Climate change: a bioethical emergency and health priority

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Climate change: a bioethical emergency and health priority

J.C. Macedo

^a^,^b^,^c

aNursingSchool,UniversityofMinho,Minho,Portugal

bHealthSciencesResearchUnit:Nursing(UICISA:E),NursingSchoolofCoimbra(ESEnfC), Coimbra,Portugal

cJusGov,ResearchCentreforJusticeandGovernance,SchoolofLaw,UniversityofMinho, Minho,Portugal

Rec¸ule8novembre2022 ;acceptéle28janvier2023

KEYWORDS Bioethics; Biopolitics; Climatechange; Publichealth; Survivorship

Summary

Background.—Thisarticlereﬂectsontheconsequencesandchallengesthathumanityisfacing inthecontext ofthe currentclimatechange.Itisarguedthatbioethicsshould, asapplied ethics,assumetheemergenceofclimatechangeand,asaconsequence,thehealthsystem shouldprioritizemitigationpolicies.

Methodology.—Throughthenon-systematicreview,wetriedtoextractthedocuments’contri- butiontobioethicsandpublichealth.

Discussion.—Climatechangeisabioethicalproblembecauseitcausesdamagetoall(biosphere) whichimpliesareﬂectiononvaluesandresponsibility.Ontheotherhand,theconsequences ofclimatechangeonthehealthofthepopulationleadustodemandurgentmeasuresforthe well-beingofthepopulation.

Perspectives.—Itfollowsfromthisreﬂectionthatbioethicsmustaddressclimatechangeasan emergencyinitsagendabecausethesurvivalofhumanityisatstake.Simultaneously,thismea- sureshouldbetakenbythehealthsector,particularlypublichealth,toimplementmitigating measuresfortheconsequencesofclimatechangeonthehealthofpopulations.

Adressee-mail:jmacedo@ese.uminho.pt

Introduction

TheUNSecretary-General,AntónioGuterres,inanopinion article onclimatechange in the NewYork Times,in April 2020stated:‘‘[...]wearerunningoutoftimeapproaching https://doi.org/10.1016/j.jemep.2023.100872

creativecommons.org/licenses/by/4.0/).

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a pointof noreturn forhuman health, which dependson planetaryhealth’’[1].Effectively,theclimatechangethat we arewitnessingor know of throughthemedia istrans- formingtheworldandjeopardizinghumanhealth andthe very survival of the biosphere. If we do a little memory exerciseandrecallthelasttwodecades,extrememeteo- rologicalphenomena,suchasforestﬁres-especiallyinthe greatAmazonianforest-,longperiodsoflowrainfall,heat waves,hurricanes,andﬂoodswillcome tomindrelatively frequently.

What we currently know is that thereis an increasing cause-effectrelationshipbetweengreenhousegasemissions and climate change [2]. We also know that the average temperatureoftheplanethasincreasedby1^◦Csincepre- industrialtimes.Ifwedonotreducegasemissions,wecan be certain of a temperature increase of between 1.5^◦C and 3^◦C by the middle of this century, and of between 4^◦C and 8^◦C by 2100 [3,4]. Additionally, as D.B. Resnik states:‘‘Populationgrowthhaswidespreadimpactsonthe climatebecauseitincreasestheproductionofgreenhouse gases and decreases the removal of atmospheric CO2 by forests’’[4].

If nothing is done, this increase in global temperature willhavea devastatingimpactonnature,causing irrever- sible changes in many ecosystems and a consequent loss ofbiodiversity.Risingtemperaturesandintensiﬁedweather phenomenawillalsoresultinenormouscoststotheworld economy. In addition, there is evidence of a relationship between climate change and public health [5]. The Lan- cetCountdownreportof2021,callsthissituationaglobal healthcrisis,illustratingthecatastrophicconsequencesfor thehealthofpopulations,especiallyinthemostvulnerable countries[6].

