While we do not believe that the investigators should be prohibited from offering gifts in these circumstances, we believe the practice should be strongly discouraged. First, it has the potential to be unfair, with investigators preferentially giving gifts to patients and families with whom they have become emotionally bonded, and not to patients and families who were equally generous but with whom personal relationships were absent. Second, it would tend to create expectations among donors that monetary gifts should be forthcoming. In the absence of enforceable standards about the size of such gifts, donors could feel angry or insulted if their expectations were not met.
