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. (shrink)

The National Health Service (NHS) was the first healthcare system globally to declare ambitions to become net carbon zero. To achieve this, a shift away from metered-dose inhalers which contain powerful greenhouse gases is necessary. Many patients can use dry powder inhalers which do not contain greenhouse gases and are equally effective at managing respiratory disease. This paper discusses the ethical issues that arise as the NHS attempts to mitigate climate change. Two ethical issues that pose a barrier (...) to moving away from metered-dose inhalers are considered: patients who decline an inhaler with a smaller carbon footprint and increased cost. I argue that while a patient is not morally justified in refusing a more environmentally sustainable inhaler due to the expected harms, a doctor may still prescribe a metered-dose inhaler if they believe that switching without consent might undermine trust or substantially worsen the patient’s health. Turning to cost, I argue that the imperative to combat climate change means the NHS should accept small increased financial costs for lower carbon inhalers, even though this provides no additional direct benefit for the patient. I then go on to consider the implications of the preceding analysis for policy and practice. I argue for a policy that minimises the impact of inhalers on the climate by advocating for a principle of environmental prescribing and explore decision-making in practice. While the arguments here pertain primarily to inhalers, the discussion has broader implications for debates around healthcare’s responsibility to be environmentally sustainable. (shrink)

In an accompanying feature article, Parker argued that general practitioners should support efforts by the National Health Service to reduce greenhouse gases by avoiding metered-dose inhalers and by prescribing similarly effective inhalers with smaller carbon footprints.1 He also argued that patients are not morally justified in declining to use dry powder inhalers which do not contain greenhouse gases and when judged to be readily available and similarly effective, unless, when patients resist that option, their trust in the professional relationship (...) is undermined.1 Prescribers should, therefore, take account of factors not only concerning the benefits and costs to individual patients including the strength of the professional relationship, but broader social considerations including potential effects on climate change and planetary health. In this commentary, I present three additional factors to broaden the context of Parker’s excellent analysis. The first is that a discussion with patients on the effects of various forms of inhalers on the environment may bring to their attention the seriousness of anthropogenic climate change and open opportunities …. (shrink)

There is a need for all industries, including healthcare, to reduce their greenhouse gas emissions. In anaesthetic practice, this not only requires a reduction in resource use and waste, but also a shift away from inhaled anaesthetic gases and towards alternatives with a lower carbon footprint. As inhalational anaesthesia produces greenhouse gas emissions at the point of use, achieving sustainable anaesthetic practice involves individual practitioner behaviour change. However, changing the practice of healthcare professionals raises potential ethical issues. The (...) purpose of this paper is twofold. First, we discuss what moral duties anaesthetic practitioners have when it comes to practices that impact the environment. We argue that behaviour change among practitioners to align with certain moral responsibilities must be supplemented with an account of institutional duties to support this. In other words, we argue that institutions and those in power have second-order responsibilities to ensure that practitioners can fulfil their first-order responsibilities to practice more sustainably. The second goal of the paper is to consider not just the nature of second-order responsibilities but the content. We assess four different ways that second-order responsibilities might be fulfilled within healthcare systems: removing certain anaesthetic agents, seeking consensus, education and methods from behavioural economics. We argue that, while each of these are a necessary part of the picture, some interventions like nudges have considerable advantages. (shrink)

I am grateful for these four wide-ranging and incisive commentaries on my paper discussing the ethical issues that arise when we consider the carbon footprint of inhalers.1 As I am unable to address every point raised, instead I focus on what I take to be the common thread running through these papers. Each response has something to say regarding the scope of healthcare’s responsibility to mitigate climate change. This can be explored at the intuitional or structural level, or at (...) the individual patient and practitioner level leading to a further issue of the relationship between these perspectives. Coverdale argues for broadening the scope of individual responsibilities regarding the climate.2 Discussing inhalers does not go far enough and doctors, argues Coverdale, are well placed to draw attention to the various behaviour changes patients can undertake both through role modelling and in the clinic. While Coverdale makes some excellent points, I have three worries about his proposal. One is relevance. Climate concerns may not always be pertinent in the clinical encounter; think of counselling a bereaved patient or somebody needing a fit note. Related to this is opportunity. General practitioners capacity to cover an inordinate amount in a 10 min consultation …. (shrink)

At the 2019 and 2021 International Conference on Environmental Psychology, discussions were held on the future of conferences in light of the enormous greenhouse gas emissions and inequities associated with conference travel. In this manuscript, we provide an early career researcher perspective on this discussion. We argue that travel-intensive conference practices damage both the environment and our credibility as a discipline, conflict with the intrinsic values and motivations of our discipline, and are inequitable. As such, they must change. This change (...) can be achieved by moving toward virtual and hybrid conferences, which can reduce researchers’ carbon footprints and promote equity, if employed carefully and with informal exchange as a priority. By acting collectively and with the support of institutional change, we can adapt conference travel norms in our field. To investigate whether our arguments correspond to views in the wider community of ECRs within environmental psychology, we conducted a community case study. By leveraging our professional networks and directly contacting researchers in countries underrepresented in those networks, we recruited 117 ECRs in 32 countries for an online survey in February 2022. The surveyed ECRs supported a change in conference travel practices, including flying less, and perceived the number of researchers wanting to reduce their travel emissions to be growing. Thirteen percent of respondents had even considered leaving academia due to travel requirements. Concerning alternative conference formats, a mixed picture emerged. Overall, participants had slightly negative evaluations of virtual conferences, but expected them to improve within the next 5 years. However, ECRs with health issues, facing visa challenges, on low funding, living in remote areas, with caretaking obligations or facing travel restrictions due to COVID-19 expected a switch toward virtual or hybrid conferences to positively affect their groups. Participants were divided about their ability to build professional relationships in virtual settings, but believed that maintaining relationships virtually is possible. We conclude by arguing that the concerns of ECRs in environmental psychology about current and alternative conference practices must be taken seriously. We call on our community to work on collective solutions and less travel-intensive conference designs using participatory methods. (shrink)

