In 2012 an unusually mild winter across the USA was followed by 50 and 100 tornado strikes in the American Midwest over two 24 h periods, respectively 2 March and 15 April. Similarly, the drought and flooding that disrupted much of USA, England and other parts of the world a few months later devastated grain crops and raised food prices globally. In November Hurricane Sandy ravaged New York City and heavily populated Mid-Atlantic states leaving millions displaced, cold and/or without electricity. Record-setting storms, drought, floods and damages continue in 2013. The increased frequency of such extreme weather is a manifestation of climate change.1 The news media provides extensive coverage of the associated injuries, deaths, unrest and suffering. In the USA such reports rarely mention links between weather and climate change but recent polls found that 58% of the public would like to know what their television meteorologist thinks about climate change2 and 89% of meteorologists believe that climate change is real and caused primarily by human activities.3

Extreme weather and other manifestations of climate change cause morbidity and premature death through heat stress, air pollution, and infectious and zoonotic disease.4 ,5 These manifestations also reduce access to safe food and water, cause nutritional and waterborne diseases, and worsen pre-existing conditions. The health harms may persist and become chronic during the months it takes victims to rebuild their homes, lives and identities. Ethical values determine whether and how such harms, and the conditions which permit them to occur, are prevented and rectified, and whether and how victims are compensated or cared for.

This essay defines climate change as a neglected bioethics problem and argues that bioethical analyses could enhance mitigation efforts, risk assessments and policy. Bioethics affiliation with health, medicine and ancient philosophy contribute to its broad applicability. While environmental ethics and similar paradigms applied to climate change focus on the environment, bioethics emphasis on health has wider appeal across disciplines and to the public. Medical education,6 global health policy7 and other disciplines are grappling with ethical dilemmas about climate change but not identifying them as such.

Bioethics can broaden climate-related dialogue from specialist jargon, dogma and technical considerations to harms and benefits of related activities, particularly those affecting health.

That bioethics neglects climate change8 is clear in a literature search of PubMed (2002 and 2012) for the phrases ‘bioethics’ and ‘climate change’. It reveals only two citations, in the journals Medicine and Law and International Journal of Bioethics. Narrowing ‘bioethics’ to ‘public health ethics’ retrieves no citations but broadening it from ‘bioethics’ to ‘ethics’ retrieves 74: one in the Hastings Center Report; three in Nursing Ethics and Medicine Healthcare and Philosophy; and 70 in a range of scientific journals.

Bioethics tends to focus on problems of the wealthy and overlook consequences to others,9 but with respect to environmental problems including climate change, bioethics could help to identify the related issues and values at stake;10 address intergenerational concerns;11 explore the foundations of conflicting goods and policies;8 ,12–14 demonstrate the need to design and adopt healthy and sustainable institutions;15 elucidate human relationships with animals and environmental resources;4 ,9 incorporate climate change into bioethics curricula;16 help doctors think critically about environmental consequences of their work;17 navigate uncertainty about how and when to implement the precautionary and polluter pays principles;18 ,19 and inform risk assessments about the centrality of the environment to health.14 ,20 Such contributions addressing climate, health and bioethics are rare, and seldom appear in mainstream bioethics journals.21 Unlike bioethics, the health sector is increasingly responding to climate change.

Health sector responses

Britain's National Health Service established a Sustainable Development Unit which reduced National Health Service emissions to a third of its 1990 level through policies promoting conservation; recycling; the use of standardised sustainability measurements; and professional and public awareness of the issues.22 WHO projects aim to increase the capacity of health systems to respond by strengthening early warning and response systems to extreme heat in urban settings in China; improving water management to control diarrhoeal disease in Jordan; managing vectorborne disease risks in highlands of Bhutan, Kenya and small island states; and encouraging integration of health costs into broader policy decisions.23 The WHO, the International Federation of Medical Student Associations and Health Canada educate health professionals about the health impacts of climate change through collaborative webinars. The American Public Health Association and the US Centers for Disease Control fund preventive and adaptive projects, encourage individuals and organisations to minimise their respective emissions and also offer webinars.24 ,25

While health and other sectors recognise the severity and breadth of the impacts of climate change, bioethics is basically silent on choices and policies that worsen these impacts. Meanwhile global population grows and more people aspire to wealthy lifestyles, generating still more emissions and damaging the land, water and air essential to agriculture, shelter, sport, and physical and mental health. Once damaged, these resources cannot easily be replenished, particularly in already weakened conditions. The costs of environmental damage and depletion are rarely incorporated into health economic predictions or development projects but their value is apparent in conflicts over access to sources of water, oil, gas, fisheries, lumber and others.

