Reimagining research ethics to include environmental sustainability: a principled approach, including a case study of data-driven health research

Consideration of Sustainability When Approving Human Medical Research-A Scoping Review

This article attempts to highlight the importance of including research sustainability as imperative when assessing human medical research in terms of ethical principles. Using a scoping review of recent literature, the complexity of research sustainability is highlighted with key themes and concepts surrounding this important topic being recognized and discussed. An overall paucity of guidance documents was identified and recommendations have been made to practically address this deficiency. An example of a research sustainability evaluation tool which is currently being piloted has been provided for possible adaptation and use by Ethics Committees and Institutional Review Boards to bolster the concept and inclusion of sustainability during the research approval process.

Defending and Defining Environmental Responsibilities for the Health Research Sector

Six planetary boundaries have already been exceeded, including climate change, loss of biodiversity, chemical pollution, and land-system change. The health research sector contributes to the environmental crisis we are facing, though to a lesser extent than healthcare or agriculture sectors. It could take steps to reduce its environmental impact but generally has not done so, even as the planetary emergency worsens. So far, the normative case for why the health research sector should rectify that failure has not been made. This paper argues strong philosophical grounds, derived from theories of health and social justice, exist to support the claim that the sector has a duty to avoid or minimise causing or contributing to ecological harms that threaten human health or worsen health inequity. The paper next develops ideas about the duty's content, explaining why it should entail more than reducing carbon emissions, and considers what limits might be placed on the duty.

Physicians' duty to climate protection as an expression of their professional identity: a defence from Korsgaard's neo-Kantian moral framework

The medical profession is observing a rising number of calls to action considering the threat that climate change poses to global human health. Theory-led bioethical analyses of the scope and weight of physicians' normative duty towards climate protection and its conflict with individual patient care are currently scarce. This article offers an analysis of the normative issues at stake by using Korsgaard's neo-Kantian moral account of practical identities. We begin by showing the case of physicians' duty to climate protection, before we succinctly introduce Korsgaard's account. We subsequently show how the duty to climate protection can follow from physicians' identity of being a healthcare professional. We structure conflicts between individual patient care and climate protection, and show how a transformation in physicians' professional ethos is possible and what mechanisms could be used for doing so. An important limit of our analysis is that we mainly address the level of individual physicians and their practical identities, leaving out important measures to respond to climate change at the mesolevels and macrolevels of healthcare institutions and systems, respectively.

Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research

BACKGROUND

The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022.

METHODS

The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, research ethics committee members and other actors to engage with challenges and opportunities specifically related to research ethics. In 2022 the focus of the GFBR was "Ethics of AI in Global Health Research". The forum consisted of 6 case study presentations, 16 governance presentations, and a series of small group and large group discussions. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. In this paper, we highlight central insights arising from GFBR 2022.

RESULTS

We describe the significance of four thematic insights arising from the forum: (1) Appropriateness of building AI, (2) Transferability of AI systems, (3) Accountability for AI decision-making and outcomes, and (4) Individual consent. We then describe eight recommendations for governance leaders to enhance the ethical governance of AI in global health research, addressing issues such as AI impact assessments, environmental values, and fair partnerships.

CONCLUSIONS

The 2022 Global Forum on Bioethics in Research illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.

Health psychology and climate change: time to address humanity's most existential crisis

Climate change is an ongoing and escalating health emergency. It threatens the health and wellbeing of billions of people, through extreme weather events, displacement, food insecurity, pathogenic diseases, societal destabilisation, and armed conflict. Climate change dwarfs all other challenges studied by health psychologists. The greenhouse gas emissions driving climate change disproportionately originate from the actions of wealthy populations in the Global North and are tied to excessive energy use and overconsumption driven by the pursuit of economic growth. Addressing this crisis requires significant societal transformations and individual behaviour change. Most of these changes will benefit not only the stability of the climate but will yield significant public health co-benefits. Because of their unique expertise and skills, health psychologists are urgently needed in crafting climate change mitigation responses. We propose specific ways in which health psychologists at all career stages can contribute, within the spheres of research, teaching, and policy making, and within organisations and as private citizens. As health psychologists, we cannot sit back and leave climate change to climate scientists. Climate change is a health emergency that results from human behaviour; hence it is in our power and responsibility to address it.

How can we reduce biomedical research's carbon footprint?

Biomedical research is a significant contributor to the global carbon footprint. Practices are available that could make a difference; however, there are significant obstacles ahead, including a lack of specialist expertise in sustainable research practices.

UK health researchers' considerations of the environmental impacts of their data-intensive practices and its relevance to health inequities

BACKGROUND

The health sector aims to improve health outcomes and access to healthcare. At the same time, the sector relies on unsustainable environmental practices that are increasingly recognised to be catastrophic threats to human health and health inequities. As such, a moral imperative exists for the sector to address these practices. While strides are currently underway to mitigate the environmental impacts of healthcare, less is known about how health researchers are addressing these issues, if at all.

METHODS

This paper uses an interview methodology to explore the attitudes of UK health researchers using data-intensive methodologies about the adverse environmental impacts of their practices, and how they view the importance of these considerations within wider health goals.

RESULTS

Interviews with 26 researchers showed that participants wanted to address the environmental and related health harms associated with their research and they reflected on how they could do so in alignment with their own research goals. However, when tensions emerged, their own research was prioritised. This was related to their own desires as researchers and driven by the broader socio-political context of their research endeavours.

CONCLUSION

To help mitigate the environmental and health harms associated with data-intensive health research, the socio-political context of research culture must be addressed.

Drivers and constraints to environmental sustainability in UK-based biobanking: balancing resource efficiency and future value

BACKGROUND

Biobanks are a key aspect of healthcare research; they enable access to a wide range of heterogenous samples and data, as well as saving individual researchers time and funds on the collection, storage and/or curation of such resources. However, biobanks are also associated with impacts associated with a depletion of natural resources (energy, water etc.) production of toxic chemicals during manufacturing of laboratory equipment, and effects on biodiversity. We wanted to better understand the biobanking sector in the UK as a first step to assessing the environmental impacts of UK biobanking.

METHODS

We explored the sample storage infrastructure and environmental sustainability practices at a number of UK biobanks through a mixed methods quantitative and qualitative approach, including information gathering on an online platform, and eight in-depth interviews.

RESULTS

Environmental sustainability was deprioritised behind biobanks' financial sustainability practices. Nevertheless, both often aligned in practice. However, there was a tendency towards underutilisation of stored samples, the avoidance of centralisation, and providing accessibility to biosamples, and this conflicted with valuing sustainability goals. This related to notions of individualised and competitive biobanking culture. Furthermore, the study raised how value attachments to biosamples overshadows needs for both financial and environmental sustainability concerns.

CONCLUSIONS

We need to move away from individualised and competitive biobanking cultures towards a realisation that the health of the publics and patients should be first and foremost. We need to ensure the use of biosamples, ahead of their storage ('smart attachments'), align with environmental sustainability goals and participants' donation wishes for biosample use.

GREENER principles for environmentally sustainable computational science

The carbon footprint of scientific computing is substantial, but environmentally sustainable computational science (ESCS) is a nascent field with many opportunities to thrive. To realize the immense green opportunities and continued, yet sustainable, growth of computer science, we must take a coordinated approach to our current challenges, including greater awareness and transparency, improved estimation and wider reporting of environmental impacts. Here, we present a snapshot of where ESCS stands today and introduce the GREENER set of principles, as well as guidance for best practices moving forward.