gms | German Medical Science

24. Jahrestagung des Netzwerks Evidenzbasierte Medizin e. V.

Netzwerk Evidenzbasierte Medizin e. V. (EbM-Netzwerk)

22. - 24.03.2023, Potsdam

We have been there before: insights from empirical medical ethics for the debate on ethical recommendations in planetary health – a plea for the transparent reporting of bridge principles

Meeting Abstract

  • Joschka Haltaufderheide - Universität Potsdam, Faculty of health sciences, Professorship of Medical Ethics with a Focus on Digitization, Potsdam, Deutschland
  • Marcel Mertz - Hannover Medical School, Institute of Ethics, History and Philosophy of Medicine, Hannover, Deutschland
  • Alexander Kremling - Martin-Luther-University Halle-Wittenberg, Institute for History and Ethics of Medicine, Halle-Wittenberg, Deutschland
  • Sebastian Schleidgen - FernUniversität Hagen, Institute for Philosophy, Hagen, Deutschland
  • Julia Inthorn - Protestant Academy Loccum Hannover, Centre for Health Ethics, Hannover, Deutschland
  • Katja Kühlmeyer - Ludwig-Maximilians-University Munich, Institute of Ethics, History and Theory of Medicine, Munich, Deutschland

Gesundheit und Klima – EbM für die Zukunft. 24. Jahrestagung des Netzwerks Evidenzbasierte Medizin. Potsdam, 22.-24.03.2023. Düsseldorf: German Medical Science GMS Publishing House; 2023. Doc23ebmV1-03

doi: 10.3205/23ebm003, urn:nbn:de:0183-23ebm0031

Veröffentlicht: 21. März 2023

© 2023 Haltaufderheide et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Background/research question: Academic publications in planetary health often entail empirically informed ethical recommendations, that is, recommendations for moral actions based in empirical knowledge and ethical thinking. These often address practitioners and policy makers. A considerable example is the Planetary Health Pledge for Health Professionals in the Anthropocene [1]. However, how these and other recommendations are derived from empirical evidence and value assumptions is often far from clear and has led to heated debates [2]. Against this background, this work aims at identifying weaknesses and pitfalls in the development and reporting of ethical recommendations in planetary health debates.

Methods: Based on our conceptual work about transparent reporting of so-called bridge principles in empirically informed ethical recommendations [3], we review and conceptualize arguments from the Planetary Health Pledge as exemplary instances with a special focus on the development and reporting of ethical recommendations. The ethical recommendation to respect indigenous healing practices is reviewed in greater depth. Pitfalls and potential improvements in reporting are evaluated to raise the question of future standards.

Results: The ethical recommendation to respect indigenous healing practices can be conceptualized as being based on a) empirical assumptions and b) value judgments. In deriving recommendations from these premises, the so-called is-ought gap must be bridged. Explanations as to how this gap is bridged are essential. The concept of bridge principles can be used as a simple way to aid these explanations. However, unreported implicit bridge principles are a major weakness in the reviewed debate. They, first, bear the risk of unproven, implicit and even dubious assumptions entering the recommendations. Secondly, scientific debate is hampered due to missing transparency.

Conclusion: Planetary health is an emerging field that has not yet fully agreed on reporting standards for research under this name. In case of ethical recommendations, reporting of bridge principles can inform readers and support them in understanding the relationship between empirical and normative claims in a specific recommendation. It may pave new ways for the rigorous reporting of research that has moral implications. It should be an essential part of future reporting guidelines to ensure transparency and validity of results.

Competing interests: The authors declare to have no conflict of interest.


Wabnitz KJ, Gabrysch S, Guinto R, Haines A, Herrmann M, Howard C, Potter T, Prescott SL, Redvers N. A pledge for planetary health to unite health professionals in the Anthropocene. Lancet. 2020 Nov 7;396(10261):1471-1473. DOI: 10.1016/S0140-6736(20)32039-0 Externer Link
Wiesing U. Climate change and the different roles of physicians: a critical response to "A Planetary Health Pledge for Health Professionals in the Anthropocene". Med Health Care Philos. 2022 Mar;25(1):161-164. DOI: 10.1007/s11019-021-10051-2 Externer Link
Kuehlmeyer K, Mertz M, Haltaufderheide J, Kremling A, Schleidgen S, Inthorn J. Empirical Research and Recommendations for Moral Action: A Plea for the Transparent Reporting of Bridge Principles in Public Health Research. Public Health Ethics. 2022 July;15(2):147-159. DOI: 10.1093/phe/phac002 Externer Link