Esmée Hanna: Patient dignity must be central to appropriate disposal of body parts

Dignity in healthcare should be enacted at every step of a patient’s care, including when parts of people’s bodies have to be disposed of, says Esmée Hanna

Recent reports of hospital waste, including body parts, being stockpiled clearly has major environmental implications, as well as raising questions about how NHS procurement processes are handled. These points are hugely important and further investigation of the impact(s) of such stockpiling is required. While exposing this “stockpiling scandal” is vital to understanding how this can be prevented in the future, discussions around the scandal have not, as yet, fully captured the implications for patients.

Patients should remain at the heart of all practice. While classified as “waste” in the context of its disposal, body parts originate from patients and the news of any mismanagement of these parts undoubtedly creates questions about the dignity they’re afforded within disposal. We have seen rightful outrage about undignified handling of amputated limbs in other places, such as in a recent case in India, and we must therefore ensure that the conceptualisation of limbs as “waste” does not prevent similar fears about the dignity of disposal being expressed within the NHS context.

The Human Tissue Authority states that ‘‘the disposal of human tissue should be managed sensitively and the method of disposal should be appropriate to the nature of the material.” Appropriate disposal would encapsulate the disposal being timely, which a stockpile is clearly not.  

The loss of a body part through amputation can be seen as a bereavement to some patients and adaptation to amputation requires both physical and psychosocial adjustment. As medical professionals have noted, how limbs are disposed of after amputation is a cause for concern for some patients. Religious beliefs can also motivate preferences around how amputated limbs are disposed of, although, as our work into this area has begun to uncover, often there are limited solutions available to healthcare professionals to ensure that patient preferences can be enacted. Patients tell us that dignity is the key concern around the disposal of their limb; the amputated part is still seen as “theirs,” and therefore it is understandable that they want respect to be afforded to their lost limbs.

The scale of the stockpiling problem raised by the Health Services Journal exposé, which refers to tonnes of waste, fails to fully articulate how this could affect patients. In the backlog of 350 tonnes of waste, the expectations of patients that their amputated limbs will be properly handled in their disposal reside.

Research from Europe has suggested that medical professionals have an ethical and legal imperative to ensure that patients have a clear understanding of how their amputated limbs will be disposed of. Yet news of this stockpiling of sensitive waste raises questions about how patient centred current disposal practices are. This will also be worrying for doctors, who will have expectations that the byproduct of surgery, which is often life prolonging or life saving, will be appropriately dealt with.

“Waste” from hospitals originates from the treatment of patients. While we may often as societies be less keen to consider such “backroom” parts of medicine, ensuring that this material, including body parts, is handled appropriately is critical.

Trust in healthcare requires confidence in all parts of the infrastructure, including in the way in which private firms are selected to conduct vital work for the NHS. This is especially important as patients currently have limited options for the disposal of their limbs, and even if they are invited to consider disposal as part of their amputation care, they are often unable to enact any preferences they may have. If patients are to entrust the disposal of their limbs to the healthcare system, then ensuring that such systems are reliable and competent is essential.

The environmental impacts of waste stockpiling are undoubtedly serious, and the procurement systems that enable such situations to arise require immediate scrutiny, but, ultimately, we must also ensure that the consideration of patients is central to how this process is handled. Dignity in healthcare should be enacted at every step of a patient’s care, including when parts of people’s bodies have to be disposed of.

Dr Esmée Hanna (@DrEsmee) is a lecturer in health, wellbeing, and society at De Montfort University, Leicester. Her research focuses on health, gender, and the body and she is currently exploring the disposal of limbs after amputation within patient care.

Competing interests: None declared.