Setting: A district hospital in East Africa

Scenario: A recently-graduated expatriate physician is completing a two-month training elective in a district hospital in East Africa. During this time, a senior expatriate physician from an international medical non-governmental organization arrives at the hospital for a short two-week locum. The senior physician is soon observed by the junior physician and by hospital ward staff photographing patients who have diseases that are advanced in stage or rare in Western countries. In one instance, she shakes awake a sleeping patient with tetanus in order to take pictures of the painful muscle spasms that ensue. The junior physician learns that the senior physician intends to incorporate the photographs into future public presentations in her home country. The junior physician observes this behaviour with concern, particularly since the senior physician does not seem to obtain patient consent prior to taking photographs. However, the junior physician is hesitant about voicing his opinion given the seniority of his colleague as well as his own role as a guest in this context. He wonders how his local colleagues feel about the photograph taking. The junior physician feels unsure about what to do.

Analysis: Apply this case to the Humanitarian Healthcare Ethics Analysis Tool (HHEAT). The HHEAT  is intended to facilitate discussion and deliberation for those involved in ethically challenging situations and will assist humanitarian healthcare workers in implementing well-considered decisions.  The six steps are designed to help you or your team structure reflection and deliberation on the ethical dilemma presented in the case study. You may skip questions that appear less relevant to the issue or explore dimensions pertinent to the context but not listed in the tool.

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Disclaimer: Case studies in the ENHA (Ethics Narratives in Humanitarian Aid) series are based on the reflections of humanitarian healthcare workers on ethical challenges experienced in the field. While the stories presented in the cases draw on real events and the accounts of real persons, many stories are composites in which similar experiences are woven together. In all of the stories, details such as names, dates, locations, career and life stage, gender, and profession have been changed, obscured, or omitted. Any resemblance the stories may bear to actual persons, places, and events is co-incidental.

While the stories often aim to show what the protagonist is thinking or feeling, the Humanitarian Healthcare Ethics Research Group’s intent as the stories’ author is not to suggest that the values and assumptions held by a story’s protagonist are those of all or many humanitarian healthcare workers. Similarly, the values, opinions and actions of a protagonist or other actors in a story should not be understood to reflect those of, or be endorsed by, the Humanitarian Healthcare Ethics Research Group.

How to cite: Humanitarian Healthcare Ethics. 2014. ENHA Case Study Series: Photographing Patients without Consent. www.humanitarianhealthethics.net.

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