According to the widely accepted principles of beneficence and distributive justice, I argue that healthcare providers and facilities have an ethical duty to reduce the ecological footprint of the services they provide. I also address the question of whether the reductions in footprint need or should be patient-facing. I review Andrew Jameton and Jessica Pierce’s claim that achieving ecological sustainability in the healthcare sector requires rationing the treatment options offered to patients. I present a number of reasons to think that we should not ration health care to achieve sufficient reductions in a society’s overall consumption of ecological goods. Moreover, given the complexities of ecological rationing, I argue that there are good reasons to think that the ethical duty to reduce the ecological footprint of health care should focus on only nonpatient-facing changes. I review a number of case studies of hospitals who have successfully retrofitted facilities to make them more efficient and reduced their resource and waste streams.
Climate change justice is a branch of philosophical inquiry concerned with fair terms of cooperation for addressing global climate change. Global climate change refers to the adverse effects of rising average global temperature on meteorological, environmental, and societal systems due to human activities. Independent observations show a rising trend in average global surface temperature since 1880, with most of the relevant global warming occurring since the 1980s. These climatic changes are the outcome of heightened concentrations of greenhouse gases (GHGs) – e.g., carbon dioxide, methane, nitrous oxide – in the atmosphere. These gases are produced by a wide range of human activities, from the burning of fossil fuels for energy at both the industrial and the consumer level to overall land use. The fundamental relation between concentrations of GHGs in the atmosphere and global warming is well understood. And yet, achieving effective and fair international coordination to respond to the problem of global climate change has been far more challenging than expected. One of the reasons for this is that any attempt to address global climate change raises complex problems of justice. First, those communities that are most vulnerable to the risks and harms of climate change have contributed the least to the problem. Second, economic capacity to address the problem is not distributed equally around the globe. Third, political communities and generations have clashing interest claims in relation to the burdens of addressing climate change. These circumstances raise pressing questions about how to coordinate global and intergenerational cooperation. The debate over climate change justice has been primarily concerned with what counts as a just allocation of burdens and benefits in the global response to the problem of climate change. To a large extent, philosophical interest in these questions developed against the backdrop of the international effort to reach a global agreement. A prominent discussion within this debate is concerned with the allocation of duties and rights with regard to climate action. Broadly speaking, there are two distinct categories of climate change action. One is mitigation, which refers to efforts to reduce GHG emissions; the other is adaptation and refers to a wide range of actions to help adjust social systems to a changing climate. Much of the philosophical debate has revolved around the allocation of mitigation duties. More recently, questions of justice for adaptation along with alternative perspectives that challenge the allocative framework have been attracting interest.
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