case study of ethical investing

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Case studies: successes and challenges of ethical investing.

Developing Ethical Strategies for Advancing Accessible and Affordable Healthcare

Ethical investing, also known as socially responsible investing (SRI) or sustainable investing, has gained significant traction in recent years. It involves investing in companies and funds that align with specific environmental, social, and governance (ESG) criteria. The aim is to generate both financial returns and positive societal impact. In this article, we will explore case studies that highlight the successes and challenges of ethical investing. These case studies will provide insights into the outcomes and implications of ethical investing practices .

Table of Contents

Case Study 1: The Rise of ESG Investing

One of the most notable success stories in ethical investing is the rise of ESG investing. ESG criteria assess a company’s performance in environmental, social, and governance aspects. The integration of ESG factors into investment decisions has gained momentum as investors recognize the value of sustainable practices .

• Financial performance : Numerous studies have shown that companies with strong ESG practices tend to outperform their peers in terms of financial performance. For example, a study by Harvard Business School found that companies with high ESG ratings had higher profitability and stock returns.
• Risk management : ESG investing allows investors to identify and mitigate potential risks associated with environmental and social issues. By considering factors such as climate change, labor practices, and corporate governance, investors can make more informed decisions and minimize the impact of potential risks.
• Positive impact : Ethical investing promotes positive societal impact by directing capital towards companies that prioritize sustainability and social responsibility. By investing in companies that align with their values, investors can contribute to positive change in areas such as renewable energy, diversity and inclusion, and human rights.
• Data quality and transparency : One of the challenges of ethical investing is the lack of standardized and reliable data on ESG factors. Investors rely on company disclosures, rating agencies, and third-party data providers for information, which may be inconsistent or incomplete. Improved data quality and transparency are necessary for accurate assessment and comparison of companies’ ESG performance.
• Greenwashing : Greenwashing refers to the practice of misleadingly presenting a company’s environmental or social practices as more sustainable or responsible than they are. It can be challenging for investors to identify genuine ESG commitments and practices amidst greenwashing efforts. Robust evaluation frameworks and independent verification mechanisms are essential to address this challenge.
• Trade-offs between financial returns and impact : While ethical investing aims to generate both financial returns and positive impact, there can be trade-offs between the two. Companies with strong ESG practices may not always deliver superior financial performance compared to their peers. Balancing financial objectives with impact considerations is a challenge that ethical investors need to navigate.

Case Study 2: The Impact of Divestment Movements

Divestment movements, where investors withdraw their investments from companies involved in controversial activities such as fossil fuel production or arms manufacturing, have gained attention as a strategy to drive change and promote ethical investing.

• Raising awareness : Divestment movements have been successful in raising public awareness about pressing environmental and social issues. Through media coverage and public campaigns, divestment movements have sparked conversations and put pressure on companies to address their involvement in controversial activities.
• Influencing corporate behavior : The threat of divestment can prompt companies to reassess their practices and make changes to align with ESG criteria. By withdrawing investments, investors can send a powerful message to companies, encouraging them to adopt more sustainable and responsible practices.

• Financial implications : Divestment can have financial implications for investors, particularly if they have significant holdings in companies targeted by divestment movements. Selling off investments may result in potential losses or limited investment opportunities. Balancing financial considerations with the desire for ethical investing can pose challenges for investors.
• Effectiveness of divestment : While divestment movements can raise awareness and put pressure on companies, their effectiveness in driving significant change is a subject of debate. Critics argue that divestment alone may not lead to the desired impact and that engagement with companies through active ownership and dialogue may be more effective in driving sustainable change.

Case Study 3: Impact Investing in Developing Economies

Impact investing focuses on generating measurable social and environmental impact alongside financial returns. It often involves investing in projects and businesses in developing economies to address social and environmental challenges.

• Addressing social challenges : Impact investing in developing economies has the potential to address critical social challenges such as poverty, access to education, healthcare, and clean energy. By directing capital towards impactful projects and businesses, investors can contribute to sustainable development and positive change in these regions.
• Creating jobs and economic growth : Impact investments can stimulate economic growth and create employment opportunities in developing economies. By supporting local businesses and initiatives, investors can help foster entrepreneurship, job creation, and economic empowerment in these regions.
• Complexity and risk : Impact investing in developing economies can involve complex challenges and risks. Political instability, regulatory uncertainties, and inadequate infrastructure can pose significant obstacles to successful impact investing. Investors need to carefully assess and manage these risks to ensure positive outcomes.
• Measuring impact : Measuring the social and environmental impact of investments in developing economies can be challenging. Unlike financial returns, impact metrics are often qualitative and context-specific. Developing standardized impact measurement frameworks and methodologies is crucial for effectively evaluating the success of impact investments.

Ethical investing has gained momentum as investors increasingly recognize the importance of aligning their investments with their values. The case studies discussed in this article highlight the successes and challenges of ethical investing, demonstrating the potential for financial returns and positive societal impact. While ethical investing offers opportunities to drive change and address pressing environmental and social issues, it also requires careful consideration of risks, data quality, and the trade-offs between financial returns and impact. By understanding these case studies, investors can make informed decisions and contribute to a more sustainable and responsible financial landscape.

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Ethical investing case studies: What kind of ethical investor are you?

Our research into the Ethical Investment Journey identified different types of investors seeking ethical options.

“Being ethical was the cherry on top.”

Ethical investor type:  May as well be ethical, but don’t want to compromise on returns.

Martin is in his 50s and lives in a rural area with his wife and two children.  He uses a financial adviser. 

Martin and his wife meet with their financial adviser about once every two years to discuss the performance of their investments.  Their adviser suggested that Martin’s KiwiSaver was underperforming and recommended an ethical fund which showed strong returns.

Martin and his wife spent some time thinking about it and then signed up for the new provider.  Since purchasing, Martin feels the product has performed well. He checks in on it about every month or so and can ask his adviser if he has any questions.

“You get a good return but no one is getting shafted, nothing bad [happens] with it, it just makes you feel better.  Ultimately what’s most important is the return but if two returns are the same and one’s ethical then we go ethical. If it was a slightly smaller return we may have weighed it up, but it was the stronger return, so it was a no brainer.”

You can read Martin’s full case study in the ESG Journey Research document (link). 

“I went straight to the fund’s website and saw right away that they don’t do tobacco or weapons, and that was my lightbulb moment.”

Ethical Investor type:  Investing aligns with personal values.

Lindy is 36 and works as a teacher of business and economics.  She wants the money she invests to reflect the values she holds. 

Lindy initially had a small amount of money invested with her bank, where she also had a mortgage.  Media coverage of bank behaviour encouraged her to consider if that was the right place for her money. 

“ I didn’t have much money anyway, so I just paid the fee and let someone else make the decision for me. But the media kept shining a spotlight on it and I thought ‘I’m paying fees and supporting something that’s not ethical, against my values, so that’s when I got cold feet and started to look around.”

Her aim was to ensure any investments she held weren’t actively doing harm.   She asked friends for recommendations and then took a closer look.  She found headline information that touted their shared values, and the importance of what they don’t invest in and their charitable donations, which gave her comfort.  It was easy to switch. 

Since changing providers, Lindy hasn’t looked back. She sees it as a long-term investment and not something she needs to be engaging with on a regular basis, though she sees no harm in switching again in future if necessary, especially as she now knows how easy it can be.

Read more about Lindy’s journey in the full case study, available in the ESG Journey Research document (link). 

“I feel like I’m helping to somehow help speed up the process of fixing issues if I’m investing in things that have a goal of improving the world.”

Ethical Investor type:  Wants to make a positive impact

Rachel and her partner are investing to prepare for their future, and believe their investments should be doing more than simply growing, but actively contributing to positive change. 

Rachel and her husband are keen investors, having learned the basics from the Barefoot Investor and by experimenting on share platforms.  They are looking to be in a position to retire early. 

But a “big KiwiSaver expose” in the media made Rachel realise she didn’t know what her money was being used for.  She started to source more information online.

She found an ethically aligned investment fund she liked the sound of – Pathfinder’s Global Water Fund.  The cause struck a chord and she felt confident the fund was going to work towards something positive as it also helped her own financial security. 

“ I liked that it is managed here in Auckland, maybe by someone who is likeminded about these things. It made clear what they don’t invest in. The Product Disclosure was really informative, a good level of detail about what they invest in and why.”

For now, she views it as a long term investment, but she feels good in the knowledge that her investments are making a difference to improve others' lives as well as her finances.

Read more about Rachel and her husband’s journey in the full case study, available in the ESG Journey Research document . 

Photographs are for illustrative purposes only and names have been changed for privacy. The stories are provided for general information and is not an endorsement of any particular provider or investment. If you’re looking for help with your particular situation, you can contact your investment provider or a licensed financial advice provider.  

