From the biomedical model to the climate-sensitive model: A necessary adjustment for research ethics committees

Abstract

Ethics committees are not yet fully integrated into the response to climate change, whether they are national ethics committees (NECs) that issue advisory opinions or research ethics committees (RECs) that review research protocols. This article took this observation as its starting point to consider how ethics committees could support to more accurately assess the consequences of climate change on health, through a lens that focuses on the health of younger and future generations yet within the wider context of ecosystems. From November 2024 to November 2025, the R(H)OPE- The Right To An Open Future - project brought together eight partners based in six countries across four continents. An analysis of the literature and the case studies written by selected partners has led to the formulation of eight recommendations to guide ethics committees, international regulators (WHO, CIOMS, etc.) and ethicists towards adapting the biomedical model. These recommendations add intergenerational responsibility to the consideration of current intragenerational inequalities (Global Ethics) in order to preserve the right to an open future for young people and future generations.

1. The observation

While there is an urgent need to establish “an interdisciplinary ethical commitment to address the greatest threat to our health”, as already highlighted by Littler et al. in 2023 [1], ethics committees are not yet fully integrated into the response to climate change [2], whether they are national ethics committees (NECs) that issue advisory opinions or research ethics committees (RECs) that review research protocols. Even international ethics committees [3], [4], [5], [6] have so far only issued a limited number of opinions directly addressing the link between health and climate change.

2. Objective and method

The R(H)OPE project – The Right To An Open Future - took this observation as its starting point to consider how ethics committees could support to more accurately assess the consequences of climate change on health, through a lens that focuses on the health of younger and future generations yet within the wider context of ecosystems. From November 2024 to November 2025, the R(H)OPE project brought together eight partners based in six countries across four continents: Bangladesh (Bangladesh Bioethics Society); Barbados (The University of the West Indies); Belgium (Université Libre de Bruxelles; Université de Liège; Université de Mons); Côte d'Ivoire (UNESCO Chair in Bioethics, Université Alassane Ouattara, Bouaké); Mexico (National Bioethics Commission of Mexico) and the United Kingdom (Nuffield Council on Bioethics). The project involved two strands of reflection: (i) a pragmatic approach based on cases written by selected partners already facing the most dramatic consequences of climate change, and (ii) a theoretical approach focusing on the need to devise new ethical concepts and principles relevant to climate change, going beyond the biomedical model usually referred to by ethics committees. An analysis of the literature and the case studies has led to the formulation of the eight recommendations set out at the end of this article. This review was carried out jointly during the plenary meetings of the R(H)OPE consortium and at meetings organised locally by each partner, thereby ensuring that the recommendations are well-founded and grounded in practice.

3. The resources of ethics committees to respond to the health challenges of climate change

Ethics committees have valuable expertise in dealing with instances of uncertainty and lack of consensus. In many ways, they are trained to deal with conflicts of interest and need, to clarify the values at stake, and to address trade-offs based on conflicting priority values. Their mandate often includes promoting underrepresented voices and protecting populations or communities from different vulnerabilities they may suffer. In the field of research ethics, they seek to balance collective interests with those of individual research participants. NECs and RECs examine scientific and technological developments, often taking into account longer-term considerations, including the evolution of humanity and what should or should not be preserved for future generations. RECs already have been reviewing research protocols aimed at documenting the effects of climate change on health or the effectiveness of certain measures taken to address it [7], [8]. As such, not only do they witness the efforts of the scientific community to understand and address this global challenge, but also they must ensure the adequate protection of research participants from communities affected by climate change and potentially traumatised by increasingly extreme weather events. Sometimes, RECs themselves have direct experience as victims of climate change and see their own role jeopardised by extreme events that disrupt their daily activities. The same can be said for the researchers whose protocols are under ethical review. At this stage, it must be noted, however, that the integration of ethics committees into the broader response to climate change remains insufficient, particularly with regard to the points set out in our recommendations.

