Grateful patient fundraising has come under ethical scrutiny amid increasing United States (U.S.) healthcare financial pressures. However, there is a paucity of scholarship applying theoretical frameworks to better understand the ethical complexities of this topic. Grateful patient fundraising (GPFR), refers to the professional practices and various methods utilized by healthcare providers, institutions, and development professionals to identify, encourage, or directly solicit charitable financial contributions from current and former patients and families (Collins, Rum, Wheeler, et al., 2018; Edwards, 2022; Tovino, 2014). GPFR is of growing interest as an area of empirical study and ethical debate. As a testament to its growing importance, the Association of American Medical Colleges (AAMC) for the first time asked institutions about grateful patient programs in its 2021 annual development survey (Association of American Medical Colleges, 2022a). With ongoing pressure on finances in U.S. healthcare, a deeper understanding of the fundraising practices and tactics used by physicians and development professionals to engage patients and families in giving mission-critical philanthropic dollars was warranted. To better understand the GPFR phenomenon, twenty-three physicians involved with direct patient care across three private nonprofit AMCs in Philadelphia, Pennsylvania participated in semi-structured interviews in order to learn how they professionally and personally understood the ethics of patients being identified, solicited, and thanked for philanthropic dollars by healthcare providers and their institutions. A normative ethics rights-balancing theoretical framework (MacQuillin, 2021, 2023; MacQuillin & Sargeant, 2019) was applied to better understand and inform ethical GPFR practices and donor cycle stages including identification, research, solicitation, and stewardship.