About my recently published textbook:
This bioethics text is the first to cover the emerging area of environmental bioethics. Chapter 8 is entirely devoted to environmental bioethics. It includes an introduction to the issues, a selection of readings representing a range of perspectives, and a set of case studies that guide the reader into further exploration of the moral issues.
Contemporary Bioethics does much more, as well. It captures the spirit of bioethics as a rich, exciting, and continually evolving field. The text spans the breadth of this broad discipline, covering all the main topic areas of bioethics, including abortion, reproductive ethics, end of life care, research ethics, the doctor-patient relationship, and allocation of resources. It also pushes into new territory not traditionally covered in introductory texts: environmental sustainability and climate change, terrorism, neuroethics, immigration, genetic manipulations, and interconnections between first and third world health.
See my most recent essays on environmental bioethics:
The Ethics of Sustainable Healthcare Reform
(co-authored with Dan Bednarz).
Podcast “The Ethics of Environmentally Responsible Health Care. A Conversation with Jessica Pierce, PhD.” Listen here
What is Environmental Bioethics?
Bioethics is a branch of normative ethics that addresses questions raised by the application of the biological sciences to human life. Environmental bioethics is a sub-field of bioethics that focuses on the complex interactions between humans, health, healthcare, and the natural environment. The normative vision guiding environmental bioethics is this: biology, and especially medical science, can be used to promote and sustain health and well-being for all people, coupled with broad respect for human rights and ecological viability.
The word “bioethics” suggests an ethics concerned with bios, or life. And this, indeed, is what American biochemist Van Rensselaer Potter had in mind when he coined the term. He conceived of ethics as a dialogue between medical science and values, the ultimate purpose of which is to protect and nurture life on earth. Bioethics, in Potter’s formulation, is a “bridge.” It is a bridge not only between a scientific orientation and a values orientation, but it is also a bridge to the future. Our survival depends on being able to bring values and science together, allowing values to shape the scientific enterprise in ways both sustainable and humane.
For most of its life as an academic field, bioethics has veered away from this broad Potterian vision. It has instead remained focused on the narrower enterprise of medicine, without explicitly placing this enterprise within its larger context of planetary health. It is a truism, of course, that there can be no enduring health without a healthy home planet. But this necessary natural substrate of human health has been largely invisible and taken for granted, both by health professionals and by bioethicists.
Times have been changing, though, and bioethics is finally making what might be called “the environmental turn.” Environmental decline, or “change” if you prefer the more neutral description, is now impinging on everything we do, personally and professionally. Although environmental problems were certainly real and pressing at the birth of bioethics, they have lately begun to shape consciousness and conversation in more central ways. For example, thirty years ago, few people worried about global warming, and many were downright skeptical. Now, climate change is a reality, not a prediction. Its effects on human health are real and documented, and it shapes many of our individual and collective decisions. It is also beginning, in small ways, to shape the conversation about health, medicine, and medical ethics.
Scholars and activists are trying to return bioethics to its environmental roots, and by doing so maintain its relevance in the 21st century by bringing the field into connection again with the big question of human survival. I call this new, ecologically perceptive vision “environmental bioethics.” Ethicists and health professionals are exploring what an environmentally sustainable health care system might look like, how doctors might take environmental values seriously within their practice, how climate change might shape the conversation about health care priorities, what concepts from ecosystem science are applicable to the conversation about human health, and whether the moral vocabulary developed within the field of environmental ethics might have something to offer bioethics.
Some of my older work in environmental bioethics can be found here:
The Ethics of Environmentally Responsible Health Care, with Andrew Jameton (Oxford University Press, 2001).
This book is the first and most comprehensive statement of environmental bioethics. We illustrate how environmental decline relates to human health and to healthcare practices in the United States and other industrialized countries. We also outline trends affecting health and focus on the connections between ways of practicing medicine and the environmental problems that damage ecosystems and make people sick.
REVIEWS of The Ethics of Environmentally Responsible Health Care
“The first sentence of this book reads, “The foundation of human health rests on healthy, stable ecosystems.” One rarely encounters this view expressed in medical literature, yet it lies at the heart of creating a sustainable modern healthcare system.
By far the majority of analyses of the American healthcare focus narrowly on reform –slight to dramatic- through rebalancing the (allegedly) three core issues of the 1) cost, 2) coverage and 3) quality of care. Pierce and Jameton locate medicine in the context of ecological sustainability, which correctly subsumes –not negates- these three issues.
