Ethical Issue in Preparing Manuscript on Esthetic Patients
Article information
The International Committee of Medical Journal Editors (ICMJE) has recommended the following for the protection of patient’s privacy [1]:
Patients have the right to privacy. It should not be infringed without informed consent. Identifying information, such as names, initials, or hospital numbers, should not be disclosed in written descriptions, photographs, or pedigrees unless the information is essential for scientific purposes and the patient (or parent or guardian) gives written informed consent for publication. Informed consent for this purpose requires that an identifiable patient be shown at the manuscript to be published. Authors should disclose to these patients whether any potential identifiable material might be available via internet as well as in print after publication. Patient consent should be co-signed by the author(s) and filed at the journal, or both, in accordance with the relevant law or regulations. Journals could establish their own guidelines or policies under the general legal principles for privacy protection. Nonessential identifying details should be omitted. Informed consent should be filed if there is any doubt on the anonymity for patients such as masking the eye region in photographs of patients, which is not enough for protecting anonymity. In the case the patients de-identified, the authors should assure and then the editors should guarantee that such changes do not distort scientific meaning.
If authors abide by the above rules, there would be minimum ethical or legal issues occurred in publishing patient’s face including eyes. In particular, the informed consent in the field of facial transplantation will require those as follows [2]: The face will adapt to the shape of the underlying bony structure; there will be some superficial characteristics of the donor; a ‘third’ face is likely which will resemble the recipient more than the donor; and the recipient will not take on the identity of the donor postoperatively.
Because the legal standards for protecting the patient’s portrait are different country by county, authors should follow the regional standard. Although the right to privacy or portrait in Korea has been well protected, the responsibility would be exempted if: publisher receives written document of the informed consent; and it is the reasonable public concern [3]. There was a case when patient’s portrait was disclosed via internet without patient’s permission by the staff of plastic surgery clinic in Korea [4]. Although it is not committed by the surgeon of the clinic, he has also legal responsibility for supervising the staff. In this case, both the staff and the surgeon received the judgment that they must make compensation for the damage of patient with pecuniary reward according to Article 750 of the Korean Civil Law. This is not an academic case related to journal publication; however, the court would deliver the same judgment without informed consent. Therefore, when physician receives informed consent from aesthetic patients or their family members, following items are recommended to agree for the publication of patient’s whole or part of body including face:
I understood that my portrait can be published for the scientific improvement and patient care. I permit that whole or a part of my body may be disclosed via internet as well as in print after publication only for research and educational purpose. I will not ask any ethical or legal liability after the disclosure of my portrait after publication.
The inclusion of patient’s portrait is inevitable process for the development of clinical research. Although authors do their best masking the patient’s portrait, it is impossible to protect it completely. Above procedure of receiving the informed consent will be the best way to keep the ethical or legal standard.