(This article appeared originally in June of 2010. It wasn’t properly tagged and I am resubmitting it so Google can see it.)

An quite intelligent gentleman sent me an e-mail asking what I thought ethically about TV crews filming real cases up to and including surgery. He referred to two articles, Doctors on the Cutting Edge of Reality (The Boston Globe), and ABC’s ‘Boston Med’ shows the painful reality of surgery at the heart of 3 Massachusetts hospitals, (The New York Daily News).

The program is “Boston Med,” an eight part documentary filmed by ABC. The newspaper article from the Boston Globe quotes George Annas and Arthur L. Caplan. Both express ethical concerns about the program suggesting that the program is inappropriate and exploitative. Inappropriate because filming changes the acts of the filmed. Exploitative because these patients did not come to the hospital with the intent of being in a film.

Now, the tricky part, is this ethical or unethical based on my judgment? After all, that is what the gentleman asked me. I will discuss the two kinds of objects posed by the critics quoted by the Globe. Is the filming inappropriate or exploitative?

I do not believe such filming is inappropriate. Being filmed is rapidly becoming a constant. Cameras are located at businesses and parking areas. There are also cameras at public facilities likes parks and bridges. I could go on listing where business or government cameras might be found. In addition, personal cameras either individually or part of a another apparatus like a cell phone are also very common. So, my first claim is that being filmed is a cultural phenomenon. I believe that we are in a sea change period of cultural change in which it is rapidly becoming accepted behavior. That does not totally resolve the issue. We are not totally accustomed to being filmed yet. So, the next element is consent.

It is clear from the articles that the institutions, the professionals and the patients had signed waivers. It is entirely possible to improperly influence all of the different levels of personnel and patients to get their consent. However, a television network has enormous experience in these matters and with what can be only described as an alert and experienced legal department. My opinion is that no lawyer would allow the program to go forward with his strong participation and with all possible safeguards.

Does being filmed change human behavior? I would say almost certainly. We always do things differently if we are being observed. We care what other people think. We can become self-conscious. Strangely that really isn’t the ethical question here. The ethical question is, “Does this change technical competence or medical judgment for the worse?” I know of no such evidence. My personal experience is that when watched, I am more careful, take greater pains and think more about what I am doing. (If anyone reading this post has any study or data that suggests that being filmed is detrimental to performance, I want to know where to find that study. I want to read it and thoroughly understand it. That study would be vital and would undoubtedly change the procedures of knowingly filmed observations.)

Exploitation is more difficult. Where do you cross the line between objective reporting and using people? The network will make a great deal of money from these programs. The hospital and the doctors as part of the hospital are essentially participating in public relations program which will enhance the reputation and thus, the value of the institution.

The patients are not part of this. They do not profit and their stories, the intimate details of their medical records and and procedures, are used by the network to make money. This is exploitation. These patients are not a routine participants. The very nature of the television strongly suggests that the reason they would choose these particular stories is that they are not routine. And even if their stories are in some sense routine, they are still individual stories, critical elements of their life stories.

You could argue that in our strange celebrity culture, the very fact of appearing on television is in some sense compensation. “In some sense” doesn’t cut it. There are people who genuinely enjoy their jobs, they like what they do and many enjoy being seen doing it. They still expect to get paid. There is a difference between the urge to appear on Jerry Springer and having a serious medical problem brought before the public.

The patients should be paid or compensated in some other way. There should be some value given for the value that was taken. It is not the custom to share our medical problems, treatments and individual stories with millions of strangers. These stories are the personal property of the patients, not the hospital and not the doctors. As a society we have already acknowledged the vital nature of medical record privacy in the form of HIPAA, The Health Insurance Portability and Accountability Act of 1996.

It is obvious from these accounts that the patients voluntarily signed away their rights and allowed the network access to their stories. What has been done here and is being done is legal. But being in compliance with the law is not the measure of ethical responsibility or, what is most important, what is right and wrong.

James Pilant