Moving Environmental Bioethics into the 21st Century: Green Bioethics and the Common Good Author: Cristina Richie Persistent link: http://hdl.handle.net/2345/bc-ir:106939 This work is posted on eScholarship@BC, Boston College University Libraries. Boston College Electronic Thesis or Dissertation, 2016 Copyright is held by the author. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http:// creativecommons.org/licenses/by-nc-nd/4.0). Boston College Morrissey College of Arts & Sciences Graduate School Department of Theology MOVING ENVIRONMENTAL BIOETHICS INTO THE 21ST CENTURY: GREEN BIOETHICS AND THE COMMON GOOD a dissertation by CRISTINA RICHIE submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy May 2016 © copyright by CRISTINA SOFIA RICHIE 2016 Abstract Moving Environmental Bioethics into the 21st Century: Green Bioethics and the Common Good Submitted by Cristina Richie Director James Keenan Environmental conservation is a pressing issue for modern humans. Health care systems and the consumption of medical goods should therefore be assessed in light of environmental sustainability. While the primary focus of environmental bioethics has been hospitals and health care facilities, ethicists must also address the offerings of the medical industry going forward. My dissertation proposes four principles to assess the environmental sustainability of current and future medical developments, techniques, and procedures. The four principles of green bioethics are: 1. General allocation of resources should precede special interest access: distributive justice 2. Current human needs over current human wants: environmental conservation 3. Simplicity before complexity: reducing dependence on medical intervention 4. The common good should drive health care instead of financial profit: ethical economics. The four principles of green bioethics will move environmental bioethics into the 21st century in a responsible and sustainable manner. Table of Contents DEDICATION ACKNOWLEDGEMENTS CHAPTER 1 Introduction to Moving Environmental Bioethics into the 21st Century: Green Bioethics and the Common Good………………………………………………….1 CHAPTER 2 The Common Good: Theological Grounding for the Four Principles of Green Bioethics……………………..53 CHAPTER 3 General Allocation of Medical Resources before Special Interest Access: Distributive Justice…………………………………………………………………...…102 CHAPTER 4 Current Humans Needs before Current Human Wants: Environmental Conservation……………………………………………………….…..169 CHAPTER 5 Simplicity before Complexity: Reducing Dependence on Medical Intervention……………………………………......245 CHAPTER 6 The Common Good Should Drive Health Care Instead of Financial Profit: Ethical Economics……………………………………………………………..…….....304 CONCLUSION……………………………………........................................................352 BIBLIOGRAPHY……………………………..……………………………………......359 i Dedication For my grandmother, Rosemary “ReRe” Richie, who has displayed dedication to God, grace in ageing, wisdom in life, and has loved me in innumerable ways. ii Acknowledgements I want to thank and acknowledge the contribution of the following groups and people: Those on my committee: Lisa Cahill for her support, consideration, and generous exegesis of my arguments; Andrea Vicini for his guidance—beginning with my ThM thesis—and erudite insight, and especially to my director Jim Keenan who impelled my writing to develop beyond my perceived existential limits and who inspires my work by his candor, productivity, and knowledge. Boston College, the Theology Department faculty, especially professors who taught me during my coursework, and Mrs. Charlotte McLeod Flatley, who funded my studies with a generous four-year PhD fellowship. My fellow PhD students—particularly the ethics students—for their fellowship during colloquiums. I was inspired by those ahead of me and pushed by those behind me. Special gratitude to Kate Jackson-Meyer, David Kwon, and Aaron Taylor, who helped me through the comprehensive exams. Thanks also to Jen Lamson-Scribner for our weekly meetings and again to Kate for her joy and intelligence. The students I have taught at Massachusetts College of Pharmacy and Health Sciences (Boston, MA.) who sustained my passion for education. My father Pat, who is our family’s first theologian, my mother Nico, a theologian in her own right, my sister Angelica, a pillar of integrity, my brother Matteo, a man of ideas and wit, and my grandmother who this dissertation is dedicated to. Jason. Who supported me as I pursued Lamentation 3:28, knowing the truth of Ecclesiastes 4:12b. Thank you. iii CHAPTER 1 Introduction to Moving Environmental Bioethics into the 21st Century: Green Bioethics and the Common Good I. Introduction This chapter will