Bioethics Forum Essay
Living Good and Healthy Lives on a Changing Earth: What Should Bioethics Do?
What does it mean to live well on a warming planet? And as the climate changes, how might health care, education, and other sectors support, or obstruct, our ability to respond? The answers to these profound, and profoundly bioethical, questions will critically influence human well-being in this century and beyond. Daniel Callahan, cofounder and President Emeritus of The Hastings Center, and Cheryl Cox Macpherson, professor and chair of the bioethics division at St. George’s University School of Medicine in Grenada, brought together a group of scientists, educators, and bioethicists in early June to consider these questions and begin an interdisciplinary conversation on how the field of bioethics might address the challenges posed by climate change, particularly at the intersection of climate and health.
An impetus for the meeting was the recognition, perhaps still underappreciated in the literature, that climate change is essential to discussions of health and, therefore, should be an essential part of teaching bioethics. Participants included scholar-educators at New York University, Yale, Columbia, the Icahn School of Medicine at Mount Sinai, and AMA Journal of Ethics, among other institutions, who teach at the intersection of climate and health. Bringing together experts from disparate sectors of health education illustrated a powerful diversity of perspectives, while showing how much is still to be done to break down silos in order to center climate issues in health education.
Educators at the workshop discussed how focusing on specific cases or conditions associated with climate change, like valley fever, a fungal infection that has become more common in the southwestern United States, and the terrorist conflicts near Lake Chad in west-central Africa, allows students to have productive discussions and see the direct connections between health and the environment.
Framing the human and environmental effects of climate change in terms of resilience and vulnerability provides conceptual tools to appreciate how complicated the impacts of climate change are. One meeting participant suggested that conceiving of climate change not as a “battle” to be “won,” but instead as a condition of life going forward could help us appreciate its gravity without feeling overwhelmed, which in turn could help us consider meaningful ways to respond.
The expansive, multifaceted causes and impacts of climate change require not only care in framing, but new ways of thinking about responsibility. Who is to blame when Miami, whose porous limestone foundation make sea walls useless, is under water? What recourse do the people of an island nation have when a storm of unprecedented fury destroys infrastructure and lives? Who pays, and what are the proper punitive damages, when the Micronesian nation of Kiribati is submerged? Rights-based legal and ideological frameworks are poorly equipped to consider harms that can only be described probabilistically or in terms of existential threats to future generations (including generations of nonhuman animals) and ways of life. New ways of thinking about solidarity and responsibility may help us reflect and act in the face of greater harms to come.
The philosopher Hans Jonas recognized the need for proportionality between progress and Earth’s ecosystems when writing that our “descendants have a right to be left an unplundered planet.” How should we enjoy the fruits of discovery and “progress” while celebrating (and sustaining) the lives and resources we have? How should we address this tension in a responsible health and science policy? Bioethics has long brought an ethic of proportionality to conversations about which applications of a given technology should be pursued or left alone, and such questions are at the heart of debates on climate change. Bioethics can help build concepts and models that permit us to hold space for the simultaneous harms and benefits that come from generating emissions, and think about these harms and benefits across generations.
Proportionality also comes to bear on discussions on efforts to extend the human lifespan. Elixirs of youth have long been sought, and some researchers claim that recent and near-future advances in biomedicine will enable people living today to live 150 years or longer. How should we consider this desire and possibility? In our aging society, the elderly are among the most vulnerable to climate change, and their health needs increase demand for energy and health care (itself a significant consumer of energy and producer of emissions). These are complex, value-laden topics that have no easy answers and no easy outs, but they raise questions that we must answer—and we will, one way or another.
How we think and talk about climate change, the conversations and value tradeoffs inherent in our responses, and how we educate citizens, health professionals, and others are essential aspects of responding to climate change in ways that value human and nonhuman well-being. As medicine’s adoption of the principles of patient autonomy and confidentiality illustrate, bioethics has long had an important role to play in thinking about what values and priorities should be at the center of a just health care system. Interdisciplinary by nature and long attentive to issues of framing and language, bioethics is well positioned to reflect on climate change’s disparate impacts and offer thoughtful critique of some of the most hubristic, techno-optimistic remedies that have been suggested. We hope to continue this conversation in bioethics and across disciplines.
Ben Wills is a project manager and research assistant at The Hastings Center. Cheryl Macpherson, PhD, is a professor at St George’s University School of Medicine and a senior research fellow at the Windward Islands Research and Education Foundation in Grenada.
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