In September 2024, we launched the network online. We had presentations from 3 members of the network, Dr Katherine Rawling (project Co-I, University of Leeds), Dr Andreas Pantazatos (University of Cambridge) and Toni Harding (Wellcome Collection), plus an introduction to the network by the Principal Investigator of the project, Dr Beatriz Pichel (De Montfort University), which you can read below:
This network and the activities we’re organising are possible thanks to the support from the Arts and Humanities Research Council, which has awarded us a research networking award for two years, from July 2024 to June 2023. While the network has just started, it has been a long time in the making –our first (failed) attempt was in 2019. Throughout the years, Kat and I have been grappling with ethical issues in our own work, often having more questions than answers.
One of the main questions that remains at the heart of this project is the tension between widening access to historical materials and protecting people, both the people in the photographs and current viewers. In recent years, archives and museums have been opening up historical medical collections to the public, often placing them online. This is a very welcomed step to make the past accessible. However, medical photographs often show vulnerable or identifiable patients, naked, in pain, restrained, sometimes underage, who did not consent to have their portrait taken. Moreover, medical photographs are not always categorised as such. While there are collections of medical photographs in archives, more often than not, medical photographs are printed in books and journals, pasted on casebooks or just added to archived papers and classified as ephemera. The wide availability of medical photographs of the past, therefore, pose ethical questions to the researcher, the librarian, curator or cataloguer, and the viewer.
But the ethical status of historical medical photographs is also a point of contention. In the UK, these photographs are accessible 100 years after their production. This means that now, in 2024, we can freely work with photographs up to 1924 -pending copyright restrictions, etc. In contrast, contemporary medical photographs are currently considered sensitive objects. Health organisations like the NHS have issued guidelines to ensure that the taking, circulation and storage of photographs is ethically compliant. This usually means you need the patient’s informed consent not only to take the photographs, but also to use these photographs in particular ways –specific permission to publish the photograph, or to use it in teaching, etc. Consent can always be withdrawn. Medical photographs also need to protect the privacy and anonymity of the patient as much as possible, so clinical photographs need to avoid faces or any identifying features if possible. Each organisation has its own protocol and medical photographers are trained in these. While applying this already existing ethical protocol is tempting, unfortunately it does not work with historical materials. First of all, the concept of ‘informed consent’ did not exist at the time. It is also difficult to ascertain the lack or not of consent from the images themselves. While some medical photographs are clearly the result of violence, and we can see hands forcefully handling patients to hold a pose, other images that are not distressing by today’s standards were the result of coercion or exploitation. Similarly, anonymity is not always the most ethical stance in relation to this material. Sometimes, naming the patients and telling their individual stories, particularly when they belong to minorities or marginalised groups, is a more powerful ethical decision. Finally, there is the potential for secondary trauma from viewing these images, which often come with offensive, racialised, ableist or stigmatising language.
We need, therefore, a new ethical framework to assess historical medical photographs that goes beyond the medico-legal principles of consent and anonymity. Heritage institutions such as the Wellcome Collection have advanced new access policies, and we will hear about it later, but there is no shared guidance. While we’re not proposing that there should be a unified approach necessarily, there is value in sharing the decision-making that goes behind these policies. One of our aims, therefore, is to co-create some best practice guidelines that can guide researchers, librarians, cataloguers, curators, etc. dealing with these materials.
However, the question of ethics goes beyond protocols and guidance. One key issue this network will discuss is the difference between ethics as in research ethics protocols, and philosophical ethics. We believe that as important as the practical guidance is the theoretical discussion of our ethical positions. We do not want to provide a checklist that will guarantee that your research or your cataloguing is ethical, but a framework to think through our ethical responsibilities towards people in the past as well as current users. In the network, we will discuss ethical theories and approaches such as the ethics of care, that might guide our decision-making.
As a result of this, we will rethink what kind of questions are actually questions about ethics. We want to examine not only what contemporary uses of medical photographs are ethical, but also the ethics of past uses of these photographs. As mentioned before, usually the ethics of medical photography is reduced to the issue of consent (whether the subject consented to have their photograph taken). But we know that photographic practices in the nineteenth century were much more complex than that and cannot be reduced to the moment in which the photograph was taken, with or without consent. Medical photographs were routinely exchanged, printed, discussed, stored, manipulated or disposed of. Different values and power dynamics were at play when taking, producing, circulating and consuming medical photographs, often in relation to race, gender, ability, class and age. Beyond consent, we will examine issues of race, gender, ability, class and age among others as ethical questions.
This network, therefore, seeks to develop both best practice guidelines specially adapted to early medical photographs, and an ethical framework through theoretical, historical and heritage research. We aim to:
1. Co-create innovative ways of researching, curating and disseminating medical photographs that guarantee access to early medical photography while protecting the dignity of historical subjects and contemporary viewers.
2. Provide the theoretical and practical tools to broaden current understandings of the ethics of medical photography to include the specific challenges posed by historical materials.
3. Confront the racist, ableist, misogynistic and other damaging legacies of the representations, language and practices of many early medical photography collections.
As a result of this approach, this network will go beyond the looking/ not looking dilemma that has dominated photographic studies. From Susan Sontag to Georges Didi Huberman and Susan Crane, most of the studies on the ethics of photography have discussed whether the ethical stance is to choosing not to look out of respect for the people in the photographs or rather, to actively look at them. Rather than focusing the discussions on whether we should be looking at particular collections, we will balance the ethical needs of heritage institutions, researchers and the public in an attempt to widen access to early medical photographs while respecting the dignity of both historical subjects and present viewers. Similarly, we believe that the discussion of the ethics of medical photography, and the questioning of what we mean by ethics, will lead to broadening the concept of medical photography itself. Rather than focusing on clinical images, this network will examine a wide range of photographic materials related to illness and health taken between 1839 and 1924, including ethnographic and anthropological expeditions, public health initiatives and private photographic collections owned by doctors, among others.
We are aware we have big ambitions, and this project is a huge undertaking, hence the network. It is clear that we can only properly address these questions from a multidisciplinary perspective.