Hidden in plain sight: the covering of patients' eyes and a microethics of medical photography.

Abstract

This article uses the author's experience of researching historical photographs of facial injury and surgical reconstruction to think through the ethics of writing about and publishing images of patients anonymised by excising or covering their eyes. This article specifically highlights tensions between the British Medical Journal's guidelines for patient anonymity in imagery and those of the archives of the British Association of Plastic, Reconstructive and Aesthetic Surgeons. The rules for reproducing these sensitive images are not standardised across disciplines nor across journals and medical archives. But by using lived academic experience, visual analysis and philosophical enquiry, a flexible personal directive (or microethics) for working with these images can be reached.In order to more fully understand where the present-day suggestion of and debates around blocking out patients' eyes for anonymity come from, this ethical analysis is tied back to the historical precedent of Harold Gillies' 1920 publication Plastic Surgery of the Face, in which civilians' eyes are covered. Theories of looking and of photography unpick some of the complex ideas that these images raise regarding patient agency in medical imagery. This article will have direct application for any researcher grappling with similarly difficult material wondering how to frame their own microethics or ethics in practice for discussing, showing or publishing these types of images.