Skip to main content
Top

Open Access 04-09-2023 | Climate Change | Original Article

Sustainability as an Intrinsic Moral Concern for Solidaristic Health Care

Authors: Marcel Verweij, Hans Ossebaard

Published in: Health Care Analysis

Login to get access

Abstract

Environmental pollution and greenhouse gas emissions that contribute to climate change have adverse impacts on global health. Somewhat paradoxically, health care systems that aim to prevent and cure disease are themselves major emitters and polluters. In this paper we develop a justification for the claim that solidaristic health care systems should include sustainability as one of the criteria for determining which health interventions are made available or reimbursed – and which not. There is however a complication: most adverse health effects due to climate change do occur elsewhere in the world. If solidarity would commit us to take care of everyone’s health, worldwide, it might imply that solidaristic health system cannot justifiably restrict universal access to their own national populations. In response we explain health solidarity is to be considered as a moral ideal. Such an ideal does not specify what societies owe to whom, but it does have moral implications. We argue that ignoring sustainability in political decision making about what health care is to be offered, would amount to betrayal of the ideal of solidarity.
Footnotes
1
Given laws based upon the United Nations Paris Climate Agreement (COP21, 2016).
 
2
Health care is not the only sector in which environmental sustainability is intrinsically connected to their basic values. It obviously applies also to organizations or sectors that have planetary health or the protection of the natural environment as their ultimate aim anyway. But there are more institutions (analogous to solidaristic health care systems) for which sustainability is a constitutive element of their ultimate values. Think of the FAO (Food and Agriculture Organization of the United Nations) given its commitment to food security for all. For most public or private organizations, it is less clear that sustainability would be an intrinsic – hence inevitable value. This of course does not preclude the possibility that many such organizations can and do decide to embrace sustainability as a key value, or that they internalize the norms for sustainable production that are imposed upon them.
 
3
Cristina Richie offers a provocative argument for a green bioethics, which implies that health systems should be much more restricted to basic health care [9].
 
4
Ideals are in this way like imperfect duties. If I decide not to help a specific person in need, this does not necessarily imply a violation of the duty of beneficence – imperfect duties allow for personal choices about when, where and in what ways to act in line with duty. The imperfect or wide obligation of beneficence however does rule out being indifferent to other people’s needs.
 
