The background has been divided into several sub-headings to help the reader better navigate the complexities surrounding research sustainability.

The term “sustainability” is used across a broad conversation encompassing social, environmental, and economic constructs (Browne 2022). There are however various definitions of sustainability as identified by a literature review by Moore (Moore, et al. 2017) and more recent reviews explain how the definitions around sustainability are constantly developing and emerging (Ruggerio 2021). In another paper, sustainability is defined as “meet(ing) the needs of the present without compromising the ability of future generations to meet their own needs” (Gabrielle and Cristina 2023, 429). It should be noted that this latter definition is considered “rather vague” and has been the source of considerable contention (Ravago, et al. 2015). The accepted definitions of sustainability generally describe three pillars, environmental, economic, and social. That is, processes that do not cause irreversible change to the environment, that are economically viable, and benefit society (Rodriguez, et al. 2002). Research sustainability describes research that is designed and delivered in a way that minimizes the impact and enhances the benefits environmentally, socially, culturally, and economically to the communities improved by that research (Charles Sturt University 2019).

Helping both guide and enhance research ethical review, the National Health and Medical Research Council (NHMRC) in partnership with a consortium of Australian Universities, has developed a comprehensive guidance document titled the “National Statement on Ethical Conduct in Human Research 2023.” The latest version of this document was published in mid-2023 and is the main guidance document used by HREC’s in Australia and took effect in January 2024 (NHMRC 2023). The purpose of this paper is to provide some guidance for HREC’s both in Australia and internationally, beyond what is available in the National Statement, in terms of inclusion of sustainability within the research review process. This was aided through a scoping review of the current literature with a general focus pertaining more towards a reduction in Carbon footprint as this has been more widely reported with association to medical research. However, other aspects of research sustainability such as research bias and wastage, possible exemptions as well as pollution are among those discussed.

Globally, healthcare is moving toward for-profit operational models. If instead, healthcare and health research moved to ethical economics and promoted humanistic healthcare, this would contribute to a reduced carbon footprint, reduction of the harm caused to communities, particularly those in developing countries who do not benefit from clinical trials but rather experience harm from the climate change they contribute to (Samuel 2023).

In 2015, the 2030 Agenda for Sustainable Development was adopted by United Nations Member States. This document outlined seventeen Sustainable Development Goals (SDG) to be achieved by 2030. These all relate to improving lives and protecting the environment and all depend on strong economic modelling. These elements similarly underpin the model of Doughnut Economics which is being implemented by many businesses and communities and is a good fit for research sustainability (Raworth 2017).

Despite all the research, evidence, and strategies, there are circumstances when aspects of research sustainability may have a diminished priority and may need possible exemption. An example of this occurred during the COVID pandemic. The latter had a short-term positive impact on CO2 emissions and air quality with fewer cars on the road, planes in the air, and most factories temporarily closed. However, the large number of single-use personal protective equipment (PPE) required, estimated globally to be 129 billion facemasks and 65 billion gloves each month, the haphazard disposal of these, and the significant volume of hospital waste generated, raised important questions about safe waste management, possible pollution, and eliminated gains within the broader construct of sustainability (NSW Health 2020).

Within the global medical research landscape, Australia is perceived as a world stakeholder in medical research and has invested heavily with billions of dollars being allocated through various sources including government contributions such as the Medical Research Future Fund (Department of Health and Aged Care 2023) as well as industry sponsored investment. Most of this research undergoes some form of ethical review via Human Research Ethics Committees (HREC).

Western Sydney Local Health District (WSLHD) is a large state-based (New South Wales) provider of health-related services to 1.5 million of the Sydney population. Additionally, it hosts a substantial medical research and governance portfolio including a large HREC which has acknowledged the imperative of incorporating the concept of research sustainability within its decision-making process.

Ethical review of human research is generally seen to have a positive effect on research outcomes but not without criticism which often relates to delays in approval of studies which can be viewed as obstructionist (Martinez 2023). Nevertheless, this paper attempts to advocate that Human Ethics and Institutional Review Boards should include as an additional consideration the concepts of sustainability within their remit when approving research.

Although sustainability is always present in the background of contemporary scholarship and research, literature which examines the interconnections, discourses, and dimensions of sustainability in research is still being developed and requires further investigation. There is however agreement that sustainability and ethics bisect in terms of societal values, morals, and norms (Walsh et al. 2021).

The quality of each project should be considered from the ethical and research sustainability perspective to ensure robust, efficiently run projects, which will also show improved health outcomes. The research sustainability of projects can be improved and assessed using the 4Rs Reduce, Reuse, Recycle, Replace. Considering the volume of research projects undertaken globally, single ethics review, approval across multiple sites, using platform or umbrella designs, and creating tiered review pathways based on risk profiles are all steps towards sustainable research (Glasziou, et al. 2021).

All medical research has a carbon footprint even if the results are not published. Human research relies heavily on data and digital infrastructure to store, manage, and analyse the data generated by research. Digital infrastructure has a rapidly expanding impact on carbon emissions worldwide. Artificial Intelligence (AI) is doubling its thirst for digital data every three to four months, and is therefore outpacing efficiency, while at the same time increasing waste, toxins, and environmental damage. The digital sector is calculated to contribute between 2.1 per cent and 3.9 per cent of global carbon emissions (Samuel 2023). Medical research is a small portion of all digital technology, but it is also the fastest-growing sector with increasingly significant impact over time (NIHR 2019). The carbon footprint of healthcare in Australia for example, represents approximately 7 per cent of the country’s total, which is significant (NSW Health 2022).

Reducing the carbon footprint of healthcare relies on evidence-based strategies developed from sustainably conducted research. It has been well documented that pollution from solid waste and emissions negatively effects both acute and chronic health outcomes. This has led the same authors to suggest that the way forward is to apply Health System Science frameworks to sustainability stewardship. This includes the core domains of structure/process, policy/economics, information/technology, determinants of health, value, and system improvements (Sood and Teherani 2022). Other authors suggest that research sustainability should be viewed in terms of scientific quality, social value (including environmental), respect for persons, communities and the environment, justice and favourable benefit to risk ratios (Gabrielle and Cristina 2023). Walsh and colleagues (2021) on the other hand, considers sustainability in terms of ontology, epistemology, and the ethical stance of what is morally good, bad, right, and wrong. These authors identify three key relational concepts to ethics sustainability, namely, ecocentrism (ecology), biocentrism (biology), and anthropocentrism (humanity).