive gift items and sometimes
even money. The different practices for accepting gifts exist: never, always and conditional.
It is considered as a “Professional misconduct” accepting gifts from the patients which also
suggests “boundary crossings” that eventually leads to “boundary violations”. But when the
gift is rejected by the doctor, the giver might feel offended or it is even considered as
impolite, but still not only doctor’s but all the professionals must make a habit of politely
deny to accept the gifts as this is good practice in their own benefit. There is a generalized
agreement that accepting any gifts from person related to the organization we are working for
in inappropriate. There are no practices, guidelines or articles that suggest acceptance of gift
is ethical. It is collective thought that, doctors should reject gifts given the patient-doctor
relationship does not allow any kind of ‘Give and Take’. When gifts are presented to the
doctors from patients they should consider these issues:

1. Is the gift given to get preferential treatment?

There are many situations where patients offer gifts to the doctors to get preferential
treatment. If patients get preferential treatment from the doctor, he is treated better
than other people and has advantage over others. Accepting gifts can change doctor-
patient relationship and also makes difficult for the doctor to discuss sensitive matters
 with the patient. If the doctor accepts gifts, and does not change the standard of care,
the patient may feel displeased.
2. Is the gift offered of a personal care?
Gifts of personal nature should be rejected to maintain the boundaries of
professionalism. It is not mentioned in any professional code of conduct to accept any
kind of informal gifts from anyone associated directly or indirectly with that
organisation or profession.

3. Is the gift excessively valuable?

Monetary gifts might be seen as “tip” or “paying off” the doctor. There are cases
where doctors have accepted large monetary gifts and have attracted media attention,
leading to decline in public trust. Trust issues arise due to such practices.

Within the medical practices, the main argument that arises from accepting gifts from
individual patients is need for justice and equality while dealing with patients. If doctors will
accept gifts from patients who can afford them, then the question arises, will doctor be able to
give same attention and priority to all the patients equally? Accepting gifts will develop some
“favourite” patients, and therefore develop risk for others. Doctors will then spend more time
and attention to those ‘favourite’ patients which will lead to violation of the doctor’s code of
conduct. This will also lead to internal conflicts and rivalries amongst other doctors as well as
staff. A doctor who becomes a friend can no longer take critical decisions related to
acceptance of gifts.

Offering gifts does not always show ‘gratitude’, or ‘thankfulness’ or to develop a bond. It can
also be offered to satisfy personal interests or benefits. Gifts can be offered to doctors in the
form of bribe to do illegal things. Such as:

1. Bribe can be offered to doctors to change the medical report.

There are number of cases when bribe was offered to the doctor to change post-
mortem report, mainly in accidental or murder cases. This is highly unethical as the
doctor is defying with his profession and indirectly supporting a criminal. This can
also result in damaging the doctor’s and the medical institutes name if the crime is
caught.

2. It can also be offered to know the sex of the unborn child.

Sex determination is illegal in India: In Indian society still some people want to have
a boy and do not wish to have a girl child. Hence once the lady is in pregnancy,
people bribe the doctor to conduct sex determination test so as to determine sex of the
child. If the tests show it is girl child, they think of undergoing abortion.
 3. To undergo abortion.
As discussed in point above, if it is witnessed that the baby is a girl child, people
again bribe the doctor for abortion which is also illegal practice. Many doctors have
been caught and their degrees have been seized for carrying out the abortion.

4. Prescribe illegal drugs or steroids.

There have been some cases where the doctors have been bribed to provide
prescription for drugs and medicines which are otherwise not advised in normal cases.
Such drugs and steroids are very difficult to reach by common man. It is also an
illegal practice to prescribe such drugs and getting caught can impose a huge
punishment.

5. Illegal human organ trafficking.

Human organ trafficking is practiced in many parts of the world. The main reason for
this increasing demand for organ transplant, especially kidney transplant is very high
and common. Doctors are even bribed to commit crime as sinful as this. Few cases
have been witnessed where even for the minor stomach ache, the doctors have
prescribed to undergo surgery and without knowledge of the patient, their kidneys
have been removed. Many doctors have been announced life time jail for committing
such crime.

6. In many hospitals, babies born in poor families are given to rich families who bribe
the doctor.
This is a reality in many hospitals where children born in poor families are given to
rich families who offer money in return to the doctors. The poor family is told that the
child is dead upon his/her birth. As rich people offer more money, some doctors agree
to help them even if it something their profession don’t allow.

According to the American Medical Association: Council on Ethical & Judicial

Affairs
 Even in some cases, if a doctor accepts gifts, it should be of benefit to the
patients not himself/herself, and also it should not be of any substantial value.
 Any subsidies from the industry should not be accepted directly or indirectly
to pay for travelling cost, stay, or any personal expenses of the doctors who
are attending any conference or meetings.
 No gifts should be accepted if there are strings attached in any form.

The doctor’s must not encourage the patients to give or lend money or any kind of gifts,
which will directly or indirectly benefit them. Also, the doctors must not pressurize patients
or their family members to make donations to any organisation or people. If a doctor accepts
gift once, it will not be a onetime event. It will occur again and again. The patient will start
expecting some kind of particular behaviour from the doctor, which may be difficult to
achieve. A boundary must be decided in a doctor-patient relationship to avoid such situations.
As the intention of giving gift is not clarified by the patient, it becomes an issue. Such
practices can spoil the reputation of ‘doctors’ profession as whole. As all patients are same
for a doctor, be it a poor, rich, black, white or even a family member of the doctor, accepting
gifts from anyone can create differences in behaviour, judgement and preferences amongst
the patients. The doctor must abide by the rules of his profession.

Suggested Strategies:
The patient may easily interpret the rejection of gifts as personal rejection; therefore the
doctor should carefully choose words and a tone of voice which will convey refusal of gifts in
such a way that will not affect the doctor-patient relationship. There are several strategies for
refusing a gift from a patient or drawing a boundary line for future:

i) Use of soft tone such as “I appreciate your gratitude over the years, but I cannot
accept such gifts, as it is against my ethical or professional standards. These gifts are
likely to influence me, and indirectly other patients will face injustice.”
ii) By saying that it is against their personal principles: “I appreciate your gesture, but I
have a general principle that I do not accept gifts from patients. The best gift you can
give me is being satisfied with whatever treatment I provide you and by following my
prescriptions and suggestions strictly.”
iii) By reassuring the patients that even if they bring gifts to the doctor, all the patients are
same for him and all will be treated with equal care and attention.

CONCLUSION:
Accepting gifts from patients remains an issue that divides the doctors. Gifts should
not be accepted in any situation be it in medical profession or any organisation, one
should be faithful towards organization as well as job. When the patient offers gift to
the doctor, the problem is that the receiver is swayed to make decisions. The doctors
should maintain professionalism and straightway reject all the gifts offered to them.
So technically, accepting gifts was and will always remain unethical in my opinion.
References:

1. Spence.Sean.A (2005, Dec 24-31). Patients Bearing Gifts: Are There Strings
Attached? Retrieved from URL https://www.jstor.org/stable/25455752
2. Andrew Caddell, Lara Hazelton (2013, Dec). Accepting gifts from patients.
Retrieved from URL https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC3860914/
pdf/0591259.pdf
3. Dr. Penny Browne (2017, Nov 14). Bequests from patients: an ethical dilemma.
Retrieved from URL https://www.avant.org.au/news/bequests-from-patients-an-
ethical-dilemma/
4. Elizabeth Gaufberg (2007, Aug 1). Should Physicians Accept Gifts from Patients?
Retrieved from URL https://www.aafp.org/afp/2007/0801/p437.html