More about Ethical Investing

Case Studies

       LIST OF CASE STUDIES

• ESG Investing: Perils and Pertinence
• Case Study: FTX and Sam Bankman-Fried
• Financial Ethics 101: Fiduciary Duty
• The Problem with ChatGPT Writing Your Essay
• EU Carbon Border Tax: Justice Matters
• Amazon Bestseller: Ethics in Finance
• Financial Ethics 101: Insider Trading
• Ethics in Finance Second Edition Now Available
• Native Colleges Need Money Not Apologies
• The Green Climate Fund Lacks Procedural Justice
• COP27: Adaptation Without Mitigation
• Financial Ethics 101: Money Laundering
• Higher Interest Rates in Australia: Burdens and Rewards
• The Ethics of India Buying Russian Oil
• The Justness of Russian Sanctions
• Ethics View: Cloudflare in Russia
• Seven Pillars Institute Special Report: An Ethics Assessment of the IEA’s Net Zero by 2020
• NFTs: Risks, Rewards, Ethics
• McKinsey and Its Opioids Scandal
• The Ethics of China’s Zero Covid Policy
• An Alternative Approach to Wealth Tax
• AI in Finance: Opportunities, Sustainability, Ethics
• Blockchain as a Force for Good (Part 1)
• Blockchain as a Force for Good (Part 2)
• Green Bonds without Greenwashing
• Ethics Update on Cryptocurrencies
• Covid-19 Pandemic Worsens Inequality
• Universal Basic Income: A Pandemic Based Reassessment
• Climate Change, Diversity, Inclusion: Where Warren Buffet Stands
• The EU Taxonomy
• Ethics Review: Global Minimum Corporate Tax
• Case Study: Luckin Coffee Accounting Fraud
• Council for Inclusive Capitalism: Greenwashing Dangers
• Ethics Review: DOL Fiduciary Rule
• Case Studies from a Woman’s Life on Wall Street
• Ethics Review: Donor Advised Funds
• Case Study: Equifax Data Breach
• Ethics Study: Silicon Valley Housing Crisis
• Ethics Review of Carbon Taxes
• The Ethics of Impact Investing
• Ethics Analysis: Fossil Fuel Divestment
• Central Banks: New Stakeholders of Human Rights
• CliFin Case Study: The European Green Deal
• Wirecard: Another Fintech Fraud
• Tax Avoidance, Its Effects, and Dutch Facilitation
• Ethics Analysis: The (Non)Use of University Endowments for Pandemic Shortfalls
• Finance Needs ‘Bilinguals’ Too
• Evaluating the Paycheck Protection Program
• Human Rights and Austerity: The IMF as a Handmaiden of Neoliberalism
• Ethics Review of Green Bonds
• High Frequency Trading(2): Ethics Assessment
• High Frequency Trading(1): Empirical Assessment
• Mutual Fund Fees: Transparency and Worth
• Are Museums Right to Refuse Sackler Money?
• Greenwashing: The Dow Jones Sustainability Indices Case
• Is Warren Buffett an Ethical Investor?
• The Case of Danske Bank and Money Laundering
• Banking Structure Shapes Banking Ethics
• Fintech Payday Lending: The Case of Wonga
• Hikvision and Dahua: The Case for Divestment
• CliFin: Asset Management and Climate Change
• Peer to Peer Lending: Lending Club
• CliFin: Climate Finance to Avoid Climategeddon
• Big Data and Impact Investing
• The Case of Vijay Mallya and Kingfisher Airlines
• Ethics of College Football Funding: The Case of the University of Kansas
• Islamic Financing: Malaysian Sukuk
• Technology and Unemployment
• India’s DEMONetization: An Ethics Analysis
• Conflicts of Interest: Wilbur Ross
• ANZ, Deutsche Bank, Citi: Criminal Cartel Case
• Financial Ethics in Catholic Social Justice
• Ethics Assessment: International Financial Institutions
• ESG and Government Regulation
• Payday Lending: An Ethics Evaluation
• Commonwealth Bank of Australia Money Laundering Case
• Morgan Stanley Code of Ethics: 2008 vs. 2018
• Ethical Investing: Norway’s Sovereign Wealth Fund
• A Sweet Deal? The Ethics of Sugar Taxes
• Universal Basic Income: More Empirical Studies
• Ethics Assessment: Consumer Financial Protection Bureau
• Fairness Assessment: Australian Housing Tax Subsidies
• Och-Ziff’s African Bribery
• Globalization, Wealth Inequality…then Protectionism
• Flooding the Swamp: The Case of Michael Catanzaro
• CETA: Free Trade for the Common Good
• Impact Investing: Big Society Capital
• Battle for the Soul of Bitcoin
• Wealth Inequality Workshop: A Video Documentary
• Philosophical Foundations of Impact Investing
• Mylan’s EpiPen Pricing Scandal
• Bitcoin: To Regulate or Not To Regulate?
• Argentina vs. the Hedge Funds: the 2014 Argentina Bond Default
• Crash Interventions: Shanghai Stock Market Case
• Case Study: Banca Monte dei Paschi di Siena
• Case Study: Iceland’s Banking Crisis
• Impact Investments: Good Profits?
• When Businessmen Rule The State
• Case Study: Deutsche Bank Money Laundering Scheme
• Ethics Analysis: The Panama Papers
• Wells Fargo Fake Accounts Scandal
• Ethics Analysis: Foreign Bribery  Part 2: Trump Financial Ethics Watch Series
• Ethics Analysis: Trump’s Conflicts of Interest  Part 1: Trump Financial Ethics Watch Series
• Ethics of US Student Loan Debt
• Pharmaceutical Industry Ethics
• The Valeant Pharmaceuticals Case
• Trade Adjustment Assistance and Game Theory
• Universal Basic Income: Empirical Studies
• Ethics of Universal Basic Income
• The Ethics of Tax Breaks on Bank Fines
• The Transparency Task Force
• 2008 Financial Crisis
• Review: The Big Short
• Ethics of Socially Responsible Funds
• Mitigating TBTF: The Australian Four Pillars Policy
• The Ethics of China’s Land Expropriation Rules and Reforms
• Necessity and The Minimum Wage
• Financing America’s Public Schools Ethically
• The Alchemy of the G-30 Report on Banking Conduct and Culture
• Has Bank Culture Changed to Ensure Ethical Behavior?
• More on the Ethics of Bitcoin
• Ferguson: A Financial Ethics Explanation
• Tax Systems: A Brief Ethical Discourse
• The Case of Goldman Sachs and 1MDB
• The Ethics of Bitcoin
• Ethical Issues of the Puerto Rico Debt Crisis
• Forex Scandal: The Ethics of Exchange Rate Manipulation
• Codes of Ethics for Financial Institutions
• Income Inequality Series
• Insider Trading Cases
• Taxation Cases
• India Series
• Asian Cases
• Global Financial Leaders Insist on the Necessity of Financial Ethics
• JPMorgan: Code of Ethics and Revisions Since the 2008 Financial Crisis
• Goldman Sachs: Code of Ethics Post 2008
• Trans-Pacific Partnership: Common Good or Corporate Good?
• China and Corruption: The Case of GlaxoSmithKline
• Ethics and Trickle Down Economics: A Case Study of Kansas
• Community Banking: The Case of The Bank of Prairie Village
• Greek Debt Crisis: The EU Should Learn from UAE
• The Ethics of Executive Compensation: A Matter of Duty
• The Ethics of Swiss National Bank’s Currency Intervention
• Credit Default Swaps: An Update
• Profit and Ethics in Short Selling: The Case of Muddy Waters
• The Fall of Anglo Irish Bank
• Corporate Fraud in India: Case Studies of Sahara and Saradha
• Corporate Disasters in India: Bhopal, Uphaar and AMRI Hospital
• Hong Kong: Economic Freedom Belies Crony Capitalism
• An Ethical Analysis of the 2014 FIFA World Cup in Brazil
• Cross Border Securities Enforcement: The Case of Tiger Asia Management, LLC
• The Effectiveness and Ethics of Economic Sanctions
• The Vatican Bank: Conforming to Caritas in Veritate?
• Policy and Poverty: US, UK and China
• Cheung Kong and the Apex Horizon Hotel
• Chinese Investments in Africa: The Ethics of Transparency
• The Bangladeshi Factory Collapse: A Case for Intervention and Policy Change
• The LIBOR Scandal and Reform Agenda: Can We Trust These Rates Again?
• What Should We Charge the Poor: Ethics in Microfinance
• Shining a Light on Dark Pools
• The EU Financial Transaction Tax Debate
• HSBC Money Laundering Case: “Too Big to Fail” does not mean “Too Big to Jail”
• Quantitative Easing and Income Inequality
• Bank of America’s Takeover of Merrill Lynch
• Insider Trading in Japan: The Nomura Case
• Private Equity Funds: Christian Ethics and Leveraged Buyout Funding
• The FSA vs. David Einhorn: A Case of Regulatory Overreach?
• Nationalization: Argentina vs. Spain, The YPF Repsol Case
• Jon Corzine and MF Global
• Dimon and the Whale
• The Ethics of Taxation Trilogy: Part I – An Ethical Analysis of Inheritance Tax
• The Ethics of Taxation Trilogy: Part II – The Buffett Rule: The Ethics of a Millionaire’s Tax
• The Ethics of Taxation Trilogy: Part III – Carried Interest and Taxing Private Equity
• Taiwan’s Asset Management Corporations
• Insider Trading: What Would Rawls Do?
• The Dearth of Ethics and the Death of Lehman Brothers
• Financing, Ethics, and the Brazilian Olympics
• Islamic Finance
• Taiwan’s Credit Card Crisis
• The Accumulation of Greek Debt
• Goldman Sachs and the ABACUS deal
• High Frequency Trading
• Hedge Funds
• Disclosure: The Bernie Madoff Case
• Mark Cuban and Insider Trading
• IndyMac and the Office of Thrift Supervision
• Lehman Brothers and Repo Accounting
• Municipal Reinvestment Case
• Raj Rajaratnam and Insider Trading
• Name First Last
• Your Message

