Faculty of Health and Medicine, Lancaster Medical School, Lancaster University, Lancaster, UK
J Med Ethics. 2023 Feb;49(2):92-98. doi: 10.1136/jme-2022-108388. Epub 2022 Aug 18.
The National Health Service (NHS) was the first healthcare system globally to declare ambitions to become net carbon zero. To achieve this, a shift away from metered-dose inhalers which contain powerful greenhouse gases is necessary. Many patients can use dry powder inhalers which do not contain greenhouse gases and are equally effective at managing respiratory disease. This paper discusses the ethical issues that arise as the NHS attempts to mitigate climate change. Two ethical issues that pose a barrier to moving away from metered-dose inhalers are considered: patients who decline an inhaler with a smaller carbon footprint and increased cost. I argue that while a patient is not morally justified in refusing a more environmentally sustainable inhaler due to the expected harms, a doctor may still prescribe a metered-dose inhaler if they believe that switching without consent might undermine trust or substantially worsen the patient's health. Turning to cost, I argue that the imperative to combat climate change means the NHS should accept small increased financial costs for lower carbon inhalers, even though this provides no additional direct benefit for the patient. I then go on to consider the implications of the preceding analysis for policy and practice. I argue for a policy that minimises the impact of inhalers on the climate by advocating for a principle of environmental prescribing and explore decision-making in practice. While the arguments here pertain primarily to inhalers, the discussion has broader implications for debates around healthcare's responsibility to be environmentally sustainable.
英国国民保健制度（NHS）是全球第一个宣布立志实现净零碳排放的医疗体系。要实现这一目标，必须摆脱含有强大温室气体的计量吸入器。许多患者可以使用不含有温室气体且同样能有效治疗呼吸道疾病的干粉吸入器。本文讨论了 NHS 试图减轻气候变化所引发的伦理问题。在 NHS 试图减轻气候变化的过程中，有两个伦理问题构成了障碍：一是患者拒绝使用碳足迹较小且成本增加的吸入器，二是成本问题。我认为，尽管患者因预期的伤害而拒绝使用更环保的吸入器在道德上是没有正当理由的，但如果医生认为未经同意转换可能会破坏信任或严重恶化患者的健康，那么他们仍可以开计量吸入器。至于成本问题，我认为抗击气候变化的紧迫性意味着 NHS 应该为低碳吸入器承担较小的额外财务成本，即使这对患者没有额外的直接好处。接着，我进一步考虑了前面分析对政策和实践的影响。我主张通过倡导环境处方原则来将吸入器对气候的影响降到最低，并探讨实践中的决策制定。虽然这里的论点主要涉及吸入器，但讨论对围绕医疗保健对环境可持续性的责任的辩论具有更广泛的意义。