Abstract Environmental and public health-focused sciences are increasingly characterised as constituting an emerging discipline—planetary medicine. From a governance perspective, the ethical components of that discipline may usefully be viewed as bestowing upon our ailing natural environment the symbolic moral status of a patient. Such components emphasise, for example, the origins and content of professional and social virtues and related ethical principles needed to promote global governance systems and policies that reduce ecological stresses and pathologies derived from human overpopulation, selfishness and (...) greed—such as pollution, loss of biodiversity, deforestation and greenhouse gas emissions, as well as provide necessary energy, water and food security. Less well explored in this context, however, is the ethics that should underpin global use of emerging technologies such as nanotechnology as forms of planetary therapeutics. Nanotechnology may be particularly important, for instance, as a mechanism for improving upon photosynthesis and engineering it into human structures for localised production of carbon-neutral hydrogen based-fuel and carbohydrate-based food and fertilizer. Artificial photosynthesis, because of its unique and widespread public and environmental benefits in this period of human history, may even be termed the moral culmination of nanotechnology, assisting this planet to move beyond the Anthropocene epoch to that of the Sustainocene. This paper explores practical steps towards planetary nanomedicine involving governance of artificial photosynthesis, including a UNESCO Universal Declaration on the Bioethics and Human Rights of Natural and Artificial Photosynthesis (Global Solar Fuels and Foods ). Content Type Journal Article Category Original Paper Pages 1-13 DOI 10.1007/s11569-012-0144-4 Authors Thomas Faunce, College of Medicine, Biology and the Environment and College of Law (joint Appointment), Australian National University, Acton, Australia Journal NanoEthics Online ISSN 1871-4765 Print ISSN 1871-4757. (shrink)

The United States health care industry is the second largest in the world, expending an estimated 479 million metric tons (MMT) of carbon dioxide per year, nearly 8 percent of the country's total emissions. The importance of carbon reduction in health care is slowly being accepted. However, efforts to “green” health care are incomplete since they generally focus on buildings and structures. Yet hospital care and clinical service sectors contribute the most carbon dioxide within the U.S. health (...) care industry, with structures/equipment and pharmaceuticals ranking as the third and fourth highest emitters in the industry. Given the magnitude of health care carbon emissions—and the paucity of attention to the carbon of hospital care and clinical services—this essay identifies overuse of health care as a health threat with serious ethical implications, offers a data‐driven action plan for carbon reduction in health care, and provides practical suggestions for more sustainable health care delivery in the United States. (shrink)

We are in the midst of a crisis of climate change and environmental degradation that will only get worse, unless significant changes are rapidly made. Globally, the healthcare sector causes a large share of our total environmental footprint: 4.4% of greenhouse gases. Sustainable healthcare has emerged as a way for healthcare sectors in high‐income countries to help mitigate climate change by reducing their emissions. Whether global health should be sustainable and what ethical grounds might exist to support such (...) a claim are not questions that have been investigated. The paper argues that global health practice—the delivery of health services to underserved populations in resource‐poor areas of the world—should be sustainable as a matter of climate justice and solidarity. Reducing climate change‐related risks and harms for the vulnerable is integral to the mission of global health and thus it is necessary to consider the climate impact of its practice. The field has a duty to provide sustainable health services that are responsive to climate change‐related changes in the local burden of disease and to build sustainable health system infrastructure. Specific responsibilities for global health funders, managers, and implementers to uphold the duty are proposed. To conclude, the paper considers what limits might be placed on the duty to deliver sustainable global healthcare. (shrink)

This paper investigates the effect of female representation on the board of directors on corporate response to stakeholders’ demands for increased public reporting about climate change-related risks. We rely on the Carbon Disclosure Project as a sustainability initiative supported by institutional investors. Greenhouse gas emissions measurement and its disclosure to investors can be thought of as a first step toward addressing climate change issues and reducing the firm’s carbon footprint. Based on a sample of publicly listed Canadian firms (...) over the period 2008–2014, we find that the likelihood of voluntary climate change disclosure increases with women percentage on boards. We also find evidence that supports critical mass theory with regard to board gender diversity. These findings reinforce initiatives being undertaken around the world to promote gender diversity in corporate governance while demonstrating board effectiveness in stakeholder management. (shrink)

In this commentary, I describe an ecostructural approach to health ethics, which is grounded in a conception of people as ecological subjects and privileges place in supporting health and health justice. This approach sees people as dwelling in health ecosystems that can support or undermine health, and it situates us in social norms and processes, with a particular concern for structural health injustice. In patient care, an ecostructural approach can be operationalized by attending to conditions in the sites where birthing, (...) healing, and dying take place and by critiquing their economic structures. For public health, relationships between people, animals, land, the built environment, and climate demand attention, as do racist norms and economic processes that thwart health justice. For global health, an ecostructural approach might envision a revolution in governance that challenges nationalism, in which health systems treat citizens while depending on human resources supplied through structures that sustain health injustice. (shrink)

