Does clinical ethics need a Land Ethic?

A clinical ethics fit for the Anthropocene-our current geological era in which human activity is the primary determinant of environmental change-needs to incorporate environmental ethics to be fit for clinical practice. Conservationist Aldo Leopold's essay 'The Land Ethic' is probably the most widely-cited source in environmental philosophy; but Leopold's work, and environmental ethics generally, has made little impression on clinical ethics. The Land Ethic holds that "A thing is right when it tends to preserve the integrity, stability, and beauty of the biotic community. It is wrong when it tends otherwise." I argue that a Land Ethic helps to re-frame problems in clinical ethics that more common philosophical approaches struggle to handle, and that it can be incorporated into clinical ethics without succumbing to "environmental fascism". I motivate viewing problems in clinical ethics from the perspective of the 'integrity of the biotic community', then illustrate how this perspective can offer guidance where more commonly-invoked theories-such as consequentialism and Kantian-inspired approaches-struggle, using antimicrobial resistance in nosocomial infection as a case study. The Land Ethic equips us to understand human values as arising within and inseparable from a social-ecological context, and by treating communities (both human and biotic) as valuable in themselves rather than just through the aggregate welfare of their individual participants, we can avoid problems with the 'repugnant conclusion' and utility monster that plague utilitarian accounts.