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Article (23 01 23)
Article (23 01 23)
On the ethics of
body-part disposal
Source: Aeon.co/Ideas
Our limbs can be a crucial part of our sense of self and identity, so
amputation is often traumatic to the emotional and psychological
wellbeing of patients. For years after an amputation, patients’ ability to
perform personal, work and leisure activities can be heavily impacted, and
their body satisfaction can diminish. Once amputated, the limb moves from
being part of the bodily whole, to being merely a ‘part’. Yet patients often
still consider this ‘part’ as ‘theirs’. Even after the limb is physically removed,
severance from the self is not absolute. In fact, the grief of losing a limb is
suggested to be similar to losing a spouse.
At present in the UK, there are limited options for patients regarding limb
disposal after amputation. Hospital incineration is the most common
method, however recent scandals around medical waste disposal has
raised questions about the dignity of such methods for patients and their
amputated limbs. Given the grief that patients can experience in relation to
amputation, considering a more dignified approach to the disposal of
limbs, and the ethical issues of disposal, is now a pressing concern.
Yet for many patients, such opportunity to state their preference or wishes
around their own body parts is not offered or available. Standard practice
in the UK is for limbs to be disposed of via medical waste incineration,
which is a collective and impersonal process that routinely fails to offer
patients the opportunity for the return of ashes, for example. The lack of
choice, the challenges around consent, and the rights of the patient to have
freedom to make decisions around their ‘lost’ limbs highlight the existing
ethical tensions around limb disposal after amputation.
Within the consideration of the ethics of limb disposal, there are a number
of tensions around the ‘ownership’ of limbs and who has the ‘right’ to
decide on the disposal of the amputated part. Some scholars believe that a
property approach is too individualistic, and therefore fails to look at the
complexity of the wider picture. As Imogen Goold, an associate professor
of law at St Anne’s College, Oxford, and colleagues have suggested, there
are a number of different interests in bodily material, which creates
conflict. There are also tensions deriving from the idea of ‘biovalue’ which
relates to the intrinsic value found in biomaterial such as human tissue.
While the ‘value’ of limbs is less frequently considered than the ‘value’ of
internal organs (say, for sale or for transplantation), they do nevertheless
have ‘biovalue’. Medical waste management is big business: HES, for
example, reported record profits in the year preceding the stockpiling
scandal. The sector as a whole might be worth £70 million pounds per year.
Therefore, the waste-disposal industry sees limbs as part of its ‘business’,
from which it makes profit to ‘manage’ such waste. Commercial activities
often sit at odds with patients’ wishes. The logic of market forces is
different from the logic of beliefs and desires around the patients’ own
bodily autonomy.
How then do we reconcile the business of medical waste (if we agree that
commercial activities are an inevitable part of this process) with medical
ethics? The concept of dignity could help us, and the Royal College of
Nursing defines it as:
To treat someone with dignity is to treat them as being of worth, in a way
that is respectful of them as valued individuals … When dignity is present,
people feel in control, valued, confident, comfortable and able to make
decisions for themselves.
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