In theseterms, we seethat climatechange is aglobal challengethatrequiresglobalconsensussolutionsthatmiti- gatetheconsequencesforthebiosphereingeneralandthe healthofhumankindinparticular.Someadvocatethedeve- lopmentofclimateliteracyintheframeworkofanintegral formationoftheperson.Intheseterms,apersonwithcli- mateliteracyisequippedwiththemeanstounderstandthe complexeffectsofclimatechangeonhumanhealthandthus canrecognizethecausallinkbetweenclimate changeand health,evaluateandinterpret scientiﬁcdata,makeinfor- med and responsible decisions,and advocate for policies thatprotecthealth[7].Therearesomechangesintheenvi- ronmentalthinkingof citizensand politicians.On theone hand,wehavewitnessedsocialdemonstrationssuchasthe ClimateStrike,alertingpeopletoclimatechange,especially youngpeople,inspiredbyGretaThunberg—aSwedishtee- nagerwhostartedapersonalprotestoutsidehercountry’s parliament-and,ontheother,wehaveseenpoliticaldocu- ments suchasthe Paris Agreementin 2015 [8], the most recentGlasgowClimatePactof2021[9],theUnitedNations Agenda 2030 for SustainableDevelopment [10], the Euro- pean Green Dal [11], UNESCO’s Universal Declaration on BioethicsandHumanRights(2005)[12],theUNESCO’sDecla- ration of Ethical Principles about Climate Change (2017) [13].

Inthislineofthought,webelieveitisimportanttomake abioethicalreﬂectiononclimatechange:howdobioethics facethisprobleminitsscientiﬁcdomain?Whatbiopolitics isatworkonthisissue?

Climate change: a bioethical emergency

AlistairCampbell,DirectorEmeritusoftheCentrefor Bio- medicalEthicsandVisitingProfessorofMedicalEthicsatthe National Universityof Singapore,warns in hisbook,Bioe- thicsthebasics,thatthemostsigniﬁcant ofallbioethical issueswemustfaceatpresentisnotthedilemmasofhealth carefrombirthtodeath,greaterthanallthesechallengesis whetherwecansafeguardourplanetandlife,forourselves andfuturegenerations[14].

Indeed,climatechangeisabioethicalproblembecause itentailsharmtoall(biosphere),andallowingthistoconti- nue,impliesareﬂectiononvaluesandresponsibility[15,16].

Recognizingthattherearedenialistcurrentsinthisarea ofscientiﬁcknowledge,whichdoesnotbelieveintheimpact ofhumanaction,especiallyinthemassiveuseoffossilfuels asa primarycontributor toclimate change [17], we take theopposite position,that is, despite some uncertainties thatscienceitselfmayhave,we considerthatthehuman handisnotuninvolvedintheincreaseoftheso-calledgreen- housegases (which trap heat in the atmosphere) such as carbondioxide — the most abundant —nitrous oxideand methane, which have contributed to the increase of the earth’stemperature withinevitable consequences onlife [18].Evenpeoplewhoarenotfromthescientiﬁcworldreco- gnizethe gravity of the situation, asis the case of Pope FranciswhowrotetheEncyclicalLetterLaudatoSi‘(about thecareofthecommonhome)in2015andstated:‘‘Ifthe annualtrendcontinues,thiscenturycouldwitnessunprece- dentedclimate change andan unprecedented destruction ofecosystems...’’[19].Also,accordingtoBillGates:

Thereisnoscenarioinwhichwecancontinuetoincrease levelsofcarbondioxideintheatmospherewithoutthe planetwarmingup,andthehotteritgets,theharderit willbeforhumanitytosurvive,letalonethrive.

The scientiﬁccommunityandorganizationssuchasthe UnitedNationsIntergovernmentalPanelonClimateChange (IPCC)statethatonlysubstantialandsustainedreductions ingreenhousegas emissions canlimit global warmingand therebyreducetherisksandimpactsofclimatechange[20].

Facedwiththesefacts,howcanweafﬁrmthatthispro- blemisabioethicalemergency?Itseemsobvioustous,given the verynature of bioethics andits origins. According to Potter:

Mybioethics hasalways beendeﬁnedasan attemptto combine biological science and knowledge of the huma- nities, stressing that ethics cannot be separated from biologicalfacts. InGlobalBioethics(Potter,1988)Iargued thatmedicalethicsandenvironmentalethicsshouldnotbe separatedfromeachother[21].

WewouldsaythatthisseminalinsightofPotterneedsto berescuedsothat:

Inthe faceof the newpowers thatscience gives man over life and himself, it is imperative that society becomesaware ofallits long-term consequencesand, inaninterdisciplinaryandpluralisticdialogue,opento anincreasinglyinformedpublic,takingallthenecessary decisionstopromotesustainabledevelopment[22][our translation].

