Should healthcare professionals incorporate climate impact into treatment decisions?

Climate change isn’t just an environmental issue – it’s a health issue. The same systems that care for us contribute to the problem.

Globally, healthcare contributes about 5% of total greenhouse gas emissions (Costello, 2009). In the UK, the NHS has pledged to reach Net Zero emissions by 2040 (NHS England, 2025). There is a related and challenging question: to what extent should professionals consider environmental costs when deciding how to treat patients?

But beyond healthcare, climate change is already harming health. The Lancet Commission warned that it will worsen existing inequalities through extreme weather, food insecurity, and disease (Costello, 2009). Those least responsible – often poorer communities – are hit hardest. This makes sustainability not just a scientific issue, but a societal and moral one.

Healthcare’s climate impact

The scale of the problem is enormous. Every medical procedure, from MRI scans to anaesthetic gases, carries a carbon cost. In 2020, the anaesthetic gas Desflurane, a potent greenhouse gas contributor, was removed from NHS use because cleaner alternatives were available (Meyer, 2020). This kind of change suggests that medicine can evolve without harming patient care.

The ethical balance

Healthcare professionals are trained to focus on what is best for their patients. But what if a treatment that helps one person harms others through its environmental impact? While medicine has traditionally emphasised the benefit to the patient and the right to choose, also known as autonomy, adding sustainability introduces a collective dimension: protecting future patients and populations.

Philosopher J.S. Mill’s “harm principle” argues that freedom is limited when our actions harm others. In a warming world, high-carbon healthcare does just that. That harm is dispersed in time and location, reducing the sense of personal responsibility.

Some argue that the considerations arising from sustainability (Herlitz, 2023) should outweigh patient demand, while others caution against compromising clinical effectiveness. Finding the balance is complex: how much health benefit should be sacrificed to reduce emissions?

Information empowers patients

One solution lies in transparency. Just as menus display calories, patients could be informed about the environmental impact of their treatment choices. Perhaps patients are more open to receiving this information than we think, viewing it as part of truly informed consent rather than activism (Cohen, 2025).

Of course, health professionals must tread carefully. Overloading consultations with environmental data could overwhelm patients and erode trust. That’s why institutions and not just individuals, must take the lead – by removing the most harmful options, supporting staff education, and embedding sustainability into everyday decisions.

Beyond the consultation room

Climate-conscious healthcare isn’t about denying treatment – it’s about rethinking what good care means. It recognises that our duty to heal extends beyond the present moment, to the health of future generations.

A Green Bioethics asks us to widen our moral lens: to see sustainability not as a trade-off, but as part of caring better (Richie, 2019). Every unnecessary investigation avoided, every low-carbon anaesthetic used, every conversation about sustainability contributes to that process. If the healthcare system itself makes people sick – through pollution, emissions and depletion of resources – then even the best medicine won’t be enough.

Dr Peter Carter, Senior Lecturer in Medical Ethics and Law, School of Medicine

References

Cohen, E. S., Kringos, D. S., Grandiek, F., Kouwenberg, L. H. J. A., Sperna Weiland, N. S., Richie, C., Hehenkamp, W. H. J. and Aarts, J. W. M. (2025) 'Patients' Attitudes Towards Integrating Environmental Sustainability into Healthcare Decision‐Making: An Interview Study', Health Expectations, e70155. Available at: https://doi.org/10.1111/hex.70155

Costello, A. et al., (2009) 'Managing the Health Effects of Climate Change: Lancet and University College London Institute for Global Health Commission' The Lancet, 393(9676), pp. 1693-1733. Available at: https://doi.org/10.1016/S0140-6736(09)60935-1

Herlitz, A., Malmqvist, E. and Munthe, C. (2023) ''Green' Bioethics Widens the Scope of Eligible Values and Overrides Patient Demand: Comment on Parker', Journal of Medical Ethics, 49(2), pp. 100-101. Available at: https://doi.org/10.1136/jme-2022-108849

Meyer, M. J. (2020) ‘Desflurane Should Des-Appear: Global and Financial Rationale’ Anesthesia and Analgesia, 131(4), pp. 1317-1322. Available at: https://doi.org/10.1213/ane.0000000000005102

'Delivering a net zero NHS', NHS England.

Richie, C. (2019) Principles of Green Bioethics. Michigan: Michigan State University Press.