Beyond the Hippocratic Oath: Healthcare's Responsibility to the Environment
Beyond the Hippocratic Oath: Healthcare's Responsibility to the Environment
Uncovering the innovative strategies and cost-saving initiatives that are driving the National Health Service UK's ambitious goal of achieving net zero emissions by 2040.
This blog is based on topics covered in Episode 4: Journey to Zero - How to Lead the Climate Revolution in Healthcare with Dr. Nick Watts.
If you haven’t listened to it yet, check it out on Apple, Spotify, Substack or wherever you get your podcasts.
As was tradition on graduation day, my classmates and I stood to recite the Hippocratic Oath. An ancient rite of passage, that provides us with a compass to navigate our newfound responsibility.
It was a special moment witnessed by our families and professors, marking the transition from student to doctor.
The most recognised part of this code, first, do no harm, serves as a clear reminder that all of our actions, no matter how well-intentioned, carry the potential to cause harm.
As a medical student, I remember watching senior doctors intently to see how these principles were applied in practice.
Where Do Our Responsibilities Start?
It wasn’t long until I was put in their shoes. The frenetically complex job of complex decision-making. Unfortunately, all too often, there is a conflict between time, resources and ideal decision-making.
One core lesson I took away, was that a good doctor front foots this responsibility as best they can - with early, clear, regular and honest communication with patients and colleagues. Core to upholding our oath is respecting the autonomy of the individual patients for whom we serve.
Early in my career, my views on this singular patient focus were challenged when I completed some research on Surgeons’ understanding of surgical costs1. We found that, despite rising costs and resource scarcity, there was poor awareness of surgical costs across all levels of experience.
At the time, discussing the costs of anything was taboo. How could you weigh the cost of something for your patients? You just did the right thing for them no matter the cost.
However, this research opened up my thinking to that of an added dimension, resource allocation. It highlighted that each choice we make, from prescriptions to investigations, is not in isolation and adds to the cost of the system as a whole.
Thus those decisions take resources away from others, affecting the patients in front of me, and the ones behind them.
Where Do Our Responsibilities End?
Following this thread of reasoning a few steps further, it’s not hard to see the additional sphere of influence that healthcare, and by extension healthcare professionals. Different avenues to help or harm our patients and communities include social, political and environmental spaces.
What is the balance between healthcare and social welfare? Should there be a distinction?
How should political decisions be made about individual and population rights to healthcare?
What is healthcare’s responsibility to climate change?
Traditionally, many on the frontline of healthcare have been insulate from these considerations. At times we’ve seen ourselves as too complex, too expensive, and, perhaps too virtuous. However, there is a growing recognition of the interconnected and dependent nature of healthcare with other systems - and the need to align our values with our actions.
Focusing on the climate, it’s not hard to see the relationship between our climate on our health. With 2023 set to be the hottest year on record2, we see spikes in the number of heat-related deaths3, deaths and injuries from extreme weather events4 and the return of infectious diseases like Malaria5.
Healthcare globally is also a large contributor to climate change, with 5-8% of total greenhouse gas emissions6. To reduce these aforementioned impacts on health and healthcare systems, and be consistent with our values, we must step up to the climate challenge.
Thankfully, large organisations like the National Health Service UK are committed to their values and this great challenge by committing to net zero by 20407. Other major health systems in the US8 and around the globe are also joining suit.
They’re paving the way with not only climate initiatives but cost-saving ones too9. This includes a multitude of less carbon-intensive medications, switching energy from renewable sources, creating training and grants for bottom-up environmental projects and using carbon-conscious purchasing agreements. Doctors from around the world are now calling for and taking action.1011.
Healthcare extends beyond traditional individual patient care. We’re part of a much bigger system. This added knowledge and responsibility helps us to refocus on one of our most fundamental ambitions. First, do no harm.
https://pubmed.ncbi.nlm.nih.gov/25112174/
https://www.nature.com/articles/d41586-023-03523-3
https://www.theguardian.com/us-news/2023/aug/01/heat-related-deaths-us-temperatures-heatwave
https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.01125
https://www.washingtonpost.com/climate-environment/interactive/2023/malaria-disease-spread-climate-change-warming/
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.01247
https://www.england.nhs.uk/greenernhs/a-net-zero-nhs/
https://www.hhs.gov/climate-change-health-equity-environmental-justice/climate-change-health-equity/actions/health-sector-pledge/index.html
https://www.england.nhs.uk/long-read/greening-the-business-case/
https://www.theguardian.com/environment/2023/oct/28/doctors-from-around-the-world-unite-to-call-for-urgent-climate-action
https://www.england.nhs.uk/blog/three-years-on-clinical-staff-continue-to-lead-and-inspire-us-as-we-build-a-greener-nhs/#:~:text=Our%20NHS%20staff%20and%20teams,now%20and%20for%20future%20generations.