• Energy Research

One manifestation of climate change is the increasingly severe extreme weather that causes injury, illness and death through heat stress, air pollution, infectious disease and other means. Leading health organisations around the world are responding to the related water and food shortages and volatility of energy and agriculture prices that threaten health and health economics. Environmental and climate ethics highlight the associated challenges to human rights and distributive justice but rarely address health or encompass bioethical methods or analyses. Public health ethics and its broader umbrella, bioethics, remain relatively silent on climate change. Meanwhile global population growth creates more people who aspire to Western lifestyles and unrestrained socioeconomic growth. Fulfilling these aspirations generates more emissions; worsens climate change; and undermines virtues and values that engender appreciation of, and protections for, natural resources. Greater understanding of how virtues and values are evolving in different contexts, and the associated consequences, might nudge the individual and collective priorities that inform public policy toward embracing stewardship and responsibility for environmental resources necessary to health. Instead of neglecting climate change and related policy, public health ethics and bioethics should explore these issues; bring transparency to the tradeoffs that permit emissions to continue at current rates; and offer deeper understanding about what is at stake and what it means to live a good life in today's world.

Climate change has substantial impacts on public health and safety, disease risks and the provision of health care, with the poor being particularly disadvantaged. Management of the associated health risks and changing health service requirements requires adequate responses at local levels. Health-care providers are central to these responses. While climate change raises ethical questions about its causes, impacts and social justice, medicine and bioethics typically focus on individual patients and research participants rather than these broader issues. We broaden this focus by examining awareness among health-care providers in the Caribbean region, where geographic and socioeconomic features pose particular vulnerabilities to climate change. In focus groups, Caribbean providers described rises in mosquito-borne, flood-related, heat-related, respiratory and mental illnesses, and attributed these to local impacts of climate change. Their discussions showed that the significance of these impacts differs in different Caribbean nations, raising policy and social justice questions. Bioethics and public health ethics are situated to frame, inform and initiate public and policy dialog about values and scientific evidence associated with climate change. We urge readers to initiate such dialog within their own institutions about the context-dependent nature of the burdens of climate change, and values and policies that permit it to worsen.

Decisions about environmental health policy often deal with contentious issues. David Resnik and colleagues (2018) highlight some such issues, arguing that the accountability for reasonableness (AF...

AbstractClimate change harms health and damages and diminishes environmental resources. Gradually it will cause health systems to reduce services, standards of care, and opportunities to express patient autonomy. Prominent public health organizations are responding with preparedness, mitigation, and educational programs. The design and effectiveness of these programs, and of similar programs in other sectors, would be enhanced by greater understanding of the values and tradeoffs associated with activities and public policies that drive climate change. Bioethics could generate such understanding by exposing the harms and benefits in different cultural, socioeconomic, and geographic contexts, and through interdisciplinary risk assessments. Climate change is a bioethics problem because it harms everyone and involves health, values, and responsibilities. This article initiates dialog about the responsibility of bioethics to promote transparency and understanding of the social values and conflicts associated with climate change, and the actions and public policies that allow climate change to worsen.

We appreciate Ford’s documentation of the many ways in which climate change threatens the traditional lifestyles and health of indigenous and other populations.1 As Ford states, the impacts of climate change on indigenous peoples are primarily studied in Australia and the Arctic, leaving much unknown about their global scale and manifestations in other regions.1 We believe that small island communities such as the Caribbean are also vulnerable to climate change because of their coastal-dependent geographies and lifestyles. The Caribbean population was estimated at 37.5 million in 2000,2 and Caribbean nations constitute approximately half of the 39 members of the Association of Small Island States.3 Like much of the world,4 the Caribbean is already experiencing increased salinity of drinking water, sea level rise, decreased habitable and agricultural land area, disrupted fisheries, and diminished food security.5 Its limited infrastructure and socioeconomic resources leave it at least partly reliant on foreign aid for climate mitigation and preparedness efforts. In one of our qualitative studies, Caribbean islanders described their personal experiences and perceptions about climate change as increased average temperatures, severity of weather events, and changes in rainfall patterns. They had observed geographic changes including beach erosion, sea level rise, drying rivers, and reduced vegetation and ground cover. They discussed the growing regional attention to disaster preparedness since the devastation of Hurricane Ivan in 2004, including efforts to digitize and archive legal and historical documents to prevent losses like those caused by Hurricane Ivan. Participants identified subsequent regional business opportunities in conservation and alternative energy, government efforts to promote the use of drought resistant crops after the severe drought of 2010, and a policy on climate change education being considered for public schools. Participants noted that relatively high rates of interisland movement and population growth stretch Caribbean social services and encroach on diminishing areas of habitable land. The discussion itself seemed to galvanize participant recognition that climate change threatens natural resources, such as rushing rivers and sandy beaches, that they take for granted. Although preliminary, our data show that climate change is altering Caribbean life. Further research on the health impacts of climate change on indigenous peoples and in unique geographic, economic, and sociocultural contexts is needed. Governments, industries, and individuals are unlikely to respond to climate change until it threatens things they value in their own lives. Ford’s article, and findings like ours, may help them to appreciate the urgency of doing so.

AbstractMedical professionalism is reflected in attitudes, behaviors, character, and standards of practice. It is embodied by physicians who fulfill their duties to patients and uphold societies' trust in medicine. Professionalism requires familiarity with the ethical codes and standards established by international, governmental, institutional, or professional organizations. It also requires becoming aware of and responsive to societal controversies. Scientific uncertainty may be used to teach aspects of professionalism in science courses. Uncertainty about the science behind, and the health impacts of, climate change is one example explored herein that may be used to teach both professionalism and science. Many medical curricula provide students with information about professionalism and create opportunities for students to reflect upon and strengthen their individually evolving levels of professionalism. Faculties in basic sciences are rarely called upon to teach professionalism or deepen medical students understanding of professional standards, competencies, and ethical codes. However they have the knowledge and experience to develop goals, learning objectives, and topics relevant to professionalism within their own disciplines and medical curricula. Their dedication to, and passion for, science will support basic science faculties in designing innovative and effective approaches to teaching professionalism. This paper explores topics and formats that scientists may find useful in teaching professional attitudes, skills, and competencies in their medical curriculum. It highlights goals and learning objectives associated with teaching medical professionalism in the basic sciences.