Literature
1.
go back to reference Steffen, W., et al. (2015). Planetary boundaries: Guiding human development on a changing planet. Science, 347, 1259855.CrossRefPubMed Steffen, W., et al. (2015). Planetary boundaries: Guiding human development on a changing planet. Science, 347, 1259855.CrossRefPubMed
2.
go back to reference Rockstrom, J., Gaffney, O., & Thunberg, G. (2021). Breaking boundaries: The science behind our planet. DK. Rockstrom, J., Gaffney, O., & Thunberg, G. (2021). Breaking boundaries: The science behind our planet. DK.
3.
go back to reference Tollefson, J. (2021). Top climate scientists are sceptical that nations will rein in global warming. Nature, 599, 22–24.CrossRefPubMed Tollefson, J. (2021). Top climate scientists are sceptical that nations will rein in global warming. Nature, 599, 22–24.CrossRefPubMed
4.
go back to reference Romanello, M., et al. (2021). The 2021 report of the Lancet countdown on health and climate change: Code red for a healthy future. The Lancet, 30(10311), 1619–1662.CrossRef Romanello, M., et al. (2021). The 2021 report of the Lancet countdown on health and climate change: Code red for a healthy future. The Lancet, 30(10311), 1619–1662.CrossRef
5.
go back to reference ten Have, H., & Gordijn, B. (2020). Sustainability. Medicine, Health Care and Philosophy 23, 153–154.CrossRefPubMed ten Have, H., & Gordijn, B. (2020). Sustainability. Medicine, Health Care and Philosophy 23, 153–154.CrossRefPubMed
6.
go back to reference Lenzen, M., et al. (2020). The environmental footprint of health care: A global assessment. The Lancet Planetary Health, 4, e271–e279.CrossRefPubMed Lenzen, M., et al. (2020). The environmental footprint of health care: A global assessment. The Lancet Planetary Health, 4, e271–e279.CrossRefPubMed
7.
go back to reference Dunk, J. H., & Jones, D. S. (2020). Sounding the alarm on climate change, 1989 and 2019. New England Journal of Medicine, 382, 205–220.CrossRefPubMed Dunk, J. H., & Jones, D. S. (2020). Sounding the alarm on climate change, 1989 and 2019. New England Journal of Medicine, 382, 205–220.CrossRefPubMed
9.
go back to reference Richie, C. (2019). Principles of green bioethics. Michigan State UP. Richie, C. (2019). Principles of green bioethics. Michigan State UP.
10.
go back to reference Little, J. C., Hester, E. T., & Carey, C. C. (2016). Assessing and enhancing environmental sustainability: A conceptual review. Environmental Science and Technology, 50, 6830–6845.CrossRefPubMed Little, J. C., Hester, E. T., & Carey, C. C. (2016). Assessing and enhancing environmental sustainability: A conceptual review. Environmental Science and Technology, 50, 6830–6845.CrossRefPubMed
11.
go back to reference Myers, S. & Frumkin, H. (2020). Planetary health: Protecting nature to protect ourselves. Island Press. Myers, S. & Frumkin, H. (2020). Planetary health: Protecting nature to protect ourselves. Island Press.
12.
go back to reference Munthe, C., Fumagalli, D., & Malmqvist, E. (2021). Sustainability principle for the ethics of healthcare resource allocation. Journal of Medical Ethics, 47, 90–97.CrossRefPubMed Munthe, C., Fumagalli, D., & Malmqvist, E. (2021). Sustainability principle for the ethics of healthcare resource allocation. Journal of Medical Ethics, 47, 90–97.CrossRefPubMed
13.
go back to reference Polisena, J., Angelis, G. D., Kaunelis, D., Shaheen, M. & Gutierrez-Ibarluzea, I. (2018). Environmental impact assessment of a health technology: A scoping review. International Journal of Technology Assessment in Health Care, 34, 317–326.CrossRefPubMed Polisena, J., Angelis, G. D., Kaunelis, D., Shaheen, M. & Gutierrez-Ibarluzea, I. (2018). Environmental impact assessment of a health technology: A scoping review. International Journal of Technology Assessment in Health Care, 34, 317–326.CrossRefPubMed
14.
go back to reference Prainsack, B., & Buyx, A. (2011). Solidarity: reflections on an emerging concept in bioethics. Nuffield Council on Bioethics. Prainsack, B., & Buyx, A. (2011). Solidarity: reflections on an emerging concept in bioethics. Nuffield Council on Bioethics.
16.
go back to reference Dawson, A. J., & Verweij, M. F. (2012). Solidarity: A moral concept in need of clarification. Public Health Ethics, 5, 1–5.CrossRef Dawson, A. J., & Verweij, M. F. (2012). Solidarity: A moral concept in need of clarification. Public Health Ethics, 5, 1–5.CrossRef
18.
