We need to re-think medical ethics in the era of the Anthropocene, writes public health physician, Professor Tony Capon.

With the release of the latest Intergovernmental Panel on Climate Change report last month, scientists delivered a “final warning” on the climate crisis.

This United Nations report is further evidence that climate change is a major threat to human health in Australia and globally.

Notably, climate change is not the only global environmental change with major health consequences.

Pollution, biodiversity loss and ecosystem degradation all harm health in myriad ways.

Earth scientists now argue that, collectively, the human species is changing earth systems to such an extent that we are leaving the Holocene epoch (the time since the last ice age) and entering a new geological epoch called the Anthropocene.

In 2015, the Rockefeller Foundation and The Lancet published the report of their Commission on Planetary Health titled Safeguarding human health in the Anthropocene epoch.

The Commission found that, by almost any measure, human health is better now than at any time in the history of human life on earth.

However, these health gains have come at the cost of degradation of natural systems on a scale never seen previously.

The Commission concluded that continuing degradation of earth systems threatens to reverse the health gains of the past century.

Medical ethics

So, environmental change harms health — what has that got to do with medical ethics?

The reason this is relevant to medical ethics is that modern health care has a big environmental footprint.

In 2020, we published the first global assessment of the environmental footprint of health care.

We found that, internationally, health care was responsible for 4.4% of all greenhouse gas emissions, 2.8% of all particulate matter, 3.4% of all nitrogen oxides, and 3.6% of all sulphur dioxide. All these environmental pollutants harm health in different ways.

As we care for health, we’re harming health at the same time.

Modern medical ethics can be traced back to Hippocrates in ancient Greece, some 2500 years ago.

Hippocrates wrote books including On airs, waters and places. He was speaking to his patients, thinking about how they lived and where they lived, and making ecological deductions about their health.

In this context, he advanced the Hippocratic Oath as ethical guideposts for medical practice.

Fast forward to modern times and the Declaration of Geneva was adopted by the World Medical Association in 1948. The Declaration outlines the professional duties of physicians and affirms the ethical principles of the medical profession.

For earth scientists, the middle of the 20th century also marks the beginning of what is called the Great Acceleration in consumption that underpins the Anthropocene.

Since 1948, the Declaration of Geneva has been amended and edited several times, most recently in 2017. However, there is no mention of natural systems in the current version.

Perhaps it’s time for this to change?

There is no doubt that human health and wellbeing entirely depends on the health of natural systems, and there is also no doubt that health care has a large environmental footprint.

It follows that when making clinical decisions in the Anthropocene, physicians must take care to minimise the environmental footprint of the care they provide.

The pressing need for a re-think

It’s been argued that doctors should take a Planetary Health Pledge. However, it would also make sense to integrate this important issue into the Declaration of Geneva.

Beyond the Declaration, it’s clear that health systems must urgently get their own house in order by addressing their environmental footprint.

The National Health Service (NHS) in the United Kingdom recently announced an ambition to be the world’s first net zero health system. The Australian Government is currently consulting about our first National Health and Climate Strategy.  

Achieving these ambitions will require a change of clinical culture and mindset.

Health care must account for its environmental footprint. Health workers will need new skills to address these challenges.

As modern physicians, we have a duty of care to both people and the planet.

Tony Capon FAFPHM directs the Monash Sustainable Development Institute in Melbourne. He is a public health physician, a Commissioner with the Rockefeller Foundation—Lancet Commission on Planetary Health, a member of the MJA Editorial Advisory Group, and a member of the Expert Advisory Committee for the Climate and Health Alliance.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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