Introduction:
Environmental Bioethics in the 21st century
In 2014, the global carbon emissions of the healthcare industry were 2.0 gigatons or 4.4% of world emissions; if healthcare were a country, it would be the 5th largest carbon emitter worldwide. However, attention to the impact that healthcare has on the environment is often overlooked when climate, sustainability, and health are discussed in university courses, journal articles and issues, major international conferences, and books and monographs.[i] Moreover, these discussions fail to invoke an ethical methodology which makes sustainable healthcare sensible to a variety of stakeholders— such as clinicians, researchers, patients, and healthcare policymakers—who have the power to minimize climate change and healthcare carbon.
Hence, environmental bioethics is an ethical response to climate change and health, rooted in philosophy, ecology, and medicine. Environmental bioethics examines the impacts of climate change on health and the impacts of healthcare on the environment that is, medical carbon emissions.
First, the effects of climate change on population and individual health include climate change health hazards such as death and injury by flooding, famine, vector borne illness, pollution, and heat. These anthropocentric concerns should not be overshadowed by larger planetary and ecosystem concern of non-human health. Concepts such as “planetary health” and “One health” recognize the interconnection of all those inhabiting the planet.[ii] These aspects of environmental bioethics contextualize and distinguish between global and local impacts of climate change and identify points of interconnectedness between individuals and populations.
Second, environmental bioethics analyses and highlights the impact that the healthcare sector and medical industry itself has on climate change through carbon emissions. Healthcare carbon emissions come from upstream sources like water, energy, and medical supplies, which require infrastructure, raw-materials extraction, manufacturing, and transportation. Downstream sources of medical carbon include healthcare delivery such as consultations, procedures, pharmacy services, and hospitalization. Healthcare delivery infrastructure such as administrative services, procurement, food services, waste services, transportation, and operations management also emit carbon, as does medical research and medical engineering.
[i] Atwoli L, A HB, Benfield T, et al. Call for emergency action to limit global temperature increases, restore biodiversity and protect health. BMJ Glob Health 2021;6(9) doi: 10.1136/bmjgh-2021-007228 [published Online First: 2021/09/07]; Pörtner H-O, Roberts DC, Adams H, et al. Climate change 2022: Impacts, adaptation and vulnerability. IPCC Sixth Assessment Report 2022. Atwoli L, Erhabor GE, Gbakima AA, et al. COP27 Climate Change Conference: urgent action needed for Africa and the world. Lancet 2022; 400: 1563–65.
[ii] Lerner H, Berg C. A Comparison of Three Holistic Approaches to Health: One Health, EcoHealth, and Planetary Health. Front Vet Sci 2017;4:163. doi: 10.3389/fvets.2017.00163 [published Online First: 2017/11/01]; Barton Behravesh C. Introduction. One Health: over a decade of progress on the road to sustainability. Rev Sci Tech 2019;38(1):21-50. doi: 10.20506/rst.38.1.2939 [published Online First: 2019/10/01]; ‘ Organization WH. Taking a multisectoral one health approach: a tripartite guide to addressing zoonotic diseases in countries: Food & Agriculture Org. 2019.; Organization WH. Joint Risk Assessment Operational Tool (JRA OT): An Operational Tool of the Tripartite Zoonoses Guide–Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries: An Operational Tool of the Tripartite Zoonoses Guide–Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries: Food & Agriculture Org. 2020; Pettan-Brewer C, Martins AF, Abreu DPBd, et al. From the Approach to the Concept: One Health in Latin America-Experiences and Perspectives in Brazil, Chile, and Colombia. Frontiers in Public Health 2021;9 doi: 10.3389/fpubh.2021.687110