Video Sharing in Surgery: A Literature Review and Ethical Analysis

Introduction: The rising popularity of Snapchat and Instagram, as opposed to more ‘traditional’ social media platforms like Facebook and Twitter, has not gone unnoticed. Some plastic surgeons have gained enormous followings on Snapchat for their live surgery broadcasts and operating room theatrics including wearing fanciful costumes and dancing in the midst of surgery. Many question the ethics and professionalism of broadcasts done more for the purposes of entertainment than education, and have called for the development of more structured oversight and guidance in this area. To this end, we endeavored to provide a comprehensive review of what is, in fact, known about such ethical and professional implications, as well as offer our own analysis of these issues. Methods: Following PRISMA guidelines, a review of the literature on plastic surgery and social media was performed. Pubmed and Ovid MEDLINE were searched for the terms “plastic surgeon”, “plastic surgery”, “social media”, “ethics”, “professionalism”, and “snapchat”. Abstract review of all articles was performed. For the ethics analysis, the four principles of medical ethics (4P) were used. The 4P include: 1) respect for autonomy of the patient 2) beneficence, or promoting what is best for the patient; 3) nomaleficence, also known as ‘do no harm’; and 4) justice. Related principles include disclosure and informed consent. Results: 87 articles returned that contained both variants of plastic surgery and social media as keywords. Of those, manual assessment returned 34 articles that were found to be relevant to the social media use in plastic surgery. No peer-reviewed articles were found in which a single mention of the social media application Snapchat was made, nor were there any that addressed the ethical and professional implications of sharing plastic surgery videos live on social media platforms. Some may point out that all patients provide consent before they appear on video and claim this is a matter of “informed consent” and “respect for patient autonomy”, but it is debatable as to whether these patients truly understand what they are consenting to. Videos may be downloaded, saved, shared, or even manipulated by other social media users. Do these patients also consent to the possibility that their video may be morphed or tampered with? If a patient has their surgery broadcasted live on social media but then wishes to have this video deleted, is it ever truly removed? The fact that the patient has consented to such treatment does not define what it permissible. For example, while it is possible for a patient to consent to sexual activity with a physician, that activity is still not professional or ethical despite the consent. Conclusion: The impact of social media on the practice of plastic surgery remains largely unexamined. Using the four principles, it was determined that the ethics remain questionable for certain aspects of sharing live videos of plastic surgery on social media.