Academic Neurology Unit, The University of Sheffield, Sheffield, UK
Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
J Med Ethics. 2020 Dec;46(12):791-796. doi: 10.1136/medethics-2020-106855. Epub 2020 Oct 7.
Industrialisation, urbanisation and economic development have produced unprecedented (if unevenly distributed) improvements in human health. They have also produced unprecedented exploitation of Earth's life support systems, moving the planet into a new geological epoch, the Anthropocene-one defined by human influence on natural systems. The health sector has been complicit in this influence. Bioethics, too, must acknowledge its role-the environmental threats that will shape human health in this century represent a 'perfect moral storm' challenging the ethical theories of the last. The US conservationist Aldo Leopold saw this gathering storm more clearly than many, and in his Land Ethic describes the beginnings of a route to safe passage. Its starting point is a reinterpretation of the ethical relationship between humanity and the 'land community', the ecosystems we live within and depend upon; moving us from 'conqueror' to 'plain member and citizen' of that community. The justice of the Land Ethic questions many presuppositions implicit to discussions of the topic in biomedical ethics. By valuing the community in itself-in a way irreducible to the welfare of its members-it steps away from the individualism axiomatic in contemporary bioethics. Viewing ourselves as citizens of the land community also extends the moral horizons of healthcare from a solely human focus. Taking into account the 'stability' of the community requires justice. The resulting vision of justice in healthcare-one that takes climate and environmental justice seriously-could offer health workers an ethic fit for the future.
工业化、城市化和经济发展带来了前所未有的（尽管分布不均）人类健康改善。它们还前所未有地开发了地球的生命支持系统，使地球进入了一个新的地质时代，即人类世——一个以人类对自然系统的影响为特征的时代。卫生部门也参与了这种影响。生物伦理学也必须承认其作用——将影响本世纪人类健康的环境威胁构成了挑战过去伦理理论的“完美道德风暴”。美国自然资源保护论者奥尔多·利奥波德比许多人更清楚地看到了这场即将来临的风暴，他在《土地伦理》中描述了安全通道的开端。它的起点是对人类与“土地共同体”（我们生活和依赖的生态系统）之间伦理关系的重新解释；使我们从共同体的“征服者”转变为“普通成员和公民”。土地伦理的正义质疑了生物医学伦理学中许多隐含的关于该主题讨论的假设。通过重视社区本身的价值——以一种不可简化为其成员福利的方式——它摆脱了当代生物伦理学中个体主义的公理。将自己视为土地社区的公民，也将医疗保健的道德视野从单纯的人类焦点扩展到了社区。考虑到社区的“稳定性”需要正义。这种医疗保健正义的愿景——认真对待气候和环境正义——可以为卫生工作者提供一种适合未来的伦理。