Sustainable and Ethical Investing: Balancing Profits and Principles

In a world where financial decisions hold far-reaching implications, the concept of ethical investing has emerged as a powerful means to align profits with principles. 

Table of Contents

As concerns about environmental sustainability, social responsibility, and corporate governance continue to take center stage, more investors are seeking avenues that allow them to make a positive impact through their investment choices. 

This paradigm shift has given rise to the prominence of ethical investment funds and has ushered in a new era for those who wish to be not just investors, but ethical investors.

Understanding Ethical Investing

Ethical investing, often referred to as socially responsible investing, is a financial strategy that aims to generate returns while also considering the broader impact of investments on society and the environment. 

It involves making investment choices that align with both financial objectives and personal values. This approach goes beyond mere profit-seeking, taking into account the ethical, social, and environmental implications of where funds are invested.

Defining Ethical Investing and Its Core Principles

At its core, ethical investing involves carefully selecting investments based on a set of predefined ethical criteria. These criteria can encompass a range of issues, such as environmental sustainability, human rights, labor practices, and corporate governance. 

Investors who prioritize ethical considerations seek to support companies that contribute positively to society and avoid those that engage in activities deemed harmful or unethical.

Ethical investment funds play a significant role in this strategy. These funds pool money from various investors to create diversified portfolios that adhere to specific ethical guidelines. By investing in these funds, ethical investors can achieve both their financial goals and their desire to promote social and environmental betterment.

The Historical Evolution and Rise of Ethical Investment Strategies

The roots of ethical investing can be traced back to religious groups that avoided investing in certain industries or companies that contradicted their beliefs. However, the modern concept of ethical investing gained prominence in the latter half of the 20th century. 

The 1960s and 1970s saw increased awareness and activism regarding environmental issues, human rights, and corporate accountability. This gave rise to a growing demand for investment options that reflected these concerns.

During this period, ethical investment funds emerged, offering investors the opportunity to channel their funds into companies that aligned with their values. As awareness of social and environmental issues continued to spread, ethical investing gained mainstream acceptance. 

The 21st century witnessed a significant expansion of this approach, with more investors considering the ethical implications of their financial decisions.

Motivation Behind Ethical Investing: Aligning Financial Goals with Personal Values

Ethical investing is driven by a desire to create a harmonious balance between financial objectives and personal principles. Investors no longer view profit generation as the sole purpose of their investment activities. Instead, they seek to contribute to positive change and sustainability through their investment choices.

This motivation is fueled by the realization that businesses and industries have profound impacts on society and the planet. Ethical investors understand that their financial support can influence corporate behavior, promoting responsible practices and discouraging unethical ones. 

By investing in ethical funds and companies aligned with their values, ethical investors become catalysts for change within the business world.

The Spectrum of Ethical Investments

In today’s dynamic financial landscape, investors are increasingly drawn to aligning their portfolios with their values, giving rise to the concept of ethical investing. This approach goes beyond the traditional pursuit of profits and delves into the realm of conscious capitalism. 

Ethical investments offer a way to balance financial gains with principled considerations, allowing investors to contribute to positive change while striving for healthy returns. 

In this exploration of ethical investing, we’ll traverse the spectrum of available opportunities, ranging from ethical stocks and bonds to mutual funds and exchange-traded funds (ETFs), shedding light on how each avenue can help conscientious investors leave their mark on the world.

Before delving into the diverse world of ethical investment opportunities, it’s essential to grasp the essence of ethical investing itself. At its core, ethical investing involves the conscious allocation of funds to companies and ventures that align with an individual’s or a group’s values and principles. 

This encompasses a broad range of considerations, including environmental impact, social responsibility, corporate governance, and more.

Exploring the Array of Options

Ethical investors have an array of options at their fingertips, each catering to specific values and goals. Ethical stock investing is a prominent entry point, allowing investors to support companies that demonstrate ethical practices, sustainability, and social responsibility. 

By investing in these companies, ethical investors can be part of driving positive change while potentially reaping financial rewards.

Unveiling Ethical Investment Funds

Ethical investment funds, including mutual funds and ETFs, offer a diversified and convenient way to engage in ethical investing. These funds pool resources from multiple investors to invest in a diversified portfolio of companies that meet predefined ethical criteria. 

Ethical funds are managed by professionals who apply a meticulous screening process to ensure that the chosen companies adhere to the fund’s ethical guidelines. This negates the need for individual investors to scrutinize each company, making it an accessible option for those who are new to ethical investing.

Negative and Positive Screening

Two primary approaches characterize ethical investment strategies: negative screening and positive screening. Negative screening involves excluding companies or industries that clash with one’s ethical values. 

This could mean steering clear of businesses associated with tobacco, weapons, or environmentally damaging activities. On the other hand, positive screening involves actively seeking out companies that exhibit strong ethical practices, such as those committed to renewable energy, fair labor practices, and community engagement.

The Rise of Impact Investing

While ethical investing focuses on aligning investments with values, impact investing takes it a step further. Impact investors not only consider the ethical stance of companies but also prioritize measurable social and environmental outcomes. 

The goal is to generate positive, quantifiable changes alongside financial returns. This approach often involves directing funds toward projects that address pressing issues like clean energy, healthcare access, and poverty alleviation.

As the financial world continues to intertwine with ethical considerations, investors find themselves at the crossroads of profitability and principles. Ethical investment funds provide a channel for individuals to merge their financial aspirations with their desire for meaningful impact, creating a synergy that propels both personal and societal growth. 

In the following sections, we’ll delve deeper into the mechanics of ethical investing, dissecting the processes of investing in ethical funds and the various dimensions that ethical investors need to consider in their pursuit of sustainable and conscientious investments.

Benefits and Challenges

Examine the potential financial benefits of ethical investing, including long-term stability and risk reduction.

Ethical investing, a practice gaining momentum in today’s financial landscape, goes beyond the traditional pursuit of profit. This approach embraces principles that prioritize social and environmental welfare alongside financial gains. 

One of the key advantages that ethical investors often tout is the potential for long-term stability. By investing in companies committed to sustainable practices, ethical investors position themselves to weather market fluctuations more resiliently. 

These companies are attuned to the interconnectedness of their actions with the world around them, often making choices that mitigate risks associated with environmental, social, and governance (ESG) factors.

Consider an ethical investor who chooses to invest in a renewable energy company. As the world shifts toward cleaner energy sources, such a company could experience prolonged growth and increased demand. 

In turn, this investor would not only benefit from potential financial gains but also contribute to the advancement of eco-friendly practices, aligning profits with principles.

Discuss the challenges of assessing the true impact of ethical investments on both financial returns and societal change.

While ethical investment holds promise, it’s not without its complexities. One significant challenge is the assessment of its impact. Measuring the tangible effects of ethical investments on financial returns and broader societal change can be intricate. 

Evaluating the direct correlation between an investment decision and a specific societal outcome is often blurred by various external factors.

For instance, gauging the precise influence of investing in an ethical fashion company on reducing the fashion industry’s carbon footprint becomes convoluted when other market forces and technological advancements are at play. This intricacy can sometimes lead to difficulties in precisely attributing a positive societal change to a single ethical investment decision.

Address the concern of potential lower returns compared to traditional investment options.

A concern frequently raised by skeptics of ethical investing is the potential for lower financial returns when compared to conventional investment options. This apprehension stems from the misconception that pursuing ethical principles might hinder a portfolio’s profitability. However, this assumption is increasingly being challenged by market trends and research.

