Bioethics Forum Essay

Now What? Bioethics and Mitigating Climate Disasters

For those committed to realistic responses to our current climate crisis, the results of the presidential election are a major step backward. Announcements of cabinet choices for the second Trump administration are a very strong indication of a return to policies of denial, greenwashing and undoing the progress of recent years. One bright spot in this otherwise gloomy picture is that much of the mitigation effort contained in the Inflation Reduction Act should be in place by January 2025, and thereby difficult to undo. Still, we might well ask: Now what? Is there a way to make a difference over the next four years? And, especially, does bioethics have a role in this effort?

 I argue that there is important work ahead and bioethics should be squarely in the middle of it. The work is less in federal policy and more in public persuasion. The role for bioethics is to bring global warming and its catastrophic health consequences into focus as an existential crisis neither party can ignore.

The effects of climate change are profound, overwhelming, and increasingly severe. They are well-known, but, I think, rarely penetrate far enough to motivate action. Melting polar ice, shrinking permafrost regions, rising and warming ocean, hotter average temperatures, increasingly frequent and severe forest fires, hurricanes, typhoons, and similar storms and unprecedented flooding are part of what we are already experiencing, and they will worsen.

The future health consequences of these environmental changes are almost unimaginable. Massive numbers of deaths, especially among the world’s poorest populations, will occur because of unrelenting heat, uninhabitable land, food and water shortages, and the breakdown of economies and national governments. Already a quarter of the earth’s population lacks safe drinking water, with the result that nearly 2 billion people currently struggle to meet their daily needs for clean water. By 2030, increased salination of irrigated farmland, evaporation caused by increased heat, and frequent flooding of coastal areas will mean that an additional 1 billion people will be without a safe source of potable water. Moreover, climate change affects the spread, intensity, and seasonality of infectious diseases like malaria and cholera. In general, climate change will produce a substantial increase in transmission of disease worldwide. Heat emergencies, mental health disorders, and broader health problems like declining food safety and its consequences add to the growing damage of climate change.

The burden of change to avoid or mitigate such disastrous health outcomes lies with the major polluters. The United States, China, and India, are the top emitters of greenhouse gas, responsible for over 42% of all global emissions. Bioethicists in the U.S. should hold the country accountable as a major polluter with obligations to mitigate climate change and the health disasters that follow from it as part of bioethical commitments to justice. A key tactic in holding the U.S. accountable is to battle for the hearts and minds of our fellow citizens, and here is where bioethicists can make a difference.

The conventional wisdom is that those in denial of climate change cannot be swayed by facts and reasoning. Yet the idea that denial is a psychological monolith impervious to persuasion is more a dogma than reality. I argue that it is more accurate to differentiate between those who deny climate change as part of their political identity and those who deny it out of ignorance, convenience, avoidance, fear, or a sense of helplessness. The first group is ideologically committed to its position and, therefore, is very unlikely to accept scientific evidence of climate change. The second group, however, is our persuasion target. A renewed commitment by bioethicists to educate and persuade the public is imperative. It is very important to start with careful listening, and to have empathy for the many reasons that denial seems reasonable to many people. In the dialectical interaction of persuasion, moral judgments have no place. Patience and persistence will be essential.

Suggestions for bioethics and bioethicists:

1. Bioethicists who work in hospitals and academic medical institutions must urge their leadership to be proactive in creating greener systems of care. A good place to start is with Practice Greenhealth.
2. Help to educate the press about global warming. This effort could involve partnering with climate scientists to offer workshops and continuing education.
3. Join local health boards and focus attention on global warming as a central health hazard for communities.
4. Include global warming as a central topic in all bioethics courses at every educational level.
5. When invited to speak or write, choose global warming as the topic. Emphasize:
6. The disastrous health effects of global warming. The health ethics of the larger “bios-ethics” must now complement the ethics of individual medical care.
7. Active resistance to disinformation and greenwashing. Fossil fuel companies have deep pockets to promote false claims that they are adopting green energy while simultaneously shifting blame to individual lifestyle choices rather than polluting corporations. It cannot be forgotten that ExxonMobil withheld and lied about its own research accurately predicting the ill effects of fossil fuels for decades.
8. Better understanding of how science works — how it continuously gathers new evidence about climate change to improve the accuracy of its assessment of the catastrophic health effects. Emphasize that there is no longer any significant debate about what we are facing, only about how severe and how soon the devastation will occur.

Bioethics was born as a response to threats to the humanity of patients and research subjects. The integrity of the field now depends on whether it can respond to the environmental threats to humanity and the planet, rather than playing for small stakes at the margins of the crisis we now face.

Larry R. Churchill, PhD, is Ann Geddes Stahlman Professor of Medical Ethics Emeritus at Vanderbilt University and a Hastings Center fellow.