In hospital resource allocation conflicts between health goods and environmental goods, a relational, co-benefits frame, rather than a dualistic, competing goods frame, is key

Abstract

Health systems contribute to the environmental crisis. Yet, addressing this problem seems to generate a resource allocation dilemma for hospitals: investing in healthcare delivery seems to mean sacrificing environmental goods, and vice versa. We question this zero-sum thinking. After presenting the benefits of investing in the two seemingly competing goods—environmental goods and health goods—we propose that the apparent dilemma arises due to a tendency to think in dualisms. Consequently, health and environmental goods seem, respectively, to correspond to opposing sides of four dualisms: human/nature, local/global, present/future and therapy/prevention. We argue, instead, that a relational frame that considers the human person in their relational context should be used to approach the problem. A relational understanding of the human person as a meaning-making subject in relationship to all that is shows us that choosing between either health goods or environmental goods is frequently a false dichotomy: both can serve the well-being of human beings adequately understood. Such an approach, then, widens our conception of health and healthcare to include environmental goods. This wider conception of health and healthcare means that hospitals should (1) look for co-benefits in the first instance when allocating resources, thereby often resolving zero-sum thinking that gives rise to the competing goods dilemma, and (2) in the remaining cases where co-benefits are not achievable, use classic resource allocation principles, such as proportionality of benefits and burdens, to reach allocation decisions about a now wider range of goods (i.e., health and environmental, rather than merely health goods).