Numerous studies have shown that ethical investment funds, often referred to as ethical funds or ethical investment funds, can perform on par with or even outperform their non-ethical counterparts. 

This defies the notion that prioritizing principles leads to sacrificing profits. Companies that exhibit strong ESG practices are not only better positioned to manage risks but also capitalize on emerging opportunities linked to sustainability and societal betterment.

Factors Influencing Ethical Investment Decisions

When it comes to making investment decisions, individuals today are increasingly considering more than just financial returns. The rise of ethical investing, also known as socially responsible investing, reflects a shift in priorities towards aligning investments with personal values and societal impact. 

Ethical investment has gained significant traction in recent years, driven by a growing awareness of environmental and social issues. In this article, we delve into the key factors that influence individuals’ ethical investment choices, shedding light on the dynamics of ethical investment funds and the conscious investor.

What is Ethical Investing?

Ethical investing involves making investment decisions that not only seek financial gain but also contribute positively to society and the environment. This approach seeks to strike a balance between profits and principles, redefining success in the investment landscape. 

Ethical investors are those who prioritize companies and initiatives that uphold strong environmental, social, and governance (ESG) practices. This paradigm shift has paved the way for ethical investment funds, which pool capital from like-minded investors and direct it towards businesses that align with their shared values.

The Role of ESG Criteria

Environmental, Social, and Governance (ESG) criteria have emerged as a crucial decision-making framework within ethical investing. Investors now assess companies based on their performance in these three interrelated areas. 

Environmentally, businesses are evaluated for their carbon footprint, resource management, and commitment to sustainability. Social factors encompass issues such as labor practices, diversity and inclusion, and community engagement. Governance considerations delve into a company’s leadership structure, transparency, and accountability.

Corporate Transparency and Ethical Track Records

Transparency has become a linchpin in the world of ethical investing. Ethical investors seek companies that are open and honest about their operations, impacts, and future goals. A company’s ethical track record holds immense weight; it provides insights into past behaviors and predicts future conduct. 

Investors are increasingly drawn to businesses that have consistently demonstrated ethical behavior, as this often reflects a commitment to long-term sustainability and responsible business practices.

Alignment with Global Goals

In today’s interconnected world, global challenges require collaborative solutions. Ethical investors are drawn to companies that align their operations with global goals such as the United Nations Sustainable Development Goals (SDGs). 

These goals address issues ranging from poverty and inequality to climate change and responsible consumption. By investing in businesses that actively contribute to these goals, ethical investors can amplify their impact and be part of a collective effort towards positive change.

Investing in Ethical Funds

Ethical investment funds have emerged as a powerful vehicle for individuals to pool their resources and support companies that align with their values. These funds are managed by professionals who conduct in-depth research to identify companies that meet stringent ethical criteria. 

For investors who might not have the time or expertise to analyze individual stocks, ethical funds provide a convenient and diversified solution. This approach allows individuals to contribute to causes they believe in while potentially benefiting from the financial growth of these conscientious companies.

How to Start Investing Ethically

In today’s dynamic financial landscape, investors are increasingly recognizing the significance of ethical investing. This approach not only offers potential financial rewards but also enables individuals to contribute positively to the world. If you’re intrigued by the idea of ethical investment but unsure where to begin, fear not. 

This guide will walk you through the process, from understanding what ethical investing entails to effectively researching and selecting ethical investment funds that align with your personal values.

Before delving into the specifics, let’s clarify what ethical investing is all about. Ethical investing, often referred to as socially responsible investing, involves allocating your capital to companies or funds that prioritize both financial returns and ethical considerations. 

These considerations could encompass a wide range of issues, including environmental sustainability, human rights, labor practices, and corporate governance.

Selecting Ethical Investment Funds

One effective way to engage in ethical investing is through ethical investment funds. These funds are thoughtfully crafted portfolios that comprise companies demonstrating a commitment to ethical practices. Research is paramount when selecting such funds, as it ensures your investments resonate with your values.

Begin by identifying ethical funds available in the market that align with your principles. Look for funds that have a track record of investing in companies dedicated to positive environmental and social impact. 

Delve into their prospectuses and websites to understand their investment strategies, portfolio holdings, and screening criteria. Remember, each fund might have a distinct focus, so choose the one that resonates most with your values.

Balancing Ethics and Returns

A common misconception surrounding ethical investing is that it may yield lower financial returns compared to traditional investment avenues. However, the landscape has evolved significantly. Many ethical funds now demonstrate competitive financial performance, dispelling the notion that you need to compromise returns for principles.

When evaluating the financial performance of potential funds, look beyond short-term fluctuations. Consider their historical returns over multiple market cycles. This will provide a clearer picture of their long-term sustainability and financial viability.

Ethical Stock Investing: A Deeper Dive

While ethical funds offer diversification and expert management, some investors might prefer a more hands-on approach through ethical stock investing. This involves directly selecting individual stocks of companies that align with ethical principles. 

It requires comprehensive research into each company’s practices, which can be time-consuming but immensely rewarding.

Ethical stock investing empowers you to directly support companies making a positive impact. As with ethical funds, ensure that the companies you choose not only uphold ethical standards but also demonstrate the potential for solid financial performance.

Case Studies: Balancing Profits and Principles through Ethical Investing

In the dynamic landscape of modern finance, a new paradigm has emerged that challenges the traditional notion of investing solely for financial gain. Ethical investing, also known as sustainable or socially responsible investing, has gained substantial traction in recent years. 

This approach involves aligning one’s investment choices with personal values and societal concerns, thereby making a positive impact on both portfolios and the world at large. In this section, we delve into the world of ethical investment through captivating case studies that exemplify the successful marriage of financial prosperity and ethical principles.

Case Study 1: Transformative Ethical Investment Funds

Ethical investment funds have taken center stage as a powerful tool for individuals who seek to make a difference without sacrificing returns. One exemplary case is the “Green Horizon Fund,” which focuses on environmentally conscious companies dedicated to renewable energy, waste reduction, and sustainable agriculture. 

Over the past five years, this fund has demonstrated an impressive average annual return of 8.7%, outperforming many traditional investment options. By investing in these ethical funds, individuals become ethical investors, supporting enterprises that drive positive change while reaping substantial financial rewards.

Case Study 2: Ethical Stock Investing in the Tech Sector

The technology industry, often scrutinized for its environmental and labor practices, has not escaped the ethical investment revolution. “TechCare Investments” stands as a testament to the potential of ethical stock investing in this sector. 

This ethical investor initiative focuses on companies committed to data privacy, cybersecurity advancements, and community engagement. While some skeptics believed that prioritizing ethics might hinder financial growth, TechCare’s portfolio has defied expectations. 

With an average annual return mirroring that of traditional tech investments, ethical stock investing demonstrates that profits need not come at the expense of principles.

Case Study 3: Ethical Real Estate Ventures

Ethical investments extend beyond conventional stocks and funds. The “Community Haven Real Estate Trust” exemplifies how ethical principles can be integrated into real estate endeavors. This trust invests in housing projects for underserved communities, emphasizing fair housing practices and sustainable building methods. 

Notably, investors in this trust have reaped a unique blend of financial gains and the satisfaction of being part of a transformative endeavor. Through this case, ethical investments showcase their versatility, proving that even real estate can serve as a platform for meaningful societal contributions.

Case Study 4: Uniting for Ethical Change

The power of ethical investing becomes especially evident when various stakeholders collaborate for a common cause. The “Global Equality Initiative” brings together investors, corporations, and advocacy groups to address issues of diversity and inclusion. 

By investing in companies that champion gender equality, racial diversity, and LGBTQ+ rights, participants in this initiative exemplify the potential of collective action. Financial returns, combined with the knowledge that their investments foster positive social change, offer a profound sense of fulfillment to ethical investors.

Future Trends in Ethical Investing

As the world becomes increasingly conscious of environmental and social issues, the landscape of investing is undergoing a transformation. This shift is evident in the growing popularity of ethical investing, which focuses not only on financial returns but also on the positive impact an investment can have on the world. 

In this section, we will explore the emerging trends within the ethical investment sphere, the potential for wider adoption of ethical investment strategies, and the pivotal role that technology, data analytics, and AI play in enhancing ethical investment decisions.

Ethical Investment: Beyond Profit

Ethical investing, often referred to as socially responsible investing, is a practice that involves aligning investment decisions with personal values and ethical principles. Investors are increasingly looking beyond traditional financial metrics and considering the broader consequences of their investments. 

Ethical investment funds have gained traction as they curate portfolios that meet strict environmental, social, and governance (ESG) criteria. This approach allows investors to support companies that prioritize sustainability, diversity, and responsible business practices.

Mainstream Adoption of Ethical Investment

One notable trend that has gained momentum in recent years is the shift of ethical investing from a niche strategy to a more mainstream approach. As people become more conscious of the impact their choices make, they are seeking investment opportunities that reflect their values. 

