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. (shrink)