By Esmée Hanna and Glenn Robert
Whilst ethical issues relating to the disposal of body parts generally are increasingly discussed (largely prompted by high profile organ retention scandals), what happens in the specific case of amputated limbs has not received much attention. Amputation is however increasingly common, in part due to growing rates of diabetes and vascular diseases; for example, it is estimated there has been an almost 20% increase in diabetic related lower limb amputations since 2010 .
Our own interest in limb disposal practices arose from the experience of a relative of the lead author in 2017. After the decision was taken that an emergency amputation was necessary, the extended family who had gathered at the hospital were asked a rather unusual question by the nurse: ‘what do you want to do with the leg?’ This was not a question the family had given much prior consideration to. As applied health researchers, we were intrigued to learn more about practices relating to the disposal of limbs after amputation as well as the options available to patients and their families. We were surprised to learn that the disposal of limbs has also received very limited academic attention.
In Autumn of 2018 it emerged that there was a crisis of medical waste management within the UK; this included limbs and other body parts being held in a ‘stockpile’ due to a backlog of medical waste by the then NHS contractor, Healthcare Environmental Services. We highlighted at the time how the coverage of this scandal largely focused on potential public health issues and NHS procurement failures but side-lined patient and family experiences. We argued that patient distress in thinking that their recently amputated limb was being held in a stockpile was also significant and that disposal matters as part of patient care (whether concerning the information patients are provided with in terms of their options as well as questions of consent for their body parts to be disposed of through waste management services).
In the patient and public involvement (PPI) work we have undertaken to inform our research agenda on limb disposal, patients tell us that such choice matters. Being told the options and knowing what will happen to their amputated limb is important. Patients feel this choice carries even more significance if people hold particular religious or cultural beliefs relating to the disposal of their limbs. Patients do think of amputated limbs as still being ‘theirs’; the limb matters and its loss can be a source of grief and distress. Dignified and respectful disposal is seen as fundamental.
In our forthcoming paper in JME, ‘The ethics of limb disposal: Dignity and the medical waste stockpiling scandal’ we consider further the patient experience of limb disposal, using the stockpiling scandal as a test case for how a dignity framework could be used to shape waste management practices in ways which would help ensure that patients are central to consideration of best practice. Using dignity as a central value for disposal of limbs is a way by which healthcare provision can seek to avoid future stockpiling scandals and make sure that patient centred care extends to the disposal of limbs.
Authors: Dr Esmée Hanna, De Montfort University; Prof. Glenn Robert, King’s College London
Competing interests: None to declare