The Ethics of "Gawking" in Medicine
The following original article which I wrote and was published today at the Bioethics.net website is reproduced here with permission. ..Maurice
06/20/2013
THE ETHICS OF “GAWKING ” IN MEDICINE
Maurice Bernstein, MD
Gawking, defined in Merriam-Webster dictionary as “to gape or stare stupidly.” It is the “stupidly” which I think sets the ethics of the behavior. The “stupidly” can represent more than some ignorance of what is being observed but also a lack of true purpose at the time of the observation for either understanding or even participation. Gawking is directed primarily for self-interest of the gawker and for no other purpose. A general example of gawking can be given as motorists stopping briefly at an automobile accident simply to observe the trauma but not with an intent to provide assistance. A more specific example of gawking was described in the Associated Press article November 12 2012 in the aftermath of Hurricane “Sandy”:
Garbage trucks, hulking military vehicles and mud-caked cars move slowly through a Staten Island waterfront neighborhood still reeling from Superstorm Sandy’s storm surge. Then comes an outlier: a spotless SUV with three passengers peering out windows at a mangled home choked with sea grass. Residents recognize the occupants right away. They’re disaster tourists, people drawn to the scene of a tragedy to glimpse the pictures they’ve seen on television come to life.
So then, in general, what has ethics to do with gawking? Well, one can say that gawking having only to do with self-interest and absence of benefit or consent by those being gawked can be deemed unethical. Considering the ethics, a more benign example would be a gentleman gawking at an attractive lady on the street. For whose interest is the results of the gawking? Of course, it is that for the gentleman. What benefit is surreptitious gawking for that woman? None, if she is not informed and perhaps some, if she was…but that would depend on her interpretation. Does it make any difference, though, to the lady not to be informed? Well, she can’t complain since she was walking out in a public place, so the gentleman’s gawking has really not produced any injury and which would be strictly termed unethical.
However the example of gawking which could be looked upon as unethical is, as in the case of observing the harm to others, such as the automobile accident or being a “disaster tourist” such as the Sandy experience is where that the ethical principle of beneficence is missing. Instead of a humanitarian “Good Samaritan” action on the part of the gawker to provide “good” to the harmed or injured, the behavior is strictly self-serving. That is unethical.
So now, what about gawking and its ethics in relation to the medical profession? The duty of the medical profession is essentially to the benefit and good for the patient among other ethical principles and along with the attempt to preserve the decisional autonomy of the patient. Within the United States, The Health Insurance Portability and Accountability Acts (HIPAA) deals with assuring confidentiality of patient historical information (that which is spoken or written) but there are no laws of which I am aware which regulates how a patient’s physical body, during clinical evaluation, procedures or surgery can be maintained as private and away from the unwanted eyes of onlookers about whom the patient was unaware and had not given consent. These onlookers have been termed “gawkers” by the patients on finding that they had been present. All you need to do is go to my “Bioethics Discussion Blog”(www.bioethicsdiscussion.blogspot.com) and read the comments by patients written over the years to my many threads on “Patient Modesty” for confirmation of the application of this expression. And who are these “gawkers”? The name has been applied to medical students, nursing students, technicians, medical industry representatives and other “visitors”, none of whom were consented to be present by the patient and who are standing around and not specifically contributing to the care and attention to the patient but looking at the patient’s body for their own various interests. Yes, the patient’s physical body, uncovered to various degrees along with the observation of the activities of others attending to the patient may be of value to those simply “looking on” even beyond some personal prurient interest. However whatever the value to the gawker or the eventual benefit to others, the fact that these individuals have not been directly accepted to be present by the patient and not directly involved in the patient’s care makes their gawking unethical. As far as some patients are concerned “gawking” on them is more than “staring stupidly” but “staring without informed consent.” What these patients would want is talking consent in place of doing gawking.
As a patient, what would be your opinion?
posted by Maurice Bernstein, M.D. @ 11:22:00 AM
7 comments
7 Comments:
Informed consent - what a joke!
What are the rules for informed consent? If it means a full explanation of what will happen, who will be involved in their care, and..their state of undress, then informed consent is the respectful, moral and not only the right thing to do, but what is necessary.
It's not done because the medical community really doesn't want to tell you more "than you need to know". There is no autonomy, respect for the patient or human decency involved in healthcare, except for a small fraction of providers.
It's in shambles. Let's ask these ethic committees how they would feel laying naked in front of gawkers? How many of them would approved then?
