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The micro-level of climate protection in healthcare and physicians’ professional ethos: a reply to the commentaries
  1. Henk Jasper van Gils-Schmidt1,
  2. Sabine Salloch2
  1. 1 Department Health Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
  2. 2 Hannover Medical School, Institute for Ethics, History and Philosophy of Medicine, Hannover, Germany
  1. Correspondence to Professor Sabine Salloch, Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany; salloch.sabine{at}

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We are extremely grateful for the insightful and thought-provoking commentaries on our feature article.1 We have distilled four themes emerging from the commentaries, and we would also like to address one misunderstanding of our argument that has appeared.

Microlevel as the entry point: clinical decision-making and climate protection

In our article, we explicitly acknowledge that major decisions relevant for climate protection take place at the mesolevels and macrolevels of healthcare, a point raised again in some of the commentaries.2–4 Climate protection is a societal issue, and we thank these authors for the concrete proposals of potential models to guide action. Yet, to us, it still makes sense to reflect simultaneously on the responsibilities that physicians have themselves. Without wanting to put the main responsibility on them, we argue it is important to start thinking about the scope of action that physicians actually have (or not have). As we have argued the need for climate action comes ever more into focus of society, we wanted to explore whether the professional ethics of the medical professionals needs to be amended.

Our argument is that this is the case, based on the reasons that climate change has a big health impact while simultaneously the health system has a strong climate impact. Based on the World Medical Association (WMA) Declaration of Geneva the focus on the individual patient is clear, but this and other important codices do also include a public health perspective. The (model) Professional Code for Physicians in Germany, for example, states in its first article that ‘Physicians serve the health of …

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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