Physician-Patient Relationship. When Gift Becomes Bribe Essay (Critical Writing)

Gift and Bribe

As the concept of gift and bribe is variable and differ from country to country in regard to particular cultural context and the cultures are not the all alike, the definition or conceptual understanding of both gift and bribe is not the same. Despite, efforts have been made to define gift and bribe. According to the Markkula Center for Applied Ethics (ETH301), a gift is something of value given without expectation of something in return.

Gift is considered as a sign of goodwill or of appreciation. On the contrary, a bribe is the remuneration for the performance of an act which is inconsistent with the work contract or nature of the work one has been hired to perform. Of course, bribe is not only limited to a physical form e.g. money, gift, entertainment but can also include the form of a kickback. The difference between gift and bribe is that a gift is the consideration as an exchange of love, affection or appreciation.

The intention of the gift is the cardinal aspect for consideration relating to gifts if the likely perception of the gift-giving relationship is that the gift could influence the intended recipient’s performance of his or her official function, and then the gift should not be accepted. But, bribe is intended to corrupt any proceeding unlawfully and with criminal intention. According to Dictionary.com bribe is the “money or any other valuable consideration given or promised with a view to corrupting the behavior of a person, esp., in that person’s performance as an athlete, public official, etc.” (Brody, Rowman and Littlefield, November, 2007).

Actually, gift is the bribe because it impacts upon the minds of the people to favor the person or groups from whom they receive some incentives or benefits instead of performing their statutory duty. “Dishonest and ingenious doctors can take in sums much greater than $100,000 a year” (Veracity, 07 July, 2005). An article published in 1992 on The New England Journal of Medicine written by Douglas Waud, M.D., suggests that the term gift should be understood as bribe. This bribery includes providing meals, giving key-ring, fax machine or car phone or free trips for tour and other gifts which severely damage the professional ethics of the doctors.

Gift and Bribe around the World

Both gift and bribe are inter-linked and proper explanation is required for their better understanding. They have taken an important place almost in all the economies. Due to the malpractices done by the doctors, the health and welfare ministry of South Korea has ordered doctors to prescribe generic drugs only and has warned that those who violate this rule will not be reimbursed. “By the end of April, 150 doctors had been accused of receiving illegal benefits and police had passed a dossier on to the Korean Medical Association” (Gulland, 26 May 2001). In all former soviet blocs, giving bribe to the doctors under-the -table is predominantly prevalent.

The fierce is that doctors warn the patients that without receiving the payment, they would not provide treatment which in turn, would lead them to the death. “’The practice of “informal payments” to doctors for faster and better care equals 5 to 30 per cent of all health care spending in most countries in the region” (Colquhoun, April-May 2004). In Malta, the bribery practice in medical profession is much dominant. Of course, Govt. has also taken rigorous approach for effectively eliminating this corrupt practice. Galizia (22 September 2006) provides that “[t]he Chamber of Small and Medium Enterprises in Malta has suggested to the government that it should bar doctors from prescribing branded medicines, obliging them to prescribe generics instead” In Australia, “[t]he Australian Competition and Consumer Commission have decided to impose a new code of conduct which will require pharmaceutical companies to detail the cost and type of expenses they provide to doctors” (Barlow, 27 July 2006).

Effect of Bribe Culture

“Twisted together like the snake and the staff, doctors and drug companies have been concerned in a web of interactions as controversial as they are ubiquitous” (Moynihan, 31 MAY 2003, p.1189). Many physicians receive multiple gifts from drug companies every year. Consequently, they are becoming more corrupt and the spirit of medical profession is breaking down. Common people are getting more frustrated. Due to the frequent bribe practice, following results are merged:

1. Interaction between doctors and drug companies influence the behavior of the doctors.
2. The ratio of pharmaceutical expenditures is increasing rapidly and closer entanglement between doctors and drug companies are affecting the prescribing strategies.
3. Gift giving culture on the part of the companies creates an entitlement and obligation for the doctors that conflict with their primary obligation to patients.