Life is getting digital more than ever as technology improves. While the Internet is responsible for two percent of global greenhouse gas emissions, it is underestimated as a pollutant. Since public awareness is one of the most important preservation methods, it can contribute to protecting the environment from carbon emissions by raising people's understanding. In this regard, serious games, as a type of gamification transmitting educational content besides entertainment, immerse the player in enjoyment while teaching them a specific topic (...) or enhancing their skills in a field. This study proposes a serious game, taking the digital unseen carbon footprint and its effects on the landscape into the topic. The game considers SDG goals provided by the United Nations Department of Economic and Social Affairs. In this regard, the research uses SDGs 4 and 7 by providing quality education for all and access to sustainable energy by changing people's everyday habits. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:When Is Enough, Enough?Megan HomsyThis was a case that stuck with many members of our transplant team for a long time. The patient was a 44-year-old Caucasian male evaluated for a liver transplant with a diagnosis of hepatitis C virus (HCV), originally diagnosed 11 years before the transplant evaluation. The patient met the criteria for the following substance use diagnoses: alcohol use disorder moderate in sustained remission, in a (...) controlled environment, opioid use disorder, severe, in sustained remission, on maintenance therapy, in a controlled environment, stimulant use disorder, amphetamine-type, severe, in early remission, in a controlled environment and stimulant use disorder, cocaine-type, severe in early remission, in a controlled environment.The patient had been living in a sober living housing program for approximately ten months prior to his transplant evaluation with me, his social worker. He had also been diagnosed with depression and bipolar disorder. He had been intermittently linked with mental health services and had participated in numerous detox and substance abuse programs over the last ten years, with varying degrees of success. He was in dual diagnosis treatment (i.e., treatment for co-occurring substance use and mental health disorders) through his Suboxone clinic and was completing toxicology screenings on a biweekly basis.After concluding the minimum three months of drug and alcohol treatment set forth by the state's Organ Transplantation Consortium, the patient graduated from his sober living program, moved in with his sister, and was listed for a liver transplant.The patient was transplanted five months after his clinic evaluation. At the time of the surgery, the patient's Suboxone was abruptly discontinued and replaced with IV Dilaudid. Within days of his transplant, the patient frequently expressed concerns about his pain. Several medical services attempted to manage the pain medications, resulting in his pain management plan being changed repeatedly and much confusion over his current medication regimen. During his liver transplant hospitalization, the RN found the patient with a needle in his arm, and after a search of the patient's hospital room, the hospital police found drug paraphernalia and illicit substances. The patient was eventually discharged to an inpatient substance abuse program, which he left before completing the program and against medical advice.During his first year post-transplant, I attempted to arrange other various treatment programs for him (most of which he did not follow through with) and to find housing for him (as he had been forced to leave his sister's home after his relapse). Eventually, the patient was incarcerated on drug-related charges. Numerous times, the patient missed completing his labs and his post-transplant appointments. He did not refill his immunosuppressant medications, and for lengthy periods of time, he was unreachable by the transplant care team, which resulted in my team members and I calling the patient's family, other providers, and the police for safety checks.In the aftermath of these issues, my colleagues and I had to reckon with the realization that we had failed the patient. As a team, our transplant center created a task force to review this case and what to do in the future to prevent such breakdowns in patient care. We created protocols for managing patients who, at the time of their transplant, are on Medication Assisted Treatment (MAT) such as Suboxone and methadone. Staff across the multidisciplinary team attended trainings regarding addiction, pain management, and best practices for MAT services. Additionally, our transplant center collaborated with our hospital's addiction treatment program for a streamlined referral process for transplant patients to addiction services.This patient's case and its sensational nature resulted in many conversations, both professional and unprofessional. Members of the social worker department became aware that personnel within transplant, though not involved in patient care, were inappropriately discussing this patient's case and engaging in unprofessional behavior. Said actions led to the termination of a member of the transplant team. I was placed in the unenviable [End Page E3] position of having to report this behavior to hospital management and legal teams to protect a vulnerable patient.The ethical challenge behind this case really stems from the transplant team attempting to balance two... (shrink)

Before Euro-American settlement, many Native American nations intercropped maize (_Zea mays_), beans (_Phaseolus vulgaris_), and squash (_Cucurbita pepo_) in what is colloquially called the “Three Sisters.” Here we review the historic importance and consequences of rejuvenation of Three Sisters intercropping (3SI), outline a framework to engage Native growers in community science with positive feedbacks to university research, and present preliminary findings from ethnography and a randomized, replicated 3SI experiment. We developed mutually beneficial collaborative research agendas with four Midwestern US Native (...) American nations. Ethnographic data highlighted a culturally based respect for 3SI as living beings, the importance it holds for all cultural facets of these Native nations, and the critical impact the practice has on environmental sustainability. One concern expressed by Native growers during ethnographic research was improving soil health—part of the rationale for establishing the 3SI agronomic experiment. To address this, we collaboratively designed a 3SI experiment. After 1 year, 3SI increased short-term soil respiration by 24%, decreased salt-extractable nitrate by 54%, had no effect on soil microbial biomass (but increased its carbon-to-nitrogen ratio by 32%) compared to the average of monoculture crops. The overarching purpose of this collaborative project is to develop a deeper understanding of 3SI, its cultural importance to Native communities, and how reinvigorating the practice—and intercropping in general—can make agroecosystems more sustainable for people and the environment. (shrink)

Ethics of Inclusion captures fairness and social justice for all from an ethical perspective in our post-pandemic world. The book discusses inequality in Healthcare, Economics & Finance, Education, Digitalization, and the Environment, in order to envision economics of diversity and a transition to a more inclusive society. A wide-ranging approach addresses issues of inequality in access to innovations such as telemedicine and artificial intelligence, economic gains of robotics, and big data insights. A rising performance gap between the finance sector and (...) the real economy opens in the post-COVID-19 era, with system-inherent inequality, given elevated inflation levels and disparate impacts of low interest rate regimes around the globe. Education offers social transfer hubs and inclusion potential for societal advancement and international development. The transition to a greener economy is addressed in an analysis of the Green New Deal and European Green Deal including the Sustainable Finance Taxonomy. The book sets out a hopeful agenda for equality and social justice to deliver a post-pandemic Renaissance. (shrink)

In this paper, I explore one way to bring bioethics and environmental ethics closer together. I focus on a question at the interface of health, sustainability, and justice: How well does a society promote health with the use of no more than a just share of environmental capacity? To address this question, I propose and discuss a mode of assessment that combines a measurement of population health, an estimate of environmental sustainability, and an assumption about what constitutes a fair or (...) just share. This mode of assessment provides an estimate of the just and sustainable life expectancy of a population. It could be used to monitor how well a particular society promotes health within just environmental limits. It could also serve as a source of information that stakeholders use when they deliberate about programs, policies, and technologies. The purpose of this work is to focus attention on an ethical task: the need to fashion institutions and forms of life that promote health in ways that recognize the claims of sustainability and justice. (shrink)

According to the widely accepted principles of beneficence and distributive justice, I argue that healthcare providers and facilities have an ethical duty to reduce the ecological footprint of the services they provide. I also address the question of whether the reductions in footprint need or should be patient-facing. I review Andrew Jameton and Jessica Pierce’s claim that achieving ecological sustainability in the healthcare sector requires rationing the treatment options offered to patients. I present a number of reasons to think that (...) we should not ration health care to achieve sufficient reductions in a society’s overall consumption of ecological goods. Moreover, given the complexities of ecological rationing, I argue that there are good reasons to think that the ethical duty to reduce the ecological footprint of health care should focus on only nonpatient-facing changes. I review a number of case studies of hospitals who have successfully retrofitted facilities to make them more efficient and reduced their resource and waste streams. (shrink)

In this paper we argue the need to reimagine research ethics frameworks to include notions of environmental sustainability. While there have long been calls for healthcareethics frameworks and decision-making to include aspects of sustainability, less attention has focused on howresearchethics frameworks could address this. To do this, we first describe the traditional approach to research ethics, which often relies on individualised notions of risk. We argue that we need to broaden this notion of individual risk to consider issues associated with (...) environmental sustainability. This is because research is associated with carbon emissions and other environmental impacts, both of which cause climate change health hazards. We introduce how bioethics frameworks have considered notions of environmental sustainability and draw on these to help develop a framework suitable for researchers. We provide a case study of data-driven health research to apply our framework. (shrink)

Should we care about the environment because it is economically valuable or because nature has intrinsic value? This book gives a clear overview of some of the main theoretical problems within environmental ethics and offers definitive solutions and alternatives.

