Dr. Andy

Reflections on medicine and biology among other things

Sunday, March 13, 2005

The Ethicist

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.

4 Comments:

At 9:09 PM, Anonymous jb said...

When a doc does a Good Samaritan deed such as this, he benefits from a degree of legal protection that ordinarily does not apply. My understanding is that the burden of proof is on the plaintiff to prove that the care provided was way bad, not just outside the standard of care. In order to keep this degree of protection, the doc has to provide the care with no expectation of compensation. If Dr. Morrow receives such compensation, could he lose some of the Good Samaritan protection? Comments, updates, and corrections from actual trained lawyers are of course welcome (taking legal advice from a surgeon is as smart as having your hernia repaired by a lawyer).

 
At 9:01 AM, Blogger Dr. Andy said...

I have heard of a study that couldn't find a single case of a physician being held liable for providing emergency care in a "Good Samaritan" situaton, but I don't have a reference I could give you.

I doubt that taking a reward after the fact would change one's liability, but trying to charge for your services probably would (but I'm a doc too, not a lawyer)

 
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