**4. Medical model of disease**

One approach to understanding climate change is that of the medical model of disease. This model assesses how several risk factors and causative triggers interact to produce a "disease" characterized by specific pathology that presents with a combination of symptoms and signs that help establish a diagnosis and suggest potential treatments [33]. This has been greatly enhanced using technology such as laboratory testing, imaging studies and genetic analyses. Agusti opines that this approach is more applicable to acute disease rather than chronic disease as chronic diseases tend to induce secondary effects and produce additional comorbidities leading to ever increasing adverse impacts on the afflicted organism. The chronic disease model integrates more risk factors and triggers that interact, (*e.g.* aging and smoking), which induce damage to several organ systems concurrently, (*e.g. c*ardiovascular and respiratory) [34]. Type two diabetes mellitus, a disease that results in elevated blood sugar, provides an example. This disease occurs from inadequate insulin production and/or insulin resistance that often leads to multiorgan dysfunction. These comorbidities include large vessel complications such as stroke and cardiovascular disease as well as microvascular complications such as nephropathy, retinopathy, and polyneuropathy. The net result is a significantly reduced quality of life, wherein the person survives but in a compromised state. To avoid these complications, the disease process must be identified, confirmed as a diagnosis, and treated as soon as practical. In the early stages of type two diabetes, the body can tolerate some excess glucose, but there is a threshold beyond which compensatory mechanisms fail and hyperglycemia begins to exert its deleterious effects. In this analogy, global temperature rise is equivalent to increasing blood sugar levels that must be identified and reduced before long-term complications arise. Restated, it is better to recognize and treat an asymptomatic person with an elevated blood sugar with oral medications than to begin aggressive high dose insulin when that person is admitted to an intensive care unit with a hyperglycemic coma. While an asymptomatic person may deny their disease's existence despite laboratory testing, it is only a matter of time before the consequences are self-evident such that denial is no longer possible. However, a person's willingness to accept a medical diagnosis, seek treatment and adhere to that treatment is highly variable between individuals and reflect cultural background, education, and acceptance of scientific principles.

George Engel MD described the biopsychosocial model of disease in which social and psychological factors have a significant impact on disease development and management [35]. For example, the Pima people in the Sonoran Desert region have one of the highest rates of diabetes on the planet [36]. Their ancestors had to adapt to an environment where nutrients were scare such that evolution favored the survival of those individuals who could extract the most calories from limited food sources. Human evolutionary biology has prioritized calorie dense foods as their consumption favored survival and subsequent reproduction such that humans will consume these foods preferentially [37]. The Pima people, who did not live in an

area conducive to intense agriculture, consumed whatever calories were available to endure episodes of relative famine, especially calorie dense foods such as animal fat. This ancient adaptive strategy became maladaptive once these people adopted a Western diet high in processed sugar and saturated fat that induced an exponential increase in the incidence of diabetes mellitus. For the Pima people, education strategies designed to limit the consumption of high calorie foods is more likely to be successful than insisting that they return to their ancestral diet. In this analogy, the modern world is unlikely to be willing to return to a pre-industrial state. Few people would be willing to eschew modern conveniences such as electricity, indoor climate control, and internal combustion engine modes of transportation. Therefore, any viable solution to climate change must integrate the realities of the Western standard of living. Just as it would not be feasible for the Pima people to resume their Pre-Colombian lifestyle, it would not be feasible to return to a pre-industrial civilization.

### **5. Origins of human civilization**

As humans evolved from primates, brain development eventually resulted in language and the ability for critical thinking. Our evolutionary history likely began as small bands or tribes of hunter-gatherers in which the individual was required to subordinate his or her immediate desires to that of the tribe's overall benefit. For example, a hunter who successfully killed an animal would benefit from its sole consumption, but that hunter's long-term survival would be threatened if the consequences were expulsion from that group. This struggle between critical thinking that resides in the cortex that accepts delayed gratification and emotional behavior residing in the limbic system favoring instant gratification has been traditionally viewed as the struggle between good and evil [38]. Therefore, it became important to define "good" or ethical behavior from "bad" or unethical behavior. Behaviors that enhanced tribal survival were more likely viewed as "good," "ethical" or "normative" thus necessitating the suppression of contrary behaviors. "Proper behavior" included deference to the tribe and the forces of nature, as natural phenomena were understood as the vicissitudes of arbitrary spirits or deities. Pre-agricultural societies such as the San people of the Kalahari Desert tended to have an egalitarian culture and a belief system that can be generally characterized as a struggle between good and evil. In such societies, subordination of the individual to the needs of the group was more likely to insure survival than individual efforts. Gender parity likely existed in which women performed the child rearing and gathering while men provided meat derived from hunting that was not invariably successful. This arrangement optimized child survival given the relatively prolonged time required for human development and dependency on others for survival. Given that such tribes were nomadic, few material possessions would be accumulated such that there were fewer disparities between the richest and poorest members of a tribe. However, this remains speculative as this occurred before recorded history.