The R(H)OPE project posits an explanation for this shortcoming: the use of a biomedical model that generally considers risks to be generated by advances in biological and medical science itself, as well as by research practices thereby referring to the direct or indirect responsibility of research teams. Climate change goes far beyond this usual framework of responsibility in research, calling into question research ethics objectives and practices that have been widely shared in certain parts of the world for several decades. Furthermore, the relationship between climate change and health is complex and multifactorial and must be viewed from an increasingly urgent perspective, leading us to consider the current threat to the Earth's habitability if the temperature rise exceeds the 1.5 °C target and 2 °C limit set by the Paris Agreement. This perspective directly concerns younger and future generations and requires us to consider a framework that protects the overall health of human beings as well as that of non-human species and ecosystems. In order to respond adequately to what is happening, we need to reconceptualize and to transform the traditional biomedical model into a climate-sensitive model.

4. The climate-sensitive model: another way of looking at global health from the perspective of future generations

The holistic nature of health is clearly stated in the WHO's Constitution: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.^” [9]

Several conceptual models have been developed to frame the relationships between humans and what affects their lives, including the interrelationship with other humans, non-human species and their shared environments, particularly in the field of health. These models attempt to limit traditional ethnocentric and anthropocentric bias and increasingly favour holistic approaches, bringing with them specific values and ethical concepts [10]. For example, the “One Health” model owes much to the knowledge and policies put in place in response to zoonoses and epidemics, which have gradually shifted from a prevention regime to a preparedness regime; the “Eco Health” model develops a similar approach by also integrating the ideals of equitable sustainable development; finally, the “Planetary Health” model is defined as “the health of human civilisation and the state of the natural system on which it depends^”. [11] Of course, these approaches, which emphasize relationships and a holistic view, have long been present in different cultures and indigenous peoples. Our goal is to consider them in light of climate change and current health and environmental conditions.

These approaches have greatly supported an increasingly integrated understanding of the links between various forms of life and their environments. However, the R(H)OPE project's work and recommendations attempt to go beyond these models through a focus on future generations as an enabling concept. The focus extends beyond survival towards autonomy – being able to choose between several possibilities – and a recognition that power relationships must be considered. A focus on survival may mask the need to consider inequalities and disparities. This would not only jeopardise individual relationships, but also social cohesion within communities at large. In such a world all rights but the right to survive would (or will) have disappeared. Not compromising the possibility for (future) generations to exercise their rights is an idea that philosopher Joël Feinberg [12] developed under the term “right to an open future”, a term that was subsequently mobilised in the field of genetics. Building on Feinberg's work, the R(H)OPE project uses the “right to an open future” as an ethical matrix that highlights the responsibility of the current generation in combating the reduction of moral possibilities that climate change implies for the practices of younger and future generations. More recently, this idea that a degraded world could jeopardise the possibility of making moral choices has been developed by Stephen M. Gardiner [13]. This ethical matrix serves to guide ethical concerns linking the health of future generations and the effects of climate change. This framework can also serve as an “ethical test” for assessments carried out by ethics committees: for example, by acting or allowing something to happen in a certain way, are we producing consequences that reduce opportunities or, on the contrary, increase or enrich them for future generations?

5. Eight recommendations for research ethics committees based on the climate-sensitive model

Drawing on an analysis of case studies and relevant literature,the R(H)OPE project has formulated several recommendations to guide ethics committees (particularly RECs), international regulators (WHO, CIOMS, etc.) and ethicists in adapting the biomedical model. These recommendations address how the biomedical model has influenced both the functioning of RECs and the process of ethics review. Notably the recommendations emphasize the inclusion of intergenerational responsibility alongside current consideration of intragenerational inequalities (Global Ethics) to safeguard the right to an open future for young people and future generations.

Some of the points set out in the recommendations may also be useful for any public health research aiming to use a climate-sensitive model (such as community-based participatory research, environmental epidemiology research, etc.).

