Green bioethics, patient autonomy and informed consent in healthcare

Ecological preferences and patient autonomy

Healthcare systems contribute considerably to worldwide carbon emissions and therefore reinforce the negative health impacts of climate change. Significant attempts to reduce emissions have been made on the macro level of politics and on the institutional level. Less attention has been paid so far to decisions that take place at the micro level of immediate doctor-patient contact. Current bioethical debates discuss potential tensions between 'Green Healthcare' and an orientation towards ethical principles such as promoting patient welfare or respect for patient autonomy. The article addresses this debate from a different angle starting from the premise that at least some patients might have a preference to reduce carbon outputs that are often deeply rooted in their personal value system. Taking different accounts of patient autonomy as a starting point, the article analyses whether such preferences must be respected as being part of patient autonomy. The analysis comes to a positive conclusion but highlights that certain factors such as misinterpretation, lack of understanding or pressure must be carefully considered. In addition, a patient's climate-related preference does not per se justify the choice of treatment but must be integrated into shared decision-making and reconciled with the healthcare professional's expert judgement on the intervention being a legitimate and promising way for reaching certain treatment goals. As a recommendation, empirical research on stakeholders' attitudes, knowledge and practice regarding ecological sustainability in clinical decision-making is needed together with further ethical analyses.

Patient autonomy in the era of the sustainability crisis

In the realm of medical ethics, the foundational principle of respecting patient autonomy holds significant importance, often emerging as a central concern in numerous ethically complex cases, as authorizing medical assistance in dying or healthy limb amputation on patient request. Even though advocates for either alternative regularly utilize prima facie principles to resolve ethical dilemmas, the interplay between these principles is often the core of the theoretical frameworks. As the ramifications of the sustainability crisis become increasingly evident, there is a growing need to integrate awareness for sustainability into medical decision-making, thus reintroducing potential conflict with patient autonomy. The contention of this study is that the ethical standards established in the 20th century may not adequately address the challenges that have arisen in the 21st century. The author suggests an advanced perception of patient autonomy that prioritizes fostering patients' knowledge, self-awareness, and sense of responsibility, going beyond a sole focus on their intrinsic values. Empowering patients could serve as a tool to align patient autonomy, beneficence, and the aim to reduce resource consumption.

Harmonising green informed consent with autonomous clinical decision-making: a reply to Resnik and Pugh

Resnik and Pugh recently explored the ethical implications of routinely integrating environmental concerns into clinical decision-making. While we share their concern for the holistic well-being of patients, our response offers a different clinical and bioethical stance on green informed consent and patient autonomy. Contrary to the authors' lack of data to support their concerns about provider and patient willingness to engage in climate-related conversations, we provide evidence supporting their sustainability engagement and stress the importance of a proactive, anticipatory approach in healthcare to align with evolving societal values. If climate change is perceived as a politicised issue, though it is not inherently so, healthcare providers are professionally trained to address sensitive subjects and have a duty to inform patients about potential health risks. Recognising the environmental crisis as a health crisis underscores the direct connection between environmental hazards and patients' well-being. Our perspective advocates for integrating individual considerations, societal responsibilities and systemic changes to promote environmentally sustainable healthcare.

Establishing and Defining an Approach to Climate Conscious Clinical Medical Ethics

An anthropocentric scope for clinical medical ethics (CME) has largely separated this area of bioethics from environmental concerns. In this article, we first identify and reconcile the ethical issues imposed on CME by climate change including the dispersion of related causes and effects, the transdisciplinary and transhuman nature of climate change, and the historic divorce of CME from the environment. We then establish how several moral theories undergirding modern CME, such as virtue ethics, feminist ethics, and several theories of justice, promote both a flourishing of human medical practice and the environment. We conclude by defining an expanded the scope of CME as inclusive of not only patients, families, physicians, and other health professionals but other humans, non-humans, and their shared environment. We then apply this scope and theory to a widely used framework for applying CME, the Four Topics model, to construct a climate conscious approach to CME.