Principles of Green Bioethics: Sustainability in Health Care available in Paperback, eBook
Principles of Green Bioethics: Sustainability in Health Care
- ISBN-10:
- 1611863236
- ISBN-13:
- 9781611863239
- Pub. Date:
- 10/01/2019
- Publisher:
- Michigan State University Press
- ISBN-10:
- 1611863236
- ISBN-13:
- 9781611863239
- Pub. Date:
- 10/01/2019
- Publisher:
- Michigan State University Press
Principles of Green Bioethics: Sustainability in Health Care
Buy New
$49.95Overview
Product Details
| ISBN-13: | 9781611863239 |
|---|---|
| Publisher: | Michigan State University Press |
| Publication date: | 10/01/2019 |
| Edition description: | 1 |
| Pages: | 244 |
| Product dimensions: | 6.00(w) x 9.00(h) x 0.60(d) |
About the Author
Read an Excerpt
CHAPTER 1
Environmental Bioethics
From the outset, bioethics was concerned with human ties to the environment. In 1927 Fritz Jahr described bio-ethics (German: bio-ethik) as "the assumption of moral obligations not only towards humans, but towards all forms of life." Jahr expressed a compassionate ethics towards animals and plants. And, although human ethics and obligations towards flora and fauna are different, both are premised on an underlying respect. Respect for nonhumans consequently requires a moral justification for their destruction. Jahr promoted a Western, deontological articulation of bioethics, stated as "respect every living being on principle as an end in itself and treat it, if possible, as such!" Almost half a century later, the term "bioethics" appeared in English, with an astonishingly similar meaning.
In 1971 American Van Rensselaer Potter used the term "bioethics" to describe a life ethic for an industrialized society struggling against a precarious ecosystem. For Potter, bioethics was rooted in an intrinsically practical approach to sustainable life, inclusive of the earth and other organisms. In fact, the 1978 Encyclopedia of Bioethics was so influenced by Potter's scholarship that it defined bioethics as encompassing the "problems of interference with other living beings ... and generally everything related to the balance of the ecosystem." Essentially, the environment was an integral part of the original concept of bioethics. Despite having coined the term "bioethics," Van Rensselaer Potter had a subdued impact on the development of the academic discipline, and a second way of defining bioethics appeared in American academia.
In 1979 Tom Beauchamp and James Childress at the Kennedy Institute of Ethics at Georgetown University took a divergent approach to bioethics. They moved away from biotic relational systems and towards the physician-patient relationship. Initially calling it "biomedical ethics," Beauchamp and Childress offered four principles to shape the new field: respect for autonomy, beneficence, non- maleficence, and justice. Widespread consensus about the usefulness of the four principles of biomedical ethics — in tandem with institutional recognition from universities and hospitals — codified normative standards for Western, academic biomedical ethics, today called, simply, "bioethics."
The evolution of the concept of bioethics, which was formerly attentive to nature and ecosystems, into a more technological-individual field gave the appearance that Potter's bioethics was a separate discipline from academic biomedical ethics. Indeed, the current practice of identifying and conflating "bioethics" with "biomedical ethics" has erased the ecological origins of bioethics while simultaneously giving rise to the "new" discipline of environmental bioethics.
Environmental Bioethics
Environmental bioethics is a recognized subdiscipline within environmental ethics and biomedical ethics that permeates university curricula, literature, and academic conferences. It focuses on climate change–related health hazards and the environmental impact of health care as well as nutrition, pest control, natural disasters, and public health. Environmental bioethics has been addressing the intersection of environment, resource use, and human health for decades.
Two basic approaches to environmental bioethics within health care exist, each with a different emphasis. The American model, represented by the Healthier Hospitals Initiative, relies on past initiatives of sustainability and does not seek further avenues for conservation. The British model, represented by the National Health Service's various efforts at carbon reduction, uses government involvement to quantify and limit the carbon emission of the health-care industry. Both are organizational applications of environmental bioethics in health care.
The American Model
Many health-care organizations have adopted a mission of sustainability. They advocate, or participate in, selected environmental initiatives — like recycling water bottles — without attending to the other areas of resource consumption such as emergency transportation, research, or medical offerings. Hospital cafeterias, operating rooms, and buildings are touted as "green" if they move towards organic food or renewable energy. The American model of environmental bioethics operates under the assumption that health care has already become sustainable through prior initiatives and does not need to implement further avenues towards conservation.
The Healthier Hospitals Initiative (HHI) based in Reston, Virginia, is a national campaign to implement sustainable measures in the health-care sector. The HHI is a think tank and information center that provides webinars, networking, strategy sharing, case studies, and written guides to incorporate environmentally sound practices into daily operations of hospitals and health-care systems. The Healthier Hospitals Initiative focuses on six branches of ecological health care: healthier food, leaner energy, less waste, safer chemicals, smarter purchasing, and engaged leadership.
