C.S. Richie
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1
Het morele ideaal van planetaire gezondheid
Ethical implications for healthcare
Planetary health is not only a new field of research and practice; it is also a moral ideal. What are the implications for medicine and health care? In this article, we argue that within this ideal, health of humans, animals and also nature are worthy of protection for their own sake. These values can reinforce each other, but they may also conflict. We formulate a general framework that provides some direction for ethical reflection. Next we discuss implications of the ideal of planetary health for zoonotic disease outbreaks, for environmental sustainability of health care, and for global health and solidarity in the face of climate change. Planetary health demands much from health care, and this will also further exacerbate existing policy dilemmas.
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Planetary health is not only a new field of research and practice; it is also a moral ideal. What are the implications for medicine and health care? In this article, we argue that within this ideal, health of humans, animals and also nature are worthy of protection for their own sake. These values can reinforce each other, but they may also conflict. We formulate a general framework that provides some direction for ethical reflection. Next we discuss implications of the ideal of planetary health for zoonotic disease outbreaks, for environmental sustainability of health care, and for global health and solidarity in the face of climate change. Planetary health demands much from health care, and this will also further exacerbate existing policy dilemmas.
Background: In 1926, Fritz Jahr described bio-ethics (German: bio-ethik) as “the assumption of moral obligations not only towards humans, but towards all forms of life.” Jahr summarized his philosophy by declaring, “Respect every living being on principle as an end in itself and treat it, if possible, as such!.” Bioethics was thus originally an ethical system concerned with the “problems of interference with other living beings… and generally everything related to the balance of the ecosystem” according to the 1978 Encyclopedia of Bioethics. This definition was predicated on the work of Fritz Jahr, Menico Torchio, and Van Rensselaer Potter. Methods: In order to proceed with depthful analysis of the origin and major bioethical flare up, we will use critical analysis of existing literature, followed by a study trip to relevant bioethical localities (collecting photo and other documentations regarding Menico Torchio). Results: While Jahr and Potter are typically given intellectual credit for developing the field of bioethics, the eco-ethical contributions of Menico Torchio have been forgotten.This article will first trace the origins of “bioethics” – now commonly bifurcated into “biomedical ethics” and “environmental bioethics.” The former was developed by Tom Beauchamp from the Philosophy Department and James Childress of the Religious Studies department at Georgetown University and is based on principlism, with a narrow focus on medical settings. The latter addresses the environmental impact of the medical industry and climate change health hazards. Second, we will present a panorama of Torchio’s significant intellectual contribution to bioethics. Menico Torchio’s concept of bioethics synthesized work of both Jahr and Potter, advocating “the need to expand our ethical obligations and embrace the most developed groups of animals, not only physically but also psychologically.” Third, we will reflect on the lasting legacy of “bioethics” on biomedical and environmental bioethics today. Thematic elements such as interconnectedness of planetary health and human health, dedication to living in harmony with nature, and emphasis on systems and symbiosis remain unchanged from the legacy of Tochio onward. Conclusion: Our conclusion will underscore the necessity of understanding the connections between planetary, environmental, and human health.
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Background: In 1926, Fritz Jahr described bio-ethics (German: bio-ethik) as “the assumption of moral obligations not only towards humans, but towards all forms of life.” Jahr summarized his philosophy by declaring, “Respect every living being on principle as an end in itself and treat it, if possible, as such!.” Bioethics was thus originally an ethical system concerned with the “problems of interference with other living beings… and generally everything related to the balance of the ecosystem” according to the 1978 Encyclopedia of Bioethics. This definition was predicated on the work of Fritz Jahr, Menico Torchio, and Van Rensselaer Potter. Methods: In order to proceed with depthful analysis of the origin and major bioethical flare up, we will use critical analysis of existing literature, followed by a study trip to relevant bioethical localities (collecting photo and other documentations regarding Menico Torchio). Results: While Jahr and Potter are typically given intellectual credit for developing the field of bioethics, the eco-ethical contributions of Menico Torchio have been forgotten.This article will first trace the origins of “bioethics” – now commonly bifurcated into “biomedical ethics” and “environmental bioethics.” The former was developed by Tom Beauchamp from the Philosophy Department and James Childress of the Religious Studies department at Georgetown University and is based on principlism, with a narrow focus on medical settings. The latter addresses the environmental impact of the medical industry and climate change health hazards. Second, we will present a panorama of Torchio’s significant intellectual contribution to bioethics. Menico Torchio’s concept of bioethics synthesized work of both Jahr and Potter, advocating “the need to expand our ethical obligations and embrace the most developed groups of animals, not only physically but also psychologically.” Third, we will reflect on the lasting legacy of “bioethics” on biomedical and environmental bioethics today. Thematic elements such as interconnectedness of planetary health and human health, dedication to living in harmony with nature, and emphasis on systems and symbiosis remain unchanged from the legacy of Tochio onward. Conclusion: Our conclusion will underscore the necessity of understanding the connections between planetary, environmental, and human health.
