A new direction in medical ethics: embracing One Health in a new form of "weak anthropocentrism"

Indispensable animal models in laboratories, animals culled on a large scale to control pandemics, the vast amount of medical waste generated by healthcare systems—these are all corners of modern medical practice seen as "necessary costs" yet seldom scrutinized ethically. In a new Perspective article published in Science in One Health, Moshe Porat Wojakowski from Sheba Medical Center and the Hebrew University of Jerusalem and Shir Porat-Butman from Bar-Ilan University in Israel propose that medicine needs an ethical upgrade: a shift from "strong anthropocentrism" to "weak anthropocentrism." This framework allows healthcare decision-making to uphold the core principle of "patient first" while incorporating the intrinsic value of non-human life and ecosystems, providing a feasible ethical guide for achieving a truly sustainable "One Health."

Why is an ethical turn needed?

The traditional medical paradigm centers on human health, with animals and the environment viewed merely as resources, threats, or vectors of disease. Even the One Health concept, which emphasizes the interdependence of human, animal, and environmental health, often unwittingly slips back into strong anthropocentrism in practice—taking action only because ecosystem degradation or animal suffering ultimately harms humans. A deeper ethical question remains unresolved: is harming non-human life or destroying ecosystems wrong in itself?

Introducing "weak anthropocentrism": a pragmatic ethical guide

Drawing on philosopher Norton's distinction, the article proposes weak anthropocentrism as a solution:

Strong anthropocentrism: Only human interests possess intrinsic value; environmental issues matter only when they endanger humans.

Weak anthropocentrism: Retains the human vantage point but acknowledges intrinsic value in non-human beings and ecosystems (based on cultural, aesthetic, scientific, or moral grounds).

This shift is not a radical turn to biocentrism or ecocentrism, but a pragmatic middle path. It requires clinical and public health decisions to follow the principles of proportionality and least harm, ensuring human health while obligating the assessment and minimization of harm to ecosystems.

Case study: green oncology—how ethics can change clinical choices

Oncology concentrates nearly all dimensions of One Health: energy-intensive imaging and radiotherapy (environmental impact), prophylactic antibiotic use (antimicrobial resistance), and complex cytotoxic drug supply chains with waste (governance and emissions). Using green oncology as an example, the article demonstrates how weak anthropocentrism can be operationalized:

When two imaging modalities are clinically equivalent, weak anthropocentrism obliges choosing the lower-emission option because ecological integrity matters intrinsically.

When formulating antibiotic policies, assessment should include not only resistance risks for future patients but also damage to downstream microbial ecologies from hospital effluent.

In drug development, adherence to the "3Rs" (Replacement, Reduction, Refinement) for animal testing continues but is placed within a broader ethical framework.

The decision-making process thus becomes: (1) Clarify human goods (efficacy, safety, quality of life, equity); (2) Simultaneously assess ecological impacts; (3) Apply proportionality—prefer options with lower ecological harm, otherwise require justification, mitigation, and monitoring.

Ethical reshaping of the One Health action tracks

The article examines the six action areas of the One Health Joint Plan of Action (2022–2026) along the ethical spectrum from strong anthropocentrism to weak anthropocentrism to biocentrism/ecocentrism. For instance:

Responding to zoonotic epidemic and pandemics: The logic shifts from culling animals purely to protect humans, to weighing habitat conservation and animal welfare as duties, where culling is a last resort only after proportionality tests include non-human harms.

Antimicrobial resistance (AMR) governance: The focus expands from solely preserving drug efficacy for humans to limiting environmental antibiotic loads (hospital sewage, pharmaceutical waste), because the integrity of microbial ecologies itself holds moral importance.

Future direction: equipping medicine with an ethical compass

Current medical paradigms remain anchored in strong anthropocentrism. Weak anthropocentrism provides the missing ethical compass, extending the "do no harm" principle beyond humans without overturning medicine's core mission. It demands expanding evaluative criteria, embedding ecological reasoning into decision processes, and aligning clinical benefit with long-term planetary stewardship.

This framework is applicable not only to oncology but can be generalized to all medical specialties. It offers medical practitioners a concrete tool for thought, guiding medical practice toward a truly sustainable and justice-attentive future—healing patients while also safeguarding the ecological home we all share.