© The Author 2014. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com Medical Bribery and the Ethics of Trust: The Romanian Case TEODORA MANEA* University of Exeter, Exeter, United Kingdom *Address correspondence to: Teodora Manea, PhD, 19 Saxon Road, Exeter, EX1 2TD, UK. E-mail: e.t.manea@exeter.ac.uk Medical bribery seems to be a global problem from Eastern Europe and the Balkans to China, a diffuse phenomenon, starting with morally acceptable gratitude and ending with institutional brib- ery. I focus my attention on Romania and analyze similar cases in Eastern European and postcommunist countries. Medical bribery can be regarded as a particular form of human transaction, a kind of primitive contract that occurs when people do not trust institu- tions or other forms of social contract that are meant to guarantee their rights and protect their interests. Concluding with strategies to fight medical bribery, I will underline better public policies for financing health and social care, and an ethic of trust that may help to restore trustworthiness of institutions and to rebuild inter- personal trust. This should be complemented by an educational program dedicated to understanding the negative consequences and mechanisms of corruption and the importance of ethical behavior. Keywords: gratitude, medical bribery, patient–physician rela- tionship, postcommunism, trust I. BACKGROUND AND CAUSES OF MEDICAL BRIBERY Medical corruption is a phenomenon with different shades and degrees of immorality. Someone may just show their gratitude by giving the doctor a card, a bouquet of flowers, a box of chocolates, or an expensive wine. Gratitude is part of our socially accepted norms and giving expression to it is generally morally acceptable. The gift only becomes bribery and as such morally questionable when it is given (by the patient) or requested (by the doctor) as a condition for the provision of health care, access to medical Journal of Medicine and Philosophy doi:10.1093/jmp/jhu049 Journal of Medicine and Philosophy Advance Access published December 10, 2014 by guest on December 10, 2014 http://jmp.oxfordjournals.org/ Downloaded from