Science and technology plays a critical role, but not the only role, in realizing the United Nation’s Sustainable Development Goals. Not only must we observe the cultural context of scientific and technological interventions, we must respect and support the innovative capacity of those with different backgrounds. To help understand these concerns, this book puts forth the concept of generative justice in science and technology for development. This book presents community case studies concerning technological interventions in global health, the environment, (...) agriculture, and their ethics. Discusses issues around science, technology, and development in the Global South. Describes the redesign of lab-inspired prototypes after field testing with project partners. Identifies basic science/engineering principles utilized in development solutions. (shrink)

This chapter explores the question of whether or not individual agents are under a moral obligation to reduce their ‘antimicrobial footprint’. An agent’s antimicrobial footprint measures the extent to which her actions are causally linked to the use of antibiotics. As such, it is not necessarily a measure of her contribution to antimicrobial resistance. Talking about people’s antimicrobial footprint in a way we talk about our carbon footprint may be helpful for drawing attention to the global effects of individual (...) behaviour and for highlighting that our choices can collectively make a real difference. But can we be morally obligated to make a contribution to resolving a collective action problem when our individual contributions by themselves make no discernible difference? I will focus on two lines of argument in favour of such obligations: whether a failure to reduce one’s antimicrobial footprint is unfair and whether it constitutes wrongdoing because it is harmful. I conclude by suggesting that the argument from collective harm is ultimately more successful. (shrink)

In this article, we explore the world's response to the increasing impact of carbon emissions on the sobering threat posed by global warming: the carbon offset market. Though the market is a relatively new one, numerous offset providers have quickly emerged under both regulated and voluntary regimes. Owing to the lack of technical literacy of some stakeholders who participate in the market, no common quality or certification structure has yet emerged for providers. To the contrary, the media warns (...) that a relative "cowboy" atmosphere prevails in the current environment, and that there are "widespread instances of people and organizations buying worthless credits that do not yield any reductions in carbon emissions" (Harvey and Fidler, Financial Times, 2007). At this point in the evolution of the market, only a handful of offset provider-rating schemes exist; and, even these systems leave consumers with few answers when they seek to find a means by which to ensure that the said systems are having their intended impact. The purpose of this article is, first, to provide a grounded understanding of the nature of the offset market, a tendency toward carbon neutrality as a possible point of equilibrium, and the ethical tensions that surround it from the perspective of the consuming public. Second, we outline the standards environment for offset providers to illustrate most effectively the need for a single set of criteria among providers that is readily understandable by the common consumer stakeholder. We then explore the differences among the providers and articulate the specific criteria upon which providers may be evaluated by this particular stakeholder constituency, by bringing together best practices based on currently available analyses. Finally, we share the results of preliminary data collection in connection with 117 offset providers and highlight early findings. These findings allow us comparing providers effectively and efficiently on a common scale that services both providers, who thereby have greater guidance for self-assessment purposes, as well as consumer stakeholders, who then have the ability to make useful and more informed choices about carbon emission reduction in the future. (shrink)

Several climate ethicists have recently argued that having children is morally equivalent to over-consumption, and contributes greatly to parents’ personal carbon footprints. We show that these claims are mistaken, for two reasons. First, including procreation in parents’ carbon footprints double-counts children’s consumption emissions, once towards their own, and once towards their parents’ footprints. We show that such double-counting defeats the chief purpose of the concept of carbon footprint, namely to measure the sustainability and equitability of one’s activities (...) and choices. Furthermore, we show that proposals to avoid double-counting have other unacceptable implications. Second, we show that the key arguments for a supposed moral equivalence of procreation and consumption overgenerate and lead to unacceptable consequences in many cases, such as for the work of doctors who save lives or enable procreation. Finally, we propose that rather than counting children’s emissions towards their parents’ carbon footprints, we should consider these emissions as part of the parents’ carbon impact, i.e. the difference that their choices make to the overall global carbon emissions. It is from the perspective of impact that we should think about the ethics of procreation in an age of climate change. (shrink)

Bioethics is a field in which innovation is required to help prevent and respond to zoonotic diseases with the potential to cause epidemics and pandemics. Some of the developments necessary to fight pandemics, such as COVID-19 vaccines, require public debate on the benefits and risks of individual choice versus responsibility to society. While these debates are necessary, a more fundamental ethical innovation to rebalance human, animal, and environmental interests is also needed. One Health (OH) can be characterized as a strategy (...) that recognizes and promotes the synergy between human, animal, and environmental health. Yet, despite the recognition that these entities are interdependent, there is a pronounced inequality in the power relations between human, non-human animal, and the environmental interests which threatens the well-being of all. Until OH can ensure the moral status of animals and the environment and thereby the equal consideration of these interests, it will struggle to protect non-human interests and, as a result, human health. To create a sustainable health system requires a renewed concept of justice that is ecocentric in nature and an application of OH that is flexible and responsive to different ethical interests (e.g., person-centred care and physician responsibilities). Ultimately, to save themselves, humans must now think beyond themselves. Bioethics must assume a key role in supporting the developments required to create and maintain relationships able to sustain environmental and human health. (shrink)

Bioethics, Volume 36, Issue 5, Page 547-555, June 2022.

