An Overview of Ethics and Environmental Health
Abstract and Keywords
This chapter provides an overview of the ethics of environmental health, and it introduces five chapters in the related section of The Oxford Handbook of Public Health Ethics. A wide range of ethical issues arises in managing the relationship between human health and the environment, including regulation of toxic substances, air and water pollution, waste management, agriculture, the built environment, occupational health, energy production and use, environmental justice, population control, and climate change. The values at stake in environmental health ethics include those usually mentioned in ethical debates in biomedicine and public health, such as autonomy, social utility, and justice, as well as values that address environmental concerns, such as animal welfare, stewardship of biological resources, and sustainability. Environmental health ethics, therefore, stands at the crossroads of several disciplines, including public health ethics, environmental ethics, biomedical ethics, and business ethics.
We often think that protecting the environment and promoting public health go hand-in-hand, and we are usually correct in this assumption. For example, reducing water pollution not only benefits human health, but it also benefits fish and other forms of aquatic life living in streams, rivers, and lakes. Proper disposal of hazardous waste protects people and nonhuman species from harm. However, environmental protection and public health promotion sometimes conflict (Resnik, 2009). For example, building a dam may help to promote public health by ensuring that people have an adequate supply of water for drinking, sanitation, and agriculture. But the dam may damage ecosystems and habitats and threaten various species. Clearing land to build a new hospital may benefit public health by providing residents with access to medical care, but it may also harm the environment by contributing to deforestation. Moreover, the hospital itself may consume a great deal of energy and generate waste, both of which may adversely impact the environment. Pesticides used in agriculture and mosquito control can promote public health by helping to provide food for the world’s growing population, but they also pose risks to human health and nonhuman species.
The moral dilemmas related to environmental health ethics go beyond conflicts involving public health and protection of species, habitats, or ecosystems. Other values at stake may include respect for autonomy and human rights, social justice, economic development, animal welfare, sustainability, and obligations to future generations (Resnik, 2012). For example, a new domestic waste disposal center located in a rural part of a county may benefit the whole community at the expense of those living near the center, who may face increased health risks. Enhanced air quality standards may (p. 700) promote public health and protect the environment but also slow economic development. Zoning regulations that attempt to control urban sprawl to facilitate walking and biking can promote public health but interfere with property rights. Zoning regulations that prevent people from building in areas prone to flooding (to minimize the human toll of natural disasters) may also interfere with property rights. Policies designed to protect fetuses from exposures to toxic chemicals may discriminate against women and violate their right to work. A building code that sets high safety standards may protect public health but also make housing unaffordable. Population control policies may help societies control the adverse environmental and public health effects of development and growth but also threaten reproductive rights. Climate change policies raise issues of global justice, because various nations (and communities within nations) may face different economic, social, and health impacts of climate change and bear differential responsibility for causing climate change.
Environmental health ethics lies at the intersection of several different disciplines, including public health ethics, environmental ethics, biomedical ethics, business ethics, and environmental law. It draws on ethical concepts, principles, and theories from these different areas and makes use of facts and empirical data from various scientific disciplines, including toxicology, exposure biology, ecology, climatology, hydrology, medicine, epidemiology, public health, occupational health, and economics (Frumkin, 2010; Resnik, 2012). Environmental health ethics issues range from local concerns, such as waste management and urban development, to national ones, such as air and water quality, to global concerns, such as climate change. Environmental health ethics topics (some of which overlap) include:
• Regulation of Toxic Substances: Issues pertaining to the regulation of pesticides and industrial chemicals.
• Air and Water Pollution: Issues related to establishing standards for air and water quality.
• Water Use: Issues related to water rights and allocating water among different users.
• Waste Management: Issues related to managing domestic, agricultural, construction, hazardous, radioactive, medical, sewage, and electronic waste.
• Agriculture: Issues related to the use of pesticides, chemical fertilizers, genetically modified (GM) crops, and antibiotics in agriculture.
• Transgenic Organisms: Issues related to creating GM organisms for use in agriculture, medicine, and industry.
• Vector-Borne and Zoonotic Diseases: Issues related to controlling or preventing diseases carried by mosquitoes, birds, ticks, pigs, and other nonhuman vectors.
• Antibiotic Use: Issues related to the proper use of antibiotics in medicine and agriculture to prevent antibiotic resistance.
• Food Safety: Issues related to promoting health and safety in food manufacturing, preparation, marketing, and consumption.
(p. 701) • The Built Environment: Issues related to environmental and health risks pertaining to structures used for living and working, such as houses, schools, roads, dams, bridges, and cities.
• Occupational Health: Issues related to managing health risks at work.
• Disaster Management: Issues related to preparing for and responding to natural disasters, such as hurricanes, floods, tornadoes, fires, and earthquakes.
