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A focus group study of ethical issues during climate-informed health decision-making

Nature Climate Change volume 14, pages 1040–1046 (2024)Cite this article

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Abstract

Healthcare delivery contributes to carbon emissions, exacerbating climate change and its associated health impacts. There is limited understanding of stakeholder views regarding ethical issues at the intersection of health choices and environmental impact. Here we performed a qualitative study involving seven focus groups with 46 participants who were patients and physicians in the northeastern US health systems. Both patients and physicians were amenable to health decisions that are beneficial for the environment and health. A consumptive healthcare system impeded both groups’ assumption of health-related climate responsibilities. Physicians, however, underestimated patients’ interest in discussing the environmental impacts of health decisions. Patients expressed tension between a personal interest in limiting climate change through health choices and ensuring others were also accountable; they were also concerned that physician paternalism might impede climate-informed health conversations. These findings outline barriers to climate-informed healthcare and begin to establish how they can be addressed.

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Fig. 1: Thematic analysis of major ethical issues by participant type.

Data availability

The institutional review board approval for this study does not allow for individual participant data or complete transcripts of the focus group text to be released. Additional de-identified quotes and code books supporting the findings are available upon request to the corresponding author and are subject to approval by the institutional review board. The corresponding author will attempt to respond to requests within 12 weeks, subject to institutional review board approval.

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Acknowledgements

This study was supported by the Greenwall Foundation (Making-a-Difference award to A.H.). A.H. was also supported by a grant from the National Cancer Institute of the National Institutes of Health (K08 CA273043). The sponsors had no role in the study design; collection, analysis and interpretation of the data; writing of the report; or the decision to submit for publication. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, and mention of trade names, commercial products or organizations does not imply endorsement by the US government.

Author information

Authors and Affiliations

  1. Dana-Farber Cancer Institute, Boston, MA, USA

    Andrew Hantel, Anna Revette, Brett Nava-Coulter, Thomas P. Walsh & Gregory A. Abel

  2. Harvard Medical School, Boston, MA, USA

    Andrew Hantel & Gregory A. Abel

  3. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Emily Senay

  4. University of Edinburgh, Edinburgh, Scotland, UK

    Cristina Richie

  5. University of Chicago, Chicago, IL, USA

    Fay J. Hlubocky & Mark Siegler

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  1. Andrew Hantel
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Contributions

A.H., C.R., M.S. and G.A.A. devised the study concept. A.H., E.S., C.R., F.J.H., A.R. and G.A.A. developed the project’s methods. A.H., E.S., A.R., B.N.-C. and T.P.W. collected the data, and C.R. analysed the data. A.H., C.R., A.R., B.N.-C. and T.P.W. drafted the paper, and E.S., F.J.H., M.S. and G.A.A. provided critical review. All authors revised the paper and provided final approval before submission.

Corresponding author

Correspondence to Andrew Hantel.

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Competing interests

A.H. reports receiving personal fees from AbbVie, AstraZeneca, BMS, Celgene and GSK (advisory boards), the American Journal of Managed Care (speaking fee), Genentech and Jazz Pharmaceuticals (consultancy), and Real Chemistry (spousal employment) outside the submitted work. G.A.A. reports receiving personal fees (consultancy) from Novartis outside the submitted work. All other authors declare no competing interests.

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Nature Climate Change thanks Iris Blom, Zerina Lokmic Tomkins and Julian Sheather for their contribution to the peer review of this work.

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Supplementary Tables 1–4 and Text.

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Hantel, A., Senay, E., Richie, C. et al. A focus group study of ethical issues during climate-informed health decision-making. Nat. Clim. Chang. 14, 1040–1046 (2024). https://doi.org/10.1038/s41558-024-02121-z

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