The ethics of climate change and health-care delivery: a national survey of US-based physicians

Health harms from climate change are partly driven by health-care emissions. Physician perspectives on the related ethical dilemmas of professional responsibilities, health equity, and trade-offs between individual health choices and the environmental impact of health care are not well described in current literature. We performed a cross-sectional survey of US-based physicians between July 18, 2023, and May 28, 2024 to assess related perspectives, and we analysed the results by the respondents' perceived impact of climate change on their patients' health (moderate-high impact vs no-to-low impact). 529 surveys were delivered, of which 304 (57·5%) were returned. 113 (37·4%) of 302 respondents reported that climate change had a moderate-high impact on their patients' health, whereas 249 (82·5%) respondents viewed climate change as having greater health impacts on patients with less access to health care. 105 (35·0%) of 300 respondents reported that the environmental impact of health care should be reduced even if it requires limiting treatment options of similar effectiveness. In response to hypothetical scenarios, the patients in the moderate-high impact group was more willing to place such limits (adjusted predicted probability=50%) than the no-to-low impact group (adjusted predicted probability=25%, difference=25% [95% CI 13-38]). In addition, the patients in the moderate-high impact group (adjusted predicted probability=86%) was more willing to initially trial a less effective but less environmentally toxic antihypertensive medicine than the no-to-low impact group (adjusted predicted probability=69%, difference=17% [95% CI 6-27]). A sample of US-based physicians accepted their health care-related responsibilities towards climate change and viewed its health impacts as inequitable. Perceptions of the health impact of climate change influenced willingness to accept limited treatment options for environmental reasons.