About my recently published textbook:
Podcast “The Ethics of Environmentally
Responsible Health Care. A Conversation with Jessica Pierce, PhD.
Bioethics: A Reader with Cases,
Jessica Pierce and George Randels (Oxford University Press).
This new bioethics text (forthcoming
in October, 2009) 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.
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
See my most recent
essays on environmental bioethics:
Environmental Bioethics—A Manifesto
Ethics of Sustainable Healthcare Reform
(co-authored with Dan Bednarz).
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
Some of my older work in environmental
bioethics can be found here:
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
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
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
—Ted Schettler (Environmental Health Perspectives)