• Health Care Economics and Organizations
• Health Promotion
• Public Policy
• Human Rights

Through their article, van Gils-Schmidt and Salloch1 provide a thorough and thought-provoking analysis of why physicians’ practical identities ought to entail climate protection, thus placing the issue outside the realm of private choice and into that of professional moral duties. We seek to complement the authors’ argument by providing a conceptual basis for a duty to climate protection not on the micro level of healthcare professionals but rather on the meso level of healthcare institutions. While, as we will show, these two levels are interdependent at multiple scales regarding practical implementations, they require different theoretical foundations and separate analyses of how their duties toward climate protection are justified. To do so, we need to turn to a normative theory of institutions, customarily found within normative political theory. We argue that Seumas Miller’s teleological account of social institutions provides the best framework for fleshing out why climate protection ought to be considered a moral duty of healthcare institutions.

Healthcare institutions are, first and foremost, social institutions. They provide a collective good—the good of health—that is produced by its members, is available to the whole community and ought to be provided because it is desirable (p40). …