go back to reference Verweij, M. F. (2015). How (Not) to Argue for the Rule of Rescue. Claims of Individuals versus Group Solidarity. In Identified versus Statistical Lives: An Interdisciplinary Perspective (eds. Cohen, I. G., Eyal, N. & Daniels, N.) Oxford University Press, 137–149. Verweij, M. F. (2015). How (Not) to Argue for the Rule of Rescue. Claims of Individuals versus Group Solidarity. In Identified versus Statistical Lives: An Interdisciplinary Perspective (eds. Cohen, I. G., Eyal, N. & Daniels, N.) Oxford University Press, 137–149.
19.
go back to reference Jennings, B. & Dawson, A. J. (2015). Solidarity in the moral imagination of bioethics. Hastings Center Report, 45, 31–38.CrossRefPubMed Jennings, B. & Dawson, A. J. (2015). Solidarity in the moral imagination of bioethics. Hastings Center Report, 45, 31–38.CrossRefPubMed
20.
go back to reference Ter Meulen, R. (2017). Solidarity and justice in health and social care. Cambridge University Press. Ter Meulen, R. (2017). Solidarity and justice in health and social care. Cambridge University Press.
21.
go back to reference Rescher, N. (1987). Ethical idealism. Inquiry into the nature and function of ideals. University of California Press. Rescher, N. (1987). Ethical idealism. Inquiry into the nature and function of ideals. University of California Press.
22.
go back to reference van der Burg, W., & Taekema, S. (2004). The importance of ideals. Debating their relevance in law, morality, and politics. Peter Lang. van der Burg, W., & Taekema, S. (2004). The importance of ideals. Debating their relevance in law, morality, and politics. Peter Lang.
23.
go back to reference Kolers, A. (2021). What does solidarity do for bioethics? Journal of Medical Ethics, 47, 122–128.CrossRefPubMed Kolers, A. (2021). What does solidarity do for bioethics? Journal of Medical Ethics, 47, 122–128.CrossRefPubMed
24.
go back to reference Venkatapuram, S. (2011). Health justice. An argument from the capabilities approach. Polity Press. Venkatapuram, S. (2011). Health justice. An argument from the capabilities approach. Polity Press.
25.
go back to reference Pärnänen, K. M. M., et al. (2019). Antibiotic resistance in european wastewater treatment plants mirrors the pattern of clinical antibiotic resistance prevalence. Science Advances, 5, eaau9124.CrossRefPubMedPubMedCentral Pärnänen, K. M. M., et al. (2019). Antibiotic resistance in european wastewater treatment plants mirrors the pattern of clinical antibiotic resistance prevalence. Science Advances, 5, eaau9124.CrossRefPubMedPubMedCentral
26.
go back to reference Mortimer, F., Isherwood, J., Wilkinson, A., & Vaux, E. (2018). Sustainability in quality improvement: Redefining value. Future Healthcare Journal, 5, 88–93.CrossRefPubMedPubMedCentral Mortimer, F., Isherwood, J., Wilkinson, A., & Vaux, E. (2018). Sustainability in quality improvement: Redefining value. Future Healthcare Journal, 5, 88–93.CrossRefPubMedPubMedCentral
27.
go back to reference Ossebaard, H. C., & Lachman, P. (2021). Climate change, environmental sustainability and health care quality. International Journal for Quality in Health Care, 33, mzaa036.CrossRefPubMed Ossebaard, H. C., & Lachman, P. (2021). Climate change, environmental sustainability and health care quality. International Journal for Quality in Health Care, 33, mzaa036.CrossRefPubMed
28.
go back to reference Richie, C. (2022). Environmental sustainability and the carbon emissions of pharmaceuticals. Journal of Medical Ethics, 48, 334–337.PubMed Richie, C. (2022). Environmental sustainability and the carbon emissions of pharmaceuticals. Journal of Medical Ethics, 48, 334–337.PubMed
29.
go back to reference ten Have, P., et al. (2022). Turning green: The impact of changing to more eco-friendly respiratory healthcare – a carbon and cost analysis of Dutch prescription data. British Medical Journal Open, 12, e055546. ten Have, P., et al. (2022). Turning green: The impact of changing to more eco-friendly respiratory healthcare – a carbon and cost analysis of Dutch prescription data. British Medical Journal Open, 12, e055546.
Metadata
Title
Sustainability as an Intrinsic Moral Concern for Solidaristic Health Care
Authors
Marcel Verweij
Hans Ossebaard
Publication date
04-09-2023
Publisher
Springer US
Published in
Health Care Analysis
Print ISSN: 1065-3058
Electronic ISSN: 1573-3394
DOI
https://doi.org/10.1007/s10728-023-00469-5