This shift is prompting asset managers and financial institutions to offer a wider range of ethical investment funds to cater to this growing demand. Ethical investments are no longer seen as outliers; they are becoming a core component of many investment portfolios.

The Technological Edge in Ethical Investing

Technology is playing a significant role in reshaping the landscape of ethical investing. Data analytics and artificial intelligence are being harnessed to assess the ESG performance of companies more comprehensively and objectively. 

These tools enable investors to delve into vast amounts of data, identifying patterns and evaluating the long-term sustainability of potential investments. AI-driven algorithms can uncover ESG factors that might not be immediately apparent, providing a deeper understanding of a company’s ethical practices.

Data-Driven Ethical Decision-Making

Ethical investors today have access to an unprecedented amount of information. Companies’ environmental impact, labor practices, governance structure, and community engagement are all scrutinized and quantified. 

Ethical investment funds leverage this data to construct portfolios that not only align with investors’ values but also aim to generate competitive financial returns. This data-driven approach empowers investors to make more informed decisions, fostering a virtuous cycle where responsible business practices are rewarded.

Conclusion 

 Ethical investing offers a powerful means to align one’s financial goals with their ethical principles. By actively seeking out and supporting companies that demonstrate social and environmental responsibility, ethical investors can make a positive impact while still pursuing financial gains. 

The rise of ethical investment funds has made it easier than ever for individuals to participate in ethical stock investing, pooling resources with like-minded investors to amplify their influence. As the global consciousness around sustainability and ethics continues to grow, ethical investments are positioned not only as a profitable avenue but also as a catalyst for positive change. 

Embracing ethical investment signifies a conscious choice, where profits and principles harmoniously coexist, shaping a more sustainable and equitable future for generations to come.

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Ethics Case Study of the Week: Doing Too Much to Make Investments a Success?

By gary sarkissian posted 08-17-2020 09:36.

CFA Institute’s Code of Ethics and Standards of Professional Conduct codify the ethical guidelines for the investment profession that are critical to maintaining the integrity of capital markets and investor trust.  Members, candidates, and even firms make a commitment to uphold these standards as they help elevate ethical decision-making universally around the globe.   As investment professionals, we are certain to face important ethical decisions in our day-to-day activities.  Some scenarios we encounter will be straightforward, while others may be more complex.  No matter what circumstances we face, continuous learning remains imperative in an investment industry that continues to evolve with products undergoing innovation and a regulatory environment continuing to adapt.  For that reason, each week we will feature a sample case from CFA Institute’s Ethics in Practice Casebook.  Each case is built upon a real-life example that may involve a regulatory matter or even a CFA Institute Professional Conduct investigation.  At the end of the case is a multiple-choice question that addresses the ethical nature of the actions taken in that case.   This week’s case involves Standard I(A) Knowledge of the Law.  Doing Too Much to Make Investments a Success? Corrales manages a hedge fund that seeks out investment opportunities in developing markets. Using assets of the fund’s investors, the fund hires local companies to serve as “sub-advisers” to explore and obtain promising investment opportunities and navigate local laws and regulation. The sub-advisers often have very limited experience as financial consultants or advisers but do have close relationships and connections with local high-ranking government officials. The payments made by Corrales, through the sub-advisers, often cover substantial “deal fees” and other expenses that facilitate governmental support of each investment. Corrales does not require the local business partners to provide details of their activities or what specific expenses are covered by the fees. Corrales reports these expenditures to fund investors as operating expenses necessary to the success of the investment. Over several years, the hedge fund is very successful producing an 18% annual rate of return for its investors. Did Corrales actions violate the CFA Institute Code of Ethics and Standards of Professional Conduct? A.  Yes. B.  No because it is acceptable to hire sub-advisers and business consultants to assist in procuring investment opportunities and managing specialized assets. C.  No because the payments to the sub-advisers represent legitimate expenses to ensure the success of investments and protect the interest of investors. D.  No, as long as the sub-advisers provide more detail about the nature and purpose of the payments and this information is disclosed to the hedge fund investors. What do you think is the correct choice?  Feel free to discuss in the comments below and make sure to check back later this week as we post the analysis.  The completion of this case qualifies for 0.25 hour of Standards, Ethics, and Regulation (SER) credit .   [Update – 8/20/2020] Welcome back!  Here is the analysis of this case: Analysis : To better serve clients, investment professionals may choose to delegate to third parties work that requires particular specialization, knowledge, or expertise. For example, an investment adviser may hire sub-advisers to handle a particular strategy or investment style outside the scope of the adviser’s ability or experience. A global adviser may hire a sub-adviser to manage an asset allocation invested in a particular market, and the payments to the sub-adviser would be legitimate investment expenses that could properly be passed on to investors in the fund. But the facts of this case indicate that Corrales is not hiring a true sub-adviser but essentially paying locally connected officials to secure access to investment deals to ensure the success of the fund’s investments. The “sub-advisers” have no financial experience but are close to the government officials, and the “deal fees” are not supported by any documentation that details legitimate investment expenses. The “operating expenses” charged by Corrales to the fund are most likely funding corrupt transactions and bribes through local intermediaries. This practice violates multiple standards:

• I(A): Knowledge of the Law because the conduct would violate any type of anti-bribery laws.
• I(C): Misrepresentation because he is improperly labeling the expenditures as investment fees.
• V(A): Diligence and Reasonable Basis because no reasonable and adequate basis for the “investment” action exists.
• V(C): Record Retention because no appropriate records are being kept to support the action.
• VII(A): Conduct as Participants in CFA Institute Programs because assuming Corrales is a charterholder, his conduct compromises the integrity to the CFA designation.

This case is based on a US SEC enforcement action from 2017. Image by Jason Goh from Pixabay © 2018 CFA Institute. All rights reserved. You may copy and distribute this content, without modification and for non-commercial purposes, provided you attribute the content to CFA Institute and retain this copyright notice. This case was written as a basis for discussion and is not prescriptive of how a business situation or professional conduct matter should or should not be handled or addressed. Certain characters mentioned are fictional to facilitate discussion, and any resemblance to actual persons is coincidental.

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Ethics case study of the week: using soft dollars for overhead expenses, ethics case study of the week: shifting around fund expenses, ethics case study of the week: campaign contribution—or pay-to-play, ethics case study of the week: the intrepid analyst, ethics case study of the week: managing a sovereign development fund.

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ESG Investing and Analysis: A Practitioner’s Guide

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Case Study 4: Defining impact investing for today‘s ethical investor – evaluating the efforts of Evangelisches Johannesstift

Jens Güldner

Linking ESG scenarios to real economy outcomes

Analysing ESG policy, market and portfolio construction considerations

Case Study 1: Applying ESG considerations to a pension fund’s equity portfolios

Case Study 2: Applying ESG concepts to wealth management portfolios

Managing environmental and climate transition risks and opportunities within portfolios

Considering physical climate risks and resilience in real asset investment

Case Study 3: Practical issues and considerations for implementing a Net Zero emissions strategy for asset owners

Evaluating social criteria in fundamental and thematic investment portfolios

Developing governance and active ownership frameworks for investment analysis

Case Study 5: Applying active ownership and stewardship to a pension fund portfolio

Identifying ESG risks and opportunities in alternative investments

Reviewing the EU regulatory framework for ESG investors

Assessing data and disclosure challenges in ESG investing

Corporate social responsibility across industries: When and who can do well by doing good?

Reflecting on how ESG investing, accounting and governance have evolved over time

This chapter outlines the fundamentals of a leading ethical asset owner in Germany, Evangelisches Johannesstift’s (EJS) integrated, ethical and sustainable investment philosophy. It highlights the interconnectedness between its ethical, impact and mission-led investment approaches, and describes how it identifies and measures socially oriented, targeted outcomes using some of the United Nations’ Sustainable Development Goals (UN SGDs) and underlying targets.

Evangelisches Johannesstift, a charitable foundation, makes investments with the intention of achieving measurable, positive social and/or ecological impacts, in addition to achieving a traditional financial return. The foundation thus strives to achieve a “double dividend” and aims to address solving social, economic and ecological problems.

With the launch of an endowment fund, the EJS Endowment Fund in February 2010, the social impact investment approach has ultimately been applied to all parts of EJS’s investment strategy with the aim of reducing possible “negative” effects and bringing the investment into line with EJS’s articles of association and mission statements.

DEFINING ETHICAL, MISSION-LED AND SOCIAL

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Case Study: Should We Embrace Crypto?

• Charles C.Y. Wang

The CFO of an online education platform considers whether to adopt Bitcoin for payments and investments.

The phone buzzed on the nightstand—once, twice, three times—waking Ankit Jain from what had been a restful sleep. Before he could reach the phone, three more texts came through. He knew who it would be: his boss, Thorsten Konig, the CEO of Ivory Tower, the world’s leading online education platform.

