If a healthcare provider’s visible tattoos offend a patient or family member, does this supersede the clinician’s rights to self-expression?
“There are many ethical issues involved when hospitals attempt to regulate the physical appearances of hospital employees,” says Bob Parke, BA, BSW, MSW, a bioethicist at Humber River Hospital in Toronto, Canada.
Regarding hospital employees with visible tattoos, Parke takes the position that while some patients and families could take offense, “one needs to look beyond a provider’s physical appearance to the quality of care that person provides to their patients.”
Parke says, however, that it may be ethically acceptable for lines to be drawn in certain cases, depending on the nature of the tattoo. Many tattoos are artistic in nature, or a form of memorial — for example, a way of honoring a family member or friend who has passed away. “Conversely, some tattoos may be perceived as offensive, lewd or hateful in nature,” says Parke. “In some cases, this is clear — for example, a tattoo of a swastika or a racial slur.”
Lauren Notini, MBioeth, PhD, a fellow in clinical and organizational bioethics at The University of Toronto Joint Centre for Bioethics, notes that in other cases, there is a certain amount of subjectivity involved. “Some patients may be more offended by certain images than others,” says Notini. For example, a very conservative patient is more likely to be more offended by a tattoo of a woman in a bikini than a less conservative patient.
“Alternatively, a very religious patient may perceive a tattoo of a devil as a sign of evil, whereas the same tattoo may not bother an atheist patient,” says Notini. “Hence, the way a particular tattoo is perceived will depend to a large extent on the values and beliefs of the person perceiving it.”
A particular kind of tattoo could harm the therapeutic alliance between the patient and provider, such as victims of trauma or abuse becoming upset by certain images. “It may be ethically acceptable for a different provider to take over the patient’s care, if the original provider is not willing to cover up the tattoo,” says Parke.
While visible tattoos may offend some patients and families, they may have the opposite effect on others.
“Indeed, some patients may personally identify with a hospital employee who has visible tattoos,” says Notini. She is aware of a pediatric anesthetist with cartoon characters tattooed on his arm. “The children this anesthetist provides care to are typically enamored with his tattoos and more willing to engage with him,” says Notini.
Similarly, tattoos can create an initial talking point between the patient and healthcare provider, strengthening the therapeutic alliance.
What if an existing hospital employee adds a highly offensive tattoo? Parke says, “As the ethicist would not be in a direct supervisory relationship with the healthcare provider, the provider may be more willing to discuss their tattoo with the ethicist, rather than with their supervisor,” he explains. If the employee refuses to cover up or even discuss the offensive tattoo, says Parke, the case may move beyond the scope of ethics and become an administrative and human resources issue.
Notini sees the following two possible roles for ethicists involving regulation of hospital employees’ appearances:
• Participating in developing or updating existing guidelines and policies addressing this issue to ensure these are consistent with ethical principles such as respect for persons and their rights.
“The ethicist may also be asked to comment on whether such documents inadvertently perpetuate social stigma on the basis of appearance,” says Notini. For instance, it should be explored whether such policies implicitly suggest that employees with visible tattoos are less professional than their non-tattooed peers.
• Consulting on specific cases.
For example, a patient or family may complain about a healthcare provider based on that provider’s tattoos or another aspect of the provider’s appearance, or may request a different healthcare provider take over their care. An ethicist can mediate between patients, families, and employees.
“In consulting about such issues, the ethicist may consider various factors,” says Notini. These include how the patient/family are perceiving the provider’s tattoos, the reasons behind the patient’s/family’s dislike of the tattoos, and the quality of care provided.
The ethicist also can explore whether the provider is willing for a colleague to take over caring for the patient, and whether such a transfer of care is appropriate and possible. “It may not be feasible, for example, if there is only one occupational therapist available on the unit,” says Notini.
SOURCES
- Lauren Notini, MBioeth, PhD, Fellow in Clinical and Organizational Bioethics, The University of Toronto Joint Centre for Bioethics. Email: [email protected].
- Bob Parke, BA, BSW, MSW, Bioethicist, Humber River Hospital, Toronto, Canada. Phone: (416) 242-1000 ext. 82808.
Email: [email protected].
If a healthcare provider’s visible tattoos offend a patient or family member, does this supersede the clinician’s rights to self-expression?
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