Gordon Self

March 28, 2011

In this column I raise everyday ethical issues. Occasionally, unique ethical quandaries trigger reflection as in last month's column around boundary setting without judging or abandoning people living with addictions.

But certainly all of us can relate to managing another moral boundary — accepting gifts that come with strings attached. In this case, how do we ensure gift-giving practices do not cause us to abandon our own integrity?

Doing business with others involves the exchange of goods and services. In return, we compensate vendors based on the terms of agreement between parties. For example, I go into a jewelry store, find a watch and offer to make the purchase. After paying, I put the watch on and leave.

But doing business with others involves more than the exchange of goods and services. In many respects, good business is about building relationships.

If I am pleased with the quality of the watch and customer service received, I will refer other customers or return myself one day for another watch. Vendor and customer loyalty are measures of good business relationship.

Fundamentally, Catholic health care is a ministry. We are called to continue the healing ministry of Jesus and to provide compassionate, quality care to all we serve. While this is true, health care is also a business, one involving responsible stewardship of our resources. Careful attention to having sufficient means is part of this equation.

We also need industry relationships to advance our ministry. We cannot run Catholic health care without interacting on a daily basis with industry vendors to ensure we have the best quality and priced medical device, drug product or tool for the people we serve.


Like the example above, I may have the money in hand but I also need a jeweler. In a highly competitive market such as health care, vendors will want our business. It is our responsibility to ask the right questions to ensure their products meet patient and resident needs, based on the best scientific evidence and quality standards.

But what if in doing business with vendors they leave behind a few promotional items like pens and notepads, or bring in pizza for staff education sessions on a new product? Is this part of building good relationship or a subtle way of influencing our clinical and professional judgment?

While the infamous all-expense junket trips to exotic locales for questionable informational sessions have largely gone by the wayside, there is still ongoing prevalence of "nominal" gift-giving practices reported in the literature. This includes sponsored golf tournaments, hockey tickets and restaurant vouchers. Even innocuous coffee cards are considered suspect according to a number of studies reported in reputable medical journals.

There is a power of reciprocity at work. Think about your dinner party guests and how many friends you "owe" dinner.

The size of the gift is not the issue or even the prevalence. What is significant is whether the gift obliges you to reciprocate, leading you to compromise your professional and clinical judgment. Indeed, there is no such thing as the "free lunch." Ultimately someone pays for it; often the consumer.

What about everyday gift-giving practices on the clinical units? For example, is it OK for a grateful family to bring in flowers or chocolates to deserving staff? When my father-in-law died, I brought pizza for the unit staff in recognition of the exceptional service they provided Wally. Not only was it a gesture of thanks, but it gave our family an opportunity to bring closure, facilitating own grief process.


But what if I brought in pizza everyday? If two call bells went off at the same time and the staff could only respond to one, would staff be more inclined to respond to the generous family member first? Would they be free not to?

These are delicate questions that we face every day, also requiring sensitivity to any cultural norms at play. While refusing a box of cigars may be appropriate, refusal of tobacco from an aboriginal family may be deemed an insult.

I invite readers to think about their own business relationships and how often it is simply an expression of good will, and when it may begin to compromise your judgment. This requires honest examination and transparent discussion. While it may be hard to articulate rules given the many subtleties and case-specific occurrences, we can at least all think twice about whether we are influenced by gifts and if they compromise our most valued asset — our reputation.

(Gordon Self is vice president, mission, ethics and spirituality for Covenant Health and can be reached at