Professional Ethics

Ethical Values meant the core ethical behavior which includes trustworthiness, respect, responsibility, fairness, and confidentiality. Personal ethics or morality can be implemented through social forces which ultimately help in sound and efficient regulation of laws. Professional ethics has somewhat relevance with personal ethics or morality. Professional ethics are observed by the codes of conduct. This code of conduct applicable for a particular profession detail the norms and principles to be adopted for the promotion and perfection of the services provided to the people. Virtually speaking, bribery corrupts the medical profession and takes away hundreds and thousands of lives silently.

Though it is considered as an offence and contrary to the ethical values, this may be accepted subject to the satisfaction of some stipulations; such as, an accepted practice in many countries, but not in the form of right or legal claim, practiced as a form of commission, avoiding red tape or seeking patronage, protection and security. In a phrase, from the viewpoint of professional ethics, bribery in medical profession instead of serving peoples’ treatment does not suggest the relevance or rationality.

Over the past decades, people have been more conscious about their health care. The genesis of Interest groups for protecting peoples’ health advocates the mass realization of improving their health care. In the recent decades, there is a growing concern against the medical professionals on the point of taking bribe from the drug companies in prescribing their drugs to the patient. It is suffice to say that bribery is dangerous for any business as it affects the common people in their consumption and create distrust or no-confidence on the businesses.

More importantly, bribe in medicine industry certainly prove adverse effect producing gross disaffection among people. In this concern, doctors are overly responsible. Because, whatever the drug companies do, doctors are responsible to rightly scrutinize the efficacies of the medicines or drugs before prescribing them.

NewsTarget.com (18 July 2005) states in a report that “[i]n 2001, 2.8 billion prescriptions were filled in the United States for an average of 9.9 prescriptions per person” Actually, this figure is too much than the actual need for the people. Doctors do this practice, i.e. prescribing unnecessary or extra drugs at the continuous persuasion by the pharmaceutical companies in exchange of bribes provided to them. The trend of increasing number of prescriptions does not suggest that there is a rise in illness or the availability of new drugs which effectively mitigate or help curing the chronic diseases; rather it is the result of corruption in medicine industry.

Actually, while prescribing medicines most doctors do not rely on the scientific research; they base their decisions on the basis of the popularity of a particular drug(s) which implies the advertising and marketing efforts of drug companies. This has been flourished for being more tempted in gaining cash rather adhering to the professional ethics and values of serving the people providing them proper medication. Consequently, a culture of bribery has been evolved.

Physician-Patient Relationship

The relationship between physicians and patients is the fiduciary relationship.

“… its foundation on the theory that the former [physician] is learned, skilled and experienced in those subjects about which the latter ordinarily knows little or nothing, but which are of the most vital importance and interest to him, since upon them may depend the health, or even life, of himself or family. “[T]herefore, the patient must necessarily place great reliance, faith and confidence in the professional word, advice and acts of the physician” (Witherell v. Weimer, 1981). So, giving or taking incentives or gifts are the contravention of their fiduciary relationship with the patients. The phenomenon of corruption or bribery culture in medicine industry is frequently going on all around the world. In addition, it is said that in the language of Richards, et al. (28 August, 1989),

“The shifting economics of medical care has destroyed the traditional physician patient relationship. Physicians were once independent practitioners who intermediated between their patients and medical businesses such as hospitals and laboratories. Now these businesses use financial incentives to manipulate patient care to benefit a third party.” (p.38)

Such third party resorts to illegal means providing cash bonuses and gifts to the doctors for earning profits in persuading the doctors for prescribing their (third party) drugs. Again, they provide a certain amount to the physicians and clinics for the care of the patients.

Conclusion and Recommendations

From the present study, it is very much transparent that gift is the reward of appreciation or goodwill, but bribe is an illegal means to corrupt any procedure or taking something through illegal means. So, gift become bribe when a corrupt or illegal flavor is clothed with it by passing the dictates of law. It is the professional ethics of the doctors to serve the people. Instead of providing proper treatment, if they resort to earning money and cause untold sufferings to the patient it is certainly against the civilized norms. Undeniably, doctors should strive for rendering the better services for the people.

