Time to expand a paradigm: Healthcare sustainability and eco-ethical assessment.

This paper aims to rethink healthcare sustainability from an eco-ethical approach, mainly referring to van Rensselaer Potter's global bioethics and Arne Naess's ecosophy. In this sense, it seeks to address the ethical problem of allocating resources from a non-individualist and essentially bio-medical perspective, which interprets health (or disease) as a mere feature of the individual. On the contrary, starting from a planetary health approach (Potter) and an "ecosophical" view of human beings (Næss), individual health gains meaning in a broader context. At the ethical level, this implies: 1. a focus on the patient's wellbeing, more than his/her diagnosis and cure; 2. a conception of shared responsibility and agency of all stakeholders; 3. the pursuit of ecologically sound decisions that go beyond the individual; 4. promoting environmental stewardship, which may overcome the dichotomy between anthropocentrism and biocentrism; and 5. pursuing epistemic humility. All these pragmatic considerations may inspire the construction of environmentally sustainable health systems. In this regard, the paradigm proposed in this paper is principally directed to healthcare organizations, and not to the particular doctor-patient relationship, where the classical principles of bio-medical ethics might still be appropriate. This non-exclusionary approach allows the integration of the two facets of bioethics: Georgetown bio-medical ethics (Kennedy Institute) and Wisconsin global bioethics (Potter).