Beginning in the 1920s, Aldo Leopold, an ecologist, educator, and prolific writer best known for “A Sand County Almanac,” was deeply disturbed by what he saw as the ruin of the land. For Leopold, land was a collective organism--not merely soil, but “a fountain of energy flowing through a circuit of soils, plants, and animals.” People, he said, are “plain members of the biotic community.” That includes their social, political, cultural, and economic institutions.
Leopold argued passionately and logically that ethics and beauty should play important roles in deciding how to live on the earth. He had no illusions that the hegemony of economics would give way easily, but he said, “The fallacy that economic determinists have tied around our collective neck, and which we now need to cast off, is the belief that economics determines all land use. This is simply not true.”
Leopold thought that three things were necessary in order to protect and preserve the ecological systems on which all species depend. One is the formulation of mechanisms for protecting the public interest in private land. Another is the revival of land esthetics. The third is refinement of restorative practices. Out of these three forces, he thought, “may eventually emerge a land ethic more potent than the sum of the three, but the breeding of ethics is as yet beyond our powers. All science can do is to safeguard the environment in which ethical mutations might take place.” [emphasis added]
Leopold chose his words wisely. He understood that ethics are subject to Darwinian evolutionary pressures and that some have more survival value than others. Ethical frameworks that address only relationships among humans and fail to address human relationships with the land do not serve us well.
About forty years later, drawing on Leopold's ideas, oncologist and inter-disciplinarian Van Rensselaer Potter introduced the term “bioethics,” which he saw as a concept that could provide a science for survival and aid in securing lives of quality. Potter was influenced by C.D. Waddington, a Scottish geneticist who thought that “what is demanded of each generation is a theory of ethics which is neither mere rationalization of existing prejudices, nor a philosophical discourse so abstract as to be irrelevant to the practical problems with which mankind is faced at that time. . . . We can, with perfect logical consistency, conceive of an aim or principle of policy which, while not in itself in its essence an ethical rule, would enable us to judge between different ethical rules. It is for such a principle that I am searching, and which I claim to be discoverable in the notion which I have referred to as 'biological wisdom.'”
Leopold, Waddington, and Potter were keenly aware that modern humans had existed on the earth for mere moments in the deep time of billions of years of other life forms. Biological wisdom, they knew, would be necessary to prolong our stay with meaningful quality. Potter said that any ethic for the human species has to be based on the possibility of severely degraded quality of life--even human extinction--and that each of us has the capacity to figure out how we “ought” to live, in order to avoid the fate of most other species.
Where and how, I've wondered, does each generation develop its theory of ethics relevant to the practical problems of the time? Where in public life and decision-making are ethics explicitly addressed? Codes of ethics, it seems, are largely limited to specific professions where they govern certain kinds of behavior and responsibilities. Medical and public health ethics are examples. I use them to illustrate how narrowness of scope prevents them from addressing important practical problems, relevant to their professions. I wonder where, if not in these professions, should Leopold and Potter's call for a broader “bioethic” be considered?
Medical and public health ethics:
At about the time that Potter coined the term, medical ethicists co-opted “bioethics” and narrowed its scope. When I first encountered medical ethics in clinical medicine, I took it for granted that the basic principles of beneficence (do good), non-malfeasance (do no harm), respect for a person's autonomy, and fairness applied to an individual patient as part of a long tradition.
The Principles of Medical Ethics of the American Medical Association focus on individual patient rights--right to competent care and respect, right to know, and right to choice. These principles charge the physician to obey the law and to regard responsibility to the patient as paramount. They instruct the physician to seek changes in legal requirements that are contrary to the best interest of the patient and to contribute to the improvement of the community and the betterment of public health. But the principles explicitly state that, while the physician cares for a patient, the welfare of that individual patient is paramount. Medical ethics, in short, focus on the autonomous individual standing separate and apart.
Years later, when I encountered public health ethics and practice, I discovered a somewhat different emphasis. Public health is concerned with the conditions that influence health or disease in communities or populations of people. It focuses less on individuals. Public health ethics recognize that individual liberty and indeed human existence rely heavily upon the interdependent and overlapping communities to which all of us belong (families, neighborhoods, workplace, religious and other social groups). Even autonomous individuals depend upon collective, civil institutions. Community flourishing depends upon the contribution of its members to shared projects.
