All creatures great and small

Bernstein draws much-needed attention to yet another authoritative report report pointing to a catastrophic loss of biodiversity and a mass extinction of species. He is right that we need to do much more to think about the environmental impact of how medicine is practised, but we need to go much further than just educing our ecological footprint. Bernstein’s main argument is that we need to conserve biodiversity because we might benefit from possible future medical developments using other living organisms - other organisms might have utility for us. This is an ontological position where human beings are seen as somehow separate from the rest of creation, and where the value of other life forms is defined by their usefulness to us. Heidegger referred to this as classifying the natural world as as just raw material for manipulation. In this view, not only the natural world, but also other human beings, are regarded as a standing reserve, to be used or discarded at will. It can be argued that the current crises of both climate disruption and mass extinctions are the result of precisely this form of anthropocentric dualism, with an underlying assumption that something (‘Mother Nature’) or somebody else (people living far away) will somehow be able to absorb and deal with whatever we demand of our environment.

A new ontological position is emerging where human beings are regarded as an integral part of Nature; even our bodies are complex ecologies of many organisms and strands of DNA, and, as the environmental philosopher Timothy Morton noted, there is no ‘away’ - everything is here, now. This new ontological position, where human beings are not separate from Nature, but where we are one part of a complex, co-evolved symbiosis of life, has profound implications for how we practise medicine. At the heart of this lies an ethical awareness. One form of such an ethical awareness has been proposed by the environmental humanities scholar Deborah Bird Rose, based on her detailed anthropological field work with Australian aborigines; she argues that we should regard other creatures as kin, and give them the same ethical considerations as other members of our families. A second approach is suggested by Hans Jonas, who argues that we need to practise an ethics of responsibility towards all purposive creatures, not just human ones. Jonas considered the ethical implication of our increasingly powerful biomedical technologies on both the very nature of who we are (such as gene therapies and behavioural control), as well as the increasing long-term impacts on future generations. Precisely because our technological power is now so great, Jonas argues that the needs and wishes of future generations, traditionally not part of ethical reasoning, can no longer be ignored. After all, the needs and wishes of future generations, both human and more-than-human, may include a planet worth living on.

BMJ 2019;365:l2385

Martin Heidegger, 1962. Being and Time. Being and Time (trans. J. Macquarrie and E. Robinson). London: SCM Press, 1962.

Timothy Morton, 2009. Ecology without Nature: Rethinking Environmental Aesthetics. Harvard: Harvard University Press.

Deborah Bird Rose, 2011. Wild Dog Dreaming: Love and Extinction. Charlottesville: University of Virginia Press.

Hans Jonas, 1984. The Imperative of Responsibility. In Search of an Ethics for the Technological Age. Chicago: University of Chicago Press.