The Section on Humanities and Law in the Department of Preventive and Societal Medicine at the University of Nebraska Medical Center has formed an interdisciplinary working group of national and Omaha-based scholars to develop the concept of a Green Health Center. During the course of the 1998-2000 academic year,s the Working Group:

• Sustained an intensive dialogue on general and specific aspects of environmentally sound health care services.
• Arrived at a consensus on and statement of ethical principles underlying an environmentally sound set of health services.
• Identified and analyzed several case studies of basic health services to be provided, modified, or avoided by a Green Health Center.
• Published the statement of principles and analyses of cases in appropriate journals and circulated these to appropriate groups for scholarly and public discussion.

The hope of the GHC project is:

• to promote public discussion of environmentally responsible health care;
• to stimulate interdisciplinary research that relates health care ethics to environmental ethics;
• to stimulate policy research that promotes sustainable health care; and
• to promote institutional innovation regarding environmentally and ethically sound health services.

Exploring Bioethics Upstream (EBU), 2000 - 2004

Exploring Bioethics Upstream undertook an exploration of organizational decision-making regarding environmental concerns at an academic medical center and teaching hospital. This exploration is an important and necessary step in a larger program of study to promote a sense of ethical responsibility for the environment in policies, education, and decisions regarding patient care and the allocation of health care resources.

Our Green Health Center project had shown that we can articulate a set of ethical principles expressing environmental responsibility in health care. Our initial experiences indicate that these principles are currently only partially realized in health care practice. To apply these principles effectively, bioethicists, clinicians, and policy-makers need to become more conscious of and to understand better how medical centers manage the flow of materials—building materials, energy, equipment, supplies, and pharmaceuticals—from vendors to their application at the bedside.

We need to understand the ethics of decisions regarding materials because these decisions play a key role in determining how health care organizations balance current patient care goals with long-term environmental concerns. More specifically, we need to learn:

1. What are the main committees, personnel, and processes in health care delivery that make decisions regarding materials affecting the environment?
2. What ethical concepts and principles inform these decisions, and to what extent and how do these decision processes include explicit or implicit references to environmental values?
3. How do organizational decisions balance the three primary ethical concerns of (a) monetary costs, (b) environmental impacts, and (c) quality of care?
4. What are the salient cases of decisions regarding materials, which give rise to ethical conflicts in balancing these responsibilities?

In addressing these questions, the project developed the concept of material responsibility. Material responsibility is the ethical responsibility of organizations and individuals for the environmental, social, and economic effects of the production, use, and disposal of materials.

To observe hospital decision processes, Dr. Jameton and Christina Kessinger attended many of the hospital committees meetings where staff considered decisions about material resources here at the University of Nebraska Medical Center and the Nebraska Health Center. They observed and participated in the committee discussions concerning the flow of materials into the medical center and hospital.