Many of these initiatives mirror other corporations' attempts to "green" their business. For instance, a part of the Healthier Hospitals Initiative "Healthier Food Strategy" includes serving less meat and sugary beverages in hospitals. "Leaner Energy" includes using less air conditioning and replacing halogen lights with light- emitting diode (LED) lights, which are cooler. In other cases, initiatives are connected to issues specific to a clinical setting.
Among the initiatives related to health care, the Healthier Hospitals Initiative addresses the ecological implications of red bag (biohazard) waste, single-use devices and reprocessing, and health-care specific toxins like Di(2-ethylhexyl)phthalate (DEHP) released from polyvinyl chloride (PVC). Overall, the HHI promotes numerous environmental choices and offers sustainable alternatives within hospitals, thus allowing health-care organizations latitude to choose tailored strategies for their ecological and economic objectives.
Healthier Hospitals Initiative transcends institutional and state lines. Opportunities to participate in the HHI are broad and include sustainable design, purchasing local food, encouraging carpooling, reducing oil expended on bottled water, retrofitting buildings with renewable energy, adding recycling programs, and educating employees on ecology. Each hospital that participates in these initiatives has a unique rationale for doing so and an individualized approach to utilizing the HHI framework.
Partnered hospitals, when they choose to join the Healthier Hospitals Initiative, are then listed on the main HHI website by location and identified by the strategies they have adopted. This type of positive pressure encourages other health-care facilities to join the Healthier Hospitals Initiative. Dignity Health and hospitals in Massachusetts are among the health-care systems that participate in the Healthier Hospitals Initiative. These examples concretize the American model of environmental bioethics in health care.
Dignity Health
Dignity Health was founded by the Catholic order of the Sisters of Mercy in 1986. With over forty hospitals and care centers across California, Arizona, and Nevada, Dignity Health maintains facilities that are both "Catholic" and "non-Catholic." These hospitals follow the common, nondenominational values of "dignity, collaboration, justice, stewardship, and excellence." As part of their commitment to the Healthier Hospitals Initiative, Dignity Health has worked towards eliminating mercury in their hospitals, utilizing plumbing devices that conserve more than 100,000 gallons of water per processor per year, and adopting sustainable-design energy retrofits. They have also been PVC/DEHP-free since 2005.
Additionally, Dignity Health was the first hospital system in California to join the now defunct California Climate Action Registry by voluntarily committing to measure and report all greenhouse gas emissions. They also partnered with Healthcare Without Harm — an international coalition working to reform the environmental- and public-health practices of the health-care industry. These changes have added up to measurable environmental conservation, with one report stating that Dignity Health had reduced their carbon emissions by 244,000 tons and recycled 16.3 million pounds of waste in 2013 alone.
The Dignity Health hospital system also eliminated 1.4 million pounds of plastic and prevented carbon-dioxide emissions equivalent to 42,815 gallons of gasoline by using reusable sharps and pharmaceutical containers. As part of the Healthier Hospitals Initiative, Dignity Health has taken a broad approach to organizational sustainability. A similar environmental trajectory is seen in Massachusetts hospitals that participate in the Healthier Hospitals Initiative.
Massachusetts Hospitals
Massachusetts is a hub of medical invention and innovation. The Boston area, in particular, features prominent and Top Ten–ranked hospitals, as well as numerous teaching and research institutions specializing in health care. Over forty hospitals in Massachusetts — including all ten in the Partners HealthCare system — have joined the Healthier Hospitals Initiative, utilizing an institutional approach to sustainability focused on the quality of food served, the type of energy used to power facilities, and efficient architectural design. In addition to the usual initiatives of organizational greening, like recycling office paper, many hospitals in Massachusetts have "started rooftop vegetable and herb gardens, and kitchen staff are purchasing more local produce from sustainable farms and seafood from local fishermen." Some hospital menus now read like "farm-to- table" restaurants. In the urbane and wealthy Boston area, this is especially attractive.
Overall, the American model of environmental bioethics in health care relies on past efforts at conservation. Any new concerns about ecology fade into the background as busy hospital administrators focus on running their health-care institutions. In contrast, the British model of environmental bioethics quantifies the carbon emissions of health care and continually reevaluates governmental policy. The National Health Service's carbon-reduction regulations target and identify areas for environmental conservation in the United Kingdom.
The British Model
The United Kingdom's 2008 Climate Change Act set a target to cut greenhouse gas emissions of the entire UK by at least 80 percent of their 1990 levels by 2050 through legally binding carbon budgets. This action required the participation of every sector in the UK, including health care. The United Kingdom has focused on carbon emissions because they are a quantifiable measurement of pollution and other environmental harm. Once calculated, carbon reduction can be implemented, often through carbon capping.
Carbon capping identifies an acceptable amount of carbon emissions, but does not permit emissions beyond that point without ramifications, which are usually economic. Carbon capping is believed to be one of the most effective ways of limiting carbon-dioxide emissions. Despite support from both science and ecology, carbon caps are difficult to implement in some countries — like the United States — and there has been international reluctance to initiate any sort of carbon capping, trading, or binding measures to reduce the amount of carbon emitted worldwide. The United Kingdom, in contradistinction, avoids these obstacles through government oversight and socialized medicine, thus successfully limiting carbon emissions.