The agricultural revolution altered this dynamic in that permanent city states arose in which food production was more reliable and a nomadic lifestyle was no longer required. Hierarchies arose in which there was a stricter division of labor, greater wealth accumulation and a need to defend the city state from neighboring tribes. This created a need for a warrior caste governed by a monarch and supported by a religious order designed to enforce the monarch's will and placate temperamental deities. This political, religious, and military aristocracy would value its members and its offspring over others. The subjugation of women likely followed

**209**

tions of modern society.

**6. Ethical constructs**

*Climate Change: A Forced Choice Ethical Paradigm DOI: http://dx.doi.org/10.5772/intechopen.95486*

combination of politicians, religious leaders and the nobility.

as it was important for an aristocratic male to ensure that his offspring were his own such that his offspring would inherit his accumulated wealth and social position. Thus, rigid rules regarding women's roles and their sexual behavior were strictly enforced. Since few labor-saving devices existed, the society's survival depended on manual labor. A shortfall in labor was likely met through indentured servants or slaves. Slavery has been widespread throughout recorded human history and did not start to diminish until after the start of the Industrial Revolution and the invention of labor-saving devices. Slaves were supplied by persons unable to pay their debts, birth into a slave family, child abandonment, war, or punishment for a crime [39]. The monarch's authority was absolute and bolstered by a religious order that would threaten divine retribution for failure to comply. In exchange, the subjects of the city-state would be protected against outsiders and the vicissitudes of temperamental deities. Expulsion from the city-state could lead to a reduced probability of survival or death at the hands of a hostile tribe. Given these alternatives and the pressure of adhere to societal norms, most subjects acquiesced to this reality. Adherence to authority, temporal and divine, was integrated into a belief system, expressed as morality, and codified into law. Although greater democratic participation has evolved, humanity still functions within a hierarchy ruled by some

The philosopher Thomas Hobbes articulated these concepts when he advocated

The Merriam Webster dictionary defines ethics as "the principles of conduct governing an individual or a group" [42]. Thus, ethics may be viewed as behavioral guidelines designed to enhance the survival of the individual and the group to which that person belongs. Implicit in this definition is that there are those within the group and those that are external to the group. Thus, the size of the "group" may range from one individual to all life forms on the planet. It is how those external to the group are treated that sets the stage for conflict. While conflict is inherent in any instance of resource scarcity, it is how conflict is resolved that determines the outcome. Many leaders invoke morality to bolster their position in such conflicts. Nonetheless, conflict resolution can be achieved by five different methods: avoidance, competition, accommodation, collaboration, and compromise [43]. These potential solutions

to climate change are discussed in the penultimate section of this chapter.

for a strong centralized authority that would prevent the expression of baser instincts in which people would stop at nothing to further their own interests including theft and murder [40]. He famously opined that existence outside a society without a rigid authority would be "nasty, brutish and short." As the son of a clergyman, Hobbes was likely familiar with the Bible and its emphasis on obedience to higher authorities. One particular passage from Genesis 1:26 has been translated as follows, "Let us make mankind in our image, in our likeness, so that they may rule over the fish in the sea and the birds in the sky, over the livestock and all the wild animals, and over all the creatures that move along the ground" [41]. One interpretation of this passage is that humans are the "in group" and that nature is available for exploitation. A more sanguine interpretation is that humans were commanded to be stewards of the earth's resources. Nonetheless, with few exceptions, modern history has been one of nature's exploitation out of proportion to conservation. If the worst outcomes of climate change are to be avoided, then it will be necessary to develop a belief system or moral code that respects nature and embraces science while accepting the reality of the political and religious founda-

#### *Climate Change: A Forced Choice Ethical Paradigm DOI: http://dx.doi.org/10.5772/intechopen.95486*

*Bioethics in Medicine and Society*

civilization.

