Business Ethics in Healthcare: Beyond Compliance

Fourteen: Environmental Responsibility and the Precautionary Principle

Case 14.1. The hospital CEO has called a meeting of the management team to decide what to do in response to an outside group, made up of environmental activists and others, that is claiming that the hospital is contributing to environmental health problems. The group, in a campaign called “Health Care Without Harm,” argues that the incineration of medical waste is a leading source of dioxin and mercury pollution. In its campaign, HCWH describes dioxin as a known human carcinogen that is also suspected of having a number of other serious effects (on the immune system, on reproductive ability, on fetal and infant development). Dioxin is formed when products containing chlorine are manufactured or when waste containing chlorine is burned. PVC (polyvinyl chloride) plastic is a major source of chlorine in medical waste. Health Care Without Harm describes mercury as a neurotoxin presenting serious risks to developing fetuses and young children. Mercury , not destroyed in incineration, is released through the smokestack and deposited in the environment. HCWH claims that medical waste may account for 20 percent of all the mercury in the solid waste stream. In healthcare mercury is used in thermometers, in blood pressure devices , in dilators and feeding tubes, in batteries, and in ®uorescent lamps. HCWH has asked this hospital, as well as others, to take immediate active steps to reduce toxic pollution. It is seeking the following actions: (1) using other technologies than incineration, like autoclaving, whenever possible to treat infectious waste; (2) ¤nding alternatives to the use Fourteen Environmental Responsibility and the Precautionary Principle of PVC plastic; and (3) ¤nding alternatives to mercury use wherever possible.1 In June of 1998, the American Hospital Association and the U.S. Environmental Protection Agency signed a Memorandum of Understanding. They agreed to undertake activities aimed at the virtual elimination of mercurycontaining waste from the healthcare waste stream (with a target date of 2005) and a reduction in the total waste generated by the healthcare industry (with a target of 33 percent reduction by 2005). It strikes many people as strange that the Environmental Protection Agency and environmental health activists have decided that it is important to target healthcare organizations in their efforts to improve the quality of the environment . It strikes people as strange because they would expect and assume that an organization dedicated to healthcare would not itself be engaged in any activities that might threaten health. This issue deserves special attention by healthcare managers precisely because it is the healthcare organization itself that is being associated with serious environmental health risks. The issue is both a major challenge and a major opportunity for the healthcare organization in its role as a citizen. The management team in the case above may not have an easy time determining the hospital’s response. This is not only because of the complexity of the issue itself, but also because education in healthcare management ethics has rarely included explicit attention to the implications of environmental responsibility . This chapter proposes some perspectives on this responsibility.2 Environmental and Health Risk Assessment One hospital executive who was faced with an actual scenario almost exactly like the one presented above informed me that management had decided to deal with the incineration issue as “a business decision.” That meant, as I understood the context, that they were going to continue to incinerate if it was the least costly manner of handling their waste. Implied in this response was, I am sure, much more than just a narrow focus on the bottom line. The unstated part of the response was something like this: “Since our incinerator is meeting all applicable emission requirements and since we have no convincing evidence that emissions at this level are harmful to public health, we think that our incineration practices are appropriate .” Therefore, the CEO felt justi¤ed in focusing on the question of the ¤nancial impact. The basic ethical issue, a dif¤cult one, is how to understand responsibility in the face of uncertainty about the environmental and/or health effects of particular practices. What should be done, for example, in the case presented above? Should management be satis¤ed that it is acting responsibly when the practices meet federally and state-mandated requirements? Environmental Responsibility and the Precautionary Principle 131 A common approach to determining a business’s environmental responsibility is a decision-making model frequently referred to as risk assessment. Risk assessment is a widely...