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How should institutions help clinicians to practise greener anaesthesia: first-order and second-order responsibilities to practice sustainably
  1. Joshua Parker1,
  2. Nathan Hodson2,
  3. Paul Young3,
  4. Clifford Shelton1,4
  1. 1Medical School, Lancaster University Faculty of Health and Medicine, Lancaster, UK
  2. 2Warwick Medical School, University of Warwick, Coventry, UK
  3. 3North West School of Anaesthesia, Health Education England North West, Manchester, UK
  4. 4Department of Anaesthesia, Wythenshawe Hospital, Manchester, UK
  1. Correspondence to Dr Joshua Parker, Medicine, Lancaster University Faculty of Health and Medicine, Lancaster LA1 4YD, UK; joshua.parker{at}


There is a need for all industries, including healthcare, to reduce their greenhouse gas emissions. In anaesthetic practice, this not only requires a reduction in resource use and waste, but also a shift away from inhaled anaesthetic gases and towards alternatives with a lower carbon footprint. As inhalational anaesthesia produces greenhouse gas emissions at the point of use, achieving sustainable anaesthetic practice involves individual practitioner behaviour change. However, changing the practice of healthcare professionals raises potential ethical issues. The purpose of this paper is twofold. First, we discuss what moral duties anaesthetic practitioners have when it comes to practices that impact the environment. We argue that behaviour change among practitioners to align with certain moral responsibilities must be supplemented with an account of institutional duties to support this. In other words, we argue that institutions and those in power have second-order responsibilities to ensure that practitioners can fulfil their first-order responsibilities to practice more sustainably. The second goal of the paper is to consider not just the nature of second-order responsibilities but the content. We assess four different ways that second-order responsibilities might be fulfilled within healthcare systems: removing certain anaesthetic agents, seeking consensus, education and methods from behavioural economics. We argue that, while each of these are a necessary part of the picture, some interventions like nudges have considerable advantages.

  • ethics- medical
  • anesthesiology
  • environment

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  • Twitter @joshp_j, @nathanhodson, @DrCliffShelton

  • Contributors All authors contributed to the conception, planning, writing and revising of this paper. Joshua Parker is the guarantor.

  • Funding This study was funded by Wellcome Trust (Grant number: 223463/Z/21/Z).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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