first present the concept of environmental bioethics as a foundational, but currently estranged, part of modern bioethics. While the primary focus of public and theological environmental bioethics has attempted to integrate environmental sustainability into medical systems already in place, theological bioethicists must also address the potential offerings of the medical industry going forward. This dissertation will therefore propose four principles of “green bioethics” that can guide ethical decision-making in the medical industry.1 The four principles of green bioethics are: 1) a general allocation of medical resources should occur before special interest access; 2) current human needs for health care should take priority before current human wants; 3) simple medical treatments should normally be chosen before complex ones; and, 4) the common good should drive health care instead of financial profit. Green bioethics specifically focuses on medical developments, techniques, and procedures2 because they are the focus of traditional bioethics. They are a specific area of the medical industry that is seldom addressed in terms of environmental impact—unlike waste management and electricity use. Further, they form a core identity of medical practice and are universal in defining medical care. Unlike a medical building, such as a hospital or clinic, which supposes a certain type of health care facility, medical developments, techniques, and procedures cross physical barriers and are the very 1 An early version of this concept was published as Cristina Richie, “Building a Framework for Green Bioethics: Integrating Ecology into the Medical Industry,” Health Care Ethics USA 21, no. 4 (2013): 7-21. 2 Defined as medical innovations—current and future—even if they are not yet feasible, or only partially worked out. Some examples include: pharmaceuticals; organs transplantation; MRI machines; X-Ray; “routine” procedures; synthetic biology; 3-D organ and tissue printing; nanotechnologies; transhumanist mechanical accouterments; reproductive technologies; germ line manipulation; human cloning; human engineering; “tongue mesh” surgery; pharmacogenomics; laparoscopy; etc. 1 foundation of health care. In proposing the four principles for green bioethics I take a comprehensive approach that accounts for the common good in many areas of health care. The theological concept of the common good offers a broad base for ethics.3 Since there is consensus among Catholic and Protestant theologians that the common good is a worthy foundation for ethical decision-making, identifying these points of convergence across Christian tradition allows for what Willis Jenkins calls “practical strategies for conservation.”4 These practical strategies for conservation will shape green bioethics throughout the dissertation. Green bioethics can move health care systems forward in an environmentally responsible manner through the four principles of green bioethics. First, however, it must be situated within the larger conversation of sustainability in the health care industry. This is the task of chapter one. In this chapter I will trace the growing concern over anthropogenic carbon emissions that cause climate change. Population growth and resource consumption are two major, interconnected culprits of carbon dioxide (CO2) emissions. Moving from worldwide carbon emissions to a narrow focus on the carbon emissions of the medical industry, I will examine the CO2 output of the National Health Services and the United States medical sector. Then, the academic and practical philosophies of environmental bioethics in both public and Catholic work will be surveyed. 3 Though not addressing ecology, Daniel Callahan does assess bioethics within the context of the common good. Daniel Callahan, “Beyond Individualism: Bioethics and the Common Good, an Interview,” Second Opinion (1988): 53-69, at 56. 4 Willis Jenkins, The Future of Ethics: Sustainability, Social Justice, and Religious Creativity (Washington DC: Georgetown University, 2013), 7. 2 Environmental bioethics in public5 discourse has been traced primarily to Van Rensselaer Potter and Jessica Pierce. The writings of these two individuals have been augmented by academic journals dedicated to environmental concerns such as the Canadian Medical Association Journal and the Journal of Medical Humanities. In addition to the academic contributions to public environmental bioethics through individuals and organizations, three outstanding initiatives of public environmental bioethics have shaped the field. Practice Greenhealth and the Healthier Hospitals Initiative (HHI) have linked health care systems to larger conservationist movements. This will be highlighted by a case