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I am going to include some pictures of patients in my manuscript, which will be submitted to a scientific journal for peer review. In order to keep the subjects’ identity and following the data protection act, I need to hide their faces.

My question is to know whether to put a black rectangle over their faces, especially their eyes or pixelising their faces. I have been told that putting a black rectangle is not recommended for this purpose, but I have never been told the reason.

Could somebody please let me know first that:

  1. Which method is better?
  2. Is that the case that blackening the face is not recommended. If true, why?
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    Rather than identifying the better method, it is perhaps better to identify the method that is acceptable to both your institute (in particular, your ethics board) and your publisher. – user2768 Nov 28 '17 at 9:06
  • @user2768 And your patients. – skymningen Nov 28 '17 at 9:37
  • @skymningen I like to think institutes only consider methods acceptable when they are acceptable to (their) patients. Similarly, albeit (in light of the above comment) perhaps more likely, institutes should only consider methods that comply with the country's legal system. Institutes are more powerful than their employees and should be better positioned to make the right decisions regarding acceptable methods. Of course, mistakes might occur, but mistakes should be rare. If mistakes are common, then employees should (rightly) be questioning their choice of employer. – user2768 Nov 28 '17 at 10:29
  • @user2768 Exactly because of your arguments I would suspect that the publisher and institute will already have been much more vocal about their preferences regarding anything in this publication than the patients, who often don't know enough about their rights to investigate for example how exactly their anonymity will be protected. Also, institutes or publishers should have a rule set somewhere in writing applicable to all publications, patients do have separate wishes and needs that need to be inquired for each patient separately every time. – skymningen Nov 28 '17 at 10:32
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    @user2768 The patient's preference IS the most important legal requirement (at least in the most countries). If you do not adhere to their preferences, there is no consent, so there is no way for you to use the data. If your patient does not want their picture to be published with a black bar you either choose pixelation or remove the picture. Or let your legal consultant know there might be problems coming up. – skymningen Nov 28 '17 at 11:43
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The BMJ Publishing Group suggests a very simple reason for the change:

We no longer publish pictures with black bands across the eyes because bands fail to mask someone’s identity effectively.

We will need the patient to sign our consent form, which requires the patient to have read the article.

If you can "blacken out" the face, then why not just crop it out altogether?

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If you are in the United States, HIPAA regulations require that no identifiable information about the patient is published without his/her written consent. This includes photographs showing the face (fully or partially) or any other distinguishing features (tattoos, etc.). At the very minimum, you should cover the entire face with a black rectangle, or crop the face out of the picture. Alternatively, you can request written permission from the patient.

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