I made a video for a class project once called Oil is Personal. It followed a character through his day while looking at the positive and negative impacts he had on oil production and use. I ended the video with a question about what your priorities for oil are. Oil impacts many aspects of health care from single use plastics to medications to patient transport. My intention was to point out that we might have more important uses for oil than pumping it out of our vehicles or using single use bags or straws or cups. The reality is of course, that we’ll need to decarbonize healthcare as well and this is the subject of Hantel and Abel’s (2021) “Action plan for environmentally responsible cancer care”.
According to Hantel and Abel, healthcare accounts for 10% of greenhouse gas emissions in the US. As an aside, this number blew me away. This is problematic because the impacts of climate change not only have negative health effects, they also can have financial impacts that can exacerbate inequity and thus increase health impacts. But what can be done?
The authors argue that doing a lifecycle analysis which tracks the impacts from production through disposal is vital. This analysis would help identify the downstream consequences of items like chemotherapy medications. In addition, they indicate that a greenhouse gas analysis would help establish a baseline so that the field can set targets and ultimately determine trade-offs. This is obviously ethically challenging territory. What is the population level consequences of someone receiving a particular treatment are significant? Does the good of the one or the many weigh more? How does the timeline of impacts affect our choices or our perception of our choices?
Although this isn’t mentioned in the article, one impact of having the identified data is that items can be prioritized. Finding an alternative to one drug over another is likely to be an expensive prospect so being able to prioritize could have advantages.
As much as there are potentially huge ethical questions with improving the environmental sustainability of cancer treatments, there are also huge ethical questions with not. If you’re a philosophy fan, it seems like a giant trolley problem which has many variations but always has some form of, what are the ethical obligations when it comes to sacrificing or saving one person or group over another. At 10% of total emissions, this is a problem we have to confront.