Health care is ubiquitous in the industrialized world. Yet, every medical development, technique, and procedure impacts the environment. Green bioethics synthesizes environmental ethics and biomedical ethics, thus creating an interdisciplinary approach to sustainable health care. Notably, green bioethics addresses not the structure of environmental sustainability in health-care institutions but the sustainability of individual health-care offerings. It parallels traditional biomedical ethics by providing four principles for ethical guidance: distributive justice, resource conservation, simplicity, and ethical economics. Through these four principles, green (...) bioethics presents a coherent framework for evaluating the sustainability of medical developments, techniques, and procedures. The future of our world may very well depend on how effectively we halt ecological destruction and conserve our resources in all areas of life. The principles of green bioethics, outlined in this book, will advance sustainability in health care. (shrink)

China has achieved economic prominence but damaged the natural environment. Can religions excite pro-environmental actions? Chinese religion encompasses Buddhism, Christianity, Islam, native Taoism, and indigenous folk beliefs (GuanDi and Mazu). We theorize that believers demonstrate more sustainable HOPE (Help Ourselves Protect the Environment) than non-believers. Religions with standardized and formal liturgy show more pro-environmental HOPE than those without it. We challenge the myth that the believers of Christianity and Islam display more sustainable HOPE than other faith. The 2013 (...) Chinese General Social Survey (involving 10,017 randomly selected participants across 28 provinces) revealed that 11.10% of them have faith. Believers display higher levels of HOPE than atheists, demonstrating the __religion__ effect. Among believers, native Taoism and Buddhism exhibit more ecological HOPE than other religions, supporting the __dogma__ effect in the Chinese culture. Religions with formalized liturgy demonstrate more pro-environmental HOPE than generalized folk beliefs—GuanDi and Mazu, validating the __liturgy__ effect. Females, married, and people with good income, education, health, and country-domicile—the haves—exhibit robust ecological HOPE. The rich get richer and greener. However, those who are older, males, urban residents, and the Han majority do not. We empirically demonstrate the Matthew Effect in Religious Social Responsibility: Religious faith facilitates believers’ pro-environmental behaviors—HOPE and ethical behaviors in China. (shrink)

During the past few decades, the global food system has confronted new sustainability challenges related not only to public health and the environment but also to ethical concerns over the treatment of farmed animals. However, the traditional threedimensional framework of sustainable development is ill equipped to take ethical concerns related to non-human animals into account. For instance, the interests of farmed animals are often overridden by objectives associated with social, economic or environmental sustainability, despite their vast numbers and influence (...) on contemporary societies. Moreover, sustainability policies necessarily involve an element of ethical evaluation; yet this element is not explicitly incorporated in prevailing frameworks of sustainable development. Our purpose in this article is to address these shortcomings by developing a Sustainability Matrix that recognizes the need to consider food system sustainability from the perspective of all interest groups affected by the issue under consideration, from a plurality of ethical standpoints. Combing sustainability principles with the basic idea of an ethical evaluation tool, the proposed Sustainability Matrix evaluates the sustainability of food-related systems, decisions and policies from the perspectives of three major strands of ethical theory and from the perspectives of human beings, farmed animals and wildlife. In terms of policy implications, the Sustainability Matrix can be applied in deciding on the specific targets of food system sustainability that can then be utilized as a basis for designing policies and measures towards the achievement of these goals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Ecological Footprints: An Essential Franciscan Guide for Faith and Sustainable Living by Dawn Nothwehr, and: The Future of Ethics: Sustainability, Social Justice, and Religious Creativity by Willis JenkinsJeffrey MorganEcological Footprints: An Essential Franciscan Guide for Faith and Sustainable Living Dawn Nothwehr Collegevile, MN: Liturgical Press, 2012. 368pp. $39.95The Future of Ethics: Sustainability, Social Justice, and Religious Creativity Willis Jenkins Washington, DC: Georgetown University Press, 2013. 304pp. (...) $34.95Dawn M. Nothwehr, OSF, and Willis Jenkins have written, so it seems, incommensurable books about the relation of religion to environmental problems. The central issue between them is whether or not it is possible to move from a theological tradition to fitting, ecologically responsible moral action. Nothwehr is quite confident that we can, and the first half of her Ecological Footprints: An Essential Franciscan Guide for Faith and Sustainable Living is, as the title suggests, a primer in Franciscan theology that moves toward a theology of sustainable living. After two opening chapters on scripture and the environment, the distinctly Franciscan quality of the guide really begins as Nothwehr surveys, over four chapters, the cornerstones of Franciscan theology: Clair, Francis, Bonaventure, and Scotus. Nothwehr’s main effort in these chapters is to draw out major themes in each figure’s work and to suggest how these themes might inform a contemporary ethics of sustainability. With heavy reliance on contemporary scholarship, Nothwehr covers significant ground: creation, the Trinity, Christology, sacramental theology, deification, panentheism, theological anthropology, and more. The effect is a bit dizzying, but a few focal lenses emerge. Across these major figures there is, Nothwehr contends, a profound commitment to the interrelatedness of all things, kinship throughout cosmos, [End Page 219] and the need for mutual respect among all creatures; all this is grounded in a vision of the Incarnation as the divine affirmation and deification of all things (121). That is, the Incarnation is the fullest revelation of the mutual love between the persons of the Trinity that shines forth throughout the creation and that summons each of us to treat all creatures as equals, as brothers and sisters united in one household (94). The ethical takeaway is straightforward: if we really held these (or similar) theological convictions, our ecological habits should follow suit (see, for example, 86).The difficulty is that environmental problems are complex and confuse our moral agency; furthermore, there is a general “spiritual malaise” that reinforces an entrenched apathy to do anything about those problems. The second half of the book takes up these complex problems, and it is there that Nothwehr hits her stride. Chapters 7 through 10 are all well-done exposés that guide the reader through the intricacies of subtle, systemic injustices that conspire to reinforce global warming (chapter 7), the global water crisis (chapter 8), problems of food access and security (chapter 9), and the crisis of peak oil and sustainable energy (chapter 10). The connection between these exposés and the earlier chapters on particular Franciscan theologians is loose but significant. While the earlier themes are not so much worked into the later chapters as they are very briefly referenced and invoked here and there, the point is that these themes from this tradition have the capacity to awaken us from our malaise and help us take responsibility for our world. In short, the Franciscan tradition, as a distinct theological worldview, can provide both motivation and a fair amount of practical guidance to help us confront the environmental problems facing us.Nothwehr’s book is the kind of book Willis Jenkins claims he initially set out to write: a book that helps us see how “theology matters to processes of cultural change” and provides “grammars of belief” sufficient to “generate satisfactory responses to representative problems of human power” (vii). But in setting out to write such a book, Jenkins found that such problems overwhelm the moral repertoires of religious traditions. Environmental problems, in particular, frustrate attempts simply to put ideas into practice. This is not to say religious traditions can only be found wanting before the contemporary slate of overwhelming problems; rather, such problems provide religious traditions with opportunities for constructive reevaluation and renewal of their... (shrink)

