Can Clinical Ethics Survive Climate Change?

The Ethics of Environmentally Responsible Health Care (2004) argued that the obligation to protect nature must be a core principle of bioethics and that the environmental harm of health-care practices should be taken seriously. In the two decades since, the accelerating pace of climate change and environmental decline has strengthened the moral case for reducing the environmental costs of health care. Nevertheless, mainstream bioethics has until recently neglected these vital issues. In response, a field of clinical environmental bioethics is emerging that applies concepts and measures of sustainability to such key clinical ethical issues as humanizing technology, setting limits, caring for the dying, respecting patient wishes, and allocating resources justly. Bioethical analysis of these and other issues can support just and humane health-care adaptation to climate change. Health-care adaptation in turn plays an important role in helping communities and nations adapt to the inevitable forward march of climate change. This essay offers two recommendations: (1) establish a climate transition commission for health-care adaptation to climate change with bioethics participation, and (2) strengthen advocacy for health-care reform by uniting it with climate activism.

The Importance of Physician Climate Advocacy in the Face of Political Denial.

Most physicians accept the general scientific discoveries about anthropogenic global warming and its dangers. Occasional denial by individual physicians of climate change can be readily answered by reference to the scientific consensus. But widespread, organized, political denial of climate change is hazardous to physicians' advocacy for an effective public health and health care response to climate change. This article assumes that physician climate advocacy is ethical and celebrates the many forms of health climate advocacy already under way. It concludes by drawing attention to measures that can scale up and strengthen the health care system's organized response to growing climate health hazards.

What Moral Distress in Nursing History Could Suggest about the Future of Health Care.

The concept of moral distress was defined in 1984 as (a) the psychological distress of (b) being in a situation in which one is constrained from acting (c) on what one knows to be right. A substantial literature on the subject has developed, primarily in nursing ethics. The aforementioned elements of distress are applied here to areas of clinical and organizational significance: (a) distress from causing intimate pain during care of the dying, (b) constraints stemming from proximate and background challenges of health care organizations, and (c) changing perspectives on therapeutic technologies derived from global environmental perspectives. Although moral distress may be increasing in clinical settings, nursing advocates are developing positive ways to cope with it that can help clinicians in general.

Community-Engaged Public Health Research to Inform Hospital Campus Planning in a Low Socioeconomic Status Urban Neighborhood.

OBJECTIVE: To compare sociodemographic and motivational factors for healthcare use and identify desirable health-promoting resources among groups in a low socioeconomic status (SES) community in Chicago, IL. BACKGROUND: Disparities in health services and outcomes are well established in low SES urban neighborhoods in the United States and many factors beyond service availability and quality impact community health. Yet there is no clear process for engaging communities in building resources to improve population-level health in such locales. METHODS: A hospital building project led to a partnership of public health researchers, architects, and planners who conducted community-engaged research. We collected resident data and compared factors for healthcare use and choice and likelihood of engaging new health-promoting services. RESULTS: Neighborhood areas were strongly associated with ethnic groupings, and there were differences between groups in healthcare choice and service needs, such as, proximity to home was more important to Latinos than African Americans in choice of healthcare facility ( p adj = .001). Latinos expressed higher likelihood to use a fitness facility ( p adj = .001). Despite differences in vehicle ownership, >75% of all respondents indicated that nearby public transportation was important in choosing healthcare. CONCLUSION: Knowledge of community needs and heterogeneity is essential to decision makers of facility and community development plans. Partnerships between public health, urban planning, architecture, and local constituents should be cultivated toward focus on reducing health disparities. Further work to integrate community perspectives through the planning and design process and to evaluate the long-term impact of such efforts is needed.

A reflection on moral distress in nursing together with a current application of the concept.

The concept of moral distress can be extended from clinical settings to larger environmental concerns affecting health care. Moral distress-a common experience in complex societies-arises when individuals have clear moral judgments about societal practices, but have difficulty in finding a venue in which to express concerns. Since health care is large in scale and climate change is proving to be a major environmental problem, scaling down health care is inevitably a necessary element for mitigating climate change. Because it is extremely challenging to discuss these concerns in health care settings, those concerned about climate change and health care experience distress. This article outlines some philosophical concepts and perspectives that may be useful in mitigating this distress.

Commentary: educating the present and future health care workforce to provide care to populations.

The crisis of the rising cost of health care in the United States is stimulating major changes in the way care is being delivered. New models such as patient-centered medical homes and accountable care organizations are being developed with the expectation that health care professionals will address and improve the health of populations. Electronic health records and interprofessional teams will be critical to achieving the goal of better health. It is now time to bring together educators and clinicians at academic health centers, public health educators and practitioners, along with researchers, representatives from the health care delivery and financing systems, and community partners to reengineer health professions education to prepare health professions students for the health care system of the future.

Global bioethics.

Because there is a large agenda of work that needs to be done to help ethicists to be better able to address ethical questions in healthcare from an environmentally conscious and globally coherent point of view, Cambridge Quarterly of Healthcare Ethics is initiating this occasional column on global bioethics to provide a space to publish and discuss environmental issues in healthcare. We are initiating this section with a paper of my own outlining some broad concerns about healthcare ethics in a global context ["Casuist or Cassandra? Two conceptions of the bioethicist's role," p. 451-466] and are inviting readers to submit philosophical and multidisciplinary papers taking a global perspective on ethical issues in healthcare....