Smartphones pose new ethical challenges
Unscrupulous use is growing concern
The exponential increase in smartphones and social networking sites has led to concerns from some patients regarding the possible unlawful distribution of images outside the realms of their care.1
"This creates a unique ethical concern," says Rhys Van der Rijt, MBBS, of St. Vincent’s Hospital in Sydney, Australia. "As technology and social media become an integral component of modern life, it inevitably creates a potential interface between the clinical environment and non-private domains such as social media sites."
The unscrupulous use of clinical photography can affect the doctor-patient relationship, breech ethical codes of conduct, and have legal ramifications for the clinician, warns Van der Rijt.
"As everyone now walks around with a fully functional recording device, it becomes harder to prevent unauthorized recordings," says Jessica Wilen Berg, JD, MPH, a professor of law and bioethics at Case Western Reserve University in Cleveland.
Consent and confidentiality concerns
Patient consent and confidentiality are two fundamental ethical codes that may be breeched if the right approach is not taken in regard to clinical photography.1
However, over-enforcing rigid hospital policies and disallowing clinicians to take photographs disrupts an efficient tool for communication and compromises patient care, argues Van der Rijt.
"The clinician’s obligations to respect the patient’s rights of autonomy and confidentiality must be balanced against the benefits of clinical photography in each case," Van der Rijt says. Here are some of the primary ethical concerns involving smartphone photography:
• Informed consent. The expectation is that one will get the patient’s informed consent before any kind of recording, says Berg. If recordings are designed to be used solely for internal educational purposes, an "opt-out" model of consent might be used. In this model, patients are informed about the photography in general institutional documents and allowed to opt-out if they choose, but specific informed consent isn’t obtained for each use. Photographs used for non-clinical purposes, or for research, will need a specific, detailed informed consent, however, says Berg.
"The key, for either a specific consent or for an opt-out system, is a description of how the recording or picture will be used," she says.
• Security concerns. Smartphones raise significant security concerns because the devices are rarely used for purely professional purposes. "It seems inappropriate to take photographs on a personal device unless the consent specifically allowed for this and, thus, allowed for the personal use by the photographer," says Berg.
Partners HealthCare recently rolled out applications that allow clinicians to take pictures that are directly uploaded to the patient’s medical record, and are not stored locally on the phone.
"This is obviously a big advantage with respect to security, when you want to take a picture that’s going to be used for clinical care," says Thomas Cochrane, MD, MBA, senior ethics consultant at Brigham and Women’s Center for Bioethics and assistant professor of neurology at Harvard Medical School, both in Boston. "We still need to use caution and get consent when we want to take those images and use them for teaching or publication purposes," adds Cochrane.
Photos from personal devices should have strict electronic security and should be deleted as soon as possible if they are not used for patient records, advises Van der Rijt.
"Some hospitals are providing specific clinicians with work mobile phones to aid in the security of photographs and to ensure correct storage and disposal," Van der Rijt reports.
• Privacy. "Photography and videography in the clinic is becoming extremely common because we all have these great cameras in our pockets, built into our phones," says Cochrane. Photographs, especially when they’re personally identifiable, are a particularly sensitive type of health information, however.
"Once they are beyond the control of the photographer, these can be distributed to a large number of people or posted publicly," says Berg. "Of course, this concern exists with all digital images."
- Van der Rijt R, Hoffman S. Ethical considerations of clinical photography in an area of emerging technology and smartphones. J Med Ethics doi:10.1136/medethics-2013-101479