Power, pollution, and ethics.

Environmental problems are more urgent and serious than ever: climate change, air pollution, water pollution, shortages of freshwater, deforestation, over-fishing, antibiotic resistance, and more. Discussions in public health address these problems because they affect people's health and life prospects so profoundly. In this work, we add to the discussion by exploring the ethical aspects of a case scenario that involves pollution from a coal-fired power plant. After we note how the plant contributes to pollution, we discuss ethical issues of justice and responsibility. We show how the burdens of pollution and the benefits of the activities that generate pollution are unfairly distributed in this case. We also suggest that social justice demands certain forms of respect, consideration, and participation. Then we turn to issues of responsibility. We focus on responsibilities citizens have to try to change the social structures, background conditions, economic systems, and accepted practices that underlie the problem. We also consider responsibilities that physicians have, both collectively and individually. Taking responsibility for pollution is not a matter of following a medical protocol or legal requirement. It involves creativity, judgement, and a sense of what the situation calls for.

Should Physicians Consider the Environmental Effects of Prescribing Antibiotics?

Pharmaceuticals are beginning to receive attention as a source of pollution in aquatic environments. Yet the impact of physician prescription patterns on water resources is not often discussed in clinical decision making. Here, we comment on a case in which empiric antibiotic treatment might benefit a patient while simultaneously being detrimental to the aquatic environment. We first highlight the potential harm caused by this prescription from its production to its disposal. We then suggest that Van Rensselaer Potter's original conceptualization of bioethics can be used to balance clinicians' obligations to protect individual, public, and environmental health.

Drugs down the drain: When nurses object.

The authors examine the nursing practice of disposing unaltered controlled substances into public water systems as an issue for nurses concerned with the environmental harm it can cause. A summary of the history of controlled substance management reveals inconsistencies in the interpretation of current regulations that have led to disposal policies that vary by institution, according to a benchmarking survey of regional hospitals. Much attention has been given to the phenomenon of conscientious objection in the context of patient care that conflicts with a nurse's moral integrity. Nurses who are compelled to dispose narcotics down drains may also face this struggle. The authors submit that this disposal method is based on a type of double effect logic where preventing diversion is viewed as a good effect of flushing unused controlled substances that outweighs any harm it may cause, though there is little evidence to support this conclusion. Consequently, the topic deserves further study so that nurse managers and administrators can support and offer alternatives to nurses who object to flushing drugs down the drain.

'Iraq Water Treatment Vulnerabilities': a challenge to public health ethics.

A formerly classified US document, 'Iraq Water Treatment Vulnerabilities,' provides evidence that ill health was knowingly induced in the population of Iraq through the ruination of that country's water purification system. We believe that the uncovering of this document should stimulate the public health community to clarify principles of public health ethics and to formulate statements giving voice to these principles. We propose here two statements, one dealing with the broad issue of public health ethics and international relations, and one dealing specifically with public health ethics and water purification.