The ecomedical disconnection syndrome.

The Hastings Center's contributions to medical bioethics are deservedly celebrated. For example, their international project The Goals of Medicine: Setting New Priorities is an ambitious effort to redirect the future course of medicine.[1] Their recent projects in environmental ethics are also pioneering efforts to integrate ecology, politics, and values. Nature, Polis, and Ethics: Chicago Regional Planning, for example, aspires to inform regional environmental planning from an ethical perspective.[2] Yet together they reveal a central weakness in contemporary bioethics: failure to recognize the links between ecological ethics and medical ethics. Although each is an important project in its own right, each misses opportunities to stress the links between nature and health. Each, that is, suffers from the ecomedical disconnection syndrome. In neurological parlance, a disconnection syndrome occurs when one brain center (or neural information processing unit) cannot communicate with another, and some form of integrative impairment results. For example, when visual processing and language areas are isolated from each other by a brain lesion, such as a stroke, the patient may not be able to name pictures. We should be wary of medicalizing language, of course, but thinking about the current state of bioethics through the neurological concept of disconnection is appropriate, for the problem is one of human cognitive limitations. Our patient suffering from this disconnection syndrome is not really The Hastings Center but rather environmental science and medicine in general. Bridging medical and ecological ethics must be a critical aspect of the future of health and environmental planning and, in fact, of our species and others. The present commentary draws on Van Rensselaer Potter's original conception of bioethics as a broad exploration of the linkages between biology and human values to characterize the syndrome and develop a treatment plan. Its most expansive aspiration is to contribute to the development of viable programs of sustainable medicines in a sustainable environment. The Diagnosis The principal purpose of the Nature, Polis, Ethics project is to guide the future development of the Chicago region as a place in which human beings and other species can live and thrive. In the process of highlighting the moral issues in regional planning efforts, Nature, Polis, Ethics empowers a variety of modes of thought that too often are not conjoined. First, it empowers history, that is to say, an understanding of the past of the region and its human inhabitants. This history recounts not only the growth of human influence in the region, but the community values that led to and emerged from this development process. Second, the project empowers the notion of citizenship, particularly "democratic ecological citizenship." At the root of this citizenship are fundamental values like trust, particularly in other members of the community, as well as faith in the enterprise itself, and perhaps in matters spiritual as well. Third, it empowers evolutionary biology as one of the critical underpinnings of our knowledge of how the region has evolved and might evolve. Yet despite the emphasis on biology, there is a major theoretical and practical omission: health concepts, institutions, and professionals are left out of the account. The environment has been and will continue to be dramatically affected by the delivery of health care for citizens of the region. For example, the use or misuse of antibiotics by physicians and the use or misuse of community resources such as space and waste processing facilities by hospitals have profound effects on the environment. The success of public health (with some occasionally significant help from medicine) in increasing the lifespan of individuals has made the problem not just a matter of general overpopulation but has caused a change in the average age of our citizens. …