The Agents of Climate Justice in Healthcare.

This paper addresses the critical issue of decarbonising healthcare systems to help combat climate change. I focus on identifying the 'agents of justice' responsible for this transformation. Beginning with the claim that healthcare's greenhouse gas emissions cause injustice, the paper assumes that achieving a net zero healthcare system is essential for climate justice. The discussion centres on two prevailing perspectives: one that primarily assigns responsibility to healthcare organisations and another that holds individual healthcare professionals accountable. The paper advocates for a pluralistic approach to responsibility, contending that the complexity and scale of reducing healthcare emissions necessitate allocating responsibilities based on effectiveness. This leads to the identification of two types of responsibility: first-order responsibilities, which involve direct actions to reduce emissions, and second-order responsibilities, which involve supporting and ensuring the fulfilment of first-order duties. The paper clarifies how mitigation responsibilities should be allocated across organisations and individuals by expanding the scope of responsibility to include a broader range of agents, both within and beyond the healthcare sector. By distinguishing between first-order and second-order responsibilities, the paper offers a clearer framework for understanding the distribution of obligations in achieving climate justice in healthcare. Ultimately, it underscores that focusing solely on direct mitigation efforts by organisations or clinicians is inadequate, and a more comprehensive, multi-agent approach is required to effectively decarbonise healthcare systems.