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Many agree that drilling for oil entails a responsibility to provide a fair share of benefits to those whose land or rights are affected, but what constitutes a fair share, and who should decide or enforce its provision? Pesticides that reduce the morbidity and mortality of devastating diseases like malaria can simultaneously generate pesticide resistance, harm human and animal health, and diminish agricultural productivity. Does using pesticides entail a responsibility to protect against or limit such harms? Under what conditions is pesticide use acceptable, and how should competing interests be balanced?

In asking and answering such questions David Resnik's new book highlights the need for clinical and scientific evidence, contextual information, and bioethical principles. It argues that determinations regarding pesticides and malaria require information about the local i) prevalence of malaria; ii) burdens of malaria and pesticide/s of interest; iii) availability, effectiveness, and cost of alternatives to pesticides like bed nets; iv) availability, effectiveness, and cost of malaria treatment; and v) cost of the pesticide/s of interest. It details the breadth of environmental health, while distinguishing between environmental ethics and bioethics. These focus respectively on human obligations to non-human species and ecosystems, and on human health. The book's many reviews of objections to its arguments enhance its significance.

Resnik dedicates the book to Rachel Carson, documents her contributions to environmental science, and frames her work as the foundation for environmental health and environmental health ethics. In a conversational and digestible manner he reviews evidence and ethical perspectives on topics including DDT, genetically modified organisms, antibiotics, agriculture, and the built environment. After identifying associated conflicts between environmental health and other goods he applies autonomy, utility, and justice to show that the principle-based approach narrows the range of acceptable responses, and that interactions between health and the environment pose intriguing bioethical questions.

This subtly draws attention to the lack of, and need for, bioethical perspectives on conflicts between individual and collective goods and responsibilities. It perhaps unintentionally invites bioethicists to reconsider i) Andre Hellegers' and Van Rensselaer Potter's early dialogue on the centrality of the environment to bioethics; ii) claims by Daniel Callahan1 and Robert Veatch2 that bioethics neglects collective goods and concerns; and iii) similar views expressed recently by Susan Sherwin,3 Angus Dawson,4 and others.5

Along with bioethical principles Resnik applies principles of stewardship, sustainability, and precaution to the environmental conflicts he identifies, explaining that if a resource is needed for survival then it ought to be stewarded for future use. Stewardship requires sustainability, and sustainability requires precautions against potential threats to the sustainability of that resource. Despite controversy about the precautionary principle its use is appropriate when proportional to the probability and severity of a given threat, Resnik argues, and it is routinely used in daily life. Keeping a spare tyre in the trunk is one example that brings such abstract ideas to life throughout the book.

A chapter on climate change considers, among other things, today's staggeringly high rate of global population growth and reviews how this contributes to poverty and reverses the gains of climate mitigation. It applies utilitarian, deontological, and virtue theories to individual choices and national policies regarding reproduction, showing that these are moral concerns. While it focuses on environmental health ethics, the book's application of bioethical principles to the many topics addressed, including climate change, define these as bioethical issues. This chapter is a welcome addition to the paucity of bioethics work on climate change, and its objectivity and modest approach is a credit to Resnik, one of few bioethicists working on environmental issues.

The nearly 250 indexed and well referenced pages also expose unique ethical complexities in environmental and health policy, and environmental health research. The book illustrates how different risk factors and contexts complicate the balance between competing goods and responsibilities in ways that are often overlooked. For example the impacts of water pollution differ based on proximity, duration of exposure, and socioeconomic status. Failing to incorporate such considerations into water policies may inadvertently worsen conflicts between socioeconomic development, human rights, and health. This challenges justice which, like research ethics, is the focus of an entire chapter.

The book is a great resource for bioethics, environmental health, environmental health ethics, medicine, nursing, veterinary medicine, public health, public health ethics, and policymaking. It encourages investigation of neglected but increasingly important environmental problems; subtly defines these as bioethical concerns by using bioethical methods to explore them; and draws attention to individual and collective goods and responsibilities. Addressing the real and controversial dilemma over malaria and pesticides during my required bioethics course for medical students stimulated dialogue and interest among them. I enjoyed reading this book and strongly recommend it to everyone with an interest in health, environmental health, ethics, or policy.

Footnotes
  1. 1

    D. Callahan. Autonomy: A moral good, not a moral obsession. Hastings Cent Rep 1984; 14: 4043, p. 42.

  2. 2

    R.M. Veatch. Autonomy's temporary triumph. Hastings Cent Rep 1984; 14: 3840.

  3. 3

    S. Sherwin. Looking backwards, looking forward: Hopes for bioethics' next twenty-five years. Bioethics 2011; 25: 7582.

  4. 4

    A. Dawson. The future of bioethics: three dogmas and a cup of hemlock. Bioethics 2010; 24: 218225.

  5. 5

    A. Gutmann. The ethics of synthetic biology: Guiding principles for emerging technologies. Hastings Cent Rep 2011; 41: 1722.

Biography

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  2. Biography
  • Cheryl Macpherson is Professor and Chair of Bioethics at St. George's University School of Medicine in Grenada. She is regularly invited to speak about bioethics in courses on public health, business ethics, and veterinary medicine at SGU. She currently serves as President of the Bioethics Society of the English-speaking Caribbean (BSEC) and Vice Chair of SGU's IRB. Her research interests include bioethics as it pertains to environmental health, climate change, and related policy.