Do you think that environmental ethics should be included in the HKU medical ethics syllabus?
Dr. Abigail Wright, Coordinator of Medical Ethics and Law, MEHU
I have long reflected on whether we should be including more environmental ethics in the HKU medical ethics syllabus. Undeniably, environmental hazards have negative human health impacts. Climate change, as we are increasingly witnessing, most recently relating to widespread flooding in China and Europe, drought and wild fires across a number of mediterranean countries, US and Australia, will have adverse public health and infrastructure impacts globally and will result in increased health inequities within and between nations. In February, the UN announced that 2021 is a “make or break year” to confront the global climate emergency. As clinicians ,our professional focus is on optimising health, be it through prevention or cure, but we can’t competently do this without knowledge and understanding of the many environmental factors influencing the human condition.
Indeed, many of the most challenging ethical questions of our time address interactions between human health and environment. Improvements in human health, such as reduced mortality and decreased disease and hunger, can cause environmental harm, such as increased use of fossil fuels, deforestation, pollution, and decreased biodiversity. Questions raised include, the best way to regulate pesticides, chemicals and pollutants? Should we develop genetically modified organisms for use in agriculture, medicine, and energy production and how should they be regulated? Should we use genetically modified mosquitos to control mosquito-borne illnesses such as malaria and Zika virus? How should we ensure the safety of our food supply? What steps should we take to reduce antibiotic resistance?
All organisms depend on their environments for energy and materials needed to sustain life: clean air, potable water, nutritious food, and safe places to live. In terms of longevity, advances in agriculture, sanitation, water treatment, and hygiene have had a far greater impact on human health than medical technology, which begs the question, why aren’t healthcare professionals engaging more with discussions about these topics?
Environmental hazards (invariably caused by humans) such as pollution, toxic chemicals, and food contaminants, dangerous work, poor housing conditions, urban sprawl, and poverty, increase the risk of health conditions like cancer, heart disease, asthma, and many other illnesses.
Where conflicts exist between health and well being, and the environment, we need to consciously weigh up the benefits and risks; for example the use of pesticides to improve crop yields weighed against the hazards of the disruption to ecosystems which inevitably has broader ramifications for human health care and the environment. Banning pesticides would reduce productivity and this would potentially cause food shortages, increased food prices and famines in vulnerable parts of the world. Another important example would be global warming. A significant percentage of global climate change is due to the human production of greenhouse gases. Climate change is likely to cause tremendous harm to the environment and human health, but taking steps to drastically reduce greenhouse gases could have adverse consequences for global, national, and local economies, which itself would have negative consequences for human health and well being.
We have all be shocked by images of general waste polluting our rivers and seas, and with the increasing use of disposal face masks, the issue of medical waste has come more sharply under the spotlight. The article below, identified by Timothy Keith Hung MBBS 2026, focuses on another impact of medical waste, environmental contamination from pharmaceutical waste. Whilst the discussion centres on the direct impact on fish, it is naïve to ignore the inevitable human foodchain contamination and the potentially serious consequences for human health.
Do you think environmental ethics should feature in the medical ethics syllabus? Let me know: awright@hku.hk