Although reciprocal rights and duties can attempt to protect both private and public interests, it is not surprising that public health ethics frequently encounter the tension between the rights and interests of individuals and what is best for communities and populations of people--including current and future generations.
According to the code of ethics of the American Public Health Association, public health should:
- address fundamental causes of disease and requirements for health;
- achieve community health in a way that respects the rights of individuals in the community; and
- be developed and evaluated through processes that ensure an opportunity for input from community members.
Collaboration, transparency, and full participation are underlying requirements for realizing these principles.
Then, after addressing empowerment of disenfranchised people; providing information; respect for diverse values, beliefs, and cultures; and confidentiality and professional competence, one principle begins hesitantly to address an even larger framework:
- Public health programs and policies should be implemented in a manner that most enhances the physical and social environment.
The values said to underlie the code include the claim that people and their physical environment are interdependent. People depend upon the resources of their natural and constructed environments for life itself. A damaged or unbalanced natural environment, and a constructed environment of poor design or in poor condition, will have an adverse effect on the health of people. Conversely, people can have a profound effect on their natural environment through consumption of resources and generation of waste.
Here, we learn, public health practitioners are to be aware of the importance of the natural environment for the wellbeing of people. People and their environment are interdependent--interconnected. Here public health ethics goes beyond medical ethics by more explicitly recognizing the limits of autonomy. A fundamental principle of ecology seems to have found tentative expression.
Environmental ethics:
Meanwhile, in yet another discipline, the field of environmental ethics has for many years vigorously debated ideas that intersect with medicine and public health. How we think about humans and their place in the world with respect to other species and ecological systems is contested ground. Strong arguments stake out dramatically different positions on whether or not non-human species have rights or should be accorded some other form of moral consideration. Others focus on starkly drawn differences between individualists and holists--between those who believe that moral consideration should be given to individual people, individual animals, or individual species and those who give primacy to the whole system in which individuals exist. These debates have dominated the field of environmental ethics for decades and illustrate our tendency to think in terms of categories and dichotomies--yes/no rather than both/and.
I wonder whether we can concurrently respect the interests of people, other species, and entire ecosystems while formulating a theory of ethics relevant to the practical ethical problems of our day?
Where we are today:
The status and direction of public environmental health measures in the US and around the world are not reassuring. Changes in patterns of human disease and disability, worldwide air and water pollution, people and wildlife contaminated with toxic chemicals, soil erosion, climate change, loss of biodiversity, the collapse of fisheries, concentration of food production and distribution in large industrial systems that diminish nutritional quality and food security, increasing disparities in distribution of wealth contributing to poverty, malnutrition, and exploitation of women and children--these are worthy indicators of where we are headed.
Human activities not only have regional impacts but for the first time in history are altering planetary systems in ways that cause big effects and surprises. The hole in the stratospheric ozone layer from using chlorofluorocarbons (CFCs) and other ozone-depleting chemicals was an initial wake-up call. Now, ocean and climate scientists are increasingly concerned that the Gulf Stream in the Atlantic Ocean could stall or even be reversed in the relatively near future by ocean warming and melting of Arctic ice. In that event, the climate of Northern Europe would abruptly cool, with worldwide repercussions.
People or our technologies have filled virtually all planetary niches. Activities with limited impact on smaller scales of space and time now cause unprecedented stress on regional and global ecological systems. Human social, political, economic, and cultural institutions are deeply imbedded in these systems--changing them and being changed by them. From any perspective, the assaults on ecosystems around the world are not good news.
In modern industrial society we have never really shown a thoughtful understanding of the ecological sciences nor exhibited deep biological wisdom. Unwise experimenting, short-term gains outstripped by externalized long-term costs, perpetual growth, discounting impacts on future generations, accelerating resource consumption from dwindling supplies, failure to understand uncertainties, and the like are simply not compatible with a planet that will remain hospitable to people. Although the planet will endure in some form or other, the quality of human survival is open to question.
