The COVID-19 pandemic and the threat of climate change: the question of what social implications arise from this was addressed by experts at a symposium at the Congress of the German Society for Internal Medicine (German acronym: DGIM). Prof. Dr. Harald Lesch described the retreat of confidence in science as a major crisis. He identified a "butterfly effect of information" that should stimulate analyses of how quickly, and in what form, specialist information can be presented to a broad public. Thoroughness, he said, takes precedence over speed of information.
Prof. Dr. Urban Wiesing, medical ethicist at the University of Tübingen (Eberhard Karls Universität Tübingen), made it clear that physicians also have a social responsibility in the crisis. According to Dr. Wiesing, the medical ethos has developed over a long period of time and is primarily committed to the individual patient. This includes respecting a patient's self-determination, and proceeding fairly. The patient is protected by the duty of confidentiality and may not be discriminated against. Both the Hippocratic Oath and the Declaration of Geneva confirm the patient-centeredness of medical practice.
If external circumstances influence health, then physicians assume a social responsibility, Dr. Wiesing emphasized. This is because the professional code of conduct stipulates that physicians "participate in the preservation of the natural foundations of life with regard to their importance for human health."
Both the COVID-19 pandemic and the consequences of climate change have medical dimensions. It is also indisputable that physicians must contribute their expertise to this context, said Dr. Wiesing. After all, medicine could scientifically investigate the effects (knowledge) and develop countermeasures (action). However, physicians take on different roles, the most important of which is the physician-patient relationship. Complementary roles for physicians are 1. expert for society and political institutions, 2. being a public health expert, 3. consultant, 4. service provider. This leads to conflicts between different roles.
In their most important role, Dr. Wiesing sees physicians relieved of further social responsibility. The limitations in medical research and implementation that may arise due to environmental protection policies or in disaster situations (triage, vaccination prioritization) must be regulated well in advance and given social legitimacy.
Dr. Sylvia Hartmann, vice-chair of the German Climate Change and Health Alliance (German name: KLUG, Deutsche Allianz Klimawandel und Gesundheit e.V.) and project manager of the Health Academy, reminded the audience that a crisis not only has health consequences, but also shows ways to change for the better. “If we look at the climate debates of the past few years, they were about transport, agriculture and energy. But for a very long time”, explained Dr. Hartmann, “the health implications of that were not addressed”. Dr. Hartmann emphasized: "As physicians, we have to intervene in these situations, because we now have the chance to implement prevention on a large scale. Healthy people can only exist on a healthy planet."
Dr. Hartmann sees three areas where each person can change things: The personal-individual, the political citizen space, and the professional environment. Personally, one can make one's behavior more climate-friendly, thereby acting as a role model for family, friends, and "as a physician, perhaps also for my patients", Dr. Hartmann added. But climate protection is not an individual matter. For Dr. Hartmann, everyone should get involved politically, found associations and citizens' initiatives, and ask members of parliament and mayors on what policies they pursue to ensure that prevention is implemented on a large scale.
Physicians, in Dr. Hartmann's view, should advocate for climate protection because they enjoy a high level of trust in society: "What we say counts and has meaning for the people we talk to. We are kind of influencers in a non-digital sense". The professional code of conduct, Dr. Hartmann said, obligates physicians to think more broadly about health protection. That's why it's time for physicians to take a stronger stance on climate protection, she concluded.
This could be implemented in everyday medical practice, for example, in the context of a climate consultation, in which patients are informed about air pollution and its consequences, the effects of heat, the impact of extended allergy periods, and the benefits of more exercise and a healthy diet.
Where possible, medicinal treatments could be chosen that are climate-friendly - provided they have the same effect. Take metered-dose inhalers (MDIs) versus inhalers, for example: Both would have the same effect, but MDIs contain greenhouse gases. Hence inhalers should be chosen. "It's not about treating patients worse, but about protecting the environment," Dr. Hartmann said.
The healthcare sector itself also needs to become climate neutral, as 5% of greenhouse gas emissions in Germany come from the healthcare sector. If one takes "do no harm" seriously, it is one's duty to examine where emissions can be reduced. Health must be considered in every legislative process. With the “Health Needs Climate Protection” Initiative, clinics and physician practices are aiming to create climate-neutral healthcare by 2035.
References:
1. 127th Annual Meeting of the German Society of Internal Medicine (DGIM). Interdisciplinary session: Societal implications of the crisis, 4/17/2021, 10:45 a.m. to 12:15 p.m.
2. The “Health Needs Climate Protection” Initiative (In German: Initiative Gesundheit braucht Klimaschutz)