Environmental ethics beyond conferences
A response to the WCB bioethics in Qatar
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.
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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.
Reimagining research ethics to include environmental sustainability
A principled approach, including a case study of data-driven health research
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 healthcare ethics frameworks and decision-making to include aspects of sustainability, less attention has focused on how research ethics 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.
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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 healthcare ethics frameworks and decision-making to include aspects of sustainability, less attention has focused on how research ethics 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.
Artificial intelligence (AI) can transform health care by delivering medical services to underserved areas, while also filling gaps in health care provider availability. However, AI may also lead to patient harm due to fatal glitches in robotic surgery, bias in diagnosis, or dangerous recommendations. Despite concerns ethicists have identified in the use of AI in health care, the most significant consideration ought not be vulnerabilities in the software, but the environmental impact of AI. Health care emits a significant amount of carbon in many countries. As AI becomes an essential part of health care, ethical reflection must include the potential to negatively impact the environment. As such, this article will first overview the carbon emissions in health care. It will, second, offer five reasons why carbon calculations are insufficient to address sustainability in health care. Third, the article will derive normative concepts from the goals of medicine, the principles of biomedical ethics, and green bioethics—the very locus in which AI in health care sits—to propose health, justice, and resource conservation as criteria for sustainable AI in health care. In the fourth and final part of the article, examples of sustainable and unsustainable development and use of AI in health care will be evaluated through the three-fold lens of health, justice, and resource conservation. With various ethical approaches to AI in health care, the imperative for environmental sustainability must be underscored, lest carbon emissions continue to increase, harming people and planet alike.
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Artificial intelligence (AI) can transform health care by delivering medical services to underserved areas, while also filling gaps in health care provider availability. However, AI may also lead to patient harm due to fatal glitches in robotic surgery, bias in diagnosis, or dangerous recommendations. Despite concerns ethicists have identified in the use of AI in health care, the most significant consideration ought not be vulnerabilities in the software, but the environmental impact of AI. Health care emits a significant amount of carbon in many countries. As AI becomes an essential part of health care, ethical reflection must include the potential to negatively impact the environment. As such, this article will first overview the carbon emissions in health care. It will, second, offer five reasons why carbon calculations are insufficient to address sustainability in health care. Third, the article will derive normative concepts from the goals of medicine, the principles of biomedical ethics, and green bioethics—the very locus in which AI in health care sits—to propose health, justice, and resource conservation as criteria for sustainable AI in health care. In the fourth and final part of the article, examples of sustainable and unsustainable development and use of AI in health care will be evaluated through the three-fold lens of health, justice, and resource conservation. With various ethical approaches to AI in health care, the imperative for environmental sustainability must be underscored, lest carbon emissions continue to increase, harming people and planet alike.
The US healthcare industry emits an estimated 479 million tonnes of carbon dioxide each year; nearly 8% of the country's total emissions. When assessed by sector, hospital care, clinical services, medical structures, and pharmaceuticals are the top emitters. For 15 years, research has been dedicated to the medical structures and equipment that contribute to carbon emissions. More recently, hospital care and clinical services have been examined. However, the carbon of pharmaceuticals is understudied. This article will focus on the carbon emissions of pharmaceuticals since they are consistently calculated to be among the top contributors to healthcare carbon and assess the factors that contribute to pharmaceutical carbon emissions. Specifically, overprescription, pharmaceutical waste, antibiotic resistance, routine prescriptions, non-adherence, drug dependency, lifestyle prescriptions, and drugs given due to a lack of preventive healthcare will be identified. Prescribing practices have environmental ramifications. Carbon reduction, when focused on pharmaceuticals, can lead to cleaner, more sustainable healthcare.
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The US healthcare industry emits an estimated 479 million tonnes of carbon dioxide each year; nearly 8% of the country's total emissions. When assessed by sector, hospital care, clinical services, medical structures, and pharmaceuticals are the top emitters. For 15 years, research has been dedicated to the medical structures and equipment that contribute to carbon emissions. More recently, hospital care and clinical services have been examined. However, the carbon of pharmaceuticals is understudied. This article will focus on the carbon emissions of pharmaceuticals since they are consistently calculated to be among the top contributors to healthcare carbon and assess the factors that contribute to pharmaceutical carbon emissions. Specifically, overprescription, pharmaceutical waste, antibiotic resistance, routine prescriptions, non-adherence, drug dependency, lifestyle prescriptions, and drugs given due to a lack of preventive healthcare will be identified. Prescribing practices have environmental ramifications. Carbon reduction, when focused on pharmaceuticals, can lead to cleaner, more sustainable healthcare.