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However, we understand that it is necessary the face of theseriousness ofclimate change, revealed byscienti- ﬁcdata,thatbioethicsdeclaresthisissueasanemergency.

In other words, if the survival of human beings could, in extreme situations, be compromised by climate change, thenwewillnotbeabletoachievewhatisstatedintheafo- rementioneddeclaration.Moreover,someacademics,such asCherlyMacphersonandothers,considerthatthedilem- masandthreatsposedbyclimatechangereceiverelatively littleattentioninbioethicspublicationsorconferences,despite the gravity, injustice, and health burdens it imposes worldwide[4,15].

In any case, weknow that thetransdisciplinary nature of bioethics generates debate aimed at social and politi- calawareness[23],whichisparticularlyrelevanthere.This awarenessisthedrivingforcebehindtheconcernaboutthe realconsequencesforhumanityofclimatechangeandthe search for consensus responses for the survival of humanity.Inthisparticularcase,weagreewithRivert-Carnacand Figuereswhointheirbook,TheFutureWeChoose—How to survive the Climate Crisis (2020), clearly and directly exposethatthosewhoareawareofclimatechangeshould beconcernedabout:

• socialjustice—becauseclimatechangeaffectsthepoo- restandmostvulnerableontheplanet,bothintheclash with weather phenomena and in the lack of resources availabletorespondtocrises;

• health issues —the burning of fossil fuels not only has consequencesfortheclimate,buttheemissionsofmicro- scopicpollutants seriously affectvarioussystemsin the humanbody. This is soseriousthat itis estimated that sevenmillionpeopleayearcoulddiefromairpollution;

• economic stability and the value of investments — we must make a gradual but decisive transition to clean energy,thereisnopossibilityof goingbacktothepast andinvestingintechnologiesthatarenotonlydevaluing intheshorttermbutarealsopollutinginthesametime;

• intergenerationaljustice—thisisacauseofethicalres- ponsibility, if we act we can still somehow keep the environmentalheritageintactforfuturegenerations.Our inactionwilldeterminethefuturegenerations’inability toreversetheplanet’sinexorableconsequences.

Health, biopolitics, and survival

We can say, without any hesitation, that these concerns shouldbepresent in thebioethicaldiscourse onthe envi- ronment.Andso,wemayaskwhether,in thisemergency, wealreadyhavesomelegalorsimilardocumentsthatguide towards environmental protection in general, and health protectionin particular, takingintoaccountthe safeguar- dingof thepresent generationandfuturegenerationsand theintrinsicvaluetonature.

We sharetheideaofHansKüng,aGermanphilosopher and theologian, that ‘‘the human being cannot become better than he is by an increasing profusion of laws and regulations...’’[24].However, statesin democraticcoun- trieshavetheirpoliticalandlegalorganizationfunctioning basedonanethicalconsensusthatwillbeembodiedinthe nationalconstitutionaltext.Itisbasedonthisethicalman- date that worldleaders, in 2015, at the25th Conference

ofthePartiesoftheUnitedNationsFrameworkConvention onClimateChange(UNFCCC, COP25)in Paris, reached an agreementoncombating climatechange, called the Paris Agreement[8].Inthisagreement,anactionplanwasesta- blishedwithallcountriesto:

• keeptheincreaseintheglobalaveragetemperaturewell below 2^◦C compared topre-industrial levels and make effortstolimittheincreaseto1.5^◦C;

• present comprehensive national climate change mitiga- tionplanstoreduceemissions;

• reporttoothergovernmentsandthepublicontheirper- formanceinmeetingtheirtargets,ensuringtransparency andoversight;

• continuetoprovideclimateﬁnancefromdevelopedcoun- tries tohelp developingcountriesreduce emissionsand buildresiliencetotheimpactsofclimatechange.

Despitethisconsensualactionplan,afirstindicationof some degree of failure was soon seen when the national contributionstothe decarbonization of the 196 countries that signed the 2015 Paris Agreement were presented in advance. These contributions were still not sufficient to avoid exceeding 2^◦C, leading to a temperature increase ofcloseto3.5^◦C [18].Reaching2021,anewmeetingwas heldinNovemberintheScottishcityofGlasgow(COP26), providinga new opportunity todeepen the commitments of theParis Agreement. However,expectations werehigh and,accordingtosomeanalysts,anagreementasaudacious asexpectedwasnotreached [25].The UNclimate conference,COP26,endedwithanagreementcalledtheGlasgow ClimatePact,butjusttogiveanideaofthedifficultyinrea- chingaconsensus,itshouldbenotedthatthefinaltextdoes notpointtofossilfuelsasthemaincauseofclimatechange anddoesnotcallforthecompleteeliminationoftheiruse, butonly callsonthe signatorycountriesof thedocument tograduallyreduceenergyobtainedbyburningcoalandto graduallyeliminatesubsidiesforfossilfuels[5].

