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Bærøe K, Bhopal AS, Gundersen TO. Towards an environmentally sensitive healthcare ethics: ten tasks and one model. JOURNAL OF MEDICAL ETHICS 2024; 50:382-383. [PMID: 38443166 DOI: 10.1136/jme-2024-109875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Kristine Bærøe
- Institute of Health and Society, University of Oslo Centre for Medical Ethics, Oslo, Norway
- University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Anand Singh Bhopal
- Department of Global Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - TOrbjørn Gundersen
- University College of Norwegian Correctional Service, Lillestrøm, Norway
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Moyano-Fernández C, Rueda J, Delgado J, Ausín T. May Artificial Intelligence take health and sustainability on a honeymoon? Towards green technologies for multidimensional health and environmental justice. Glob Bioeth 2024; 35:2322208. [PMID: 38476503 PMCID: PMC10930144 DOI: 10.1080/11287462.2024.2322208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
The application of Artificial Intelligence (AI) in healthcare and epidemiology undoubtedly has many benefits for the population. However, due to its environmental impact, the use of AI can produce social inequalities and long-term environmental damages that may not be thoroughly contemplated. In this paper, we propose to consider the impacts of AI applications in medical care from the One Health paradigm and long-term global health. From health and environmental justice, rather than settling for a short and fleeting green honeymoon between health and sustainability caused by AI, it should aim for a lasting marriage. To this end, we conclude by proposing that, in the upcoming years, it could be valuable and necessary to promote more interconnected health, call for environmental cost transparency, and increase green responsibility. Highlights Using AI in medicine and epidemiology has some benefits in the short term.AI usage may cause social inequalities and environmental damage in the long term.Health justice should be rethought from the One Health perspective.Going beyond anthropocentric and myopic cost-benefit analysis would expand health justice to include an environmental dimension.Greening AI would help to reconcile public and global health measures.
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Affiliation(s)
| | - Jon Rueda
- FiloLab Scientific Unit of Excellence, University of Granada, Granada, Spain
| | - Janet Delgado
- Department of Philosophy 1, Faculty of Philosophy, University of Granada, Granada, Spain
| | - Txetxu Ausín
- Institute of Philosophy, Spanish National Research Council, Madrid, Spain
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Anderson W. Toward Planetary Health Ethics? Refiguring Bios in Bioethics. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:695-702. [PMID: 37624544 PMCID: PMC10943140 DOI: 10.1007/s11673-023-10285-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023]
Abstract
In responding to perceived crises-such as the COVID-19 pandemic-in routinized ways, contemporary bioethics can make us prisoners of the proximate. Rather, we need bioethics to recognize and engage with complex configurations of global ecosystem degradation and collapse, thereby showing us paths toward co-inhabiting the planet securely and sustainably. Such a planetary health ethics might draw rewardingly on Indigenous knowledge practices or Indigenous philosophical ecologies. It will require ethicists, with other health professionals, to step up and become public advocates for environmental sustainability. The COVID-19 pandemic should be seen as opening a portal to planetary health ethics or ecologized bioethics.
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Affiliation(s)
- Warwick Anderson
- Anthropology, SSPS, Social Science A02, University of Sydney, Sydney, NSW, 2006, Australia.
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Parker J, Hodson N, Young P, Shelton C. How should institutions help clinicians to practise greener anaesthesia: first-order and second-order responsibilities to practice sustainably. JOURNAL OF MEDICAL ETHICS 2023:jme-2023-109442. [PMID: 37734908 DOI: 10.1136/jme-2023-109442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/01/2023] [Indexed: 09/23/2023]
Abstract
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.
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Affiliation(s)
- Joshua Parker
- Medical School, Lancaster University Faculty of Health and Medicine, Lancaster, UK
| | - Nathan Hodson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Paul Young
- North West School of Anaesthesia, Health Education England North West, Manchester, UK
| | - Clifford Shelton
- Medical School, Lancaster University Faculty of Health and Medicine, Lancaster, UK
- Department of Anaesthesia, Wythenshawe Hospital, Manchester, UK
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Pratt B. Expanding health justice to consider the environment: how can bioethics avoid reinforcing epistemic injustice? JOURNAL OF MEDICAL ETHICS 2023; 49:642-648. [PMID: 36717251 DOI: 10.1136/jme-2022-108458] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/22/2022] [Indexed: 06/18/2023]
Abstract
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.