Against the backdrop of the 2008 Climate Change Act, the United Kingdom's National Health Service (NHS) drafted Saving Carbon, Improving Health: NHS Carbon Reduction Strategy for England, and the National Institute for Health Research (NIHR) Carbon Reduction Guidelines. Both evaluate the effects of health care on climate change, following the wisdom that "quantifying the environmental impact of health care is important to determine the potential value of mitigation efforts and to reduce harm associated with health care delivery." The British model of environmental bioethics is structured, uniform, and thorough.
National Health Service Carbon Reduction Strategy
The National Health Service's 2009 Carbon Reduction Strategy for England outlines conservationist strategies for medical organizations and clinical research laboratories in the UK. The NHS initiative implemented systematic and aggressive policies to reduce carbon emissions in their health-care system under the twofold aim of carbon reduction and more efficient health care.
National Health Service guidelines for carbon reduction parallel many of the strategies for reducing carbon emissions that were highlighted in the Healthier Hospitals Initiative, such as encouraging carbon-neutral transportation — like walking and biking — eliminating animal-based foods from menus, and reducing water waste. Moreover, several unique proposals, such as reducing the "oversupply" of food to curb obesity and examining pharmaceutical-related carbon emissions, also appear in the guidelines. The NHS recognizes that providing better health care for their citizens will "reduce levels of demands for health services" later, and thus environmental burdens on hospitals and clinics.
In observation of the fact that medical demands put pressure on resources and lead to greater carbon emissions, the West Midlands Cancer Intelligence Unit within the UK pioneered the use of cancer registry data along with Geographical Information Systems (GIS) to calculate the carbon emissions associated with treating breast cancer. They report, "Data comparisons from 1999 and 2004 showed that there has been a 214% increase in total car miles travelled which equates to over 400 tonnes of carbon associated with radiotherapy treatment in the West Midlands. Looking at patient and visitor mileage, and therefore carbon, will prove to be a useful tool in the designing of low carbon patient pathways." The diligence with which the NHS is assessing and modifying activities within their health-care system also appears in the companion to the Carbon Reduction Strategy, the National Institute for Health Research Carbon Reduction Guidelines.
National Institute for Health Research Carbon Reduction Guidelines
Clinical research is a carbon-emitting activity. Part of the "associated carbon footprint" of the universities, hospitals, and general health-care facilities are the academics in offices entering data, performing a systematic review of relevant research, running clinical trials, or working in the laboratory. Since health-care delivery and health-care research are intricately connected, the United Kingdom's 2008 Climate Change Act required carbon assessments of both institutional branches. The National Institute for Health Research (NIHR) is the branch of the NHS that supports clinical research — case studies, clinical trials, study design, data collection, and trial monitoring. The NIHR Carbon Reduction Guidelines were crafted to make researchers aware of the carbon impact of their activities and then offer avenues to modify current clinical research practices and mitigate climate change.
In two notable examples, specific clinical trials in the United Kingdom were assessed for carbon output. The first study analyzed the carbon emissions from a sample of twelve randomized controlled trials funded by the National Institute for Health Research's Health Technology Assessment program. The average emission of each trial was calculated to be 78.4 tons per trial, or 306 kg of CO per participant. The total number is equivalent to the amount of carbon produced in one year by approximately nine people in the United Kingdom. While the average of these twelve clinical trials was provided, it should be noted that each clinical trial had a different carbon footprint depending on variables such as location, enrollment, travel, distribution of materials, technological equipment, and electricity.
In a second example, the National Institute for Health Research analyzed the "Crash" trial, which was a multicenter, international, randomized, controlled trial of the effect of corticosteroids on death and disability in 10,008 adults with head injuries. The Crash trial emitted 630 tons of CO or 63 kg of COper participant. The total carbon emissions were calculated to be the equivalent of 525 round-trip flights from London to New York for one passenger. These clinical case studies offer tangible examples of quantifying carbon emissions from clinical trials. Following these carbon calculations, the NIHR Carbon Reduction Guidelines outlined nineteen key recommendations for carbon reduction for researchers. Three of the recommendations are particularly notable.
(Continues…)
Excerpted from "Principles of Green Bioethics"
by .
Copyright © 2019 Cristina Richie.
Excerpted by permission of Michigan State University Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Foreword Paul R. Ehrlich ix
Acknowledgments xiii
Introduction xv
Part I Approaches to Sustainability and Health Care
Chapter 1 Environmental Bioethics 3
Chapter 2 Green Bioethics 13
Part II Principles of Green Bioethics
Chapter 3 Distributive Justice 25
Chapter 4 Resource Conservation 49
Chapter 5 Simplicity 71
Chapter 6 Ethical Economics 91
Part III Green Bioethics in Practice
Chapter 7 The Green Patient 117
Chapter 8 The Green Doctor 129
Chapter 9 The Green Health-Care Plan 141
Conclusion 153
Notes 159
References 193
Index 219