Navigating trade-offs within a green healthcare ethics

Abstract This article showcases the relevance and complementarity of commonly used bioethics theories and frameworks for thinking about the challenges and moral tensions that (may) arise in efforts to move toward a more sustainable and ecological healthcare sector. It presents critical insights from deontology, consequentialism, virtue ethics, contractualism, modern casuistry, justice theories, and feminist approaches to bioethics, and points to important lessons from each of these for a green healthcare ethics in which acknowledging and dealing with potential, real, or apparent trade-offs is central. While ideal moral theories and frameworks such as deontology, consequentialism and virtue ethics can offer relevant normative principles to guide change at individual, organizational, and societal levels, other approaches such as contractualism and casuistry can offer practical and procedural guidance for addressing trade-off situations. In addition, justice theories and feminist approaches can offer normative grounds, respectively, for determining how to appropriately and equitably distributing the benefits, risks and burdens of specific initiatives or policies that are envisioned for transitioning to green healthcare sector, and for better understanding the role of complex human–human and human–environment relations and interdependencies in these discussions. These lessons provide foundations for the development of a comprehensive ethical framework, and we advocate for their future integration into a trade-off ethics.