At some point, the developed world’s ethical framework will surely have to change.1 The primary focus of ethical decision making in medicine is the patient and his or her immediate environment. Beneficence, non-maleficence, justice, and dignity are subservient to autonomy. Good of the community is obscured within the principle of justice. However, when self interest and inadequate resources harm others, autonomy loses integrity.
As local resources fail, fertility treatments that bring more life into an overpopulated community; or resource intensive treatment of individuals that prevent cheaper and easier treatment of very many others; or heroic life prolonging treatments in a climate of mass death naturally become harder to justify or provide. Hopefully we will soon wake up to the fact that this is becoming the global situation. When we do, let us hope that all that is good about humanity comes to the fore and that the relatively safer communities do not continue their highly disproportionate use of resources while more vulnerable ones struggle and even die. Such insularity could ultimately be the death of us all.
Good of the global community deserves highlighting in its own right as an ethical principle. Autonomy must bow to justice. Such a sea change applied across all human activity is surely the right medicine to counteract some of the damage of manmade global environmental change.
Competing interests: None declared.
References
- 1. McMichael AJ, Friel S, Nyong A, Corvalan C. Global environmental change and health: impacts, inequalities, and the health sector. BMJ 2008;336:191-4. (29 January.) [DOI] [PMC free article] [PubMed] [Google Scholar]