In light of the profound changes on the earth wrought by humans, some practical ethicists wonder whether previously held moral stances are still supportable. Fundamental questions about the morality of distribution of the world's resources among people and other species are extraordinarily important. The impacts of human activity on the health and integrity of the world's ecosystems bear directly on the quality of survival that Potter was concerned about. Though Leopold thought that the breeding of ethics is beyond our powers, we might hope that previously held ethical views will mutate into forms with survival value today. But merely hoping is not enough.
Ethics for our time:
The philosopher Herschell Elliott claimed that any viable system of ethics is contingent on its ability to preserve the ecosystems that sustain it. What are viable systems of ethics for today's world? How do we have a meaningful public discussion about ethics that matter to people, other species, and to the ecological systems that support life? Such systems of ethics need to reach well beyond medicine and public health, and they need to be discussed in the open and not only in isolated conference rooms or the pages of obscure journals read by few.
This is not easy work. Self-examination through an ethical lens is unlikely to be pleasant. Perpetual growth on a finite planet is not sustainable. Activities that may have been supportable in other circumstances become immoral when they directly or indirectly contribute to ecosystem degradation sufficient to undermine the natural systems on which the ethical frameworks rely. Rights to clean air and water don't mean much if no clean air and water are to be found. Increasingly we will question how much scarcity, suffering, or fear we require before changing course. There is little doubt that actions that were morally neutral in a world with fewer people and far-reaching technologies must come under renewed ethical scrutiny today.
Duties and responsibilities should address environmental concerns relevant to individuals and the whole alike. They must help to reconcile the tensions between the interests of individuals and the whole, between life-extending technologies available to few and the squalid circumstances of many. Practical ethics cannot focus only on the individual or the planetary whole. Fundamental, basic human rights must be protected. At the same time, the interdependence and interconnectedness of all people and all life and all things must find expression in individual and collective actions.
What are some practical guides to developing ethical stances for our time? For me, evolutionary biology, the ecological sciences, and biological wisdom open doorways to these questions. They include economics, but it is “big, inclusive economics”--as in oikos, referring to the affairs of the household--in this case, the planetary household--where no costs can be externalized and where distribution of costs and benefits matter. And as a physician, I encourage the medical profession to respond to Pierce and Jameton's call, in “The Ethics of Environmentally Responsible Health Care” (Oxford University Press, 2004), to broaden the scope of medical ethics to include explicit consideration of the larger ecological systems in which health care is provided and on which people depend.
At SEHN, we have been working for several years on the concept of ecological medicine, which is an attempt to broaden the field of vision for each of us to include the health of the systemic whole as well as whatever part is of particular interest to us in our current work. Ecological medicine is far less bounded than clinical medicine or public health, yet it includes those disciplines. Ethics for ecological medicine will necessarily differ accordingly. As these ideas take shape and collectively we develop an ethical theory for the practical problems of our time, it is essential that they be truly informed by public dialogue. I, and others, will have more to say about this. Meanwhile, we invite your response.
References/Sources:
American Medical Association; Code of Ethics
American Public Health Association; Code of Ethics
Cairns J. Sovereignty, individuality, and sustainability. Ethics in Science and Environmental Politics 71-77, Sept, 2003.
Elliott, Herschel. A General Statement of the Tragedy of the Commons.
Glendon M. A World Made New: Eleanor Roosevelt and the Universal Declaration of Human Rights. New York, Random House, 2001.
Leopold A. A Sand County Almanac. New York; Oxford University Press; 1949.
Light A. Contemporary environmental ethics from metaethics to public philosophy. Metaphilosophy 33(4):2002.
The River of the Mother of God and other essays by Aldo Leopold. Eds: Flader S, Callicott JB. University of Wisconsin Press, 1991.
Pierce J, Jameton A. The Ethics of Environmentally Responsible Health Care. New York: Oxford University Press, 2004.
Potter VR. Global Bioethics: Building on the Leopold Legacy. Michigan State University Press, 1988.
Schettler T. et al. “Ecological Medicine,” The Networker, vol. 7, #4.
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