This article will explore the academic responsibility of Evangelical bioethicists to address climate change related health hazards. First, it will provide evidence-based data on climate change related health hazards, which disproportionately affect the poor and vulnerable worldwide, and as such are a form of environmental racism. Second, it will look at responses to climate change. So-called “climate change deniers” in the United States—the majority of which are Evangelical—will be addressed and the argument will be put forth that, regardless of the causes of climate change, climate change bioethics is part of the Christian tradition of healing and justice. Focusing on climate health hazards builds consensus across partisan and denominational lines by addressing the result—not the cause—of climate change. Third, the article will confront the academic responsibility of Evangelical bioethicists in addressing climate change related health hazards using the paradigm of H. Richard Niebuhr’s homo dialectus. It will, fourth, offer public theology and biblical scholarship as ways to engage this matter of moral significance. The conclusion will urge Evangelical bioethicists to develop a framework, such as Evangelical environmental bioethics, to effectively address climate change health hazards.
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This article will explore the academic responsibility of Evangelical bioethicists to address climate change related health hazards. First, it will provide evidence-based data on climate change related health hazards, which disproportionately affect the poor and vulnerable worldwide, and as such are a form of environmental racism. Second, it will look at responses to climate change. So-called “climate change deniers” in the United States—the majority of which are Evangelical—will be addressed and the argument will be put forth that, regardless of the causes of climate change, climate change bioethics is part of the Christian tradition of healing and justice. Focusing on climate health hazards builds consensus across partisan and denominational lines by addressing the result—not the cause—of climate change. Third, the article will confront the academic responsibility of Evangelical bioethicists in addressing climate change related health hazards using the paradigm of H. Richard Niebuhr’s homo dialectus. It will, fourth, offer public theology and biblical scholarship as ways to engage this matter of moral significance. The conclusion will urge Evangelical bioethicists to develop a framework, such as Evangelical environmental bioethics, to effectively address climate change health hazards.
Increasing attention to climate change and health has re-centered environmental ethics on the medical industry and biomedical ethics on the environment. Yet, without a belief in climate change, there is little reason for sustainability in medicine. In the United States, about one-quarter of all adults self-identify as Evangelical Christians, with a sizable subset of "climate change deniers." In order for millions of Evangelicals to be persuaded about the importance of sustainability in medicine, there must be a theological justification. This article will lay the foundation for an Evangelical environmental bioethic. I will first provide a brief history of environmental bioethics. Then, Christian theology will be introduced. In the following section, the work of Richard Bauckham—as a representative of Evangelical ecological theology—will be explored. His scholarship on biblical limitation can form the basis of an Evangelical environmental bioethic. The views and actions of American Evangelicals demands special attention, not only because of their number, but also because of their influence in one of the most environmentally noxious countries in the world.
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Increasing attention to climate change and health has re-centered environmental ethics on the medical industry and biomedical ethics on the environment. Yet, without a belief in climate change, there is little reason for sustainability in medicine. In the United States, about one-quarter of all adults self-identify as Evangelical Christians, with a sizable subset of "climate change deniers." In order for millions of Evangelicals to be persuaded about the importance of sustainability in medicine, there must be a theological justification. This article will lay the foundation for an Evangelical environmental bioethic. I will first provide a brief history of environmental bioethics. Then, Christian theology will be introduced. In the following section, the work of Richard Bauckham—as a representative of Evangelical ecological theology—will be explored. His scholarship on biblical limitation can form the basis of an Evangelical environmental bioethic. The views and actions of American Evangelicals demands special attention, not only because of their number, but also because of their influence in one of the most environmentally noxious countries in the world.
In 2014, the United States health care industry produced an estimated 480 million metric tons of carbon dioxide (CO2); nearly 8% of the country's total emissions. The importance of sustainability in health care - as a business reliant on fossil fuels for transportation, energy, and operational functioning - is slowly being recognized. These efforts to green health care are incomplete, since they only focus on health care structures. The therapeutic relationship is the essence of health care - not the buildings that contain the practice. As such, this article will first postulate reasons for a lack of environmental sustainability in US health care. Second, the article will focus on current green health care initiatives in the United States in which patients and physicians participate. Third, the rationale for participation in green initiatives will be explained. Fourth, the article will propose that, based on the environmental values of patients and physicians, health care insurance plans and health care insurance companies can be targeted for green health care reform, thereby closing the loop of sustainable health care delivery.
...
In 2014, the United States health care industry produced an estimated 480 million metric tons of carbon dioxide (CO2); nearly 8% of the country's total emissions. The importance of sustainability in health care - as a business reliant on fossil fuels for transportation, energy, and operational functioning - is slowly being recognized. These efforts to green health care are incomplete, since they only focus on health care structures. The therapeutic relationship is the essence of health care - not the buildings that contain the practice. As such, this article will first postulate reasons for a lack of environmental sustainability in US health care. Second, the article will focus on current green health care initiatives in the United States in which patients and physicians participate. Third, the rationale for participation in green initiatives will be explained. Fourth, the article will propose that, based on the environmental values of patients and physicians, health care insurance plans and health care insurance companies can be targeted for green health care reform, thereby closing the loop of sustainable health care delivery.