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Commentary
‘Green’ bioethics widens the scope of eligible values and overrides patient demand: comment on Parker
  1. Anders Herlitz1,2,3,4,
  2. Erik Malmqvist1,2,
  3. Christian Munthe1,2
  1. 1 Department of Philosophy, Linguistics & Theory of Science, University of Gothenburg, Goteborg, Sweden
  2. 2 CARe, University of Gothenburg, Goteborg, Sweden
  3. 3 Department of Philosophy, Lund University, Lund, Sweden
  4. 4 Institute of Future Studies, Stockholm, Sweden
  1. Correspondence to Professor Christian Munthe, Department of Philosophy, Linguistics & Theory of Science, University of Gothenburg, Goteborg 405 30, Sweden; christian.munthe{at}gu.se

https://doi.org/10.1136/jme-2022-108849

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    Introduction

    Parker’s article is a welcome attempt to address the importance of environmental sustainability in the realm of clinical ethics.1 We support the recent movement to seriously consider the environmental impact of healthcare institutions in bioethics.2 3 Still, we find two partly linked weaknesses of Parker’s analysis and guideline suggestion. These relate to a need in ‘green’ bioethics to see beyond the normal healthcare ethical focus on health-related values related to individual patients, and to primarily adopt institutional ways of framing central decision problems.

    ‘Green’ bioethics looks further than the patient and beyond health

    Traditional bioethics applies a restricted scope of values to assess clinical decisions: primarily health-related patient well-being (including life) and patient autonomy. If a decision improves (or, as in Parker’s inhaler case, maintains) a patient’s health-related well-being, this supports it. However, if a decision improves a patient’s non health-related well-being, say, winning a beauty contest or securing a job by having cosmetic surgery, it is not supported. And so on. This idea of healthcare as, in Michael Walzer’s classic terminology, a separate ‘sphere of justice’ has two interrelated limitations: it reflects a bias towards individual patients over other people, and it restricts the scope of values allowed to influence healthcare ethical judgements. These limitations appear once we see that the issue addressed by Parker can be framed either as prescription decisions taken by individual doctors against the background of …

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    Footnotes

    • Twitter @AndersHerlitz, @erik_malmqvist, @christianmunthe

    • AH, EM and CM contributed equally.

    • Funding This research was supported by the UGOT Challenges Initiative at the University of Gothenburg, no award/grant number, for CARe: The Centre for Antibiotic Resistance Research; the Swedish Research Council (VR), contract no. 2018-05771, for the project EDAR: The Environment as a Driver for Antibiotic Resistance; and the Swedish Innovation Agency VINNOVA, contract no. 2021-02699, for the project PLATINEA 2.0: Availability and Individualised Use of Antibiotics.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.