{"id":4607,"date":"2024-12-11T08:33:13","date_gmt":"2024-12-11T07:33:13","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4607"},"modified":"2025-02-18T16:11:32","modified_gmt":"2025-02-18T15:11:32","slug":"do-ecological-preferences-belong-to-patient-autonomy-the-answer-is-yes","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2024\/12\/11\/do-ecological-preferences-belong-to-patient-autonomy-the-answer-is-yes\/","title":{"rendered":"Do ecological preferences belong to patient autonomy? The answer is yes"},"content":{"rendered":"

By Sabine Salloch<\/p>\n

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 \u201cGreen Decision-Making\u201d or \u201cClimate-Sensitive Health Counselling\u201d with various stakeholder groups (doctors, students, lawyers, bioethicists) a first impetus goes into the direction to say: \u201cCare for the individual patient must never be compromised by ecological strategies.\u201d 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.<\/p>\n

As much as I understand such concerns standing behind the reluctance to wholeheartedly support \u201cgreening\u201d 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 \u2013 not least as climate change is the single biggest threat to human health in the medium and long run.<\/p>\n

Isn\u2019t 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<\/a> that is dealing with patients\u2019 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<\/em> the patient but with<\/em> 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\u2019 lifestyle and preferences.<\/p>\n

Not only the healthcare system and its \u201cgreen\u201d strategy counts thus. Nor does healthcare professionals\u2019 willingness to adapt an eco-friendly strategy. In post-paternalistic medicine, it is finally about the individual patient\u2019s values and preferences. Patients, however, need to be encouraged to become active partners when it comes to decision-making that \u2013 next to many other aspects \u2013 also includes ecological trade-offs.<\/p>\n

 <\/p>\n

Paper title:<\/strong> Ecological preferences and patient autonomy<\/a><\/p>\n

Author<\/strong>: Sabine Salloch<\/p>\n

Affiliations<\/strong>: Hannover Medical School<\/p>\n

Competing<\/strong> interests: no competing interests<\/p>\n

Social media accounts of post author:<\/strong> @salloch.bsky.social<\/p>\n","protected":false},"excerpt":{"rendered":"

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 […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":503,"featured_media":4608,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8100,968,8092],"tags":[],"class_list":["post-4607","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-autonomy","category-clinical-ethics","category-environmental-ethics"],"yoast_head":"\nDo ecological preferences belong to patient autonomy? 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