HISTORY OF MEDICINE / ARCHÆOLOGY: A Question of Ethics and the History of Medicine

This entry is written in response to a question from a student. As a historian one of my research specialisms is in the history of medicine and one of my other research foci is the archaeology of disease and palaeopathology. As such a major part of my research has involved the physical evidence of human existence and interaction with disease - bones. Human remains. And as such there are several highly important ethical considerations in relation to my research. I’ve decided to set out, broadly, the system of ethics I use when it comes to both teaching, writing, studying and also in dealing with a wider audience - both in terms of non-specialists and the general public. I hope that this exposition may prove useful as an, albeit brief, summary of what might be considered good ethical practice.

There has bene extensive debate over the display of human remains in the context of museums - given all the associated ethical questions, and the legacy of racism and colonialism with which, in the West, such displays are indisputable a result of. In the case of Archaeology there are questions over the use of unidentified remains as demonstrations of burial archaeology. I once visited a small museum which had a recreation of a Saxon burial (complete with the remains as they were uncovered), laid into the floor of one of the rooms of the museum. It was striking, and while a demonstration of Anglo-Saxon burial culture, I remember feeling distinctly uncomfortable with how the remains were treated. One of the arguments thrown out regularly is that these are ‘ancient’ remains and the timescale means offense to the individual’s kin is not an issue. This is however something of a straw man argument. The complex ethical and cultural issues around human remains are too complicated to be distilled into a single post - however I would say that personally in terms of recreating example burials, there are plenty of other ways in which this can be done. In some senses we should perhaps import our ethics on human remains themselves from the field of medicine and pathology - handle carefully and with respect.

What then of images of human remains? Here the lines are perhaps simpler to define. I personally feel that in these cases the audience of the research is key. There is a distinct difference between an image contained in a medical textbook and an image shared on social media. Some may note the link here to ‘trigger warnings’ and ‘content warnings’. These terms have become the subject of extensive debate in the media - however it is rarely mentioned in the media that it is in fact from the media themselves that the system originates. Viewers of both the BBC and ITV will be familiar with the stock phrase ‘The following report contains images which some viewers may find disturbing’. This is a very literal content warning which can come from the mouths of news presenters in the UK since at least the 1980s. It appears in news broadcasts including coverage of the war in the Balkans and notorious murder cases. Here the individual context is significant - the viewer is given a clear opt-out. The same is true of presenting graphic or potentially disturbing images of human remains or humans in general in the context of an article, academic text or academic presentation. There is an expectation on the part of the reader of a textbook on burial archaeology that it will contain diagrams or images of burials. An anatomy textbook will contain images of living individuals with conditions, taken for the express purpose of inclusion. The same cannot be said of social media, where there is no clear-cut opt-out. Arguably both Facebook and Twitter give users the ability to mute specific topics or accounts - but many users are not aware of this feature or how to implement it. Even this is predicated on the individual audience member being aware of the likelihood of the imagery before it has been shared. And as content is easily shared by other accounts it is perfectly possible for images which you have no interesting in to find their way into your timeline. In these circumstances the potential shock value is heightened, and in most cases will overtake any degree of educational value / public engagement. Leaving aside the question of image rights (it is fundamental to note that simply because an image is free to share, it does not mean that it is ethically right to do so) there is also the complex issue of consent. An individual may have consented for their image to be used in a medical textbook but may perhaps have strong reservations against the image being used in other contexts. In many cases the individual in the image is deceased and it may be impossible to discover their wishes - in these circumstances I would state that the presumption should always be towards a hard opt out for any usage outside of specifically academic literature. The same should be the case when a living individual cannot be located, and as such their wishes cannot be definitively established.

In handling human remains, and in running laboratory tests, the rules are relatively simple - all remains must be treated with respect, and if the individual’s specific culture is known - in a culturally sensitive manner. All laboratory tests should be carried out using the absolute minimum of intervention or necessary destruction. Destructive testing should be avoided as much as is possible. Individual local policies around human remains must be followed to the letter. There is no negotiation on this point. In terms of description care should be taken to avoid sensationalism. Graphic descriptions of injuries should be avoided unless specifically required by the context - and again the rules for academic literature are broader than those we should apply in terms of social media. The question should always be asked - what purpose does this serve? Is it appropriate for the context?

Away from human remains what consideration should we give to other physical evidence - to manuscripts and records? Here the considerations are simpler. Manuscripts should always be presented in context. Their content should always be represented faithfully. In terms of secondary material this means a rigorous approach to the citation of prior works, and prior ideas. Again, the copyright status of material is largely irrelevant - if the author is known, the author should be cited. If the author is anonymous, this should be noted. When manuscript images are shown, the MS in question should be referenced. Out of context crops - while sometimes amusing - should be avoided. This is not an anti-humour standard - but rather notes that the contents of manuscripts are often used out of context to promote questionable ideas and to reinforce negative ideologies. Furthermore, the work of those who had painstakingly digitised manuscripts should not go unacknowledged. While there is a debate to be had over the relative merits of working with digitisations - they are an important resource particularly for academics who are, through disability or health issues, unable to always work with the originals. While personally I would always wish to view a physical manuscript where possible (especially one I intend to heavily rely on) my own health conditions often preclude this in some cases. Digital images of manuscripts should perhaps be treated with a similar level of respect as the manuscripts themselves.

This set of ethical practices can be summed down into a ten point ethical list for medical historians.

1. Always work within the lines of existing legislation whether that be around reproduction of images, or analysis of human remains.
2. Always treat the human subjects of such studies with respect, regardless of whether dealing with physical remains or with images.
3. Regarding human remains, all testing should be as minimally invasive as possible, only destructive where necessary, and all samples treated with the same respect as those from living subjects. 
4. All remains should be handled and treated with respect, and in a cultural appropriate manner.
5. Images should never be used for shock value. Sensationalism should be avoided. Just because an image is rights free, the question should always be asked - is this necessary?
6. On social media - images of wounds et cetera - should be avoided unless behind an explicit opt in (such as tagging as sensitive – Twitter for example has the option to tag media as sensitive – giving people a choice to view the image or not (unless they have previously deactivated this and thus opted in themselves by default)) and permission should always be source. Illustrations should always be considered in place of photographic material. In academic literature, photographs should be used, if usage rights and individual wishes can be confirmed.
7. All sources must be cited. Anonymous sources should be noted as such. No excuses.
8. Treat all subjects in as culturally appropriate manner as possible.
9. Graphic descriptions should only be used in the appropriate context in academic literature and avoided in other outlets.
10. Present facts as facts, theories as theories, and conjectures as conjectures. Blurring the lines helps no-one and is arguable disrespectful to the subjects in hand.

This can also be summarized with the simple question - how would I feel if this subject was a loved one of mine, or myself? Respect, honesty, and rigorous analysis are the three core tenets of this philosophical approach to medical humanities. This summary is only my personal view, and I am painfully aware that there will be many who disagree with my views. Being true to your own ethics is important, however consideration must always be given to the potential impact that our actions may have on others.