Adapting the Composition, Training and role of RECs

• 1.REC members must urgently receive additional training on climate change and health, as well as on mitigation and adaptation measures.
• 2.One or more additional member(s) with specific expertise in climate and health, as well as in mitigating the ecological cost of research must be included in RECs.
• 3.To promote awareness as a first step, RECs must engage in a conversation with the research teams on (1) potential adaptations of the research setting, both to reduce Greenhouse gas emissions and (2) to discuss impacts for the future, in the “right to an open future”.

Adapting the Ethics Review Process

• 4.When more knowledge about the methodologies for limiting Greenhouse gas emissions in research (including outside clinical trials) will be available, the ecological cost of research must be integrated into the RECs' ethical assessment of the social value of a given research protocol. The “right to an open future” framework should be used to guide ethical deliberation.
• 5.RECs must assess structurally potential climate vulnerability in research participants and communities where the research is conducted, including mental health. This assessment must go beyond the individual participants to include the community and the Milieu as the relevant unit, one that is moral and relational. Relevant protective measures must be requested from the research teams, either as modifications to the protocol (including to avoid secondary victimisation and mental health consequences), or as part of ancillary care (according to the research possibilities).
• 6.Epistemic diversity must be promoted by research teams and RECs, in particular to identify climate vulnerabilities associated with research activities. Information must be obtained fairly from the communities, respecting cultural context, and citizens' contributions must be equitably recognised in the results and publication of research.
• 7.RECs should go beyond ‘disaster ethics’, which is generally a ‘post hoc’ approach. When the working conditions or the physical or mental health of participants and researchers may be affected by the impacts of climate change, REC must request that provisions and procedures be systematically established in anticipation of extreme weather events, including mental health support for communities and researchers. This should be mandatory for all clinical trials involving investigational medicinal products, which must remain available under all circumstances. This would involve a new type of risk assessment covering the safety of participants as well as that of researchers.
• 8.Where appropriate, RECs must liaise with NECs (i) to inform and shape the agenda of research programmes, so that the underlying consequences of climate change, particularly on mental health, are better documented, and (ii) to raise awareness among society and policymakers about climate change and its consequences for young people and future generations beyond the realm of research.

6. Conclusion

These recommendations provide a basis for enriching the biomedical model by rendering it more sensitive to the links between climate change and health. While research ethics committees focus primarily on human health, this scope of concern must be broadened to include the health of other forms of life and ecosystems. This expansion requires the addition of further recommendations, an approach that should incorporate and complement the current results of the R(H)OPE project. Indeed, any research that requires moving beyond a short-term, individualistic and anthropocentric perspective can benefit from these recommendations. National and research ethics committees play a crucial role in health governance to ensure that the response to climate change is ethically informed and calibrated. For these committees to continue to produce relevant ethical reflection and assessment of the effects of climate change on health in general and in research protocols in particular, it is imperative not only that the biomedical model be revised to become a climate-sensitive model, but also that the conditions for ethical considerations and behaviour in human relations and, beyond that, within and towards other forms of life, be preserved. Preserving this ethical dimension is at the heart of the “right to an open future”.

Copyright

In the original work on which this article is based belongs to the WHO. The authors have been given permission to publish this article. The author(s) alone is/are responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of the WHO.

CRediT authorship contribution statement

Marie-Geneviève Pinsart: Writing – original draft. Virginie Pirard: Writing – review & editing. Florence Caeymaex: Writing – review & editing. Katrin Solhdju: Writing – review & editing. Sarah Cunnigham-Burley: Writing – review & editing. Maili C. Raven-Adams: Writing – review & editing. Patricio Santillan-Doherty: Writing – review & editing. Michael H. Campbell: Writing – review & editing. Lazare Poame: Writing – review & editing. Shamima Lasker: Writing – review & editing.

Funding

This study was commissioned and paid for by the World Health Organisation (WHO).

Declaration of competing interest

As the principal coordinator of the R(H)OPE consortium, I declare that I have no conflict of interest regarding the content of this publication and its submission to Dialogue in Health.

The members of the R(H)OPE consortium declare that they have no conflicts of interest.