• Energy Production and Use: Issues related to acquiring and using different forms of energy, such as coal, oil, natural gas, biofuels, wind energy, and nuclear, solar, and hydroelectric power.
• Climate Change: Issues pertaining to minimizing humanity’s role in causing global warming and mitigating the effects of climate change on human health and environment.
• Population Control: Issues pertaining to controlling population growth, which has widespread impacts on health and the environment.
• Precaution: Issues related to taking precautionary measures to prevent harm to public health and the environment in the face of uncertain scientific evidence.
• Environmental Justice: Issues related to the distribution of health risks among different human populations living or working in the environment.
• Environmental Research Ethics: Issues related to the ethical conduct of environmental health research, such as the ethics of research with human or animal subjects, research integrity (e.g., misconduct, authorship, peer review, conflict of interest), and social responsibility.
Many of these issues overlap and are addressed in chapters in the Environmental Health section of The Oxford Handbook of Public Health Ethics, and some are dealt with in chapters in other sections of this volume.
While the notion that environmental health ethics should constitute a field of study in its own right is relatively new, many of the issues that fall within its purview have been discussed for some time (Potter, 1971; Shrader-Frechette, 1991, 2002, 2011; Cranor, 1997, 2011; Pierce and Jameton, 2001; Elliott, 2011; Brown, 2012). Over forty years ago, the scholar credited with first coining the term bioethics, Van Rensselaer Potter (1971), conceived of bioethics as fundamentally concerned with environmental issues. Potter argued that medicine and health care should incorporate ecological concepts, and that bioethics should involve a global integration of biology and human values (Whitehouse, 2003). Potter’s approach to bioethics soon lost favor, however, as bioethicists began focusing on issues in medical practice and research, such as end-of-life decisions, informed consent, medical paternalism, assisted reproduction, allocation of scarce medical resources, clinical trials, human genetics, confidentiality, and research with vulnerable populations (Whitehouse, 2003). Scholars who focused on environmental issues formed their own discipline (i.e., environmental ethics) and tended to focus on topics not directly related to health care, such as agriculture, sustainability, animal welfare, climate change, and obligations to future generations. Some have suggested (p. 702) that bioethicists should bridge the gap between medical and environmental ethics and reincorporate Potter’s vision (Whitehouse, 2003). Renewed interest in environmental and global bioethics reflects this philosophical outlook (Dwyer, 2009; Resnik, 2009).
The methods used to make ethical decisions pertaining to environmental health are similar to those used in other practical ethics disciplines. To make an ethical decision pertaining to environmental health policy or practice, one should strike a reasonable balance among competing values, principles, or interests in light of the relevant facts and information and available options (Kass, 2001; Beauchamp and Childress, 2012; Resnik, 2012). Public policy should include input from various stakeholders, such as government officials, business leaders, and environmental and public health groups, as well as the general public and uniquely impacted communities. Public policy decisions are often made by government agencies and officials who may be influenced by powerful business interests or political organizations. To ensure that environmental health decision-making is fair, publicly accountable, and inclusive, efforts should be made to include populations that lack political or economic power and influence in decision-making (Shrader-Frechette, 2002). Decision-making approaches involving democratic deliberation in open forums can help promote participation of these populations.
Overview of Section Chapters
The five chapters in this section of The Oxford Handbook of Public Health Ethics address several important topics in environmental health ethics. In “Industrial Chemicals, Pesticides, Public Health, and Ethics,” Elise M. R. Smith and Mark F. Miller address the ethical issues raised by exposures to chemicals and pesticides, including conflicts between public health and the agriculture industry, public health and social justice, and public health and environmental protections. In “Occupational Health and the Built Environment: Ethical Issues,” David B. Resnik examines the ethical issues related to health risks people encounter in environments in which they live and work, including property rights, worker rights, environmental justice, economic development, and access to affordable housing. In “Environmental Justice, Ethics, and Public Health,” James Dwyer describes how environmental exposures raise issues of justice, explores different approaches to environmental justice, and considers our moral duties to promote environmental justice. In “Energy, Emissions, and Public Health Ethics,” Cheryl C. Macpherson considers the ethical issues raised by climate change, including environmental protection versus economic development, national and international justice, and moral responsibility. Lastly, in “Environmental Health Research and Ethics,” David B. Resnik considers some of the key ethical issues that arise in environmental health research involving human subjects, including returning individualized research results, protecting privacy and confidentiality, research on environmental interventions, intentional exposure studies, and protecting vulnerable human subjects. Together, the chapters in this section of the Oxford Handbook provide the reader with a useful introduction to some of the (p. 703) ethical and policy dilemmas that arise at the intersection of public health and the environment.
This research was supported by the Intramural Program of the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH). It does not represent the view of the NIEHS, NIH, or US government.
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