The ethics of image manipulation

In health care PR, the biggest issue is HIPPA. I believe that health care facilities and professional communicators want to post pictures or testimonials of satisfied customers in their websites and publications, but at the same time the patients may not wish their picture or testimonial be published on the website. According to the Dysmorphology Subcommittee of the Clinical Practice Committee, American College of Medical Genetics, as relating to patient photographs, “In each case it is not only prudent, but necessary for the patients’ protection and interest that appropriate consent be obtained” (Dysmorphology Subcommittee, 2000).

In my experience, patients tend to not want to be photographed while they are in the hospital. While working as a photographer and magazine/newspaper editor while in the Army, I was often tasked to write a story to promote the availability of flu shots or other health care concerns. Gathering consent as a photographer is a bit of a cumbersome event. I have to admit that on occasion I posed while one of the photographers took a shot of my arm being poked or my person being examined. Close ups of these types of things seemed to work best. On another occasion, I posed while my belly was being measured for a physical fitness exam. I supposed that this was pushing the limit on journalism ethics, but too often it proved to be difficult to arrange or happen to show up and find a legitimate patient willing to have their picture taken in a certain medical situation. After all, in many cases the task for the assignment was given late and deadlines were always looming. However, these are very simple situations.

What about stories on STDs and other possibly embarrassing scenarios? These are very important informational pieces that are vital from an informational perspective. Perhaps in these cases one could do without a photo, which I must admit I have done in certain publications in newspapers and websites. But back then, over 10 years ago, one’s story always suffered when it didn’t have an accompanying photo. Creativity in this realm was often the key. For one STD story I took several “artsy” shots of some pamphlets on the topic and with some condemns lying around. I think one of the photographers who worked for me once took a shot of a nurse appearing to be handing a condemn to the camera. But even still, this is still a light subject area.

What about cancer patients or other terminal issues that have a profound impact. It might be hard to get consent. I’ve never been tasked with such photos, but I can see the importance that it would have with certain facilities – especially where an organization wants to spread awareness to drum up support for a particular program. As I started this discussion, consent is the best way to go. I spent some time talking about how deadline crunches and being forced to come up with something on the fly that pushed the ethical boundaries of truth. For those reasons, it is important to plan out these photos well ahead of time so that the photographer has time to get the consent they need along with all of the other requirements of such thing.

The eHealth code of ethics clearly lays out the guiding principles that address “sets forth guiding principles under eight main headings: candor; honesty; quality; informed consent; privacy; professionalism in online health care; responsible partnering; and accountability” (Rippen & Risk, 2000)

The National Press Photographers Association lays out several guidelines when it comes to photojournalism. I am including below in image of 9 of the NPPA guidelines.

(NPPA, 2017)

Of particular note is #1, that is that a photographer should be “accurate and comprehensive” when photographing subjects. Also involved in this discussion is #2, that is an avoidance of staging photographs. One also can not overlook #5, where it is pointed out that a photographer should not intentional impact or modify the image captured. And finally, #6 clearly points out the limitations of editing images. From my experience, this issue goes to the question of enhancing vs. manipulating images while working with them digitally. I view enhancing images as acceptable behavior while manipulating images as ethically unacceptable. I view enhancing images involving such things as;

1. Adjusting the brightness or contrast of an image

2. Dodging of burning an image

3. Cropping an image to suit the needs of the publication or other reasons of enhancement

4. Using a filter on the image

I view manipulating images to be such things as;

1. Changing the content of the image.

To me, changing the content of the image involves a lot of things. This would include removing blemishes, body fat, shadows or adding or deleting things such as power lines or other structures, things or people. This could also include things such as making the sky appear more azure than it really is. Putting two or more images together or cutting and pasting things into the image also fall under this category.

A Photo Review article does a really good job of addressing many of the ethical issues involved in image manipulation. It points out that an image should unswerving in “perspective and geometry” along with pointing out many of the things discussed thus far in this post (Photo Review, 2017).

The Department of Defense lays out several guidelines that are very specific about where the line is drawn between enhancement and manipulation. I am including the following paragraph from DoD Instruction Number 5040.05, Alteration of Official DoD Imagery

1. Photographic techniques common to traditional darkrooms and digital imaging stations such as dodging, burning, color balancing, spotting, and contrast adjustment that are used to achieve the accurate recording of an event or object are not considered alterations.

(DoD, 2006)

With today’s digital imagery, manipulation is getting way to easy, but it appears that we have come to expect it. I feel that further, more specific guidelines in this area are needed so as to more accurately reflect the integrity of photographs, especially when considering images taken in the very sensitive field of health care information.

References

DoD (Department of Defense) (2006) . DoD Directive 5040.05 . Alteration of Official DoD Imagery . retrieved from https://fas.org/irp/doddir/dod/i5040_05.pdf

Dysmorphology Subcommittee of the Clinical Practice Committee, American College of Medical Genetics, Cunniff, C., Byrne, J. L. B., Hudgins, L. M., Moeschler, J. B., Olney, A. H., … Figone, C. (2000). Informed consent for medical photographs. Genetics in Medicine, 2(6), 353–355.

NPPA (National Press Photographers Association) (2017) . Code of Ethics . retrieved July 23, 2017 from https://nppa.org/code_of_ethics

Photo Review (2017) . Ethics and Editing . tips . retrieved July 23, 2017 from http://www.photoreview.com.au/tips/editing/ethics-and-editing

Rippen, H.& Risk,A. (2000) e-Health Code of Ethics (May 24). J Med Internet Res. 2000 Apr-Jun; 2(2) May 24,2000. doi: 10.2196/jmir.2.2.e.