Does global warming trump all hot-button ethical issues?

Imagine you go to a conference on major bioethical questions -- controversial issues like abortion, embryonic stem cells, assisted reproduction and euthanasia -- and a keynote speaker uses all his allotted time warning about global warming. Is this the wrong issue to discuss -- or the only one worth talking about?

The question arose at the annual conference of the European Association of Centres of Medical Ethics (EACME) that ended at the weekend in Prague. Dr. Richard Nicholson, editor of the Bulletin of Medical Ethics, told the assembled bioethicists they had to look beyond their usual issues to consider the far larger ecological threat he said could soon end up destroying mankind.

The issue is urgent for bioethicists, he said, because the healthcare industry in the rich OECD countries is a major source of carbon dioxide emissions. It also spends vast amounts to prolong patients' lives, about half of it in the final months before death. "The more effort we put into saving individual lives, the more likely we are to doom the human race to extinction," he said.

"Just being a little bit more green isn't the answer," he insisted. Rich countries will have to find ways to cut their carbon emissions almost completely within the next few years. His outlook for the healthcare industry was summarised in a bleak PowerPoint slide:

Possible changes in medicine

• close most hospitals and concentrate on good-quality primary care
• reverse the brain drain and send redundant health workers to developing countries
• outlaw assisted reproduction
• stop medical research undertaken for utopian or financial reasons.

If western countries closed all their hospitals, he said, life expectancy there would drop by only eight months.

"What is more important," he asked, "maintaining our wealth and economies for 20-30 years until climate change wipes them out, or trying to ensure that as much as possible of the human race survives?"