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May 29, 2014 | Posted By Marleen Eijkholt, PhD

Imagine you or your partner want to take your placenta home after birth. You feel that the placenta is part of your (partner’s) body and you should be allowed to take it home.  Maybe to eat it: ‘I ate my wife's placenta raw in a smoothie and cooked in a taco’ (Guardian 30 April 2014) or to bury it for cultural reasons, as protection of the soul and the newborn (LA times 31 December 2013). In Oregon you are legally allowed to take it home. In some hospitals elsewhere, you are not. Imagine that due to circumstances, you end up in a hospital that prohibits you from obtaining the placenta. What’s next?

Requests to take placentas home after birth are increasing. Human placentophagy is on the rise. Kim Kardashian spoke about it in her soap series not too long ago.  Newspapers are full of stories about placentas, their use and ability, and significant amounts of websites discuss the pros and cons of bringing placentas home. Different sources report on the alleged benefits of eating your placenta and other reasons to take it home. The public exposure to this ‘appetite’, its context and the rise in requests, raise concerns about prohibitive practices. Prohibitive policies are likely to come under increased scrutiny. My question in this context: What about eating placentas, what about policies prohibiting this?

Medical waste:

Placentas are traditionally considered medical waste. See here. Hospitals have a duty to carefully dispose of  medical waste. Waste entails risk: “… poor management of health care waste potentially exposes health care workers, waste handlers, patients and the community at large to infection, toxic effects and injuries, and risks polluting the environment”. Laws prohibit medical facilities to release medical waste with stringent policies as the result of this duty. Some of these have explicitly addressed placentas. Concerns about health risks, such as contamination, have even led to stringent prohibitions to prepare placenta smoothies.

But what if you don’t consider the placenta a waste? What if you, or a patient, considers the placenta ‘special’, and does not agree with the hospital’s label of the placenta as waste. Should the hospital keep strictly to their waste policy or their definition of waste? Can we identify any harms of allowing a placenta to be taken home? Are there any harms of making it an exception to medical waste?

Placentas as waste?

I don’t see any harms in taking the placenta home if someone wants to. I think it is fair to make an exception for individual items not to be classified as waste, if an individual asks for it. We see that certain types of ‘waste’ already acquire a special status. Recent outrage concerned the incineration and burning of aborted fetuses as clinical waste, for example. This resulted in a call not to consider dead fetuses as waste.

Medical harms, physical harms, cannibalism or a slippery slope?

Aside from a controversial definition, indeed, medical waste entails the risk of harm. But does this uphold for the placenta? If everyone would freely obtain their placenta and throw it outside on the street, this may create a (public health) risk. However, appropriation of the individual placenta itself, in individual cases, will not result in harm if it is handled carefully.  Under a ‘promise’ to carefully treat the placenta and not hold the hospital liable, I am unsure that there is a problem with release of a placenta. Forms stipulating the release of placenta and waiver of liability have already appeared on the internet.  Furthermore, no physical harms are connected to the placenta either. Apart from one post, no other articles suggest that the placenta entails a risk of physical harm for the consumer. Individuals who would like to bury the placenta, would not encounter that risk in any case. Then, what about cannibalism? If the person would choose to eat the placenta: What about the risk of harm to ‘dignified’ human material? This is not an easy question to answer, and we don’t know if this is the intention of the placenta’s use. In short: it may be indeed cannibalism if someone decides to eat the placenta. The dictionary defines cannibalism as: “the eating of human flesh by another human being“ so that eating human tissue/ flesh equates with cannibalism. However, the problem & harm of cannibalism seems to be mostly related to the killing or commodification of the human (tissue). Taking the placenta home and eating it, may not be seen as such. So finally, what about the risk of harms for the slippery slope? Would release of placentas create a slippery slope for individuals to obtain any tissue they desire?  

No reasons to freeze placenta distribution

Perhaps the release of placentas would open the door to take home surgically removed tumors, amputated feet for individuals who want this. It would create the harm of a slippery slope for human tissue appropriation. I am not sure, however, that this should be prohibited, as long as the tissue itself does entail a clear and direct risk of harm. Although policies around medical waste are important for public hygiene, I think that stringent application of this prohibition for individuals to take home their placenta does not seem to make sense. At least, it does not seem to make sense for the reasons stated above.  I was taught that for a policy to work, it should be supportable (reasonable), feasible and maintainable and support for a policy could derive from concerns about harm. I don’t see a harm in allowing the placenta to be taken home, for reasons of eating or burying it. Placentas have given me food for thought.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

2 comments | Topics: Clinical Ethics, Reproductive Medicine

Comments

Howard Cain

Howard Cain wrote on 06/03/14 10:55 AM

Wow! This is an interesting topic and it is coming up again and again. In a pluralistic society like ours we have to be ever so careful not to impose the majority's values on the minorities. This is particularly true in the hospital setting where people are more vulnerable than usual. Some peoples' culture and religion call for the retention of the placenta for religious/cultural rituals and observances which include burial as well as ingestion. As unpalatable as eating a placenta may be to me I would probably find some way to do it if I thought the well being of my newborn or the spiritual protection of my still born depended on it. Some people even believe that there is nutritional and psychological benefits from eating it and we have services that will dry and encapsulate it or even sell you a cookbook describing different ways to prepare it. Hospitals are faced with biohazard laws that strictly regulate the disposal of biological material containing blood. Nevertheless, we should not use these laws as a justification of a cultural repulsion to the idea. Our laws in America do not recognize property rights to a corpse or human tissue once it is removed from the body, but they do recognized a right to possess the human tissue for proper disposal. Proper disosal includes dignified rituals and procedures in accordance with one's beliefs. These rituals and procedures should address concerns about performing indignities to human remains. Personally, I think release of the placenta should be restricted to the mother or the partner involved in creating the fetus to avoid commodification of the placenta or accusations of cannibalism. Eating one's own flash such as gnawing at wounds or reingesting one's own blood are not generally considered cannibalism. I also wonder if we could use a variant of our organ donor protocols as a template to construct an orderly way of controlling the release of the placenta. This would give us a format in which to address the significant legal concerns involved. My point is that every effort should be made to accomodate the various cultures that we encounter rather than glibly reciting the law and obstructing them unnecessarily.
marleen eijkholt

marleen eijkholt wrote on 06/07/14 7:37 AM

Thank you for your thoughtful comments on my post. I agree with you: Super interesting material, as are issues of culture/religion in general. The challenges of a heterogeneous population are fascinating in the health care setting. Where to draw the line of accommodating minorities against the 'opinion' of the majority is an great way of summarizing these issues.
I would like to give your idea of treating it under organ donor protocols some more thought!

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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