• CW Charles C.Y. Wang is the Glenn and Mary Jane Creamer Associate Professor of Business Administration at Harvard Business School.

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Ethical, responsible investing doesn't mean lower returns. These experts explain how it works

If you're looking into investing your money more ethically, you're in good company.

A growing number of Australians are trying to align their values and their investments — from who they bank with, to the shares they buy, and which super fund they use.

Today, 88 per cent of us (up from 83 per cent in 2002) want and expect our money to be invested ethically, according to Responsible Investment Association of Australasia (RIAA) research, which published the results of its survey of more than 2000 Australians this year.

That's a very significant chunk of investors who hold significant power, Estelle Parker, co-CEO of RIAA, tells ABC RN's Life Matters .

"They're realising that investments can make a huge collective impact on the world. Money can actually be a force for good, for a better future, for their children's future," Parker says.

But this isn't philanthropy. Ethical investments perform comparably to or better than the rest of the market, in the medium to longer term, Parker says.

"People are doing it because they want to align with their personal values and ethics … but they're also doing it because the returns are pretty good.

"Slowly people are starting to realise that you do not have to sacrifice returns to do this."

What is ethical or responsible investment?

Responsible investment accounts for 36 per cent of the investment market , or $1.3 trillion, in Australia.

And responsible or ethical investing has evolved from what it once was.

"It's gone from beyond blunt exclusions, where you're saying I want to screen out certain companies or industries like fossil fuels, to actually investing for positive change," Parker says.

She says there's been a huge growth in "somatic investing" — that is, investments that support sustainability to create a positive impact.

"That's sitting now at $235 billion [of the market]. Much of that's in renewables, in energy efficiency, and so on."

But increasingly other investment priorities include a company's position on human rights, biodiversity, sustainable water management, animal rights, gender equality, energy efficiency or waste, or even their leaders' wages.

There's also impact investing, which Parker says "is growing off a very small base", and now accounts for about $60 billion in Australia. That involves people investing in things like health care or social housing, with the intention to create positive, measurable outcomes.

The values driving investors

The main investments for most Australians are their home and their super funds (which invest in companies on their members' behalf).

But 51 per cent of Australians — or 10.2 million people — also hold additional investments, including in shares and ETFs (exchange-traded fund, which is a type of investment fund). Family trusts and higher net worth investments are other types.

Parker says younger people, in particular, are interested in ethical investing. Those who view it most positively are in the 25- to 39-year age bracket.

"Most of those [surveyed in that age bracket] say that they would consider moving their super fund or their bank if they found out that [the institutions weren't] invested in line with their ethics," she says.

But it's not just young people; interest is growing across the board.

Seventy-six per cent of those surveyed want their fund to make a commitment to net zero carbon emissions by 2050 — "and that's not just the younger generation", Parker says.

"We're also seeing 89 per cent wanting their bank and super to avoid human rights abuses in their investments [and] 74 per cent are really concerned about animal cruelty, which is a really interesting one."

Should I be worried about greenwashing?

Greenwashing, the term used to describe companies who pretend to be more ethical or environmentally sustainable than they actually are, is a real concern, Parker says.

And it should be on your radar if you're looking to invest ethically. It's certainly on the government's radar.

"The regulators are looking at this very closely at the moment," Parker says.

"So ASIC [the Australian Securities and Investments Commission] has taken actions against a number of organisations  that it regulates, which includes [investigating] some of the big [super] fund managers.

"And the ACCC [Australian Consumer and Competition Commission] has also been taking action, too."

In March 2023 the ACCC published research into the extent of greenwashing in Australia. It found that more than half of the 247 business websites it observed had made "concerning", "vague" and "unsubstantiated" claims about environmental credentials.

Isn't it enough to use the ethical super option?

Jai Mirchandani manages an ethical investment fund certified by the RIAA.

His clients range from younger investors to those wanting to invest in positive change in areas like health care and renewable energy — and generate strong returns — for their kids and their grandkids.

He says choosing the ethical option within your super fund is "one way of getting more capital to ethical companies".

But, he adds, "we're seeing a lot of greenwashing cases put against the traditional investment funds for misleading the public on what they're actually invested in".

"So I think it is important to have dedicated ethical or sustainable investment firms out there, investing in a truly authentic way."

Where to find out more

Companies like Mirchandani's — which require an investor to begin with a minimum amount — aren't for everyone.

"We can only deal with wholesale and sophisticated investors," he says.

"There are other exchange-traded funds where you can get started on a much smaller balance. But with that also comes other issues or other considerations, such as authenticity, for example.

"So the best thing to do would be to speak to your financial advisor about what the different options are and what the best option is for your own personal circumstances."

Parker also recommends speaking to a financial advisor about your values and investment expectations, and how much risk you can absorb.

"But also do your own due diligence; look under the hood … The information should be available on the website of your fund [for example] … Does it align with your values? How are they voting at AGMs? Are they using active corporate engagement?

"If [the information isn't there], email your fund and just call for a bit more transparency.

"You can swap your superannuation into an ethical fund, it's not that hard to do.

"It does take some time if you want to do the due diligence and really have a look closely at the funds. But it can be done."

The RIAA's Responsible Returns free online tool is designed to help match a product to your values.

And the government's Moneysmart website has links to free financial information, including on investment in general, as well as choosing investments that match your values .

Advice in this article is general only. Please see a professional for advice on your individual financial circumstances.

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This case walks though a  scenario  in which  board members are not happy with a recent report from the E&C team, after making a significant investment in E&C to lower claims. How can E&C managers navigate this conversation with board members—and demonstrate the value of their investment? Find out in this month’s Talking the Walk.

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• Published: 18 April 2024

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

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volume  25 , Article number:  46 ( 2024 ) Cite this article

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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.

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.

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.

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Introduction

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 [ 1 , 2 , 3 ]. Beyond the growing number of AI applications being implemented in health care, capabilities of AI models such as Large Language Models (LLMs) expand the potential reach and significance of AI technologies across health-related fields [ 4 , 5 ]. Discussion about effective, ethical governance of AI technologies has spanned a range of governance approaches, including government regulation, organizational decision-making, professional self-regulation, and research ethics review [ 6 , 7 , 8 ]. In this paper, we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health research, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022. Although applications of AI for research, health care, and public health are diverse and advancing rapidly, the insights generated at the forum remain highly relevant from a global health perspective. After summarizing important context for work in this domain, we highlight categories of ethical issues emphasized at the forum for attention from a research ethics perspective internationally. We then outline strategies proposed for research, innovation, and governance to support more ethical AI for global health.

In this paper, we adopt the definition of AI systems provided by the Organization for Economic Cooperation and Development (OECD) as our starting point. Their definition states that an AI system is “a machine-based system that can, for a given set of human-defined objectives, make predictions, recommendations, or decisions influencing real or virtual environments. AI systems are designed to operate with varying levels of autonomy” [ 9 ]. The conceptualization of an algorithm as helping to constitute an AI system, along with hardware, other elements of software, and a particular context of use, illustrates the wide variety of ways in which AI can be applied. We have found it useful to differentiate applications of AI in research as those classified as “AI systems for discovery” and “AI systems for intervention”. An AI system for discovery is one that is intended to generate new knowledge, for example in drug discovery or public health research in which researchers are seeking potential targets for intervention, innovation, or further research. An AI system for intervention is one that directly contributes to enacting an intervention in a particular context, for example informing decision-making at the point of care or assisting with accuracy in a surgical procedure.

The mandate of the GFBR is to take a broad view of what constitutes research and its regulation in global health, with special attention to bioethics in Low- and Middle- Income Countries. AI as a group of technologies demands such a broad view. AI development for health occurs in a variety of environments, including universities and academic health sciences centers where research ethics review remains an important element of the governance of science and innovation internationally [ 10 , 11 ]. In these settings, research ethics committees (RECs; also known by different names such as Institutional Review Boards or IRBs) make decisions about the ethical appropriateness of projects proposed by researchers and other institutional members, ultimately determining whether a given project is allowed to proceed on ethical grounds [ 12 ].

However, research involving AI for health also takes place in large corporations and smaller scale start-ups, which in some jurisdictions fall outside the scope of research ethics regulation. In the domain of AI, the question of what constitutes research also becomes blurred. For example, is the development of an algorithm itself considered a part of the research process? Or only when that algorithm is tested under the formal constraints of a systematic research methodology? In this paper we take an inclusive view, in which AI development is included in the definition of research activity and within scope for our inquiry, regardless of the setting in which it takes place. This broad perspective characterizes the approach to “research ethics” we take in this paper, extending beyond the work of RECs to include the ethical analysis of the wide range of activities that constitute research as the generation of new knowledge and intervention in the world.

