At times of man-made or natural disasters healthcare professionals have
a responsibility to protect their patients’ dignity from journalists
covering the emergency, as in many cases this is all that remains for
victims of disaster. Anant Bhan, a specialist in ethics and
rights, explores the issue.
The tsunami that marked a solemn end
to 2004 left behind unprecedented devastation. The world was shocked at
the increasing casualty figures and the realtime images of the disaster
brought by the news media. These included clips and photographs of dead
bodies, grieving relatives, and suffering patients admitted to makeshift
The photographs did help in organising a quick response from the rest of
the world, as societal pressure led governments and relief agencies to
respond with comprehensive relief measures. Graphic footage and
newspaper headlines continue to dwell on this human tragedy. However,
both healthcare workers and journalists need to carefully consider
whether it is ethical to show images of patients in obvious distress and
undergoing medical attention in emergency camps, or of dead bodies in
There are many published guidelines that journalists can turn to for
guidance on the ethics of reporting. For example, the UNESCO
International Principles of Professional Ethics in Journalism details
the principle of respect for privacy and human dignity as an integral
part of the professional standards of a journalist . The Australian
Journalists Code of Ethics calls upon journalists to respect private
grief and personal privacy, and reinforces the right of journalists to
resist their compulsion to intrude . The Code of Ethics and
Professional Conduct of the Radio-Television News Directors Association,
the world's largest professional organisation devoted exclusively to
electronic journalism, expects professional electronic journalists to
treat all subjects of news coverage with respect and dignity, showing
particular compassion to victims of crime and tragedy .
However, there has been little consideration to date of the ethics of
healthcare staff allowing access to media inside medical institutions at
times of natural disasters. In a 2003 editorial in the BMJ (British
Medical Journal), which discussed “man-made” disasters such as war,
Singh and DePellegrin questioned the use of footage of casualties from
the Iraq war without the patients' consent . An extensive debate
followed publication of the commentary (see
http://bmj.bmjjournals.com/cgi/eletters/326/7393/774); one of the
views expressed was the need to show the world the extent of killing and
maiming in the war. (http://bmj.bmjjournals.com/cgi
Media coverage of the tsunami: benefits and harms
In the post-tsunami scenario, the usefulness of the Internet and media
was apparent. For example, a young Swedish child separated from his
family was identified by his uncle on a hospital website and later
reunited in an emotional moment with his father, who had been admitted
to another hospital. The publication on government and hospital websites
of the names of those admitted to hospitals, together with news
releases, helped many identify their friends and relatives.
Furthermore, the aid response has been the largest of any disaster in
history, which may have been due to the unprecedented media coverage.
There has also been the advent of “disaster tourism” – the massive
inflow of well-meaning, but often ill-organised, charitable
organisations and aid volunteers to the tsunamihit areas .
At the same time, the media coverage of wailing relatives and dead
bodies lying in hospital morgues is deeply disturbing. The death of a
loved one is a time for privacy and respect for the dead. As a South
Asian, I am aware that in many communities the dead body is covered with
a shroud that denotes purity. It is rare to photograph or film funerals.
To infringe on the privacy of families when they are emotionally
shattered is disrespectful to the living. Photographing and filming the
deceased in various stages of undress and decomposition violates the
dead and their dignitary rights, according to most cultures. In
addition, the hordes of news media that descend on a hospital can hamper
the efficiency of the medical staff providing emergency care, where even
seconds are crucial.
Role of health professionals in protecting privacy
Health professionals and administrators can and should control media
access to hospitals and clinics. The public's right to information
should not outweigh the right of victims of natural disasters to
privacy, confidentiality, and dignity. Health professionals should be
aware that the filming of patients under their care may be used not only
for highlighting the extent of a disaster's human toll, but also for
commercial purposes, such as selling programmes and newspapers, and for
raising funds. For these reasons, extreme caution should be used in
giving permission to use images from inside hospitals in
disaster-affected areas. Ideally, the consent of the patients or
surrogate decision makers should be sought first.
It is now the ethical norm to seek consent of patients when photographs
of them (or even of their body parts) are used in medical conferences or
publications (see the guidelines on consent from the International
Committee of Medical Journal Editors, at
www.icmje.org/#privacy). A similar approach should be taken in the
event of natural or man-made disasters. If photographs of the dead or
those admitted to hospitals have to be publicised for identification
purposes, this should be done keeping local sensibilities in mind.
It is difficult for healthcare professionals to shoulder this social
responsibility during a crisis when lifesaving measures come first.
Community consent and monitoring through community leaders, tribal
elders, or local authorities might be an option. Such community
involvement would result in media coverage that would be socially and
culturally acceptable. While the usefulness of documenting and
transmitting such geographically and experientially diverse experiences
around the world is undeniable, the terms of access for media have to be
negotiated keeping the notion of consent central.
With the increasing focus in medicine and bioethics on individual
rights, the right to privacy is pivotal. Doctors and other health
professionals have a duty of care to their patients, which includes
protecting their dignity and privacy. Ethical obligations of health
professionals to monitor recording of images in health institutions need
to be higher than those of society in other venues, such as the street
or the beach.
It may be valuable for medical professionals to have a specific code,
perhaps written by disaster-relief organisations (such as the Red Cross)
together with the World Medical Association, that outlines how to deal
with the media in disaster settings. Arguably, the universal obligation
of healthcare professionals and administrators to respect the privacy
and confidentiality of their patients should suffice, but given the
nature of realities on the ground in disasters and emergencies, a
specific code would be useful.
Responsible journalism in healthcare settings at times of disaster,
facilitated by guidelines that specifically address the ethical
reporting of disasters and that are applicable universally across the
world, will also help prevent exploitation of victims of a calamity.
Such guidelines could be developed by a joint body comprised of
international medical humanitarian agencies such as the Red Cross and
Médecins sans Frontières (MSF), multinational agencies such as the
United Nations, media representatives, and media watchdogs.
The guidelines need to be acceptable to the global media community and
also need to be made binding. For example, sanctions could be imposed
upon journalists (or their parent organisations) who ignore them, or
perhaps only those journalists who have been accredited in “ethical
reporting of disasters” should be given access to disaster sites.
The guidelines could also usefully be published together with a code for
health professionals. An example of joint guidelines on ethical
reporting on health issues for the media and healthcare professionals
are those adopted in Washington State (www.wsma.org/news/guide.html).
These guidelines were jointly approved and prepared by media,
publishers, broadcasters, and hospital and medical associations, and
they could serve as a template for international guidelines on disaster
In disasters, the affected are often left with almost nothing and with
negligible negotiating power. They might be left with only their pride
and dignity, and they must not be robbed of that. Patients or affected
families might not be in a condition to respond to encroachment on their
rights. While health professionals want to facilitate recognition of
their unidentified patients and also facilitate more aid to affected
areas, they also have an enhanced responsibility to protect their
patients' dignity and rights. We should not
to be voyeurs into the grief of vulnerable victims to launch an
effective and humane response to any disaster.
- Anant Bhan is a specialist at the Centre for Studies in Ethics and
Rights (CSER), Mumbai, India, and is currently a Fogarty International
Fellow at the University of Toronto Joint Centre for Bioethics (JCB),
Canada. This article was originally published in the Open Access journal
PLoS Med. Bhan A (2005) Should Health Professionals Allow Reporters
Inside Hospitals and Clinics at Times of Natural Disasters?