Precision medicine is a field of future promise. Its imaginary is that ‘health data saves lives’. But which lives and at what costs? In this position piece, we direct attention to how non-imagination (Prainsack 2022) operates in the field of precision medicine. We argue that central actors in the field, along with social scientists researching it, non-imagine the relevance of environmental collapse to the pursuit of precision medicine, despite its huge energy consumption and focus on prolonging human lives in places that contribute the most to climate change. This non-imagination raises questions about how we as medical anthropologists approach and theorise the ‘life politics’ at the centre of anthropological studies of the life sciences. In light of the current ecological peril, we advocate for extending the discipline’s focus from the governance of life in politics, labs, and clinics to the governance of ‘earth-life’.