Our current planetary emergency is one in which we are facing significant global warming as a result of human-driven climate change. This is having and will continue to have catastrophic results for the earth’s ecosystems and for life as we know it. The Christian tradition often works actively against the seriousness of these challenges due to its eschatological outlook. Process theology, as one stream within the Christian tradition, embraces a different vision of the future that fosters engagement in current concerns (...) rather than an escapist approach. A process theological proposal is therefore offered that calls for an embodied ethic that embraces the acronym SHE. SHE stands for Sustainability, Health, and Ethics. It provides a dietary grid as a way to embody ethics to bring about societal change in light of environmental challenges. SHE is proposed against a background that argues for Christian engagement in our current global crisis. The idea of “small turnings” as a conceptual idea is adopted to help frame how the SHE grid might be understood. (shrink)

Should environmental, social, and economic sustainability be of primary concern to engineers? Should social justice be among these concerns? Although the deterioration of our natural environment and the increase in social injustices are among today’s most pressing and important issues, engineering codes of ethics and their paramountcy clause, which contains those values most important to engineering and to what it means to be an engineer, do not yet put either concept on a par with the safety, health, and welfare of (...) the public. This paper addresses a recent proposal by Michelfelder and Jones (2011) to include sustainability in the paramountcy clause as a way of rectifying the current disregard for social justice issues in the engineering codes. That proposal builds on a certain notion of sustainability that includes social justice as one of its dimensions and claims that social justice is a necessary condition for sustainability, not vice versa. The relationship between these concepts is discussed, and the original proposal is rejected. Drawing on insights developed throughout the paper, some suggestions are made as to how one should address the different requirements that theory and practice demand of the value taxonomy of professional codes of ethics. (shrink)

We are in the midst of a global crisis of climate change and environmental degradation to which the healthcare sector directly contributes. Yet conceptions of health justice have little to say about the environment. They purport societies should ensure adequate health for their populations but fail to require doing so in ways that avoid environmental harm or injustice. We need to expand our understanding of health justice to consider the environment and do so without reinforcing the epistemic injustice inherent in (...) the field of bioethics. This paper considers what work in philosophy related to the environment should be applied to help build that understanding and develops ideas about the healthcare sector’s responsibilities of justice to the environment. It first introduces the dominant multivalent environmental and ecological justice (EJ) concept in philosophy and each of its dimensions: distribution, participation, recognition and well-being. It then shows why applying that conception alone to broaden our understanding of health justice will reinforce epistemic injustice within bioethics. Drawing on EJ literature from the global South, the paper demonstrates that different ontological and experiential starting points identify additional EJ dimensions—power and harmony—and give rise to a nuanced understanding of the recognition dimension relative to the dominant EJ conception. The paper concludes by applying them to articulate healthcare sector responsibilities of justice to the environment, demonstrating they ground responsibilities beyond reducing its carbon emissions. (shrink)

For thirty years, Peter Singer's Practical Ethics has been the classic introduction to applied ethics. For this third edition, the author has revised and updated all the chapters and added a new chapter addressing climate change, one of the most important ethical challenges of our generation. Some of the questions discussed in this book concern our daily lives. Is it ethical to buy luxuries when others do not have enough to eat? Should we buy meat from intensively reared animals? Am (...) I doing something wrong if my carbon footprint is above the global average? Other questions confront us as concerned citizens: equality and discrimination on the grounds of race or sex; abortion, the use of embryos for research and euthanasia; political violence and terrorism; and the preservation of our planet's environment. This book's lucid style and provocative arguments make it an ideal text for university courses and for anyone willing to think about how she or he ought to live. (shrink)

Respiratory rhythms sustain biological life, governing the homeostatic exchange of oxygen and carbon dioxide. Until recently, however, the influence of breathing on the brain has largely been overlooked. Yet new evidence demonstrates that the act of breathing exerts a substantive, rhythmic influence on perception, emotion, and cognition, largely through the direct modulation of neural oscillations. Here, we synthesize these findings to motivate a new predictive coding model of respiratory brain coupling, in which breathing rhythmically modulates both local (...) and global neural gain, to optimize cognitive and affective processing. Our model further explains how respiratory rhythms interact with the topology of the functional connectome, and we highlight key implications for the computational psychiatry of disordered respiratory and interoceptive inference. (shrink)

Environmental pollution and climate change have been considered the main environmental challenges affecting the world’s ecosystem, including that of South Africa. They cause poverty, land degradation, and health hazards. One of the leading causes and contributing factors of environmental pollution and climate change is carbon emissions into the atmosphere. As a way to curb these emissions, Carbon tax policy has been introduced in various countries, including South Africa. In 2019, a Carbon tax was introduced to assist South (...) Africa in delivering on the commitments made in the Paris Agreement in 2015. If the policy is effectively applied, it will raise revenues while reducing carbon dioxide emissions. Before and after introducing the Carbon tax policy in South Africa, there has been debate and discussion on its impact on the environment, economy, and society. Based on the debate and discussion, it has been observed that more attention is paid to the economic implications and benefits of the tax on South Africa than the ethical implications. Thus, this paper aims to contribute to the ongoing debate and discussion by ethically evaluating the Carbon tax policy in South Africa. (shrink)