**5. Origins of human civilization**

area conducive to intense agriculture, consumed whatever calories were available to endure episodes of relative famine, especially calorie dense foods such as animal fat. This ancient adaptive strategy became maladaptive once these people adopted a Western diet high in processed sugar and saturated fat that induced an exponential increase in the incidence of diabetes mellitus. For the Pima people, education strategies designed to limit the consumption of high calorie foods is more likely to be successful than insisting that they return to their ancestral diet. In this analogy, the modern world is unlikely to be willing to return to a pre-industrial state. Few people would be willing to eschew modern conveniences such as electricity, indoor climate control, and internal combustion engine modes of transportation. Therefore, any viable solution to climate change must integrate the realities of the Western standard of living. Just as it would not be feasible for the Pima people to resume their Pre-Colombian lifestyle, it would not be feasible to return to a pre-industrial

As humans evolved from primates, brain development eventually resulted in language and the ability for critical thinking. Our evolutionary history likely began as small bands or tribes of hunter-gatherers in which the individual was required to subordinate his or her immediate desires to that of the tribe's overall benefit. For example, a hunter who successfully killed an animal would benefit from its sole consumption, but that hunter's long-term survival would be threatened if the consequences were expulsion from that group. This struggle between critical thinking that resides in the cortex that accepts delayed gratification and emotional behavior residing in the limbic system favoring instant gratification has been traditionally viewed as the struggle between good and evil [38]. Therefore, it became important to define "good" or ethical behavior from "bad" or unethical behavior. Behaviors that enhanced tribal survival were more likely viewed as "good," "ethical" or "normative" thus necessitating the suppression of contrary behaviors. "Proper behavior" included deference to the tribe and the forces of nature, as natural phenomena were understood as the vicissitudes of arbitrary spirits or deities. Pre-agricultural societies such as the San people of the Kalahari Desert tended to have an egalitarian culture and a belief system that can be generally characterized as a struggle between good and evil. In such societies, subordination of the individual to the needs of the group was more likely to insure survival than individual efforts. Gender parity likely existed in which women performed the child rearing and gathering while men provided meat derived from hunting that was not invariably successful. This arrangement optimized child survival given the relatively prolonged time required for human development and dependency on others for survival. Given that such tribes were nomadic, few material possessions would be accumulated such that there were fewer disparities between the richest and poorest members of a tribe. However, this remains speculative as this occurred before

The agricultural revolution altered this dynamic in that permanent city states arose in which food production was more reliable and a nomadic lifestyle was no longer required. Hierarchies arose in which there was a stricter division of labor, greater wealth accumulation and a need to defend the city state from neighboring tribes. This created a need for a warrior caste governed by a monarch and supported by a religious order designed to enforce the monarch's will and placate temperamental deities. This political, religious, and military aristocracy would value its members and its offspring over others. The subjugation of women likely followed

**208**

recorded history.

as it was important for an aristocratic male to ensure that his offspring were his own such that his offspring would inherit his accumulated wealth and social position. Thus, rigid rules regarding women's roles and their sexual behavior were strictly enforced. Since few labor-saving devices existed, the society's survival depended on manual labor. A shortfall in labor was likely met through indentured servants or slaves. Slavery has been widespread throughout recorded human history and did not start to diminish until after the start of the Industrial Revolution and the invention of labor-saving devices. Slaves were supplied by persons unable to pay their debts, birth into a slave family, child abandonment, war, or punishment for a crime [39]. The monarch's authority was absolute and bolstered by a religious order that would threaten divine retribution for failure to comply. In exchange, the subjects of the city-state would be protected against outsiders and the vicissitudes of temperamental deities. Expulsion from the city-state could lead to a reduced probability of survival or death at the hands of a hostile tribe. Given these alternatives and the pressure of adhere to societal norms, most subjects acquiesced to this reality. Adherence to authority, temporal and divine, was integrated into a belief system, expressed as morality, and codified into law. Although greater democratic participation has evolved, humanity still functions within a hierarchy ruled by some combination of politicians, religious leaders and the nobility.

The philosopher Thomas Hobbes articulated these concepts when he advocated for a strong centralized authority that would prevent the expression of baser instincts in which people would stop at nothing to further their own interests including theft and murder [40]. He famously opined that existence outside a society without a rigid authority would be "nasty, brutish and short." As the son of a clergyman, Hobbes was likely familiar with the Bible and its emphasis on obedience to higher authorities. One particular passage from Genesis 1:26 has been translated as follows, "Let us make mankind in our image, in our likeness, so that they may rule over the fish in the sea and the birds in the sky, over the livestock and all the wild animals, and over all the creatures that move along the ground" [41]. One interpretation of this passage is that humans are the "in group" and that nature is available for exploitation. A more sanguine interpretation is that humans were commanded to be stewards of the earth's resources. Nonetheless, with few exceptions, modern history has been one of nature's exploitation out of proportion to conservation. If the worst outcomes of climate change are to be avoided, then it will be necessary to develop a belief system or moral code that respects nature and embraces science while accepting the reality of the political and religious foundations of modern society.
