Climate change dominates BMA essay competition

by Tim Tonkin

An examination of the health service’s role in addressing climate change has won first prize in a one-off BMA presidential essay prize.

Location: UK
Published: Thursday 8 October 2020
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The prizes, which are conferred by outgoing BMA president Raanan Gillon, sought to acknowledge work providing ‘solutions-driven writing on the topic of justice and fairness in medical practice and policy’.

Sheffield-based ST3 in Neurology Alistair Wardrope took the £4,000 first prize for his essay Health Justice in the Anthropocene, which, in examining the existential threat posed by climate change, seeks to expand the conversation around making healthcare more environmentally sustainable.

Reacting to winning first prize Dr Wardrope said: ‘The acknowledgement of a need for an expanded understanding of justice in health and healthcare - one that relates our responsibilities as health workers to the position within political, social, and ecological communities that support and define us - is the most significant aspect of this prize.

‘At local, national, and international scales, the lifestyles of the wealthiest pose an existential threat to the poorest and most marginalised in society. I - and the majority of my colleagues in healthcare - know this.

‘We want to act upon it. Yet it is all too easy for us to push this knowledge to the backs of our minds and continue to live and work unsustainably in a system that accounts for six per cent of all carbon emissions and five per cent of air pollution nationally.

He added: ‘I wanted to find tools to help build the moral understandings that could resist this cognitive dissonance, to shape an understanding of just healthcare fit for the future.’

Balance of care

The competition’s second-place award went to Cambridgeshire-based consultant in acute internal medicine Zoe Fritz and her co-author academic clinical fellow Caitriona Cox.

Their entry, Integrating philosophy, policy and practice to create a just and fair health service, examined the challenge faced by doctors in balancing the needs of patients immediately within their care, with those of future patients and colleagues.

They said: ‘We felt that the NHS needed an explicit philosophy to guide it when policy makers and clinicians had to consider conflicting demands in their decision making.

‘In the essay, we show how our approach could be applied to current and challenges faced by the health service including care of patients in nursing homes during the Covid pandemic, placement of new NHS resources, and funding for nursing grants. 

‘We were delighted to be given second place for the prize, and hope that it leads to policy makers and clinicians discussing our proposals: we look forward to the debate.’

Entrants to the competition were required to submit a 500-word abstract of their proposed work, with those shortlisted then invited to submit a full essay of up to 5,000 words.

Due to the Covid-19 pandemic, the original deadline for submissions was extended until 30 June.

Dr Gillon said: ‘I was absolutely delighted at the huge number of abstracts submitted to this essay competition, coordinated by the BMA’s medical ethics and human rights department as part of my focus on "fairness and Justice" during my year as BMA president.’

‘The nine finalists’ essays were all thoughtfully argued but the winner and the highly commended runner up – both written by practising doctors – were exceptionally interesting and thought-provoking and I do hope fellow BMA members will read these two very different  perspectives on "fairness and justice in medical practice and policy".'

Winner

Health Justice in the Anthropocene: Medical ethics and the Land Ethic - Alistair Wardrope

Highly commended

Integrating philosophy, policy and practice to create a just and fair health service - Zoe Fritz and Caitriona Cox

Shortlisted essays

Genetic Information, Insurance, and a Pluralistic Approach to Justice – Jonathan Pugh

“A QALY is a QALY is a QALY”: decision-making based primarily on cost-utility analysis is inherently age-biased & The urgent need for ethical priority-setting frameworks in times of crisis – Rose Penfield

Practicing medicine justly How do we do it, what are our obligations and what should we be advocating for? – Daniel Jones

Justice as Fairness in Public Health Policies – an ethical examination of the NHS charging regulations for irregular migrants - Roghieh Dehgan

Fair access to autonomy in maternity care: what does this mean and how can it be achieved?  - Rebecca Brione

Health inequalities: A socially determined injustice – Yasmin Miller

Epistemic injustice in schizophrenia - Ellis Onword

The BMA will be hosting an online conference on medical ethics ‘Justice, fairness and medical ethics through the lens of COVID-19’ on 8 December. For more information contact [email protected]