Public health emergencies, such as the Covid-19 pandemic, put great pressure on healthcare workers (HCW) across the world, possibly increasing the risk of experiencing ethically challenging situations (ECS). Whereas experiencing ECS as a HCW in such situations is likely unavoidable, mitigation of their adverse effects (e.g., moral distress) is necessary to reduce the risk of long-term negative consequences. One possible route of mitigation of these effects is via work environmental factors. The current study aimed to examine: [1] risk factors associated (...) with ECS among HCW [2], intensity of moral distress associated with ECS across various occupational factors (i.e., profession, degree of exposure to patients with Covid-19), and [3] the impact of work environmental factors on this association, in a sample of HCW during the pandemic. We employed multiple logistic and linear regression to self-report data from 977 HCWs at four Norwegian hospitals responding to a survey at the fourth wave of the pandemic. About half of HCW in this study had experienced ECS during the pandemic, and levels of moral distress associated with such were higher than in previous studies using similar assessment methods. Younger age, female sex, geographical work area (mid-north of Norway), and profession (nurse) were all associated with higher odds (range of OR: 1.30–2.59) of experiencing ECS, as were direct contact with patients with Covid-19. Among those participants who reported that they had experienced ECS during the pandemic, moral distress levels when recalling those situations were moderate (Mean 5.7 on a 0–10 scale). Men reported somewhat lower intensity of moral distress (partial eta squared; ηp2 = 0.02). Reporting a manageable workload (ηp2 = 0.02), and greater opportunity to work according to best practice (ηp2 = 0.02), were associated with lower levels of moral distress. Our findings suggest that moral distress could potentially be mitigated on an organizational level, particularly by focusing on ensuring a manageable workload, and an ability to work according to best practice. To build sustainable healthcare systems robust enough to withstand future public health emergencies, healthcare organizations should implement measures to facilitate these aspects of HCWs’ work environment. (shrink)

In this article, we provide a description of the good in health promotion based on an empirical study of health promotion practices in New South Wales, the most populous state in Australia. We found that practitioners were unified by a vision of the good in health promotion that had substantive and procedural dimensions. Substantively, the good in health promotion was teleological: it inhered in meliorism, an intention to promote health, which was understood holistically and situated in places and environments, a (...) commitment to primary rather than secondary prevention and engagement with communities more than individuals. Procedurally, the good in health promotion arose from qualities of practices that they developed over time in respectful relationships, were flexible and responsive to communities, built capabilities in communities and were sustainable. We discuss our findings with reference to Martha Nussbaum’s normative list of functional capabilities for a good human life, David Buchanan’s vision for health promotion ethics and common concerns in health promotion ethics regarding the relationship between paternalism and freedom. Our thick, vague conception of the good in health promotion, founded in the values and practical reason of people engaged daily in health promotion work, contributes to the development of a more complete theory of health promotion ethics. (shrink)

Social policies are used to regulate how members of a society interact and share resources. If we expand our sense of community to include the ecosystem of which we are a part, we begin to develop an ethical obligation to this broader community. This ethic recognizes that the environment has intrinsic value, and each of us, as members of society, are ethically bound to preserve its sustainability. In assessing the environmental risks of new agricultural methods and technologies, society should not (...) freely trade economic gains for ecological damage, but rather seek practices that are compatible with ecosystem health. This approach is used to evaluate the environmental risks associated with genetically engineered insect-resistant trees. The use of insect-resistant trees is a biologically based pest control strategy that has several advantages over pesticide use. However, the use of genetically engineered trees presents particular ecological concerns because the trees are long lived and often are not highly domesticated. The main environmental concerns reviewed include: (1) adaptation of pests to the trees, leading to a non-sustainable agricultural practice, (2) transgenic trees producing environmental toxins, (3) insect resistance enhancing the invasiveness of the tree, causing it to become weedy or invade wild habitats, and (4) transfer of the transgene to wild or feral relatives of the tree, possibly increasing the invasiveness of weeds or wild plants. Some methods are available to offset these risks; however, the environmental risks associated with this technology have been poorly researched and need to be more clearly identified so that when we evaluate the risks, it is based on the best information obtainable. To fulfil an ethical obligation to the environment, public policies and government regulations are needed to preserve the sustainability of both the environment and the future of our production systems. A better understanding of both the ecological issues and of genetic engineering in general are needed on the part of citizens and policy makers alike to ensure that sound environmental decisions are made. Otherwise, the environmental benefits of this technology, mainly decreasing the use of more toxic pesticides in tree crops and forests, will either be lost or traded for other environmental hazards. (shrink)

This paper presents a case study of the South African operation of a logistics company, operating in a context of short-termism and under-performance. Frustration with managing in this context, and concern that this environment might erode the customer value proposition, prompted an exploration of the question: “How can the business prioritise its investment in intangibles to support sustainable growth in an environment of short-termism and sub-par business performance?” The study followed an inductive grounded theory approach and began with an (...) exploration of the system of short-termism as it was being experienced by the management team. This evolved in an iterative process to include an exploration of the customer value proposition, the organisation’s capabilities and the system of investment in intangibles. Data were collected over a period of 6 months, across a series of four stages as the management team grappled with the short-term financial objectives imposed on them. The data categories were used to develop 214 propositions across all stages. Through the four stages, four artefacts were developed from the propositions a causal loop diagram of the system of short-termism; a documented value proposition; an assessment of the health of the business’ capitals; and a multi-year intangibles investment programme. The findings indicate that a focus on investment in intangible assets can play a vital role in stimulating sustainable value creation in an environment of historically poor returns on investment and pressure for short-term financial results. It is suggested that investment in intangibles can be introduced as a multi-year capabilities investment plan. The study succeeded in getting investment in intangibles approved and the implication is that long-term decision-making can co-exist in an environment of short-termism and low growth. (shrink)

Several European and North American states encourage or even require, via good Samaritan and duty to rescue laws, that persons assist others in distress. This paper offers a utilitarian and contractualist defense of this view as applied to corporations. It is argued that just as we should sometimes frown on bad Samaritans who fail to aid persons in distress, we should also frown on bad corporate Samaritans who neglect to use their considerable multinational power to undertake disaster relief or to (...) confront widespread social ills such as those currently befalling public health (obesity) and the environment (climate change). As such, the corporate duty to assist approach provides a novel justification for sustainable business practices in such cases. The paper concludes by arguing that traditional stakeholder approaches have not articulated this duty of assistance obligation, though a new utilitarian stakeholder theory by Thomas Jones and Will Felps may be coextensive. (shrink)

