Response to Carrick

Paul Carrick detects a note of coyness when we call our proposals for environmentally responsible health care "modest." And perhaps we should have been more forthright. Perhaps we should have admitted that our agenda is, as Carrick suggests, "radical." Let us then clarify: altering the current trajectory of health care so that it aligns itself along a more sustainable path is a mammoth project, and one that we believe is vital to the healthy functioning both of the health care system itself and of the natural world, which ultimately supports human health.

Carrick has confused the substance of our proposal with the difficulties in achieving it. We do indeed propose widely adopting a health care system modest in both scale and objectives. It has become so common in the United States to suppose that good health care must be extraordinary in its technicality and expense (with average annual U.S. health care expenses per person running now over $6,000 per year and rising) that it has become "revolutionary," and to Carrick's mind dangerous, to support modestly scaled health care services. "Modesty" is a moral value that we wish to infuse into the health care vocabulary.

Because the U.S. commitment to technologically ambitious health care is so deep, moving toward sustainability will require profound shifts in how people think and conduct themselves. When it comes to our specific ideas about how to make this shift toward sustainable health care, however, we must insist on the modesty of our proposals—following Webster, modesty here means "placing a moderate estimate on one's abilities." We are philosophers, not atmospheric physicists, biologists, or hospital administrators. Making health care sustainable will require a coordinated public and multidisciplinary effort. The specific proposals that we hazarded in our book may not work. Our primary hope is that our proposals will invite others to consider sustainable alternatives in health care along the general principles that we believe are so key to health in the long run.

Carrick rejects the concept of a sustainable health care system too glibly. "They can't be serious," he seems to suggest. But we are. If he has any appreciation of the difficulty of the population/consumption/environment bind in which the globe now finds itself, he must consider our proposals seriously, or proposals like them serving the same ends. One source of Carrick's quick rejection is his misunderstanding of our limited (dare we say "modest"?) expectations of what sustainable health care can do to help resolve the burgeoning health problems of a quickly growing and heavily consuming human population. We don't, as Carrick charges, see green health care as a panacea for the world's ailing environmental condition. If only it were so easy! Instead, we think that establishing sustainable health care is a responsibility and a necessity—as is establishing sustainability in every economic sector—if the radically difficult environmental challenges of this century are to be met without egregious loss of human life and health.

Are we convinced that the Green Health Center (GHC) as we characterize it is guaranteed to be humane and sustainable? No. As we say, it is only a thought experiment. But we do believe that the values embodied in a GHC mark an important improvement on those expressed, whether explicitly or implicitly, by typical highly technological tertiary-care institutions.

Libertarian versions of modern liberalism reject, with a certain amount of dramatic horror, the notion of working together with others toward a common good. Thus Carrick takes our suggestion to include sustainability among the values that need to be considered in health care technology, architecture, purchasing, waste systems, and so on, as an assault on patient autonomy and an establishment of what he calls "environmental paternalism." We are inclined to think that if what we propose were paternalism, it could hardly be worse than the limits increasingly being imposed on human liberty worldwide by rapid environmental decline. However, he has mislabeled our proposal. Environmental problems are problems that humanity has in common. To address environmental problems of hospitals is to address endemic problems of the human community. [End Page 459...