PlainViews

EthicsWalk addresses spiritual care as an ethical enterprise. It explores why relationships between spiritual care providers and those they serve need protection, and examines what that protection entails. PlainViews invites our readers to share their responses to each EthicsWalk column, which will be published in the following issue.

If you’d like to respond to EthicsWalk, please send a comment of no more than 100 words. You can use the e-form below (click on "hearing from you," link) or submit your commentary to the editors in the body of an e-mail (or as a Microsoft Word attachment) sent to Info@PlainViews.org. Please put the phrase “EthicsWalk” in your subject line.

We look forward to hearing from you.

The Gift of Declining Presents

Should spiritual care providers accept gifts from those served?[1] Would Eid al-Fitr, Christmas, Hanukkah, and Kwanzaa pose exceptions to general prohibition? Are these questions, considered in CaseConference #2, those of Scrooge or professional ethics? Reader responses to the CaseConference are wise. Similar ones end this column.

Chaplaincy Ethics Codes are silent about gifts. Institutional policies fill the gap but often don’t clarify the humane reasoning. Most professional and industrial Codes of Ethics and Advisory Opinions prohibit or narrowly restrict the giving or receipt of gifts. Concerns about actual or perceived bribery or extortion[2] drive many.

Government regulations covering holidays, as well as other times of year,[3] prohibit employees from making gifts to supervisors or donations to causes on behalf of superiors. All are prohibited from accepting gifts (over $10) from anyone with whom the employer does business.

What constitutes a “gift?”[4] American poet Ralph Waldo Emerson wrote, “The only true gift is a portion of thyself, Thou must bleed for me.” As noted in last month’s column, too many recipients of health services in the U.S. are involuntarily “bleeding” to pay their providers. Should gifts, albeit voluntary, be added in?

Like most transactions between professionals and persons served, gifts are seldom a private matter. Implications abound for third parties. Hearing my Pilates teacher rave about presents from other students last week, I winced and questioned silently the possible implications (for her attention) of my practice of no gifts for professionals who enhance my life (as distinguished from people who provide newspaper, mail, and trash services). She didn’t solicit gifts, but she did accept. What does that mean for me, the non-gift giver?

If the gift has “no value” does it matter? A “no value gift” is an oxymoron for people of faith who recognize that “value” attaches by the act of giving, not purchase price. The “why” of giving is always different. The potential for real or perceived favoritism or “special closeness” is always alive. Below are suggestions for receiving the “giving” but refusing the present.

1. Follow your institution’s policy. Most prohibit anything other than hospitality tokens: cookies made by family members, bouquets patients can’t take home.

2. While declining presents, take time to thank persons for the gifts their lives provide. Help patients recognize how their life blesses others regardless of their state of diminished health.

3. In rare instances, accept a gift on behalf of the Spiritual Care Department. Specify the money or item is going to the institution (check with your supervisor or ethics committee).[5]

4. If patients persist in personalizing it, the gift might be in your honor.

5. If #1 – 4 are pastorally impossible or not supported by your institution and you accept a gift, clarify how it will be used at the time you accept: “Our hospital library will appreciate this book.”[6] “I will sign this check over to Katrina relief efforts.” If the gift could have value (sentimental or monetary) to family, consult family first. If donor and family are alienated, your task is facilitating reconciliation, not brokering heirlooms.[7]

6. Substitute “spiritual care providers” for “physician” in this title from a medical journal and ponder its message: “Should Physicians Accept Gifts from Their Patients? No: gifts debase the true value of care.”[8]

This holiday season, remember to thank your colleagues and honor yourself for the gifts each of your lives bestows.

[1]“Ethics Walk,” PlainViews, 12/01/04 (vol. 1, no. 21) suggested that accepting gifts from people served is a boundary issue. One reader’s response to CaseConference #2 elaborates this point well.
[2] Bribery refers to influence on decisions or actions subsequent to and based on a gift; extortion implies a gift is required in order to obtain a favorable decision or action. Both may be reflected in individual’s increasingly lavish gifts to doormen, maitre d’s and private school teachers in large U.S. cities!
[3] For example, CFR Part 2635, Subparts B,C, & H, December 2004 “Summary of Holiday Season Gift Rules.” Such rules are the basis for the highly publicized ethics cases before several state and federal government bodies.
[4] Economists, philosophers, sociologists, anthropologists, ethicists, scholars of religion and law, have published tomes on “the gift” and “ethics of gifts in friendship and business” through out history. A delightful compendium of such is The Question of the Gift: Essays across disciplines, edited by Mark Osteen. Routledge, 2002.
[5] To avoid potential legal consequences, no contribution/gift over $250 should be negotiated or accepted by you even if you are not the direct beneficiary. The donor’s lawyer or the institution’s Planned Giving professionals should handle the transaction. Never accept or arrange for gifts of money or items of value from people receiving government assistance or in bankruptcy.
[6] Caution: If you accept one family Bible how do you decline others? How many does your institution want?
[7] I am indebted to a conversation with Rabbi David Zucker for this discussion.
[8] Weijer C. “Should Physicians Accept Gifts from Their Patients? No: gifts debase the true value of care.” Western Journal of Medicine, 2001:175:3.

Anne Underwood has an undergraduate degree in religious studies, a master’s degree in rural sociology and a mid-life law degree obtained after working over a decade as a college administrator. She has mediated for the Maine family courts since 1983. Currently she serves as an advisor to the ethics commissions of ACPE, APC, the CCAR (Central Conference of American Rabbis), and NAJC, and consults with a variety of Protestant faith communities on issues of power, fair process, and congregational conflict management. Her articles on mediation and restorative justice have appeared in the ACPE News, The APC News and on the ACPE web site. Articles on clergy accountability and judicatory processes are published by the Alban Institute and The Journal on Religion and Abuse. A chapter, “Clergy Sexual Misconduct: A Justice Issue,” appears in Body and Soul: Rethinking Sexuality as Justice-Love, Marvin Ellison and Sylvia Thorson-Smith, editors, The Pilgrim Press, 2003.