Ethics of Climate-Smart Healthcare: Early Reflections from an Asia Workshop

By guest contributors Muskaan Khepla and PLOS Global Public Health Section Editor Renzo R. Guinto

On April 21 to 23, 2026 in Singapore, our Planetary Health team at the SingHealth Duke-NUS Global Health Institute in Singapore, together with SingHealth’s Office of Ethics in Healthcare, convened a regional workshop entitled “Ethics of Climate-Smart Healthcare in Asia.”

Supported by Wellcome through the Southeast Asia Bioethics Network, the workshop aimed to explore the different ethical challenges faced by healthcare systems in Asia in pursuing climate-smart healthcare – the convergence between being “low-carbon” (reducing greenhouse gas emissions and environmental footprint) and “climate-resilient” (responding and adapting effectively to the rising health impacts of climate change).

For three days, more than 30 scholars and practitioners from different fields – bioethics, climate and health, health policy, public health, social sciences, etc. – engaged in a diverse array of activities, from expert lectures and small group discussions to case study presentations and a visit to one of SingHealth’s green polyclinics. What made the workshop extra special is that it fell exactly on Earth Day (April 22) – indeed an opportune time to collectively reflect about the tight relationship between our health and our home.

The heart of the workshop was the showcase of case studies of healthcare organizations from across the Asia that are beginning to implement climate-smart healthcare strategies and measures. Early this year, we announced a call for case studies – and out of around 40 submissions, we selected 12, whose authors we invited to the workshop in Singapore.

Workshop participants learn about climate-smart healthcare technologies in SingHealth Polyclinics Tampines North in Singapore

Wider lens and fuller scanning

During the workshop, we realized that the health and health system effects of climate change are starting to be felt and slowly being documented. However, the ethics of how we respond to them are less discussed and not well documented. Trade-offs go unidentified and worse, unexamined. Meanwhile, classical bioethics, which was originally built for the clinic and the patient, is not anymore sufficient in dealing with problems that are cumulative, cross-border, and intergenerational – such as climate and health. A wider lens is needed, one that encompasses other species, entire ecosystems, and even people not yet born.

In healthcare and global health, we often invoke the value of “equity.” Without a doubt, equity will continue to be a central ethical value in our field. However, the climate crisis pushes us to start thinking more broadly. Climate and health issues require the consideration of many values – from traditional ethical values in medicine such as autonomy and beneficence, to emerging value concepts such as intergenerational responsibility and ecological justice. A fuller scanning of relevant ethical values will help ensure that trade-offs at the climate-health nexus are adequately debated rather than quietly absorbed.

Someone is always covering the cost

The case studies revealed one recurrent feature: climate-smart healthcare tends to work because someone, somewhere, is absorbing a cost the budget doesn’t show. One hospital was able to cut greenhouse gas emissions through composting and solar power, but ultimately because of frontline staff performing extra ‘green’ work. Another hospital had a plastic recycling initiative that had to be redesigned more than once, not because the technology failed, but because clinicians were choosing between time for patient care and for sorting the waste bin.

Across several case studies, this additional yet invisible burden of “sustaining sustainability” fell disproportionately on nurses, and on women. As we dug deeper into climate-health strategies in the region, we found that many of them are gender-blind. Gender commitments in national climate plans are largely superficial, and queer communities are barely present in climate-health planning exercises. During the workshop, we agreed that “intersectionality” – how different social identities and power systems overlap to produce inequity and discrimination – is one lens that can help make climate-smart healthcare more ethical, inclusive, and just (we elaborate on this idea in another recent article).

Navigating messy ethics together

Through case studies from across Asia, our workshop dissected a wide diversity of ethical tensions encountered on the road to climate-smart healthcare. In healthcare facilities, green building retrofits compete for the same budget with latest diagnostic technologies. Hospital wards had to grapple with the tension between reducing single-use materials and practicing infection control. Humanitarian NGOs debate between flying people into disaster zones and maximizing staff already present on the ground.

Our workshop did not put an end to these tensions – in fact, it wasn’t trying to. But workshop participants left with a clearer picture of the ethical problems underpinning climate-smart healthcare – and went home with much more questions to ponder. Ultimately, our workshop gave birth to a regional community of practice, linking Singapore to Saraburi, Cox’s Bazar to Cambodia – armed with common tools for navigating climate-health’s messy ethics together, and united under a shared desire to achieve good health for all while keeping our planet healthy too.

Workshop participants perform their “Planetary Health” chant in commemoration of Earth Day

About the Authors

Muskaan Khepla is Research Associate at the Planetary Health Programme of the SingHealth Duke-NUS Global Health Institute, Duke-NUS Medical School, National University of Singapore.

Renzo R. Guinto is Associate Professor and Lead of the Planetary Health Programme at the SingHealth Duke-NUS Global Health Institute, Duke-NUS Medical School, National University of Singapore. He is also the Section Editor for Environmental and Planetary Health of PLOS Global Public Health.

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.

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