Ethics of limb disposal: dignity and the medical waste stockpiling scandal.

We draw on the concept of dignity to consider the ethics of the disposal of amputated limbs. The ethics of the management and disposal of human tissue has been subject to greater scrutiny and discussion in recent years, although the disposal of the limbs often remains absent from such discourses. In light of the recent UK controversy regarding failures in the medical waste disposal and the stockpiling of waste (including body parts), the appropriate handling of human tissue has been subject to further scrutiny. Although this scandal has evoked concern regarding procurement and supply chain issues, as well as possible health and safety risks from such a 'stockpile', the dignity of those patients' implicated in this controversy has been less widely discussed. Drawing at Foster's (2014) work, we argue that a dignity framework provides a useful lens to frame consideration of the disposal of limbs after amputation. Such a framework may be difficult to reconcile with the logic of business and the 'biovalue' of the medical waste, but would we argue afford more patient-centred approaches towards disposal. It may also facilitate better practices to help mitigate future stockpiling incidences.

Percepção clínica, ética e legal de acadêmicos de Odontologia sobre gerenciamento de resíduos de serviços de saúde / Dental Students' Clinical, Ethical, and Legal Perception on Healthcare Waste Management

O objetivo desse estudo foi analisar a percepção clínica, ética e legal de acadêmicos do curso de Odontologia sobre o gerenciamento de Resíduos em Serviços de Saúde (RSS). O estudo foi do tipo observacional transversal, com amostragem censitária de acadêmicos do 8º(n=23) e 9º(n=18) períodos. No questionário aplicado abordou-se o processo de produção, manuseio e descarte dos RSS, no que concerne ao gerenciamento, legislação e questões éticas. Os dados foram organizados em planilhas e interpretados por meio de análise descritiva. Sobre as normas vigentes para o gerenciamento de RSS, 82,9% e 95,1% dos estudantes afirmaram desconhecer o tratamento/disposição final e regulamento técnico para o gerenciamento de RSS, respectivamente. Em relação ao Plano de Gerenciamento de Resíduos de Serviços de Saúde (PGRSS), 85,4% não conhecem o Código Penal e 87,8% não estão familiarizados com o Código Civil. Além de disso, a maioria dos entrevistados desconhecem as Normas da Associação Brasileira de Normas Técnicas (75,6%) e as Resoluções do Conselho Nacional do Meio Ambiente (82,9%) e da Agência Nacional de Vigilância Sanitária (95,1%). Por outro lado, 73,2% afirmam conhecer os direitos e deveres do cirurgião-dentista, presentes no Código de Ética Odontológica. Quanto à classificação dos resíduos produzidos em ambiente odontológico, 95,1% responderam corretamente sobre o hipoclorito de sódio e 97,6% sobre os roletes de algodão e gaze com sangue. Portanto, foi possível concluir que existe conhecimento satisfatório sobre os aspectos clínicos e éticos, entretanto insuficiente quanto às legislações vigentes no Brasil (AU).

The aim of this study was to analyze the dental students' clinical, ethical and legal perception on the management of health services waste (HSW). This was a cross-sectional observational study, with census sampling of students from the 8th (n=23) and 9th (n=18) terms. The applied questionnaire addressed the process of production, handling and disposal of HSW, regarding management, legislation and ethical issues. Data were organized in spreadsheets and interpreted by descriptive analysis. Regarding the current rules for the management of WHS, 82.9% and 95.1% of the students stated that they did not know the final treatment/disposition and technical regulation for HSW management, respectively. Regarding the Health Services Waste Management Plan (HSWMP), 85.4% did not know the Criminal Code and 87.8% were not familiar with the Civil Code. In addition, most respondents were unaware of the principles of the Brazilian Association of Technical Standards (75.6%) and the Resolutions of the National Environmental Council (82.9%) and the National Health Surveillance Agency (95.1%). On the other hand, 73.2% claimed to know the rights and duties of the dental surgeon, present in the Code of Dental Ethics. Regarding the classification of residues produced in a dental environment, 95.1% answered correctly about sodium hypochlorite and 97.6% about cotton and blood gauze rollers. Therefore, it was possible to conclude that there is satisfactory knowledge about the clinical and ethical aspects, however insufficient regarding the current legislation in Brazil (AU).

From waste to (fool's) gold: promissory and profit values of cord blood.

According to biomedical discourse, cord blood has been transformed from 'waste' to 'clinical gold' because of its potential for use in treatments. Private cord blood banks deploy clinical discourse to market their services to prospective parents, encouraging them to pay to bank cord blood as a form of 'biological insurance' to ensure their child's future health. Social scientists have examined new forms of (bio)value produced in biological materials emergent with contemporary biotechnologies. This paper contributes to this literature by examining the social and technical production of value in cord blood units collected for private banking. Value, in this paper is defined as a socio-cultural concept in which an object is made meaningful, or valuable, through its relations with social actors and within specific regimes of value. I draw on in-depth interviews with women who banked cord blood and key informants in private banks in Canada, to analyze how social actors produced cord blood as a valuable biological object. I show that a cord blood unit holds promissory value for women who bank and profit value for private banks and that these values are folded into each other and the biological material itself. Analyzing how specific cord blood units are made valuable provides insight into the multiple and possibly competing values of biological materials and the tensions that may arise between social actors and forms of knowledge during the valuing process.

Promising waste: biobanking, embryo research, and infrastructures of ethical efficiency.

Biobanks are custodial institutions that enhance the utility and value of biological materials by collecting and curating them. Their custodial functions tend to include ethical oversight and governance. This paper explores how biobanks increase the value of biological materials by standardizing routines of governance in order to engender "ethical efficiency." Focusing in particular upon banking of human embryos for research, the article offers an historical account of how human embryos came to be "waste" available for use by researchers in the US. It offers a case study of a human embryo biobank and the practices of ethical governance that the biobank employs to capture this waste and convert it into a valuable resource for research use. The article draws attention to the ways biobanks' emphasis on efficiency and resolving problems of ethical governance up front codifies otherwise contested normative relationships and authorizes uses of human biological materials that some see as ethically problematic, even as it eliminates institutionalized mechanisms of reflection in which such problems would otherwise be acknowledged and confronted.

"Properly disposed of": a history of embryo disposal and the changing claims on fetal remains.

This paper explores recent controversies concerning the disposal of embryonic and fetal remains in order to ask how such remains came to be classified as "medical waste." Based on archival research into the social history of human embryo collecting in Baltimore, Maryland, in the early 20th century, I argue that the classification of embryos and fetal remains as medical waste can be traced to a pragmatic alliance between embryologists and state functionaries. Embryologists relied on the state to assist them in acquiring thousands of human embryo remains for scientific study, while state authorities relied on embryologists to provide authoritative knowledge that could be used to facilitate state control over nascent citizens. This alliance contributed to the development of an "embryological worldview," in which human embryos were cast as objective biological "specimens" of use only to embryologists. This exclusive view of the social value of embryos and fetal tissue is now being challenged as other constituencies claim jurisdiction over the remains in order to advance diverse social agendas.