When the wealthy and reclusive copper heiress Huguette M. Clark died recently at the age of 104 , she left $30 million to her personal nurse and $100,000 to her doctor, among other gifts bequested to charities and her accountant and lawyer .
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The nurse, Hadassah Peri, was thrilled. She said in a statement to the media that said, in part, “I saw Madame Clark virtually every day for the 20 years. I was her private duty nurse but also her close friend.”
So what's the problem? A nurse who spent years caring for an elderly heiress got a great windfall. But there are serious ethical challenges when patients are the source of big gifts directly to their health care providers.
While hospitals allow gifts to the institution itself, most have strict rules against a doctor or a nurse personally accepting anything more than a small gift from a patient. And those rules make good sense. Patients ought not be put in the position of trying to bribe their nurse to get attention. And doctors and nurses must not shower favors on those they think might make them personally wealthy. And when a life hangs in the balance, you don’t want your doctor thinking about whether it is better for his bank account if you live or die.Story: Heiress Huguette Clark's will leaves $1 million to advisers
When it comes to big gifts to home caregivers, personal nurses and physicians and those who work outside hospital settings, the ethics are just as sticky but the rules are slim.
A patient, particularly an elderly and frail one, can get very dependent on a caregiver, particularly if they have few, if any, other social contacts. And a caregiver can be in a good position to start to influence the patient simply because they are there — never mind that they are paid to be, not because they necessarily have a strong emotional relationship to the patient.
Years ago, a private physician asked me if it would be appropriate to be named the conservator of his wealthy elderly patient’s estate. She wanted him to be in charge of her fortune, and he told me that she trusted him over anyone else she knew to do the right thing with her money. I thought this was a bad idea. If he was in charge of her medical care knowing that he stood to control a huge sum of money should she die, it would create a mountain of conflict of interest. If he had been at a hospital, that relationship would have been frowned upon — but out in the community there was nothing to prohibit it. In the end he became the conservator but stopped being her doctor.
People like Huguette Clark have the right to do with their money as they wish. Heck, when Leona Helmsley died she left $12 million dollars to her dog ! But the bequests that patients make directly to doctors and nurses who care for them in their old age in their homes or in private settings need close scrutiny by courts.
It is not always clear how competent a frail elderly patient might be when leaving big sums of money to one of the only few people may have seen for decades. Nor is it certain that ideas about how to make a gift were not suggested by those who might stand to benefit. And doctors and nurses are not above trying to alienate a patient from their families when the stakes are high.
Ideally, no doctor or nurse should allow a grateful patient to make them rich. In a non-ideal world, courts need to treat large personal gifts to healers as possibly in need of a legal cure.
Huguette Clark’s nurse promised in a statement to “devote a substantial portion of this bequest toward making the world a better place for all people.”
The ethical choice is for her, and Clark’s doctor, to donate all of their windfall.
Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.
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