Utility and justice

Climate change is among the top three global risks to the future and the related water and food shortages, and volatility of energy and agriculture prices, are among the most significant impacts.26 These have serious implications for health, healthcare and health economics. Major emissions reductions would reduce the risks but what reductions should be adopted; when should they be implemented; who should be held accountable; and what penalties, if any, are appropriate? Such determinations ought to intrigue bioethicists, policymakers and the public.

Science is unequivocal about three points of ethical significance. Measurable quantities of emissions are generated by specific human activities; atmospheric emissions are accumulating faster than they can dissipate; and accumulation has increased dramatically since 1950. While raising emissions, socioeconomic development generates benefits including the technological developments upon which healthcare and Western lifestyles depend. But these benefits are not equally accessible, and the burdens of climate change disproportionately affect disadvantaged groups.

Individuals and nations with scarce resources or minimal standards of education are less able than others to access the benefits of emission producing activities, and less able to prepare for and recover from the burdens. The quality of their homes or their homelessness leaves them more physically exposed than others to extreme weather, drought and floods, and less able to become or remain employed. These vulnerabilities challenge health, healthy child development and healthy nations.27

By elucidating the values and tradeoffs in related choices and policies bioethics could expose how climate change worsens vulnerabilities and contributes to unrest and violence. For example, agricultural disruptions contributed to rising grain prices that were widely perceived as a catalyst for the ‘Arab Spring’ uprisings. Such indirect costs are widely overlooked in dialogue about emissions but bioethics could deepen understanding of the costs, conflicts associated with, and consequences of, emissions producing activities. Bioethical analyses of environmental, economic and health inequities between rich and poor, and between generations, could bring transparency and objectivity to public and policy dialogue.

The inability to predict when or where a specific manifestation of climate change will be felt, and with what severity, deflects attention from health impacts that are already occurring, and the associated ethical concerns. Had the scientific evidence been as clear in the 1970s as today, bioethics interest in the health impacts of geography, environment, socioeconomics and culture might be greater. Bioethics might have more thoroughly explored individual and collective responsibilities to, and for, the environment. Instead of drawing attention to utility, justice and environmental conditions that bear on health, bioethics focuses steadfastly on autonomy. Bioethics could distinguish itself by bringing its principles and methods to the distinctions between luxury and subsistence emissions; distributions of benefits and burdens; and responsibilities to future generations identified in environmental and climate ethics.

UNESCO is considering whether to draft a declaration on ethics and climate change that would outline responsibilities that nations could fulfil in their respective geographic, socioeconomic and cultural settings.28 Such a declaration likely would address the utility and justice of actions and policies that, often unintentionally, increase emissions and drive climate change. Utility and justice offer a more balanced approach than autonomy to understanding and responding to climate change.

Virtues and values

The economic and other costs of allowing emissions to increase are amorphous and seem distant in space and time but are harming health now. Emissions will continue to accumulate unless global aspirations to maximum production and unlimited socioeconomic growth decline through sociological or regulatory processes. These aspirations contradict virtues like frugality and moderation and undermine things humans once valued highly, like Mother Nature. They challenge values like respect and responsibility that protect environmental resources and places of recreation and beauty. They also challenge virtues and values that underpin policies that provide infrastructure and funding for health and healthcare. Health itself is a widely shared value that is challenged by development and globalisation. How societies and individuals rank their virtues and values is evolving, and perhaps eroding, through globalisation and the well-marketed idea that bigger, newer and faster is always desirable.

Bioethics should help to explore how virtues and values affect the conflicts, tradeoffs and policies that worsen climate change. Doing so would better inform policymakers and the public; draw attention to individual and collective responsibilities for environmental resources; bring transparency to tradeoffs that permit emissions to continue rising; and generate deeper understanding about what is at stake and what it means to live a good life in today's world.