Journal of Datta Meghe Institute of Medical Sciences University

: 2019  |  Volume : 14  |  Issue : 4  |  Page : 442-

“White/black bars to cover eyes,” standard biomedical ethics, patient's privacy, and consent for publication

Beuy Joob1, Viroj Wiwanitkit2,  
1 Sanitation 1 Medical Academic Center, Bangkok, Thailand
2 Joseph Ayo Babalola University, Ikeji-Arakeji, Nigeria

Correspondence Address:
Dr. Beuy Joob
Sanitation 1 Medical Academic Center, Bangkok

How to cite this article:
Joob B, Wiwanitkit V. “White/black bars to cover eyes,” standard biomedical ethics, patient's privacy, and consent for publication.J Datta Meghe Inst Med Sci Univ 2019;14:442-442

How to cite this URL:
Joob B, Wiwanitkit V. “White/black bars to cover eyes,” standard biomedical ethics, patient's privacy, and consent for publication. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 Sep 24 ];14:442-442
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Full Text

Dear Editor,

Clinical case report is an important kind of article published in biomedical journal. The specific ethical issue regarding the clinical case presentation is very interesting. Here, the authors would like to raise a discussion on an interesting issue on publication of the patient's picture. The use of “White/black bars to cover eyes” becomes a widely discussed issue at present.

At present, some journals apply the policy that any photographs or images that have been altered in any way are acceptable, and the figure without white/black bar across the patient's face is required. Those journals usually give a reason that the policy is in place to reduce ambiguity around consent for publication when observed by readers. The main concepts are “If consent has been provided by a patient for publication of clinical images, then there should be no requirement of obstruction of the eyes” and “On the hand, if consent is not been, the image will need to be fully anonymized and cannot be presented.”

Indeed, in general, medical publication ethics, the image of a patient has to be modified to blind the face of the paper. Watermarking or barring is the basic suggestion.[1] This is a classical common ethical principle in publication practice. Nevertheless, due to the basic rule on privacy of the patient, the practitioner should not present any identifications of the patient to the public (if it is not the specific case on the facial abnormality). In fact, the patient privacy is still required in any situation. It is important in both ethical and legal dimension.[2] Having signed consent form implies no right that the practitioner can present overt unnecessary exposure of the patient. To resolve the existed conflict of using “White/black bars to cover eyes” or not, there should be a further discussion.

For resolving the problem, extensive cropping of identifiable areas by a very big bars or cropping and deletion is a possible idea. Cropping and deleting the head to sufficiently anonymize the image might be a choice. However, there still some considerations on this new recommendation. First, this is an actual extensive modification of the clinical picture, which might be a problem on reliability. The too little or too much modification should be discussed. Second, in many cultures including to Asian culture, the picture without head is considered unlucky and this can also mean the rudeness of one who crops and deletes the head of the other.

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Conflicts of interest

There are no conflicts of interest.


1Coatrieux G, Quantin C, Montagner J, Fassa M, Allaert FA, Roux C. Watermarking medical images with anonymous patient identification to verify authenticity. Stud Health Technol Inform 2018;136:667-72.
2Li M, Poovendran R, Narayanan S. Protecting patient privacy against unauthorized release of medical images in a group communication environment. Comput Med Imaging Graph 2005;29:367-83.