Today's NY Times feature "The Ethicist" has a letter from a scrupulous physician, Jon Morrow. Dr. Morrow responded to a call from help during a commercial airline flight and helped a sick passenger. He was offered a reward of frequent flier miles by the airline but declined. He wonders if it would be ethically okay to accept such a gift.
The columns author, Randy Cohen, responds that he should feel free to accept the gift, as it was given freely. I agree (which I often don't with Mr. Cohen), but I think his analysis leaves out one important point: the airline seeks no untoward secondary gain from giving the reward.
Consider a similar scenario. Dr. Morrow sees a patient and appropriately prescribes a course of expensive medication. Dr. Morrow acts of pure intention, prescribing what he believes to be the most appropriate treatment. Two days later, a drug rep from the pharmaceutical company who makes the expensive treatment calls to offer an expensive gift, say dinner for two at a fancy restaurant, as a "thanks" for prescribing the treatment. Can Dr. Morrow accept?
I think not. Doing so would call into question his motives and could be seen as a sort of bribe. The drug company is rewarding him not for doing the right thing, but to encourage use, appropriate or not, of its product. Also, the miles are a reward for an unusual (and otherwise uncomensated) action. Seeing a patient and prescribing a treatment are part of a docs expected duties, and so deserve no special reward.