Environmental problems are more urgent and serious than ever: climate change, air pollution, water pollution, shortages of freshwater, deforestation, over-fishing, antibiotic resistance, and more. Discussions in public health address these problems because they affect people’s health and life prospects so profoundly. In this work, we add to the discussion by exploring the ethical aspects of a case scenario that involves pollution from a coal-fired power plant. After we note how the plant contributes to pollution, we discuss ethical issues of justice and responsibility. We show how the burdens of pollution and the benefits of the activities that generate pollution are unfairly distributed in this case. We also suggest that social justice demands certain forms of respect, consideration, and participation. Then we turn to issues of responsibility. We focus on responsibilities citizens have to try to change the social structures, background conditions, economic systems, and accepted practices that underlie the problem. We also consider responsibilities that physicians have, both collectively and individually. Taking responsibility for pollution is not a matter of following a medical protocol or legal requirement. It involves creativity, judgement, and a sense of what the situation calls for.