Crowdfunding Medical Care Poses Ethical Quandaries for Physicians

In an era of skyrocketing costs and bewildering insurance policies and processes associated with medical care, it’s no wonder patients are getting creative in their efforts to fund their treatments. Notably, some are calling on friends, family, and even strangers to finance their medical bills through online outlets in an approach called crowdfunding.

“Despite its protean promises, however, medical crowdfunding raises a constellation of ethical and legal hurdles for patients, clinicians, institutions, and society,” write Michael Young, MD, MPhil (Massachusetts General Hospital, Boston), and Ethan Scheinberg, JD (Harvard Law School, Cambridge, MA), in a viewpoint published online, March 23, 2017, ahead of print in JAMA.

In addition to calling it “troublesome” that patients feel they have no other option but to resort to crowdfunding in the first place, Young and Scheinberg argue that this method of paying for care is not necessarily “equitable and ethically sustainable.”

Specifically, they write, only patients with the means to access the Internet have the opportunity to even start a crowdfunding campaign, potentially leading to an “underrepresentation of cases with the greatest need” akin to the criticized practice of affluent patients in need of an organ transplant purchasing one on the international black market.

A quick Google search turns up a multitude of patients and family members looking for financial support to fund care following a heart transplant, heart failure diagnosis, or myocardial infarction, as well as people seeking money for a new business venture or to put themselves through school.

Those able to start viral crowdfunding campaigns might also be given “preferential treatment or expanded access to experimental drugs,” Young and Scheinberg say. “Crowdfunding may thus engender a reprioritization of resource allocation favoring the most vocal, photogenic, or emotionally appealing, potentially crowding out causes with greater medical utility.”

For physicians especially, the authors point out the lack of guidelines on how to navigate the “sometimes difficult requests made by patients or families to participate in crowdfunding efforts.” This draws clinicians themselves into privacy and obligation issues.

And what if a physician finds that a patient’s crowdfunding campaign is purposely using misleading or even wrong information in order to raise funds? “Should crowdfunding platforms require that physicians verify medical supplications, or ensure that all relevant information that may reasonably inform donors’ decisions is provided?” Young and Scheinberg ask.

One of the “starkest ethical challenges” these activities can pose, the authors continue, is that they can “sometimes venture into illicit activities. . . . [This] is particularly notable in medical campaigns in which supplications may have particularly high emotional potency, and for which there is a strong financial incentive to generate sympathy and funds by providing exaggerated information.”

While clinicians “have no legal obligation” to manage these activities and ensure their accuracy, Young and Scheinberg write, the “ethical quandaries” are clear.

In order to improve these campaigns going forward and better specify the physician’s role, “[p]athways of disclosure should be clarified for clinicians interested in disclosing the minimal amount of information in the least disruptive and most discreet and effective fashion in settings of deceptive crowdfunding involving a patient,” they suggest. “Moreover, mechanisms of oversight of medical crowdfunding portals should be strengthened.”

Doing so will not be easy, however. “A patchwork of regulations, legal ambiguity, as well as a lack of oversight, reporting, knowledge on the part of clinicians, and direction from authoritative bodies pose substantial barriers,” they conclude. “Further discourse and empirical research around this topic is long overdue, and will only increase in importance.”