In the past two decades, the scientific community has reached an overwhelming consensus that human activities are causing changes to the global climate. Increased levels of carbon dioxide, methane, and other greenhouse gases in the last century have raised temperatures around the planet, as receding glaciers, melting icecaps, and record-breaking heat waves give evidence. Unless we change course, average global temperatures will probably increase by several degrees Celsius in the next fifty years, with disastrous environmental consequences: inundation of low-lying coastal areas, an increase in powerful hurricanes, desertification, decreased agricultural productivity, and loss of biodiversity. Although there remain some scientific uncertainties and disagreements about the extent of expected temperature increases, the magnitude of the environmental impacts, and how to mitigate global warming, there is now near-unanimity that humanity plays a significant role in changing the climate.
To date, most of the moral consciousness-raising concerning climate change has come from environmental scientists, political interest groups, social activists, and religious denominations who have taken the lead in getting people to think about climate change – along with some politicians, most notably Al Gore. Resistance to the scientific consensus, and to the recommendations for curbing greenhouse emissions, has come chiefly from industry representatives, business interests, economists – and other politicians, most notably George W. Bush. Bioethicists, for the most part, have remained on the sidelines.
This silence is perilous. Because global climate change is likely to have substantial impacts on the environment and human health, bioethicists should take part in the discussion about global warming and contribute their perspectives to these urgent issues.
There are several reasons bioethicists have had little to say about global warming. First, bioethics has traditionally focused on dilemmas and decisions related to the interactions among patients, medical professionals, and health care organizations. Topics such as abortion, euthanasia, informed consent, privacy, reproductive health, and access to health care are the bread and butter of bioethics research, education, and consultation. Concerns about global warming usually do not arise in typical encounters between medical professionals and patients, nor even in the development of institutional policies.
Second, most bioethicists work for health care organizations, such as hospitals or medical schools, which do not have a vested interest in environmental issues. Bioethicists are paid to help solve problems related health care, not to expound on environmental concerns. Third, environmental issues do not have the emotional impact of the life and death dramas that take place each day in hospital wards. Hence, they tend to draw less attention from the media, the public, and scholars. Everyone can understand and appreciate the ethical difficulties in withdrawing life support from a loved one, but not very many people can come to terms with the significance of global warming. Climate change issues are often abstract and difficult to see.
In recent years, however, a number of writers have argued that bioethicists and health policy analysts should consider how the environment affects human health and how the health care system impacts the environment.1 Environmental factors such as geography, housing, education, income, race, workplace safety, ethnicity, pesticide exposure, and clean air, water, and soil have significant consequences for human health. Some environmental factors, such as the availability of clean water and air, can be as important for the health of population as access to health care.
Additionally, differences in the social and physical environment can contribute to differences in health. People tend to have worse health if they live near environmental hazards. The devastation wrought by Hurricane Katrina in August 2005 illustrated how the environment can have a disproportionate impact on human health. Katrina’s harms were worst for people who were already socially and economically disadvantaged; those people tended to live in areas that were more susceptible to flooding and had fewer resources to draw on in order either to escape from the flooding or to deal with its aftermath. According to a recent report [pdf] on climate change, the burdens caused by global warming will also be distributed unequally: people living in developing nations will suffer greater harms than people living in developed nations, due to the effects of flooding, drought, famine, and disease.
Not only is human health greatly affected by the environment, but the provision of health care can have substantial, adverse environmental impacts (as documented in Jessica Pierce’ and Andrew Jameton’s 2003 book). Hospitals and clinics generate tons of biomedical waste and other hazardous materials. A typical heart revascularization surgical procedure creates 43 pounds of biomedical waste, according to a 1992 article in the Journal of the American Medical Association. These waste products can pollute the soil and water and pose a threat to human health and the environment. Health care institutions also contribute to global warming by using a tremendous amount of electricity for their operations or burning fuels that produce greenhouse gases. Pharmaceuticals and their metabolic products, which are excreted by the body, can enter the ecosystem, and many water sources now have trace amounts of codeine, acetaminophen, ibuprofen, digoxin, and antibiotics. The health effects of low levels of exposure to these chemicals are unknown.
If environmental issues, such as climate change, belong on bioethics’ agenda, then what can bioethicists do to help address these issues? First, they can raise awareness among leaders of health care organizations about how their decisions have an impact on climate change. They can encourage hospitals and medical centers to consider ways of reducing their contribution to global warming, such as improving energy efficiency, promoting telecommuting and telemedicine, and encouraging the use of mass transit.
Second, they can participate in debates about climate change issues that arise outside of the health care setting, such as disaster preparedness, land use policy, international law and ethics, and pollution cap and trade systems. Third, they can explore the moral, philosophical, theological, and legal foundations of environmental policy. Some situations raise fundamental conflicts between promoting human health and protecting the environment. Even a choice as simple and mundane as setting a hospital’s thermostat creates a potential conflict between human health and the environment, since lowering the setting may reduce the hospital’s impact on the environment but raising it may help promote the health of patients. Bioethicists should help health care administrators to think about decisions like these.
This research was supported by the intramural program of the NIEHS/NIH. It does not represent the views of the NIEHS or NIH.
1. D. Resnik and G. Roman, “Health, Justice, and the Environment,” Bioethics 21 (2007): 230-41; N. Daniels et al., Is Inequality Bad for Our Health? Boston: Beacon Press, 2000; J. Robert and A. Smith, “Toxic Ethics: Environmental Genomics and the Health of Populations,” Bioethics 18 (2004): 493-514.; R. Fiore and L. Fleming, “Occupational and Environmental Health: Toward an Environmentally Inclusive Bioethics,” Professional Ethics 11 (2003): 63-80.