With the aggravation of population aging, home health care services are paid more and more attention by the elderly. Previous studies aim at improving service quality and reducing cost, ignoring the coordinated and sustainable development of the economy and environment. From the perspective of sustainable development, this paper first establishes a linear optimization model considering transportation, time, and carbon emission costs. However, the uncertainty of service demand is a very difficult problem for HHC research. Most of the (...) previous studies only consider the deterministic model, which has difficulty dealing with the uncertain situation. Therefore, a robust optimization model is proposed to resist uncertain disturbances by introducing a robust uncertain set response. The experimental results show that the increase of low-carbon transition cost only increases the total cost of the LO model but has a significant positive impact on the RO model. With the increase of uncertainty, the robust model will pay the cost of robustness, but it can obtain a higher service level. In addition, when the carbon tax increases, the total transportation cost does not increase but decreases, thus obtaining environmental benefits. When the carbon tax increases by 25%, the average total cost of using the RO model is reduced by 8.274%. The research results of this paper can provide enlightenment and reference for the low-carbon transformation of HHC enterprises. (shrink)

The magnitude of South Africa’s diet-related non-communicable disease burden calls for scrutiny of sugar-sweetened beverage manufacturers’ business ethics in terms of the commercial determinants of health. We gathered and analysed relevant literature from five electronic databases to determine whether a communitarian ethic can strengthen corporate governance in support of public health. Twenty-nine of 648 results were selected for data extraction and analysis. Six thematic categories were identified: the reciprocal nature of the corporation in society; perspectives on ‘corporate citizenship’; integrative approaches (...) to corporate sustainability; critiques of Corporate Social Responsibility; legal regulation to engender communitarian consciousness; and the social contract perspective. We found that in tackling the human and economic toll of South Africa’s obesogenic environment, a diverse range of theoretical and practical perspectives supports the concept that a communitarian ethic for corporate governance can normalise accountability for population health as a human right. (shrink)

Ten years ago, when I was president and chief executive officer of Rady Children's Hospital in San Diego, if you had asked me about our commitment to environmental sustainability or about the hospital's carbon footprint, I would have given you a blank look. The issues were simply not on my radar screen. And that was true of most health care leaders.The good news? Environmental sustainability is becoming a health care priority, and exciting progress is occurring. In Greening Health Care: (...) How Hospitals Can Heal the Planet, Kathy Gerwig eloquently relates how one leading large health care system, Kaiser Permanente, achieved remarkable results in responding to the environmental health challenge over the past several years. (shrink)

It is reasonable to assume that future generations will have the same concerns we have about combating disease and illness. Natural compounds have historically been potent sources of medications. Current synthetic identification and production processes are not generating the volume of novel medications predicted, which has prompted a call to return to diverse natural sources. Biodiversity loss threatens our ability to fight off current and future infections by removing powerful potential sources of biologically active compounds needed to spur medication development (...) for cancer, human immunodeficiency virus, and antibiotic resistant tuberculosis. International and economic policy should embrace principles of sustainable biodiversity while simultaneously providing market incentives for compliance and innovation in order to maximize the health and well-being of current and future generations. (shrink)

Cap-and-trade systems for greenhouse gas emissions are an important part of the climate change policies of the EU, Japan, New Zealand, among others, as well as China and Australia. However, concerns have been raised on a variety of ethical grounds about the use of markets to reduce emissions. For example, some people worry that emissions trading allows the wealthy to evade their responsibilities. Others are concerned that it puts a price on the natural environment. Concerns have also been raised about (...) the distributional justice of emissions trading. Finally, some commentators have questioned the actual effectiveness of emissions trading in reducing emissions. This paper considers these three categories of objections – ethics, justice and effectiveness – through the lens of moral philosophy and economics. It is concluded that only the objections based on distributional justice can be sustained. This points to reform of the carbon market system, rather than its elimination. (shrink)

Ecosystem health, as James Nelson argues, must be understood as having both descriptive and normative content; it is in this sense a 'morally thick' concept. The health analogy refers (a) at the similarities between conservation ecology and medicine or plant pathology as normative sciences, and (b) to the ability of ecosystems to 'heal' themselves in the face of disturbances. Nelson, however, goes beyond these two aspects and argues that judgements of illness in ecosystems only support moral obligations to protect them (...) if they are attributed a 'good of their own'. But this latter extension of the analogy flies in the face of ecological science, which has been forced to abandon organicism. If one separates the question of the warranted assertibility of environmentalists' goals from the question of where values in nature are located, the search for an objective realm of value realism can be seen to be unnecessary. (shrink)

This article examines ethical implications of the growing AI carbon footprint, focusing on the fair distribution of prospective responsibilities among groups of involved actors. First, major groups of involved actors are identified, including AI scientists, AI industry, and AI infrastructure providers, from datacenters to electrical energy suppliers. Second, responsibilities of AI scientists concerning climate warming mitigation actions are disentangled from responsibilities of other involved actors. Third, to implement these responsibilities nudging interventions are suggested, leveraging on AI competitive games which (...) would prize research combining better system accuracy with greater computational and energy efficiency. Finally, in addition to the AI carbon footprint, it is argued that another ethical issue with a genuinely global dimension is now emerging in the AI ethics agenda. This issue concerns the threats that AI-powered cyberweapons pose to the digital command, control, and communication infrastructure of nuclear weapons systems. (shrink)

Rieke van der Graaf, Karin Jongsma, Martine de Vries, Suzanne van de Vathorst, and Ineke Bolt have done well to voice ethical concerns over the decision of the IAB to host the next WCB in Qatar. Conferences should be more sustainable. Yet, attention to the carbon impact of conferences—and, perhaps, any country that a person might travel to for business or pleasure—are only one small part of environmentally responsible citizenship, especially for those trained in ethics and committed to (...) health. Both bioethics as a discipline and bioethicists as individuals need to interrogate their environmental choices. To this end, some ecological choices are more obvious targets of ethical scrutiny—diet and travel—while others appear sacrosanct, like reproduction and even healthcare use. This underscores the importance of making sustainable and ethical organizational choices, such as where to hold a conference, without absolving environmental accountability in other ethical calculations. Many organizations in academic and clinical medicine need to make drastic alterations in their practices and policies to effectively mitigate carbon. While the burden is not only on bioethics alone, the expectation that it should be remains. (shrink)