Finally, "to do no harm" is not being addressed and many times people feel violated whether clothed or not with the presence of unauthorized, uninvited people. Sometimes they are traumatized.
And...if you've been gawked at, while in a state of undress in front of many it might be considered sexual battery and cruel and degrading.
How would you feel if that happened to you? Would you trust again? You're a fool if you would. There is greater chance your physical privacy will be violated in the hospital setting than have it be protected.
What a disgrace and a shame for the human race. We're just animals, I guess.
belinda
A recent CBS Los Angeles news item: "A 43-year-old man faces misdemeanor charges after allegedly taking inappropriate pictures of unsuspecting women at two shopping malls in Glendale" And there are many more "Peeping Tom" stories, often associated with picture taking, if you want to Google the topic. In what ways does observing nudity or partial nudity strictly for self-interest within an operating or procedure room differ from the alleged criminal behavior of those arrested "Toms"? Is it because simply the attribution of "self-interest" in general is not the criteria but it is really proven prurient self-interest that defines criminality. And then perhaps those who have been allowed by the healthcare system to stand and watch in the clinical situation can argue their self-interest is for self-education and for later care of patients in the case of students and in the case of others, some other societal, safety or humanistic value but not for personal sexual interest. In any event should those who stand and watch still have been made aware to the patient and accepted as part of the patient's informed consent? ..Maurice.
Doug Capra wrote today:
"Maurice
What's your default position here? Based upon your last sentence, it seems to be that we need to defend the position that the patient should be asked. I challenge that. I say that the default position is that the patient should be asked and those who say no to that need to defend their position."
I would say is that I would disagree about the patient "defending" the patient's decision of saying "no". Such an explanation of an autonomous decision by the patient is part of a "default" requirement if the patient is being evaluated for capacity to make their own clinical decisions which is what "informed consent" is all about. If it is already clear to the physician presenting the information that the patient has capacity to make his or her own medical decision, an expression of the rationale for the "no" is unnecessary as a default and only for the physician's curiosity. ..Maurice.
And. what if the patient says , "NO"and I don't have to give you a reason. It's none of your business.
Either conform to my terms or I'll go elsewhere?
The idea that patients have to be accountable to explain themselves based on innate social characteristics that we all haves, is not only an exercise of power differential, it just adds stress to someone who is already sick.
Then they wonder why patients avoid certain procedures. As soon as the medical community recognizes that they are the problem is when things will change.
Should a psychological study be done about the psycho social behavoirs during hospitalization, not only would there be a change in behavior, some of it would be deemed criminal.
belinda
Maurice: As you pointed out, HIPAA provides the patient with rights regarding their medical information. It strives to protect the unconsented sharing, either verbally or written, of a patient's medical information/records. But you also state that there is no such protection of a patient's body (from unconsented viewing, withheld information on procedures, etc.). Does anyone other than me find this rather disturbing? Is not our bodies just as important and private to us as our medical information? To me it is not ethical for anyone who is not directly involved in a patient's care to be present when they are either clothed or unclothed without the patient's specific consent. And that includes when they are in surgery or otherwise sedated. I have specifically been told once by a nurse that they do not disclose all information about what happens once a patient is sedated because they feel it is better for the patient not to know. I would challenge that a patient has every right to know exactly what will happen to their body, who will be present and what their role will be. That should be a part of patients' privacy rights as much as HIPAA is for their medical information. Jean
Why are we assuming that the thousands of people who consider going into any healthcare job are not working out of "self-interest?" That choice of how they want to earn a living/paycheck is clearly theirs...not ours. If you want to be a nurse/P.A./N.A./ C.N.A./ or any other A. for that matter, that is your right. But we as people and possible future patients do not automatically "owe" them anything for that decision.
If we don't want someone in the room, then that unwelcome person IS a "gawker". If we don't want someone touching us then that person needs to accept that and move on, not try to talk anyone into an uncomfortable situation. The bottom line is: choosing how you want to earn a paycheck IS self-interest.
We do not "owe" anyone in this (or any other for that matter) field a learning experience at our emotional and personal expense. As a matter of fact, we as consumers should be the ones having our personal and emotional expectations met. Until this mentality is reasonably considered, then we as future patients will always face an expectation of entitlement by the medical community.
We are all just people...how is it that so many keep forgetting that? What we all "owe" each other is respect. Saying "no" to someone is not disrespect, it is just a personal choice.
Perhaps the term "self-interest" needs a little perspective.
Suzy
Excellent commentary Suzy on this Gawking issue.
PT
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