Blog5th August 2024
As co-chair of the Nuffield Council on Bioethics (NCOB) advisory board to the environment and health priority area, I was delighted to contribute to the recent Oxford Global Health and Bioethics International Conference.
Our session probed a central question we are asking at the NCOB – how can bioethics contribute to policy issues at the intersection of climate change, the environment, and health? Caio Caesar Dib, Kyle Ferguson, Miranda MacFarlane, and Julian Sheather, joined us as expert speakers, offering insightful ideas and prompts for debate, and raising diverse practical and philosophical challenges.
Amongst my own reflections so far about the contributions that bioethics can bring, I have been struck by a point that re-emerged across the talks in Oxford; especially Dr Ferguson’s. This springs from the distinction drawn between adaptation measures—which are implemented in response to problems caused by climate change, such as ensuring safety in the face of extreme heat—and mitigation measures—which aim to prevent or lessen climate change, for instance by reducing greenhouse gas emissions.
The point I want to highlight comes from a perspective within bioethics and its embrace over recent decades of the philosophy of public health. In pithy terms, we might say that while biomedical ethics has tended to centre on questions concerning individual care and cure, public health ethics has focused on cross-societal dynamics and the creation (or otherwise) of fair conditions in which people can enjoy the best possible well-being. Or pithier still, biomedical ethics is in great part about responding to harm while public health ethics has a strong focus on preventing harm in the first place.
I realise that the characterisations here would be overly reductive if taken too literally. But the point is about the distinction that emerges with the differing general points of orientation. Even allowing for greater nuance than I am giving, we see with this representation how the basic concern can be the same: health is valuable. But at the same time, both the ends and the means of honouring that value differ. Importantly, the different discourses represent clashes—but not in a way that has to amount to a zero-sum competition. There is space for both orientations that I have (again, I hope not too reductively) characterised. And that space is best occupied by open-minded and informed dialogue.
Focusing on climate change and health ethics, this suggests to me two things for bioethics’ contribution, as applied to discussions of adaptation and mitigation measures. In a more ‘already learned’ sense, bioethics offers tremendous resources on exploring those sorts of tensions and trade-offs, through the mediation and application of ideas whose starting points differ radically. In broad terms, adaptation measures share more than passing similarity with biomedical interventions, insofar as these concern responses to harm, while mitigation measures do so with public health interventions, insofar as these concern questions of social justice and the prevention of harm.
Significantly too, there is much to be learned in a ‘perhaps forgotten’ sense. As it emerged as a ‘new’ field, public health ethics (including in the NCOB’s 2007 report on the subject) expressly shunned medical ethics as a foundation, and drew instead directly from political philosophy informed by environmental ethics and its concept of stewardship. And in this regard, people working in bioethics might reflect on what they can contribute to questions concerning ethics and the environment by revisiting their methods of recognising what they have already drawn from that area.
In approaching this, bioethics’ tendency to anthropocentrism may create philosophical problems that can be characterised alongside critiques of public health that lead to reframings such as Planetary Health or One Health. Humility is needed in recognising works in ethics that already exist, rather than imagining that what is newer terrain for (many in) bioethics is outright uncharted ground. At the same time, there is a huge wealth of directly relevant expert understanding that can be brought from bioethics to this most complex area. This includes finer-grained appreciation of the different junctures at which ethical questions arise: from individual levels, through different communities, across societies (nationally and globally), and crucially to include as well the environment. Across time and place, the trade-offs are enormously difficult, while the significance of prevention as well as remediation becomes all the more stark.
Much has been done already, and we need to see engagement and collaboration in progressing debates and forming shared understandings. As my colleague on Council, Michael Reiss, has indicated, the urgency cannot be overstated.