Unequivocally, code of conduct is necessary for the proper regulation, perfection and professional excellence in every profession. Relevantly, the medical profession is also of no exception to this. To bring a working change and eliminate this corrupt practice of bribery, following considerations may be recommended:

1. The medical professionals should be prevented from advertising their publicity.
2. No prescription of medicines on letter pads should specify the name of drug shops.
3. Abolition of the payment of a commission by the specialist to general practitioner when a patient is sent to him.
4. Stringent provisions should be made to prevent unnecessary hospitalization, tests, drugs, surgery for the purpose of earning more money.
5. Strict legislative framework should be developed to curb the bribery practice, i.e. prescribing drugs of any particular company for gaining gifts. In contravention of such provisions the convict physicians must be punished.
6. A well-formulated code of conduct should be framed to be followed both by the doctors and the drug companies or pharmaceuticals.
7. Provisions should be made so that quack or unregistered doctors cannot be allowed for performing the treatment. In contrast to this, they should be punished as per the provisions of law.
8. Provisions should be made so that doctors can not accept any advantages from another doctor or organization in case of the fact that a patient has been referred or sent to the latter for consultation or for treatment.
9. When prescribing drugs for patients, the doctor should not take charge from any pharmaceutical
10. A central ‘Ethics Committee’ should be established with the functions of supervising and monitoring whether there is any bad practice in the state. The committee would also deploy its representatives in every drug company for the implementation of drug legislation and complying with the code of practice that is designed for restricting the abuse of medical prescription. Again, a code of practice should be developed for curbing malpractice made by the doctors or medical profession.
11. Government should develop a central database system including the information of the doctors, health sectors, clinics and hospitals as well as the services provided by the public and private hospitals and prescribe the duties and responsibilities of doctors while nursing a patient for services. In this connection, Australia can be the example. Australia has set its plan to make the drug companies more transparent through the introduction of a new website providing the details of their activities and making the relevant information accessible to the public for the significant public scrutiny and developing a transparent framework of medicine industry in the country.
12. Public discourse is the most effective means to effectuate any program successfully. So, citizens group should be formed to make open discussion over the matter and collect citizens’ inconveniences and recommendations. These would widely help the policy makers in developing a more sophisticated legislative framework.
13. Only law cannot bring a change. So, mass awareness is one of the prerequisites. In this case, mass media, i.e. electronic and print media should be more active in raising mass awareness over the issue.

Reference

Witherell v. Weimer, 421 N.E.2d 869 (1981). See also: Fure v. Sherman Hospital, 380 N.E.2d 1376 (Il 1978); Taber v. Riordan, 403 N.E.2d 1349 (Il 1980); Loudon v. Mhyre, 756 P.2d 138 (1988); and Hoopes v. Hammarger, 725 P.2d 238 (Nev. 1986). Cited in Physicians and their Profession: Do Racketeering Rules Apply? LSU Law Center’s Medical and Public Health Law Site. RICO / Fiduciary Duty.

The Markkula Center for Applied Ethics (ETH301). Earthboyrod. Web.

Richards, P. Edward., et al. (1989). Physicians and their Profession: Do Racketeering Rules Apply?National Law Journal, Monday, p. 38. Web.

Gulland, Anne. (2001). South Korean government restricts prescribing to cover debt. BMJ (7297):i. Web.

Moynihan, Ray. (2003). Who pays for the pizza? Redefining the relationships between doctors and drug companies. 1: Entanglement. BMJ 326:2003, 1189-1192. Web.

Colquhoun, Patrick. (2004). Romania deserves better than medical terrorism. BNET-Business Library. Web.

Veracity, Dani. (2005). Physicians and bribery: a closer look at this common medical industry practice. Natural News.com. Web.

NewsTarget.com. (2005). Physicians and bribery: a closer look at this common medical industry practice. Web.

Barlow, Karen. (2006). ACCC implements new code of conduct for doctors. “AM”, ABC Radio National. Web.

Galizia, C. Daphne. (2006). Yes, Dr Mallia, some doctors are corrupt. the Malta Independent. Web.

Brody, Howard., Rowman., and Littlefield. (2007). The Framing Problem, and Physician Bribery. Hooked: Ethics, the Medical Profession, and the Pharmaceutical Industry. Web.