NHS should lead in ensuring goods it buys are produced ethicallyBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3107 (Published 17 May 2011) Cite this as: BMJ 2011;342:d3107
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The picture of children working in Siakot, Pakistan, working in the
manufacture of surgical instruments in last week's BMJ, 21st May, depicts
the ethical concern of using children as cheap labour to keep the cost of
single use instruments low. But should we be using these instruments? The
pressure from Primary Care Trusts to change from reusable items to
disposable has been very real and the policy is now being pursued towards
the dental profession and hospital outpatient departments.
This policy has high costs attached to it.
1. The economical impact does not need spelling out. It is far more
costly to buy single use instruments than re-use instruments.
2. The environmental impact of disposing of the instruments is cumulative.
Currently these are going into landfill sites.
3. The energy expenditure for extracting the minerals, the manufacture and
transport of the items is huge.
4. The plight of the children caught up in the manufacture of these things
in poor communities is real.
5. There is a risk to availability of supply during a national crisis,
strikes or terrorist attacks.
The basis of any policy decision should be whether instruments are
safely decontaminated and sterilised in primary or secondary care. If this
is so the procedure should be encouraged and promoted for the reasons
Our surgery has sought to meet the stringent requirements of
decontaminating surgical instruments. It has been increasingly difficult
to resist the condemnation of the PCT. We hear with dismay the advancement
of this policy into the dental and secondary care settings. What support
is there for continuing to resist the demands for the use of single-use
instruments? We would appreciate further information. Firstly on the
evidence for the risk of the use of re-usable instruments when using
washer-disinfectors and sterilisers and secondly, whether there are other
practices using these instruments in the NHS.
Please reply with an open letter or to firstname.lastname@example.org
Competing interests: No competing interests