A recent issue of the Bulletin of the American College of Surgeons calls attention to the ethical dilemmas related to obtaining, using and sharing patient photographs. There is a rare medical provider who does not carry a smart phone, tablet or other device that can readily snap pictures of good quality. When we see something clinically interesting, we often heed the impulse to capture it in a photo without thinking of the implications of what we are doing. Although identifying features are often excluded from the pictures, there is still the question of patients’ right to privacy and consent.
One may be able to anticipate the need to take photographs, for instance, for use in a publication or to record a patient’s progress in healing from a procedure. In such cases, informed consent can be obtained in advance. Often pictures can help communicate the nature and extent of injury or pathology to a supervisory physician or consultant. In such acute situations, permission can easily be obtained from the patient or family members.
Once the photos are taken and used in the clinical setting, what should be done with them? Do they belong to the patient, the hospital or the physician? Most believe that they belong in the medical record and, therefore, they belong to the patient. Applying the ethical principle of justice, the patient has the right to control use of the photos. A counter argument, however, is that if the photos are to be used for educational purposes, then societal considerations apply. How can the photos serve the greatest good? With the ability to disseminate images widely via the internet, it is essential that identifying characteristics are absent and that communication occurs over secure connections.
Finally, when the photographs have served their purpose, they should be deleted from personal mobile devices. This is essential for security reasons and to respect patient autonomy and privacy. Unfortunately, there have been episodes of blatant unprofessional sharing of photos for the amusement of others, in some cases, leading to lawsuits. Such behavior is to be condemned.
Ultimately, practitioners must observe the policies of their home institution. When institutional policies do not address a particular situation, practitioners must inform their decision making with the basic ethical principles of autonomy, justice, beneficence and “first, do no harm”.
Means JM, Kodner IJ, Brown D, et al. Sharing clinical photographs: patient rights, professional ethics, and institutional responsibilities. Bulletin of the American College of Surgeons 2015;100(10):17-22.
Article by the Publications and Communications Committee