The Hidden Costs of Environmentally Responsible Health Care

Jessica Pierce and Andrew Jameton. The Ethics of Environmentally Responsible Health Care. Oxford: Oxford Univ. Press, 2004. Pp. 149. $36.95.

Philosophers Writing On Environmental and related global health issues, such as HIV, the resurgence of tuberculosis, the intractability of dengue fever, the reappearance of polio, are often criticized for producing incestuous academic research that fails to address the practical challenges of achieving, for example, a sustainable health care system. But this gap between theory and practice is decidedly not a shortcoming of this highly original book by Jessica Pierce and Andrew Jameton. These two scholars have been practicing philosophers, so-called "bioethicists," in a high-powered academic health center for many years. Hence they have witnessed firsthand a variety of serious diagnostic mistakes, turf fights over grant funding for medical research, and power struggles between doctors and nurses trying to protect patient rights, among other things. Most recently, as this volume attests, they have also witnessed and are now calling attention to the alarming rates of consumption of raw and processed materials (e.g., wood, steel, plastic, petroleum) and accompanying quantities of medically generated waste (e.g., radiological, chemical, synthetic, and biological) spewing forth routinely from America's best hospitals.

However, one may find fault with their somewhat glib endorsement of what they cheerfully characterize as a relatively harmless 21st-century environmentally responsible "Green Health Center" (GHC). This institutional novelty is undoubtedly the pièce de résistance of their volume. In just eight chapters they also address such ambitious topics as population and consumption, public health and environmental change, and "global bioethics and justice." This provocative book would certainly spark heated debates in graduate seminars in environmental studies. It may also prove useful in advanced undergraduate courses in the medical humanities, where the intersections of environmental policy and public health are sometimes explored. Overall, it is clearly written, well documented, and accessible to professionals and the educated public alike. But their imaginative GHC project is anything but harmless. If adopted, it could undermine the autonomy of patients and their families, cheapen the respect for human life ethic, and impose on our caring communities an autocratic system of medical management that smacks of environmental paternalism. These three criticisms will be taken up later.

For now, let us appreciate that the GHC represents an idealized alternative model of how medicine should be practiced in the wake of the alleged global environmental crisis that haunts the present and future standing of all life on this planet. Specifically, the authors want to persuade us that their GHC project is morally and scientifically superior to America's currently inadequate "health care industry," one that often squanders its pharmacopeias, ignores the spiritual needs of its "patient-consumers," and sometimes overbills or miscalculates the real costs of services rendered. The authors especially condemn the typical high-tech tertiary care medical center. In general, they find it to be wasteful of nonrenewable environmental resources, indulgent of the wishes of patients or families seeking to prolong the medically expensive lives of the chronically ill or dying, overly rigid in its hierarchical, top-down decision-making processes, and polluting in its tendency to leave damaging environmental footprints where its massive buildings and parking lots are situated.

Furthermore, Pierce and Jameton want to persuade us that the changes they seek in providing GHC medical services will help ameliorate some of our planet's most serious environmental ills. These ills include global warming, which threatens to increase the incidence of infectious diseases; ozone depletion, which threatens to increase the incidence of respiratory infections and serious skin cancers; and loss of species biodiversity, which threatens to reduce the future availability of botanical remedies yet to be discovered.

To be sure, theirs is a revolutionary proposal. It is not a modest one, as they would have us believe. In fact, their idealized picture of...