Globally, healthcare is a major source of greenhouse gas emissions, intensifying the ongoing climate emergency. While strategies to cut emissions are being introduced across health systems, the degree to which environmental sustainability should influence clinical decision-making at the level of individual practitioners remains uncertain. To investigate this question, we carried out a systematic review of published arguments both supporting and opposing the integration of environmental considerations into clinical choices. PubMed was used as the main database, with additional citation searches performed through Web of Science and reference lists. Data were analyzed qualitatively using Kuckartz’s combined deductive–inductive framework, and reporting followed the RESERVE guideline. Twenty-three articles met inclusion criteria and were examined in detail. Arguments were initially organized using Beauchamp and Childress’s four principles—autonomy, beneficence, non-maleficence, and justice. From the material, new categories also surfaced: adapted notions of autonomy and non-maleficence, environmental justice, professional responsibility, politicization, reasons tied to different levels of decision-making, and miscellaneous considerations. The review revealed that the discussion remains underdeveloped and largely shaped by perspectives from wealthier nations, with voices from low- and middle-income contexts largely absent. Several arguments reflected a shift from an individualistic to a more collective framing of ethical principles. Moreover, the findings underscored the interdependence between individual clinical decisions and broader systemic responsibilities in addressing climate change. Our analysis suggests that established bioethical principles may be undergoing reinterpretation in light of environmental concerns, though such shifts are not yet widely reflected in professional standards or codes of conduct. The review may assist healthcare providers, decision-makers, and patients in articulating their own views, while highlighting the urgent need to incorporate perspectives from low- and middle-income regions.
