• Health care is a major sector of the U.S. economy. If the U.S. is to limit environmental costs generally, it must limit health care environmental costs.
• There is reason to think that high levels of public health can be maintained while dramatically reducing the environmental impact of health care.
• Limiting cost considerations only to monetary costs truncates the moral conversation by ignoring a wide range of social and environmental costs.
• Society has an obligation to minimize its environmental impact in order to protect the health and welfare of present and future human generations and show respect for non-human creatures.
• Because the health of earth's ecosystem is a necessary basis for human well-being, our pursuit of health should not undermine its viability.

As of 2004, the Green Health Center (GHC), as we conceive of it, only exists as a concept. As we imagine it, the GHC will resemble Health Maintenance Organizations and Managed Care Organizations in providing comprehensive care to individuals at an affordable price. It will provide subscribers with key health care services that are environmentally appropriate and which have a high public health impact. It will be committed--in its purchasing, hiring, capital investment, major equipment purchases, and other economic activities--to limit stringently its environmental costs to a modest level, sustainable in the long term, while at the same time maintaining a high standard of quality care.

Exploring Bioethics Upstream

Primary Justification of the Project

The general goal of this project is to teach bioethicists, and in so doing, to teach patients and clinicians, to become more conscious of the material foundations of health care; to understand the processes by which health care materials flow to their point of application; and thereby, to integrate environmental concerns more effectively into policies and education on the delivery of health care.

This project provides an important exploration on the way en route to articulating a more modest and realistic philosophy of medicine than that which now dominates health care thinking. This revised philosophy of medicine, while dedicated to the care of the suffering and vulnerable, integrates into the principles of patient care a sense of material responsibility, a sense of how the techniques of medicine are rooted in the larger environment, which must ultimately thrive in order for human health to flourish.

Why is it important in bioethics to develop a greater material awareness of health care?

For two reasons:

First, despite widespread public awareness that U.S. health care costs are excessive, our current efforts to reduce them by means of managed care have resulted in a bitter struggle between clinicians committed to better patient care and payers committed to limiting costs through often arbitrary and sometimes draconian means. Since it is necessary to limit costs and a middle ground must be found, the champions of patient care need themselves to embody in their work a sense of modesty with regard to the limits of health care (Callahan).

This consciousness can help to place responsibility back in the hands of health professionals, who are in a position to use wisely detailed knowledge of equipment, supplies, and pharmaceuticals. A clear awareness among professionals of environmental limits and of the material sources of health care could thereby help patients and clinicians to strike a balance between aspiration and limitation. Moreover, by drawing attention to environmental impacts, taking responsibility for the flow of materials provides a specific and morally legitimate ground for limiting costs. Unlike environmental costs, monetary costs can only be analyzed into lost opportunity costs of an undetermined and possibly trivial nature.