Left-wing politics by another name.
Mainstream bioethics is left-wing politics by another name. Practitioners therefore often seek to expand the jurisdiction of the field to push their favored political agendas — for example, to issues of war and peace.
In the latest example of this tendency, an influential journal just published a piece of advocacy for transforming general practitioners into instruments of fighting climate change. Specifically, the authors of the article urges doctors to nag their patients into reducing their carbon emissions. First, the authors acknowledge that the primary role of general practitioners currently is to focus on the medical issues of each individual patient, not to promote societal reform:
The General Practitioner (GP) is expected to operate with a wide sphere of interest, exploring the wider determinants of health and illness in their patients. They may use a biopsychosocial approach that attempts to navigate the relationship between the individual, their wider social network, and psychological experiences [1]. Axiologically, however, GPs are still expected to primarily confine their scope of concern to the patient immediately in front of them; the professional role of the GP is hitherto considered as being to care for the patient as their ‘first concern’ [2], and only in rare cases should they subordinate that patient’s interests to wider concerns.
But the good bioethicists now want their policy concerns around climate change to become part of the doctor–patient relationship:
GPs, however, are ideally placed as guardians of the wellbeing of future generations, with a unique insight into the broader determinants of health that include wealth, education, genetics, and the environment. As a profession, intergenerational health distinguishes the GP from most other types of doctor. For this reason, we think that general practice is a good candidate for the next steps in healthcare’s efforts to reduce its carbon footprint; the GP is a person who can translate public health concerns into doctor-to-patient encounters that can help individuals understand the roles they can play in ameliorating wider the health problems that are caused by climate change.
Good grief. The time that patients spend with doctors is often barely long enough to fully explore their medical issues. No matter. The authors argue that doctors should nag their patients about techniques to fight climate change:
There may be no specific connection between the climate and the patient’s condition. There may be cases where the intervention that may best serve the narrow interests of an individual do not serve, or are inimical to, planetary or wider interests. Our view is that, as part of GPs’ obligations to steward planetary health, and due to their unique position as trusted members of communities who have access to a wide range of people, they should devote some of their consultation time to this issue even where it is separate from considerations about that patient’s health.
They even want doctors’ continuing education to include instruction on basic climate change policy:
GPs could be trained to have a basic degree of knowledge on the major issues relating to climate change that would help them to educate patients on some of the basic changes they might make, and/or point them towards (credible and appropriate) resources where they can learn more.
Doctors have enough to do advancing and keeping up with medical knowledge. Expecting them to take courses on carbon emissions is ridiculous. The authors want to change the focus of the physician from the individual toward public policy:
Our proposal . . . may be a step away from a model of patient-centered care that is beginning to become outdated in the 21st century; or more moderately, it is simply one more situation in which doctors must make the care of the wider community their first concern, rather than the patient in front of them at a given moment. Engaging patients in these conversations is something that doctors can be trained to do, and crucially, this is something that patients may actually appreciate insofar as they, too, want a healthcare system that does more to promote planetary health and sustainable practice.
No, we won’t. I checked in for a medical exam the other day and was asked a multitude of questions that had nothing whatsoever to do with the reason I was seeing the doctor. Am I often hungry? Do I worry about becoming “unhoused”? Am I abused by a romantic partner? The last question I would have welcomed would have been about whether I have an electronic vehicle, or whether I’d give up eating meat once a week to help save the planet.
Doctors are of course free to advocate policies they favor, just like anyone else. But their personal political or policy views should not leech into their professional responsibilities as fiduciaries to individual patients. Or, to put it another way, doctors as professionals should not have dual loyalties — to the patient as well as to the state or some government policy. Subject to the rules required to protect public health, the welfare of each individual patient must be physicians’ unequivocal concern.