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Affiliation(s)
- Bridget Pratt
- Queensland Bioethics Centre, Australian Catholic University - Brisbane Campus, Banyo, Queensland, Australia
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Auckland C, Blumenthal-Barby J, Boyd K, Earp BD, Frith L, Fritz Z, McMillan J, Shahvisi A, Suleman M. Medical ethics and the climate change emergency. JOURNAL OF MEDICAL ETHICS 2022; 48:939-940. [PMID: 36442972 DOI: 10.1136/jme-2022-108738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Cressida Auckland
- Law, The London School of Economics and Political Science, London, UK
| | | | - Kenneth Boyd
- Biomedical Teaching Organisation, Edinburgh University, Edinburgh, Scotland, UK
| | - Brian D Earp
- Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Lucy Frith
- Centre for Social Ethics & Policy, The University of Manchester, Manchester, UK
| | - Zoë Fritz
- THIS institute (The Healthcare Improvement Studies Institute), University of Cambridge School of Clinical Medicine, Cambridge, UK
- Acute Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - John McMillan
- Bioethics Centre, University of Otago, Dunedin, Otago, New Zealand
| | - Arianne Shahvisi
- Ethics, Brighton and Sussex Medical School, Brighton, East Sussex, UK
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Wiesing U. Climate change and the different roles of physicians: a critical response to "A Planetary Health Pledge for Health Professionals in the Anthropocene". MEDICINE, HEALTH CARE, AND PHILOSOPHY 2022; 25:161-164. [PMID: 34529217 PMCID: PMC8443911 DOI: 10.1007/s11019-021-10051-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
The article critically responds to "A Planetary Health Pledge for Health Professionals in the Anthropocene" which was published by Wabnitz et al. in The Lancet in November 2020. It focuses on the different roles and responsibilities of a physician. The pledge is criticised because it neglects the different roles, gives no answers in case of conflicting goals, and contains numerous inconsistencies. The relationship between the Planetary Health Pledge and the Declaration of Geneva is examined. It is argued that the Planetary Health Pledge should have supplemented the Declaration of Geneva instead of changing it.
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Affiliation(s)
- Urban Wiesing
- Institute for Ethics and History of Medicine, University of Tübingen, Gartenstr. 47, 72074, Tübingen, Germany.
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Fritz Z, Huppert JL, Liddell K, Holton R, Fuld JP. Ethical principles and a practical approach to support policy making through the next phases of the COVID-19 pandemic and beyond. Clin Med (Lond) 2020; 21:e122-e125. [PMID: 33376107 DOI: 10.7861/clinmed.2020-0843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is an urgent need for an ethical framework to help us address the local and national challenges that we face as clinicians during the COVID-19 pandemic. We propose four key commitments from which a practical and consistent ethical approach can be derived. These commitments are to articulate the needs, rights and interests of the different stakeholders affected by any policy; to be accountable and transparent, recognising that people are autonomous individuals with values and concerns of their own; to consider the impact of our actions on the sustainability of the NHS, infrastructure, service demands and staff welfare; and to treat everybody equitably, with all deserving of consideration and care. Implementing these commitments will require a number of specific actions. We must put in place frameworks enabling clear advocacy for each competing objective; communicate policy and practice effectively to the public; promote integration of decision-making among social, primary, secondary and tertiary care and reduce or stop unnecessary or inefficient interventions; minimise health inequalities; and build spare capacity into the system.In this article, we expand on these actions, and note the legal context in which this would be delivered.
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Affiliation(s)
- Zoë Fritz
- The Healthcare Improvement Studies (THIS) Institute, Cambridge, UK and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Julian L Huppert
- Jesus College, Cambridge; visiting professor in the Policy Institute, King's College London
| | - Kathleen Liddell
- Medicine and Life Sciences and reader in intellectual property and medical law, University of Cambridge, Cambridge, UK
| | | | - Jonathan P Fuld
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Gillon R. Raising the profile of fairness and justice in medical practice and policy. JOURNAL OF MEDICAL ETHICS 2020; 46:789-790. [PMID: 33219012 DOI: 10.1136/medethics-2020-107039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Raanan Gillon
- Department of Primary Care and Public Health, Imperial College London, London, UK
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