I find myself bothered by the relationship between bioethics and public health ethics. Is it that the former focuses on individuals and the latter on communities? What is the relationship between the individual and their communities? Practically speaking, bioethics has been institutionalized in ways that emphasize individual (patient) integrity, while public health ethics has been institutionalized more recently to emphasize collective well-being and justice. Yet, from a philosophical—or, if you prefer, impractical—perspective, these distinctions seem to me importantly arbitrary, a fact I once illustrated by losing the attention of nearly every clinical bioethicist during an invited grand rounds. The emerging field of environmental bioethics is, in part, an effort to reconcile the individual with their communities by articulating a view of interdependence rather than mere interconnection.
Of course, environmental bioethics is rough around its edges, providing footholds for all sorts of philosophical climbing. As part of a recent workshop on environmental bioethics in Geneva, several of us mapped the various lines of theory across the field. We imagined intersecting axes (that is, more than one axis, rather than a series of sharpened wooden hewing instruments) of theory. The x-axis might represent the approach, from theoretical to practical. The y-axis might represent scale, from the individual/dyadic/biomedical to the collective/public health/ecological. The z-axis might represent scope, from deep green to anthropogenically “sustainable.” On this three-dimensional plane, environmental bioethicists stake out their own lines to follow, from the green bioethics of scholars such as Cristina Richie, whose work articulates important environmentally sustainable strategies for healthcare, to the relational environmental bioethics theorizing of scholars such as Nicolae Morar and me, and many in between.
And it is on that latter work, relational environmental bioethics, I want to focus, to scratch that bothersome itch about the relationship between individuals and communities. Morar and I have articulated the view that we have empirical and ethical warrant to understand individuals as constituted by their relations, or, in other words, as interdependent with those relations. It seems non-controversial to recognize that we—each and all—are connected through networks of ecological relations which matter both epistemologically and ethically. Our relations shape what and how we know, as well as what we value. Many feminist bioethicists and indigenous scholars hold a view of interconnectedness like this. But interdependence is distinct from interconnection. The biologist Kriti Sharma articulated the view of interdependence as holding that things exist only by virtue of their dependence on other things, such that their existence is thoroughly contingent. This view denies anything metaphysically substantial or stable about what I am, or what you are, outside of our relations. It is antithetical to a “billiard ball” view of individuals as stable entities merely trading energy while interacting (relating) as they careen between metaphorical table rails. Instead, the view from interdependence is that we are each made up of or constituted by our relations at all levels, from the environmental to the social to the microbial. These unique sets of relations are just what we are.
From an interdependence perspective, it is easy to see why we might worry about how bioethics, as a study of the individual, relates to public health ethics, as a study of communities. If the individual is, at root, a community of relations, then bioethics is public health ethics. Yet just writing that out loud gives me pause; for the ways we think about, for example, pandemic response are importantly and practically different from the ways we think about, for example, questions of informed consent at the clinical bedside. If we somehow downplayed the moral weight of individual autonomy for the sake of community health, we open the door to a central moral tension that recurs throughout history, from biomedical research abuses in the past to debates about mandatory vaccination policies today.
And indeed, I am not alone in this worry. More and more bioethicists are grappling with the genealogy of bioethics, and the so-called “tripartite” birth of the term across traditions. Outside the context of American biomedicine and the Belmont Report’s historically motivated emphasis on protecting the individual, cancer researcher Van Rensselaer Potter described bioethics in environmental terms, bridging science and the humanities to understand human flourishing and health in relation to environmental concerns such as pollution and sustainability. Much earlier, the German pastor Fritz Jahr also used the term “bio-ethics” even more broadly to extend the scope of the Kantian moral imperative to all forms of life. In the bioethics literature, too, a growing number of scholars are adopting these relational perspectives, drawing on One Health models to understand how and to what extent nonhuman animal, environmental, and human health concerns are related. Take the American Journal of Bioethics: of its last 466 published articles, 52 included titles emphasizing One Health. Google Trends also indicates a rapid rise in interest in One Health, alongside a leveling of interest in bioethics alone.
This surge in interest suggests that environmental ethics is not a fringe position, but instead the future direction of bioethical inquiry.
And yet, the institutionalization of bioethics continues to gain momentum. If you are reading this as a practitioner, a nurse, physician, clinical bioethicist, IRB member, et al., you might be asking the central and pressing “so what?” Indeed, what is the practical or applied result of following this line of thought? The relational, constitutive view increasingly convinces me. But so what if the patient in biomedicine is fundamentally relational? Are there only dark implications about the dissolution of autonomy—that there are no unique snowflakes, only water—or are there caring relations that solidify at the center for those ecological webs of relation?
Should a change in how we understand the individual in biomedicine motivate changes in the policies and practices through which bioethics operates? Environmental bioethics plays a vital role in delineating the lines to climb.
Jonathan Beever
Jonathan Beever is a Professor of Philosophy and Director of the UCF Center for Ethics at the University of Central Florida in Orlando. He works on problems at the intersections among ethics, environments, and technologies. Learn more about his work here.
