The unresolved ethics of trading patient trust for environmental sustainability

Healthcare contributes substantially to global environmental burdens, accounting for 1%–5% of total impacts depending on the indicator considered, while greenhouse gas emissions alone represent 4.4% of the global footprint.1 Beyond emissions reduction, improving healthcare sustainability offers potential benefits including reduced environmental health risks, lower costs and increased health system resilience.2 Accordingly, there are growing calls for environmental sustainability to become a significant factor in clinical decision-making.3 However, one potential approach with ethical implications is the deployment of sustainability-promoting interventions that knowingly reduce patient trust in clinicians and health systems.4