“Good Medical Practice” and the Climate Crisis

By Rammina Yassaie.

Primum non nocere. First do no harm.

Words that are ingrained into every doctor from the moment they graduate medical school, as the resounding ethical principle to live and practice by.

Medicine is often thought of as a career that involves ‘saving lives’, but how commonly are doctors encouraged to consider the carbon cost of the healthcare they provide, or the long-lasting health implications of high-emission healthcare? What do they see as their role and responsibility as trusted health voices in a world on the precipice of the sixth mass extinction?

The climate crisis is the biggest health crisis of our time, with scientific consensus defining it as a “code red for humanity”. In the summer heatwaves of 2022, there were over 3000 excess deaths attributed to heat-related illness in the United Kingdom alone, with around 30,000 people dying from air pollution each year. Moreover, the scale of the wildfires in Europe this summer is unlikely to have escaped anyone’s attention, along with devastating climate consequences reported across the globe.

All this death and destruction is but a mere drop in the rising oceans of what we can expect as Earth’s temperature continues to rise and as we continue to breach the planetary boundaries which define the “safe operating space for humanity.”

Whilst numerous Royal Colleges and healthcare providers have declared a climate emergency, it is hard to determine what this means in practical terms. However, at the very least, it arguably sends a powerful message that health leaders recognise the climate crisis for what it is.

However, in reality, the NHS’s carbon emissions are 5% of all UK emissions, greater than entire countries like Croatia or Denmark, demonstrating that our attempts to keep people healthy with our healthcare system are in fact contributing to the illness and suffering of the climate emergency worldwide.

In response to this realisation, the NHS has made an ambitious but deliverable commitment to reach net zero by 2040 and this commitment is now enshrined in law.

One would have thought, in turn, that progress was on the horizon.

In August 2023, the General Medical Council released the latest update of Good Medical Practice which sets out the standards of patient care and professional behaviour to be expected by UK doctors. These updated guidelines do offer some environmental considerations, inviting doctors to “consider supporting initiatives to reduce the environmental impact of healthcare”.

Whilst one may argue this is a step in the right direction, given what we know about the health consequences of climate inaction; the harm, suffering and pain that is in store for humanity and in particular, the profound generational and societal injustices that are unfolding before our very eyes – it seems undeniably unjustifiable to suggest our profession’s grounding principle of “first do no harm” is nothing but a mere option, rather than a pre-requisite, when it comes to providing sustainable healthcare.

This update to medical standards would have been the perfect opportunity to refocus medical minds on the importance and time critical nature of climate action and the need for sustainable healthcare as a core practice for all doctors to learn, understand and advocate for. Instead, we are in a position where the work required to counteract the impact of the largest health crisis of our time is considered simply optional. A choice. See which way the wind blows and decide if you want to practice medicine that is less harmful, or not.

It begs the question then, when aspects of medical practice are known to be harmful, unjust and unappreciative of a better, healthier and fairer way to practice, can it truly be described as “good”?


Author: Rammina Yassaie

Affiliations: Medical doctor, Senior Lecturer in Leadership at the Centre for Leadership in Health and Social Care, Sheffield Hallam University

Competing interests: None

Social Media: @ramminay

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