Abstract

This article highlights the emerging ethical issues related to reducing the environmental cost of medicines, health technologies and health services, taking as an example the situation of inhalation devices for the relief of various respiratory disorders, i.e., “inhalers”. Inhalers emit greenhouse gases that contribute to climate change. Recently proposed regulatory changes aim to control the use of greenhouse gases, but exceptions are necessary for inhalers due to the lack of less polluting substitutes and their vital importance for certain patients. Healthcare professionals and medical associations are actively campaigning for greater awareness and better education on the subject. On the political front, there are calls for legislation to encourage a rapid transition to cleaner inhalers. Long-term solutions include the use of low-carbon inhalers, such as those that use dry powder, as well as changes in prescribing and use practices. Stakeholders agree on the need to reduce environmental impact while prioritizing patient health, but ethical tensions can arise around possible real or perceived trade-offs between therapeutic efficacy, risk and inhaler durability. Our case study highlights the importance of integrating environmental considerations into health policy and clinical practice while recognising the ethically sensitive issues at this intersection, areas of uncertainty and other challenges to be overcome.