By Sabine Salloch
Healthcare is being increasingly recognized as a major emitter of greenhouse gases in industrialized societies. It accounts for approximately 5 percent of national carbon budgets. Whereas some countries already adopted national climate strategies targeting at a net-zero healthcare other governments still struggle with finding appropriate pathways. This is not surprising as, on the micro-level, ecological sustainability in healthcare comes along with profound ethical questions related to justice, trust, beneficence and autonomy. The topic of my recent paper emerged out of personal experience: Whenever I discuss issues such as “Green Decision-Making” or “Climate-Sensitive Health Counselling” with various stakeholder groups (doctors, students, lawyers, bioethicists) a first impetus goes into the direction to say: “Care for the individual patient must never be compromised by ecological strategies.” Admittedly, this is an important argument, sometimes accompanied by the fear that healthcare professionals might withhold diagnostic or therapeutic options if they come along with high ecological costs.
As much as I understand such concerns standing behind the reluctance to wholeheartedly support “greening” strategies in healthcare, I became increasingly dissatisfied with the confrontational picture that is evoked here: On the one hand, we have the patient with their healthcare needs that often necessitate a considerable usage of carbon-heavy resources. In the other hand, we have the moral imperative of reducing emissions – not least as climate change is the single biggest threat to human health in the medium and long run.
Isn’t that entirely paternalistic, I was asking myself, to see the patient as a passive object of decision making? This way I reached to the topic of my recent JME paper that is dealing with patients’ ecological preferences. Even if strong evidence is widely missing so far, everyday experience leads me to believing that there is considerable share of the population to whom climate protection matters that much that they might also want to have it considered in decisions about their healthcare. These decisions, in post-paternalistic medicine, are not made for the patient but with the patient in various forms of Shared Decision-Making. As we all know from personal experience, decisions in healthcare are not always about life and death, but they might involve intricate trade-offs on how to initiate a certain preventive strategy, where to go for treatment or when to initiate some further steps. Often, there are alternatives available that differ in their ecological footprints. Healthcare also includes counselling, e.g. for chronic conditions, that needs to sensitive towards patients’ lifestyle and preferences.
Not only the healthcare system and its “green” strategy counts thus. Nor does healthcare professionals’ willingness to adapt an eco-friendly strategy. In post-paternalistic medicine, it is finally about the individual patient’s values and preferences. Patients, however, need to be encouraged to become active partners when it comes to decision-making that – next to many other aspects – also includes ecological trade-offs.
Paper title: Ecological preferences and patient autonomy
Author: Sabine Salloch
Affiliations: Hannover Medical School
Competing interests: no competing interests
Social media accounts of post author: @salloch.bsky.social