Is once always enough? Revisiting the single use item

Abstract

The reuse of single use medical items is a complex ethical issue that many healthcare providers are faced with, for while recommendations and literature do not advocate the reuse of these items, the reality is that many single use items are frequently reused. Further, many healthcare workers are ethically divided over whether or not to share this information with their patients, or who should reveal this information. While single use items are convenient to use, the reality of the cost to the healthcare system and the environment is being realised. Three distinct issues in regard to reuse of single use items are explored: patient consent, fiscal responsibility and environmental stewardship. Exploring these issues through the ethical frameworks of utilitarianism, contractarianism, and land ethic or holism can offer guidance in attending to the question "is once always enough?" Applying an integrated ethical framework can further assist healthcare providers and stakeholders to make informed, ethical choices in regard to choosing single use medical devices and items. Short, fictionalised narratives based on authentic events are used to illustrate the ethical context of the reuse issue.

Reúso de dispositivos médicos de uso único e implicações para a segurança do paciente

“…Autores discutem que produtos de uso único abertos e não utilizados deveriam ser elegíveis para reúso sem discussões. Outros defendem que cada prática requer consideração cuidadosa 20 .…”

“…Autores afirmam que o número máximo de reúso sustentável de um produto descartável é parâmetro fundamental e deve ser avaliado por meio de análise física, química, microbiológica e testes funcionais 2,12 . Essa situação pode ser aplicada igualmente para os produtos de uso múltiplo, uma vez que esses também não podem ser reprocessados e reusados de modo indeterminado 20 .…”

Hospitals and “Used Goods”

“…While single-use items may advance patient care, they also contribute to our growing landfills, with potential risk to those living nearby. Similarly, reprocessing a used item requires chemicals that may end up in our water or even food supply [1]. While contractarianism, utilitarianism, and land ethic may seem to be in opposition at first glance, the NIMBY phenomenon of the 1980s proved that a neighborhood garbage dump is never in a community's selfinterest.…”

“…Although autonomy and informed consent are vital to maintaining the best possible individual patient care, Moszczynski points out that in our current economic climate, the needs of the health care community at large cannot be overlooked [1]. She applies utilitarianism in suggesting that reuse of items designed for single use may lessen the financial burden on society.…”

“…Although she counters that no price can be put on a person's health, the practical fact is that we live in a nation of limited health care resources, the allocation of which is an area of active political debate. If used single-use items are sterilized and donated to third-world countries, those same items should be acceptable for a Western nation with rapidly escalating health care costs [1]. That said, it remains unclear without a definitive cost-benefit analysis that considers the labor, materials, and time required for sterilization procedures whether reuse actually saves money [1].…”