This summer, The duty takes you on the side roads of university life. A proposal that is both scholarly and intimate, to be picked up like a postcard. In this text, we reflect on the ethical tension that connects and opposes the right to health and the right to a healthy environment.
The health sector is responsible, across Canada, for nearly 5% of greenhouse gas emissions associated with human activity, a production far exceeding that of the automobile in the country. These emissions are generated, among other things, at the various stages of the life cycle of medicines and health technologies, from their development and production, to their use and disposal, including their distribution. It should be noted that the increase in chronic diseases in rich countries and the aging of the population could further increase the carbon footprint of this sector in the coming years.
In 2021, the World Health Organization (WHO) declared that the environmental crisis linked to climate change is “the greatest threat to the health of humanity”. In response to this societal challenge, and noting the contribution of their sector to the problem, health professionals are getting organized in the field.
From their reflections were born several inspiring initiatives that are unfolding. The Quebec Sustainable Health Action Network (RASDQ) is a good example. One of its missions: to promote “a health and social services sector at the forefront of the fight [contre les] climate change, carbon neutral and exemplary in its environmental practices”.
Our drug, technology and health and social services intervention evaluation agencies could follow suit. Unfortunately, their degree of involvement is limited by the mandate entrusted to them and by the often insufficient and scattered data on the carbon footprint of the health products and services they evaluate.
An important pitfall must also be avoided: the ecological footprint of the health sector, like that of other sectors, is sometimes reduced to the calculation of greenhouse gas emissions and the carbon footprint. However, the use of non-renewable resources that are used in the composition of drugs and other medical devices or the discharge of chemical components and metabolic residues into wastewater from healthcare settings are other examples of major challenges.
Several concrete solutions already exist to reduce the harmful effects of the health sector on the environment, such as the electrification of transport used by healthcare staff and patients, the sorting of waste from healthcare environments, and the greening of hospitals in order to reduce heat islands. These do not necessarily involve major moral dilemmas. Above all, they invite us, collectively, to adopt best practices and to set up infrastructures favorable to them.
Thorny ethical questions
On the other hand, certain avenues, potentially just as promising, can prove to be much more sensitive, and raise some ethical questions. This may be the case, for example, of efforts to reduce overdiagnosis and overmedicalization, or to reduce the use of single-use equipment in healthcare settings.
The question that suddenly arises is: can a policy aimed at reducing the ecological footprint of the health sector compromise human health? What are the risks ? And how much risk are we willing to take?
For example, would it seem acceptable to you, on the basis of environmental arguments, to compromise the health of healthcare personnel and patients by limiting the use of non-reusable protective equipment as much as possible? Probably not. In fact, is it ever morally and socially acceptable to talk about the environment when human health (and sometimes even life) is at stake? Can we promote ecological compromises in terms of health?
Another scenario: should we consider the “environmental cost” of a treatment before recommending it for reimbursement by the public health system? At least, we should give priority to recommending the least harmful solutions for the environment when they exist. If so, would we be willing to compromise, by choosing this option, even a minimal part of the clinical benefits of the intervention? Who should decide on such compromises?
In recent years, the agri-food sector has shown us that some consumers are willing to pay more for a greener grocery basket. Studies also show concessions in the field of textiles. In the same spirit, should we see the appearance of eco-labels on medicines in pharmacies, which would allow patients to make informed choices both for their health and for the environment? Would it rather be up to doctors and other health professionals to choose, at their discretion, the health technologies to use, and the drugs to prescribe, according to the lowest environmental cost?
Human health and the environment are undoubtedly linked in many ways. Reducing the ecological footprint of the health sector can and should be driven by the need to protect not only other living species and ecosystems, but also human health itself.
In the coming years, the transition to a more sustainable and eco-responsible healthcare sector will likely raise some complex ethical questions. Bioethics gives us the space to reflect on the opportunities and concerns that will come our way along this road. This reflection must go through the consultation of the many players in the health sector and the Quebec population as a whole.