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David V. Forrest has shared his approach to soliciting charitable donations from his patients in order to replenish the financial endowment of psychiatric treatment and research in the hospital in which he works, and proposes this as a model for colleagues working in other institutions. Dr. Forrest is a thoughtful man, who has published some 30 excellent articles in this Journal alone. Yet, while I do not doubt the sincerity of Dr. Forrest's intentions, and am entirely in sympathy with his wish to redress a glaring and painful fiscal inequity, I find the solution that he implemented ethically questionable and its rationale incomplete. I further find his method of solicitation, via a letter to his patients, clinically precarious, even if, as he hastens to assure us, “No patient dropped out since the letter was sent. … No treatment appeared to be affected, and no dreams or other latent material seemed to reflect the letter.”
Dr. Forrest lists three provisos that were suggested by the Columbia Department of Psychiatry, although he does not share with us the lines of ethical deliberations that led to these conclusions, nor do we learn of the balance of consenting to dissenting opinions, if any. Nevertheless, according to him, it would be deemed ethically acceptable to appeal for funds from patients currently in treatment, providing that:
the patients are from the psychiatrist's private practice,
the psychiatrist is not the recipient of the donation (for example, by being a voluntary professor), and
* Indicates Member, Editorial Board, Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry.
“Seal up your lips and give no words but mum,” Shakespeare, Henry VI, Part 2, Act 1, Scene 2.
the psychiatrist would have no knowledge of the patient's donations or declining to donate.
Though warned by colleagues that he would lose pat