Specific Topic(s): violation of International Humanitarian Law (IHL) by armed actors and use of patients for media/publicity purposes.

Key references:

‘Ethical principles of health care in times of armed conflict and other emergencies’

• Health-care personnel respect patients’ right to confidentiality. It is ethical for health-care personnel to disclose confidential information only with the patient’s consent or when there is a real and imminent threat of harm to the patient or to others.

• Health-care personnel make their best efforts to ensure respect for the privacy of the wounded, sick and deceased, including avoiding the use of health care for the wounded and sick, whether civilian or military, for publicity or political purposes.

Geneva Conventions:

Rule 2. Acts or threats of violence the primary purpose of which is to spread terror among the civilian population are prohibited. - https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_cha_chapter1_rule2

Rule 156. Serious violations of international humanitarian law constitute war crimes. https://ihl-databases.icrc.org/customary-ihl/eng/docs/v1_cha_chapter44_rule156

Ethical principles:

WMA INTERNATIONAL CODE OF MEDICAL ETHICS: https://www.wma.net/policies-post/wma-international-code-of-medical-ethics/ - A PHYSICIAN SHALL respect a patient’s right to confidentiality. It is ethical to disclose confidential information when the patient consents to it or when there is a real and imminent threat of harm to the patient or to others and this threat can be only removed by a breach of confidentiality.

WMA DECLARATION OF LISBON ON THE RIGHTS OF THE PATIENT:

https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-rights-of-the-patient/#:~:text=Every%20person%20is%20entitled%20without,with%20his%2Fher%20best%20interests. .. Physicians and other persons or bodies involved in the provision of health care have a joint responsibility to recognize and uphold these rights. Whenever legislation, government action or any other administration or institution denies patients these rights, physicians should pursue appropriate means to assure or to restore them.

Discussion:

Review of the question: this question examines reporting and communicating violations of IHL, the use of the media to communicate, and the right of patients to confidentiality.

Interpretation of the principles/policy from the references:

• Patients have a right to confidentiality, including the right to control the use of pictures, sound or video that might be taken whilst they are under medical care.

• Armed actors have duty to comply with IHL, which includes the need for independent parties (possibly including journalists) to collect evidence of violations of IHL.

• Healthcare workers have a duty to advocate on behalf of patients’ rights. Collecting testimony from survivors can be important in detecting and reporting violations of IHL.

Framework for answering the scenario/question:

• What are your professional duties in regard to taking images, sound, video records of patients by yourself or third parties?

• What policies and procedures should in in place within a medical facility to protect patient confidentiality from journalists and other media?

• How might you respond to a journalist asking permission to take footage of your medical facility and interview patients? (what if they were employed or supported by your organisation?)

• What are your responsibilities in regard to reporting evidence of violations of IHL; as a healthcare professional, as an employee?

Further issues for consideration:

• What might you do if you felt obliged to communicate your evidence of violations of IHL? – see further reading – put ‘attacks on healthcare’ into google.

Healthcare in Danger. ICRC. At: https://healthcareindanger.org/

Responding to attacks on healthcare. WHO. At: https://www.who.int/activities/responding-to-attacks-on-health-care

Surveillance system for attacks on healthcare. WHO. At: https://publicspace.who.int/sites/ssa/SitePages/PublicDashboard.aspx