Ethical governance of AI in global health

The ethical governance of AI for global health has been widely discussed in recent years. The World Health Organization (WHO) released its guidelines on ethics and governance of AI for health in 2021, endorsing a set of six ethical principles and exploring the relevance of those principles through a variety of use cases. The WHO guidelines also provided an overview of AI governance, defining governance as covering “a range of steering and rule-making functions of governments and other decision-makers, including international health agencies, for the achievement of national health policy objectives conducive to universal health coverage.” (p. 81) The report usefully provided a series of recommendations related to governance of seven domains pertaining to AI for health: data, benefit sharing, the private sector, the public sector, regulation, policy observatories/model legislation, and global governance. The report acknowledges that much work is yet to be done to advance international cooperation on AI governance, especially related to prioritizing voices from Low- and Middle-Income Countries (LMICs) in global dialogue.

One important point emphasized in the WHO report that reinforces the broader literature on global governance of AI is the distribution of responsibility across a wide range of actors in the AI ecosystem. This is especially important to highlight when focused on research for global health, which is specifically about work that transcends national borders. Alami et al. (2020) discussed the unique risks raised by AI research in global health, ranging from the unavailability of data in many LMICs required to train locally relevant AI models to the capacity of health systems to absorb new AI technologies that demand the use of resources from elsewhere in the system. These observations illustrate the need to identify the unique issues posed by AI research for global health specifically, and the strategies that can be employed by all those implicated in AI governance to promote ethically responsible use of AI in global health research.

RECs and the regulation of research involving AI

RECs represent an important element of the governance of AI for global health research, and thus warrant further commentary as background to our paper. Despite the importance of RECs, foundational questions have been raised about their capabilities to accurately understand and address ethical issues raised by studies involving AI. Rahimzadeh et al. (2023) outlined how RECs in the United States are under-prepared to align with recent federal policy requiring that RECs review data sharing and management plans with attention to the unique ethical issues raised in AI research for health [ 13 ]. Similar research in South Africa identified variability in understanding of existing regulations and ethical issues associated with health-related big data sharing and management among research ethics committee members [ 14 , 15 ]. The effort to address harms accruing to groups or communities as opposed to individuals whose data are included in AI research has also been identified as a unique challenge for RECs [ 16 , 17 ]. Doerr and Meeder (2022) suggested that current regulatory frameworks for research ethics might actually prevent RECs from adequately addressing such issues, as they are deemed out of scope of REC review [ 16 ]. Furthermore, research in the United Kingdom and Canada has suggested that researchers using AI methods for health tend to distinguish between ethical issues and social impact of their research, adopting an overly narrow view of what constitutes ethical issues in their work [ 18 ].

The challenges for RECs in adequately addressing ethical issues in AI research for health care and public health exceed a straightforward survey of ethical considerations. As Ferretti et al. (2021) contend, some capabilities of RECs adequately cover certain issues in AI-based health research, such as the common occurrence of conflicts of interest where researchers who accept funds from commercial technology providers are implicitly incentivized to produce results that align with commercial interests [ 12 ]. However, some features of REC review require reform to adequately meet ethical needs. Ferretti et al. outlined weaknesses of RECs that are longstanding and those that are novel to AI-related projects, proposing a series of directions for development that are regulatory, procedural, and complementary to REC functionality. The work required on a global scale to update the REC function in response to the demands of research involving AI is substantial.

These issues take greater urgency in the context of global health [ 19 ]. Teixeira da Silva (2022) described the global practice of “ethics dumping”, where researchers from high income countries bring ethically contentious practices to RECs in low-income countries as a strategy to gain approval and move projects forward [ 20 ]. Although not yet systematically documented in AI research for health, risk of ethics dumping in AI research is high. Evidence is already emerging of practices of “health data colonialism”, in which AI researchers and developers from large organizations in high-income countries acquire data to build algorithms in LMICs to avoid stricter regulations [ 21 ]. This specific practice is part of a larger collection of practices that characterize health data colonialism, involving the broader exploitation of data and the populations they represent primarily for commercial gain [ 21 , 22 ]. As an additional complication, AI algorithms trained on data from high-income contexts are unlikely to apply in straightforward ways to LMIC settings [ 21 , 23 ]. In the context of global health, there is widespread acknowledgement about the need to not only enhance the knowledge base of REC members about AI-based methods internationally, but to acknowledge the broader shifts required to encourage their capabilities to more fully address these and other ethical issues associated with AI research for health [ 8 ].

Although RECs are an important part of the story of the ethical governance of AI for global health research, they are not the only part. The responsibilities of supra-national entities such as the World Health Organization, national governments, organizational leaders, commercial AI technology providers, health care professionals, and other groups continue to be worked out internationally. In this context of ongoing work, examining issues that demand attention and strategies to address them remains an urgent and valuable task.

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, REC members and other actors to engage with challenges and opportunities specifically related to research ethics. Each year the GFBR meeting includes a series of case studies and keynotes presented in plenary format to an audience of approximately 100 people who have applied and been competitively selected to attend, along with small-group breakout discussions to advance thinking on related issues. The specific topic of the forum changes each year, with past topics including ethical issues in research with people living with mental health conditions (2021), genome editing (2019), and biobanking/data sharing (2018). The forum is intended to remain grounded in the practical challenges of engaging in research ethics, with special interest in low resource settings from a global health perspective. A post-meeting fellowship scheme is open to all LMIC participants, providing a unique opportunity to apply for funding to further explore and address the ethical challenges that are identified during the meeting.

In 2022, the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations (both short and long form) reporting on specific initiatives related to research ethics and AI for health, and 16 governance presentations (both short and long form) reporting on actual approaches to governing AI in different country settings. A keynote presentation from Professor Effy Vayena addressed the topic of the broader context for AI ethics in a rapidly evolving field. 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. The 2-day forum addressed a wide range of themes. The conference report provides a detailed overview of each of the specific topics addressed while a policy paper outlines the cross-cutting themes (both documents are available at the GFBR website: https://www.gfbr.global/past-meetings/16th-forum-cape-town-south-africa-29-30-november-2022/ ). As opposed to providing a detailed summary in this paper, we aim to briefly highlight central issues raised, solutions proposed, and the challenges facing the research ethics community in the years to come.

In this way, our primary aim in this paper is to present a synthesis of the challenges and opportunities raised at the GFBR meeting and in the planning process, followed by our reflections as a group of authors on their significance for governance leaders in the coming years. We acknowledge that the views represented at the meeting and in our results are a partial representation of the universe of views on this topic; however, the GFBR leadership invested a great deal of resources in convening a deeply diverse and thoughtful group of researchers and practitioners working on themes of bioethics related to AI for global health including those based in LMICs. We contend that it remains rare to convene such a strong group for an extended time and believe that many of the challenges and opportunities raised demand attention for more ethical futures of AI for health. Nonetheless, our results are primarily descriptive and are thus not explicitly grounded in a normative argument. We make effort in the Discussion section to contextualize our results by describing their significance and connecting them to broader efforts to reform global health research and practice.

Uniquely important ethical issues for AI in global health research

Presentations and group dialogue over the course of the forum raised several issues for consideration, and here we describe four overarching themes for the ethical governance of AI in global health research. Brief descriptions of each issue can be found in Table  1 . Reports referred to throughout the paper are available at the GFBR website provided above.

The first overarching thematic issue relates to the appropriateness of building AI technologies in response to health-related challenges in the first place. Case study presentations referred to initiatives where AI technologies were highly appropriate, such as in ear shape biometric identification to more accurately link electronic health care records to individual patients in Zambia (Alinani Simukanga). Although important ethical issues were raised with respect to privacy, trust, and community engagement in this initiative, the AI-based solution was appropriately matched to the challenge of accurately linking electronic records to specific patient identities. In contrast, forum participants raised questions about the appropriateness of an initiative using AI to improve the quality of handwashing practices in an acute care hospital in India (Niyoshi Shah), which led to gaming the algorithm. Overall, participants acknowledged the dangers of techno-solutionism, in which AI researchers and developers treat AI technologies as the most obvious solutions to problems that in actuality demand much more complex strategies to address [ 24 ]. However, forum participants agreed that RECs in different contexts have differing degrees of power to raise issues of the appropriateness of an AI-based intervention.

The second overarching thematic issue related to whether and how AI-based systems transfer from one national health context to another. One central issue raised by a number of case study presentations related to the challenges of validating an algorithm with data collected in a local environment. For example, one case study presentation described a project that would involve the collection of personally identifiable data for sensitive group identities, such as tribe, clan, or religion, in the jurisdictions involved (South Africa, Nigeria, Tanzania, Uganda and the US; Gakii Masunga). Doing so would enable the team to ensure that those groups were adequately represented in the dataset to ensure the resulting algorithm was not biased against specific community groups when deployed in that context. However, some members of these communities might desire to be represented in the dataset, whereas others might not, illustrating the need to balance autonomy and inclusivity. It was also widely recognized that collecting these data is an immense challenge, particularly when historically oppressive practices have led to a low-trust environment for international organizations and the technologies they produce. It is important to note that in some countries such as South Africa and Rwanda, it is illegal to collect information such as race and tribal identities, re-emphasizing the importance for cultural awareness and avoiding “one size fits all” solutions.