And this reality is overwhelming because even if all climatecommitmentsaremetandallmeasuresfullyimple- mented, the most realistic report is that a temperature increaseof2.7^◦Cwilloccurbytheendofthecentury,with catastrophicimplicationsforhumanhealth.Indeed,atcur- rentlevels ofwarming (1.1^◦C),climate change is already exertingdevastatinghealthimpactsworldwide[26—29].In someempiricaldatafromtheLancetCountdownreportof 2021[6],itisstatedthat:

• manyinfectiousdiseasesaresensitivetoclimatechange andareincreasinginincidence:e.g.Vibriocholera,and itsenvironmentaladaptation andtransmissionpotential in the northern latitudes of the planet, has increased by 56%sincethe 1980s;thenumber ofmonths suitable formalariatransmissionhasincreasedby39%indevelo- pingcountriesand,duringthelast5years,environmental adaptationfortransmissionsofemergingarboviruses(e.g.

dengue,chikungunya,andZika)wasbetween7%and13%

higherthaninthe1950s;

• theheatwavesof2016and2020hadanenormousimpact onthehealthofpopulations,deterioratingtheirphysical andemotionalwell-beingandeventheefﬁciencyofagri- cultural work(by 2020, 79%of all potentialwork hours were lost due to extreme heat in developing countries occurredintheagriculturalsector);

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• high temperatures and low rainfall in recent decades haveprovidedtheperfectbreedinggroundforlarge-scale ﬁres, jeopardizing food production (unproductive soils) andaccesstowaterinmanypartsoftheworld;

• inaddition,therearemillionsofdeathsperyeardueto exposure togases fromburning fossil fuels and, at the sametime,thehighratesofrespiratorymorbidity.

This data allows us to state that also in the area of health,theimplementationofmeasurestomitigateclimate change isa priority.It wasin thisline thatat theUN Cli- mateConferenceinNovember2021inScotland(COP26),the WorldHealthOrganization(WHO)throughitsparticipation emphasizedthelinkbetweenhealthandclimate,andsome countriesassumed goals in theCOP26Health Programme, subscribingtothisdocument,tomakehealthservicesmore climateresilientandactivelyparticipateinreducinggreen- house gas emissions [4]. This is a structural commitment becauseitisestimatedthathealthsystemsworldwideemit 4.9%ofgreenhousegasemissions[26].

Europe,morespeciﬁcallytheEuropeanUnion,hasbeen assuming a greater political protagonism in the measures tobeimplemented tomitigateclimate change.Indeed in December2019,thepresentationbytheEuropeanCommis- sionoftheEuropean GreenDeal,whichaimstoboostthe efﬁcientuseofresourcesbyshiftingtoacleanandcircular economyandrestoringbiodiversity,andreducingpollution [11]. As a result of this Pact, in March 2020, the same CommissionispresentingaproposalforaEuropeanClimate Acttoenshrineclimateneutralityinlaw,thatis,topropose alegallybindingtargetforzeronetemissionsofgreenhouse gases by 2050 for European society. This initiative is cur- rentlyfollowingitslegislativecourseintheEuropeanbodies sothatitcanbeincorporatedintothedomesticlawofeach EuropeanUnioncountryassoonaspossible[27].

Mention should also be made of the United Nations (UN)resolutionentitled‘‘Transformingourworld:the2030 Agenda for Sustainable Development’’, consisting of 17 goals, broken down into 169 targets, adopted by world leaders,onSeptember25th,2015,atasummitatUNhead- quarters in New York (USA). The 2030 Agenda addresses severaldimensionsofsustainabledevelopment(socio,eco- nomicandenvironmental)andpromotespeace,justice,and effectiveinstitutions.Althoughthe17goalsshouldbeinter- linked, in a holistic perspective, we would highlight the ClimateActiongoal13—takeurgentactiontocombatcli- matechange anditsimpacts —,which intersectswiththe measuresimplementedinthedocumentsmentionedabove [10].

