Friday, June 09, 2006

The Precautionary Principle

When treating a patient, the Hippocratic oath binds medical doctors. The oath, which dates back to 400 BC, was written by Hippocrates, the founder of medicine. In essence, the oath entreats doctors to "do no harm." Over the centuries we have developed ways of measuring and testing the human body that provide us with checks and balances to determine if the actions of doctors comply with their obligation.

While we were aware that human activity was causing grievous injury to our greatest living ecosystem, the Earth, we had no comparable standard that empowered us to "do no harm." That was until the Precautionary Principle was born at the Earth Summit in 1992.

The Precautionary Principle, as defined in 1992 stated,

"Where there are threats of serious or irreversible damage, lack of full scientific certainty shall not be used as a reason for postponing cost-effective measures to prevent environmental degradation."

This initial definition, although considered by many to be a progressive step forward, fell way short of the ideal of "doing no harm." It defined our ability to protect the environment in cost-effective terms. Anyone who has watching while a loved one lay dying would agree that equating preserving life in cost-effective terms is completely unacceptable.

Almost as quickly as the ink in Rio had dried, the environmental community began re-scripting a better definition. In 1998, after many incarnations, a group of environmentalists produced what is now known as the Wingspread Statement. It states,

"When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically. In this context the proponent of an activity, rather than the public, should bear the burden of proof. The process of applying the precautionary principle must be open, informed and democratic and must include potentially affected parties. It must also involve an examination of the full range of alternatives, including no action."

The Wingspread Statement puts health into the equation and puts the onus of proof on the proponent. It also places financial liability firmly on the shoulders of those who would place the financial bottom line above protection of the very ecosystem that gives us life.

Needless to say, there has been considerable debate over the very definition of the Precautionary Principle. Most recently, Environment Canada invited environmental groups to participate in a teleconference to provide input on risk management and the Precautionary Principle.

For those who participated, it was clear right from the start that what Environment Canada was looking for was an endorsement of the original statement that placed financially viability over environmental health. Consider this statement from the PowerPoint presentation, which was distributed to all participants:

"Possible interim risk management measures include performance agreements, with sectors or industries, wishing to take proactive measures to prevent or manage substances of concern. The long-term goal is a marketplace that fosters producer and user responsibility for sound management of chemicals."

Bruce Cattle, an environmental activist with Picton's Safe Water Group, participated in the conference call. He said that it was clear that the purpose of the session was simply to allow Environment Canada to say that they had consulted with the environmental community at the very least, and at best get the community to buy into the current government's agenda.

Unfortunately for Environment Canada (and the reps from Health Canada who also participated) Cattle is a media savvy community worker and former radio broadcaster who called the bureaucrats bluff.

In response to the teleconference, Cattle wrote, "The whole concepts of scientific certainty, risk assessment and cost-benefit analysis must be critically scrutinized and challenged. These folks aren't even close."

Cattle pointed to Environment Canada's list of prerequisites that were also including the PowerPoint presentation including:

"The application of precaution is a legitimate and distinctive decision-making approach within risk management."

"Precautionary measures should be cost-effective, with the goal of generating (i) an overall net benefit for society and (ii) efficiency in the choice of measures."

"Where more than one option reasonably meets the above characteristics, the least trade-restrictive measure should be applied."

"Long-term goal is a marketplace that fosters producer and user responsibility for sound management of chemicals."

Clearly we've come a long way since the crystal clear definition given by Hippocrates all those centuries ago. "Doing no harm" simply means that. Allowing the marketplace to define our options for protecting the environment is startlingly similar to allowing the foxes to watch the hen house.


The Science and Health Network has some excellent resources related to the Precautionary Principle.

Rachel's Precaution website is still under development, and yet it contains valuable documents about The Precautionary Principle.

The Safe Water Group


Blogger Michael said...

Nice article and I agree with it in principle.

However, the analogy of the Hippocratic Oath can be taken further. Simply, despite popular opinion no doctor swears to the Hippocratic Oath. In modern biomedical ethics, "primum non nocere", "first do no harm" is an important principle but it is not as "crystal clear" as many would believe.

For example, if we refuse to do any harm at a tissue level, then surgery would be impossible. If we refuse to harm a patient by giving involuntary medications for someone who is psychotic or intoxicated, then they may never improve or die as the consequences. This occurs on a population level as well.

If we "do no harm" by prescribing antibiotics for respiratory tract illnesses freely, then antibiotic resistance becomes an issue.

Each action has a balance of its immediate effects as well as delayed effects and opportunity costs. Sometimes, the concept of "harm" is not as clear when taken into a broader context.

Michael Tam
vitualis' Medical Rants

June 19, 2006 8:37 PM  

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