Can care ethics help healthcare systems address their environmental harms? Findings from focus groups with members of the UK public.

Bioethics scholars have become increasingly interested in moral questions associated with healthcare's environmental harms. Much of this scholarship has remained in the theoretical space, where ethical reasoning is underpinned by certain obligations and the implementation of top-down principles. Drawing on twelve focus groups with members of the UK public, this paper aims to bring a sociological ethics of care approach to these discussions. In fulfilling this aim, we highlight how moral decision-making occurs in the context of interrelationships with others, and not simply according to top-down principles. We show how, in line with an ethics of care approach, participants prioritised caring needs based on those in close relational proximity, meaning that emphasis was placed primarily on themselves and their loved ones, followed by other humans and the NHS, and finally the environment. At the same time, we contribute to the ethics of care scholarship by showing how such relation-based hierarchical caring was affected by various socio-cultural and political factors-what we have called 'contextual caring'. We note four factors: access to healthcare, capability of care work, increasing understanding of the relationship between humans and the environment, and societal norms of environmental citizenship. We stress the importance of considering these socio-cultural and political factors in any examination of how relation-based hierarchical care occurs in practice. We reflect on the implications of our focus group findings for policy measures towards addressing the UK NHS's environmental harms.