WecouldnotfailtomentionUNESCO’sUniversalDecla- rationonBioethicsandHumanRights(2005),which,aswe have alreadypointedout,willbe stronglyaffectedin the applicationof itsprinciplesbyclimate change.Regardless ofthiscircumstance,werefertoarticle17,whichaimsto protecttheenvironment,thebiosphere,andbiodiversity:

Itisimportanttotakeintoaccounttheinteractionbet- weenhumanbeings andotherformsoflife,aswellas theimportanceofadequateaccesstoandproperuseof biologicalandgeneticresources,respectfortraditional knowledge,andtheroleofhumanbeingsinprotecting theenvironment,thebiosphereandbiodiversity[12].

ReferenceshouldalsobemadetoUNESCO’sDeclaration of Ethical Principles in relation to ClimateChange (2017) [13].This is adeclaration, whichhas been signed by 195 countries, and for the ﬁrst time establishes a reﬂection between ethics and climate change. It is undoubtedly an importantdocument,butitdoesnothighlighttheemerging natureoftheissueand,aboveall,ithasnotbeenadopted asalegaldocument,i.e.countrieshavenottakenittothe parliamentstobeadoptedasinternallaw.Moreover,thedis- seminationoftheseprincipleshasbeenresidualinthevast majorityofthecountriesthatsignedthisdocument.

Final considerations

Climate change is a challenge to humanity. We need to discussthisenvironmental problembecauseit hasserious consequencesforallecosystemsandthreatensthesurvival ofour commonhome [19].Humanity needs amore acute awarenessof thissituationandmoreeffective andtimely action. Some say that the issue of climate change is the motherof all issues [2] because of the magnitudeof the effectsitmaycauseonlifeonearth.Webelievethatthis visionistherightoneandthemostadequatetorescuethe planetfromdisaster.Accordingtosomeauthors,wearestill intimetoachievesuchafeat,ifweactimmediately[2,3].

In this sense,bioethics, goingback to itsfoundational origin [30], should, withinthe scope of itsscientiﬁc tea- ching,putclimate changeasatop priorityonitsagenda.

Thisisbecausethesurvivalofhumanityisatstakeand,in thissense,weneed theresponseofappliedethics,which includesinitsreﬂectiontheprotectionoftheenvironment, thebiosphere,andbiodiversity.

Thisreﬂectionwillbereinforcedifweareawareofthe consequences of climate change on the health of popu- lations, especially in less developed countries and with healthsystems withless resilience capacitytorespondto thisglobalchallenge.Weneedthehealthsector,especially publichealth,toassumeclimatechangeasapriorityinits attention,tointroducemitigatingmeasures,andaboveall, measurestopromotepopulationhealth.

There is some ground to be covered in environmental bioethicalreﬂection,especiallyinthepoliticalarea.There are legislative or similar documents that point to some consensusindialogueandaction.However,webelievethat thissuggestionofbioethicstopresentanemergencypolicy lineintheﬁeldofclimatechangewillmakeaninvaluable contributiontothehealthoftheplanet.Ourposition,asa proposal,isthat thereis aneed for thisemergencytobe transformedintoabioethicsconventiononclimatechange toserveasanelementofreinforcementofcountries’miti- gationpolicies.

RecallingwhatthephilosopherMariaJoséVarandastells us:

Currenteventsforceethicalreﬂectiontoleavetheintra- humanwallsandtomorallyconsidernon-humanbeings andtheplanet.However,weshouldnotforgetthatitis notsomuchnaturethatdependsonmanbut,aboveall, manthatdependsonnature.Therefore,fundamentally, whatisatstake,fromeveryangleandapproach,isthe fateofhumanity[31].

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Human and animal rights

Theauthorsdeclarethattheworkdescribedhasnotinvolved experimentationonhumansoranimals.

Informed consent and patient details

Theauthorsdeclarethattheworkdescribeddoesnotinvolve patientsorvolunteers.

Funding

Thiswork didnotreceiveanygrantfromfundingagencies inthepublic,commercial,ornot-for-proﬁtsectors.

Author contributions

AllauthorsattestthattheymeetthecurrentInternational Committee ofMedicalJournalEditors(ICMJE) criteriafor authorship.

Disclosure of interest

Theauthorsdeclarethattheyhavenocompetinginterest.

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