AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. December 2000, Volume 2, Number 12.

From the Editor

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Gifts and Gift Giving

The journal editor introduces a theme issue focused on the various manifestations and consequences of gifts and gift giving in the medical industry.

Audiey Kao, MD, PhD

It came without ribbons! It came without tags!
It came without packages, boxes or bags!
And he puzzled three hours, till his puzzler was sore.
Then the Grinch thought of something he hadn't before!
"Maybe Christmas," he thought, "Doesn' t come from a store.
Maybe Christmas perhaps means a little bit more!"

In the Dr. Seuss classic, How the Grinch Stole Christmas, the Grinch believed that a Christmas without gifts would be no Christmas at all. After fiendishly nabbing all the presents and ornaments in Whoville, he was certain that the Whos would be deprived of their cherished holiday. But to his puzzled surprise, the Whos didn't need their material gifts and presents to celebrate Christmas. In the end, the Grinch realized that the meaningful gifts of Christmas were never those that were purchased in stores and tied with ribbon, but were the warm offerings of peace and happiness that came from the heart.

As we enter this holiday season, many of us will be searching--some of us up to the very last minute--for the perfect gift to give someone special. The ritual of gift giving has a long history and manifests in many ways in different cultures. In ancient Rome, the sacrificial gift was given to the gods with the hope of divine intervention in promoting fertile lands and women. The phrase "do ut des" (I give that you may give) was recited during these sacrificial rites. Each spring, Chinese celebrate the patriotism of a poet martyr by making an offering of rice that is wrapped in bamboo leaves. These offerings were initially made and thrown in the river where the poet died as a gift to the fishes so that they would eat the rice and leave sacred the poet's body.

In the world of medicine, gifts and gift giving also take many forms and come in a variety of packages. All of us who have labored through gross anatomy have benefited from the selfless act of those who gave their bodies to medical education. Many public service announcements promote organ donation by urging individuals to give the "Gift of Life" to potential organ recipients. In many communities, patients show their appreciation to their physicians with home-baked goods and similar gifts.

While these examples appear harmless, if not beneficial, other examples of gift giving in medicine raise concerns. Despite the relationship between medicine and industry in promoting quality patient care and scientific research, the potential for undue influence generated by gifts to physicians from industry is serious and demands attention and redress by the medical profession and others. In this era of genetic and molecular medicine, some consider our growing technical ability to correct fatal or undesirable germline defects in terms of a generational gift that current peoples can give to future generations. On the other hand, there are many others who view the use of these genetic therapies as opening Pandora's Box. Thus, the consequences of gift giving and of framing potential actions as acts of giving are far from benign and unbound; rather, they may have profound effects on medicine and society.

In this theme issue of Virtual Mentor, we explore the various manifestations and consequences of gifts and gift giving in the world of medicine. In some cases, a gift may truly reflect an act of altruism. At other times, a gift is not a free lunch, and the giver may be expecting something in return; giving, like the Romans, "so that you may give." Through our selection of topics and content, I hope that you will gain a better understanding and appreciation of the meaningful implications of gifts and gift giving in your professional career.

Audiey Kao, MD, PhD
Editor



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