As is often the case when great social change is occurring, few scholars see it coming and also offer a cogent outline of the ethical challenges posed by such momentous upheavals. Pierce and Jameton’s is one of those books. For example, typically “medical ethics” is devoted to issues stemming from the (allegedly) sacrosanct value of what’s best for the patient. Questions about humanity’s organic connection to and responsibility to the natural environment are not asked or are given short shrift. These authors show how the earth is not a passive, inert and inexhaustible repository of goodies for medicine to dip into at will at no cost or consequence.
This book articulates an alternative discourse integral to the viability of healthcare in the 21st century, as its chapter titles evidence: 1) The Challenge of Environmental Responsibility; 2) Linking Health and Environmental Change; 3) Population and Consumption; 4) Environmental Aspects of Healthcare; 5) The Green Health Center; 6) At the Bedside; 7) Global Bioethics and Justice; and 8) New Ways of Thinking About Bioethics.”
“The answer to the ethical question “How should we live?” depends in part on what we know. Years ago, Aldo Leopold called for a “land ethic” as a consequence of understanding the interdependence of individuals in a larger ecological system. Here Jessica Pierce and Andrew Jameton examine new ways of thinking about bioethics, with a sense of urgency because of current ecologic realities. They ask for reexamination of the health care system in light of what we know–about not just human biology but also the biosphere.
Brief, well-referenced summaries of the links among health, environmental change, population, and consumption lay the groundwork. People profoundly stress the integrity of soil, water, air, climate, and biodiversity, causing widespread misery. Up to one-third of the global burden of disease is related to environmental factors. Unsustainable natural resource consumption and health care patterns dramatically favor wealthier individuals and countries.
Pierce and Jameton take direction from Herschel Elliott’s idea that “an acceptable system of ethics is contingent on its ability to preserve the ecosystems that sustain it.” Bioethics, therefore, has a responsibility to life-supporting systems, not just to patient rights or human rights. Good public health is essential to bioethics, in that poor public health and expensive reactions to environmentally related disease add stress to the environment. The authors remind us that poverty is a predictor of poor public health; but once some minimum standard of wealth is achieved, public health does not improve commensurate with spending. The authors then turn to the health care system.
Resource extraction, materials manufacture, and disposal are responsible for most human impacts on the natural world. The scale of health care activities and related material flows contribute substantially to environmental degradation. High-tech equipment, pharmaceuticals, transportation, and water and electricity consumption in health care have major environmental impacts. Despite the commitment of cultural institutions of wealthier countries to growth, material throughput must be drastically scaled back to achieve sustainability. The health care system must do its share, particularly in the United States, where we generate 40% of all global health care expenditures.
Marginal improvements in materials policies may help, but a fundamental reexamination of the scope of clinical services is also required–inevitably leading to concerns about “rationing.” But rationing, the authors say, should be thought of not as “less than optimal” care but rather as “sustainable optimal care” if the health care system is going to meet its ecologic responsibilities.
What might that look like? The authors describe the thought experiment of a working group that designed a “green” health clinic, from its guiding ethical principles to its physical structure and menu of clinical services. The dilemmas they faced show just how difficult it will be to get off the treadmill of growth and reliance on curative medicine without a fundamental cultural shift. Economic feasibility must be conditioned by moral feasibility–a daunting prospect, but perhaps achievable.
Bioethics has become largely limited to the narrower field of medical ethics, usually focusing on the rights and responsibilities of individuals. Autonomy, not community and relationship, has taken over discourse in bioethics. Pierce and Jameton argue that philosophies are available to save bioethics, but only by rethinking the roles and meaning of beneficence, biocentrism, ecocentrism, autonomy, coercion, justice, and modesty. Choice can be an expression of respect for one’s duties rather than desire, though it may include setting limits on oneself.
This book explores areas of discomfort. To some it may seem unrealistic. However, it calls moral concerns into health care decision making in fundamentally new ways. Who or what is “the patient”? What considerations should enter this relationship? In a world of limits, what is the morally best world? It is a call to link the biologic sciences, public health, and ecologic sciences with ethics. Aldo Leopold thought, “We can be ethical only in relation to something that we can see, feel, understand, love, or otherwise have faith in.” This suggests a way forward and, at the same time, the enormity of the cultural challenge.”
—Ted Schettler (Environmental Health Perspectives)