- BIOETHICS FORUM ESSAY
Reduce, Reuse, Recycle . . . and Inform?
The New York Times recently reported the practice, now common in a number of U.S. hospitals, of reusing “one time only” medical devices. The practice is not only cringe-worthy (a re-used feeding tube? no thanks), but in certain instances dangerous and even deadly. According to an Ascent Healthcare report, 2 percent of medical devices are reprocessed for multiple uses even though they are manufactured for one use only. Though the devices go through rigorous sterilization before being administered to a second (or third) patient, at times this sterilizing process makes them dangerous. In the case of one infant boy, a recycled — and misshapen — feeding tube caused him to gag so frequently that he never learned to swallow. The reuse of these devices raises a host of ethical issues, not least of which is the fact that patients are not told of the practice and its risks. This is the point Art Caplan makes at the close of the article, stating “I just think people oughta know what’s going on.” Translated to the medical context, this means patients should provide informed consent before receiving a recycled device.
Caplan raises a good point. Patients should know the risks involved in the reuse of medical devices. Discovering that a device is being recycled when it’s not supposed to be, and without the patient’s knowing it, will give many patients the heebie-jeebies. Call this distaste visceral, but the fact remains that reusing one-time-only medical devices violates protocol. Worse, the deviation from standard practice, though often safe, nevertheless carries a certain risk (exactly what is unknown since the FDA does not keep stringent records). And to top it all off, the whole process is being carried out on the sly. An insistence on informed consent, however, allows our moral distaste to dissipate since we assume that a patient is actively agreeing to receive a reprocessed device.
At the same time, one has to consider whether informed consent really clears up the moral messiness. Informed consent is the standard bioethics cure-all at the moment, and certainly it bears stressing, since it is too often lacking in medical research and procedures. But fixating on it oversimplifies matters and causes us to miss the nuances involved in practices like the reuse of medical devices. It assumes that, once a patient is informed of the risks, the ethical quandaries surrounding the practice largely disappear. After all, informed consent appeals to a patient’s ability to make autonomous decisions. If a patient consents to the risk of receiving a reused device, well then . . .
If only the matter were so simple. Informed consent becomes far less relevant when we consider that patients are not offered a choice between reused and new devices. Imagine: A patient with cancer of the larynx requires a laryngectomy. Hours before surgery, he receives the consent forms and finds that the hospital reprocesses certain medical devices, including feeding tubes. Reading of the risks involved, what is the patient to do? Unless he is given the option between a new and used device, how much does his consent really matter? It can be argued that the patient really does have a choice: he can choose to have his surgery at a hospital where only new devices are used. But this argument does not stand long unless we are referring to a world where surgeries are not urgent, patients are fully mobile, and the means for seeking other hospitals are unlimited. Until that happens, the choice is this: submit to the risks of a reused device or forego an often imperative procedure. For many, the choice is not really a choice. Until hospitals give up the practice of recycling single-use devices, a patient’s consent may mean less “I agree” and more “I give in.”
– Alison Jost