Your Future Grandkids Will be Mad You Got That Unsustainable Surgery

Abstract

The healthcare sector is responsible for a considerable portion of global emissions, which in turn contributes to adverse health effects associated with climate change. In this thesis, I explore philosophical justifications for including sustainability as operational norm in healthcare reimbursement decisions in the Netherlands. I argue that costs generated by climate change are equivalent to costs that are currently included in cost-effectiveness analysis (CEA), and should therefore be incorporated. I compare this proposal with a recent advisory report from the Dutch Health Institute, and argue that including climate-related costs into CEA is complementary to their proposal. Naturally, the next question is whether future climate-related costs should be discounted relative to present costs. I provide an agent-relative justification for pure time preferences based on the relationship that healthcare professionals have with their patients. I argue that in order to provide good healthcare outcomes, healthcare professionals need to form a relationship of understanding and this necessiates partiality towards present patients. As a result, in the healthcare context, present partiality is permissible, justifying a low discount rate.