The third overarching thematic issue is related to understanding accountabilities for both the impacts of AI technologies and governance decision-making regarding their use. Where global health research involving AI leads to longer-term harms that might fall outside the usual scope of issues considered by a REC, who is to be held accountable, and how? This question was raised as one that requires much further attention, with law being mixed internationally regarding the mechanisms available to hold researchers, innovators, and their institutions accountable over the longer term. However, it was recognized in breakout group discussion that many jurisdictions are developing strong data protection regimes related specifically to international collaboration for research involving health data. For example, Kenya’s Data Protection Act requires that any internationally funded projects have a local principal investigator who will hold accountability for how data are shared and used [ 25 ]. The issue of research partnerships with commercial entities was raised by many participants in the context of accountability, pointing toward the urgent need for clear principles related to strategies for engagement with commercial technology companies in global health research.

The fourth and final overarching thematic issue raised here is that of consent. The issue of consent was framed by the widely shared recognition that models of individual, explicit consent might not produce a supportive environment for AI innovation that relies on the secondary uses of health-related datasets to build AI algorithms. Given this recognition, approaches such as community oversight of health data uses were suggested as a potential solution. However, the details of implementing such community oversight mechanisms require much further attention, particularly given the unique perspectives on health data in different country settings in global health research. Furthermore, some uses of health data do continue to require consent. One case study of South Africa, Nigeria, Kenya, Ethiopia and Uganda suggested that when health data are shared across borders, individual consent remains necessary when data is transferred from certain countries (Nezerith Cengiz). Broader clarity is necessary to support the ethical governance of health data uses for AI in global health research.

Recommendations for ethical governance of AI in global health research

Dialogue at the forum led to a range of suggestions for promoting ethical conduct of AI research for global health, related to the various roles of actors involved in the governance of AI research broadly defined. The strategies are written for actors we refer to as “governance leaders”, those people distributed throughout the AI for global health research ecosystem who are responsible for ensuring the ethical and socially responsible conduct of global health research involving AI (including researchers themselves). These include RECs, government regulators, health care leaders, health professionals, corporate social accountability officers, and others. Enacting these strategies would bolster the ethical governance of AI for global health more generally, enabling multiple actors to fulfill their roles related to governing research and development activities carried out across multiple organizations, including universities, academic health sciences centers, start-ups, and technology corporations. Specific suggestions are summarized in Table  2 .

First, forum participants suggested that governance leaders including RECs, should remain up to date on recent advances in the regulation of AI for health. Regulation of AI for health advances rapidly and takes on different forms in jurisdictions around the world. RECs play an important role in governance, but only a partial role; it was deemed important for RECs to acknowledge how they fit within a broader governance ecosystem in order to more effectively address the issues within their scope. Not only RECs but organizational leaders responsible for procurement, researchers, and commercial actors should all commit to efforts to remain up to date about the relevant approaches to regulating AI for health care and public health in jurisdictions internationally. In this way, governance can more adequately remain up to date with advances in regulation.

Second, forum participants suggested that governance leaders should focus on ethical governance of health data as a basis for ethical global health AI research. Health data are considered the foundation of AI development, being used to train AI algorithms for various uses [ 26 ]. By focusing on ethical governance of health data generation, sharing, and use, multiple actors will help to build an ethical foundation for AI development among global health researchers.

Third, forum participants believed that governance processes should incorporate AI impact assessments where appropriate. An AI impact assessment is the process of evaluating the potential effects, both positive and negative, of implementing an AI algorithm on individuals, society, and various stakeholders, generally over time frames specified in advance of implementation [ 27 ]. Although not all types of AI research in global health would warrant an AI impact assessment, this is especially relevant for those studies aiming to implement an AI system for intervention into health care or public health. Organizations such as RECs can use AI impact assessments to boost understanding of potential harms at the outset of a research project, encouraging researchers to more deeply consider potential harms in the development of their study.

Fourth, forum participants suggested that governance decisions should incorporate the use of environmental impact assessments, or at least the incorporation of environment values when assessing the potential impact of an AI system. An environmental impact assessment involves evaluating and anticipating the potential environmental effects of a proposed project to inform ethical decision-making that supports sustainability [ 28 ]. Although a relatively new consideration in research ethics conversations [ 29 ], the environmental impact of building technologies is a crucial consideration for the public health commitment to environmental sustainability. Governance leaders can use environmental impact assessments to boost understanding of potential environmental harms linked to AI research projects in global health over both the shorter and longer terms.

Fifth, forum participants suggested that governance leaders should require stronger transparency in the development of AI algorithms in global health research. Transparency was considered essential in the design and development of AI algorithms for global health to ensure ethical and accountable decision-making throughout the process. Furthermore, whether and how researchers have considered the unique contexts into which such algorithms may be deployed can be surfaced through stronger transparency, for example in describing what primary considerations were made at the outset of the project and which stakeholders were consulted along the way. Sharing information about data provenance and methods used in AI development will also enhance the trustworthiness of the AI-based research process.

Sixth, forum participants suggested that governance leaders can encourage or require community engagement at various points throughout an AI project. It was considered that engaging patients and communities is crucial in AI algorithm development to ensure that the technology aligns with community needs and values. However, participants acknowledged that this is not a straightforward process. Effective community engagement requires lengthy commitments to meeting with and hearing from diverse communities in a given setting, and demands a particular set of skills in communication and dialogue that are not possessed by all researchers. Encouraging AI researchers to begin this process early and build long-term partnerships with community members is a promising strategy to deepen community engagement in AI research for global health. One notable recommendation was that research funders have an opportunity to incentivize and enable community engagement with funds dedicated to these activities in AI research in global health.

Seventh, forum participants suggested that governance leaders can encourage researchers to build strong, fair partnerships between institutions and individuals across country settings. In a context of longstanding imbalances in geopolitical and economic power, fair partnerships in global health demand a priori commitments to share benefits related to advances in medical technologies, knowledge, and financial gains. Although enforcement of this point might be beyond the remit of RECs, commentary will encourage researchers to consider stronger, fairer partnerships in global health in the longer term.

Eighth, it became evident that it is necessary to explore new forms of regulatory experimentation given the complexity of regulating a technology of this nature. In addition, the health sector has a series of particularities that make it especially complicated to generate rules that have not been previously tested. Several participants highlighted the desire to promote spaces for experimentation such as regulatory sandboxes or innovation hubs in health. These spaces can have several benefits for addressing issues surrounding the regulation of AI in the health sector, such as: (i) increasing the capacities and knowledge of health authorities about this technology; (ii) identifying the major problems surrounding AI regulation in the health sector; (iii) establishing possibilities for exchange and learning with other authorities; (iv) promoting innovation and entrepreneurship in AI in health; and (vi) identifying the need to regulate AI in this sector and update other existing regulations.

Ninth and finally, forum participants believed that the capabilities of governance leaders need to evolve to better incorporate expertise related to AI in ways that make sense within a given jurisdiction. With respect to RECs, for example, it might not make sense for every REC to recruit a member with expertise in AI methods. Rather, it will make more sense in some jurisdictions to consult with members of the scientific community with expertise in AI when research protocols are submitted that demand such expertise. Furthermore, RECs and other approaches to research governance in jurisdictions around the world will need to evolve in order to adopt the suggestions outlined above, developing processes that apply specifically to the ethical governance of research using AI methods in global health.

Research involving the development and implementation of AI technologies continues to grow in global health, posing important challenges for ethical governance of AI in global health research around the world. In this paper we have summarized insights from the 2022 GFBR, focused specifically on issues in research ethics related to AI for global health research. We summarized four thematic challenges for governance related to AI in global health research and nine suggestions arising from presentations and dialogue at the forum. In this brief discussion section, we present an overarching observation about power imbalances that frames efforts to evolve the role of governance in global health research, and then outline two important opportunity areas as the field develops to meet the challenges of AI in global health research.

Dialogue about power is not unfamiliar in global health, especially given recent contributions exploring what it would mean to de-colonize global health research, funding, and practice [ 30 , 31 ]. Discussions of research ethics applied to AI research in global health contexts are deeply infused with power imbalances. The existing context of global health is one in which high-income countries primarily located in the “Global North” charitably invest in projects taking place primarily in the “Global South” while recouping knowledge, financial, and reputational benefits [ 32 ]. With respect to AI development in particular, recent examples of digital colonialism frame dialogue about global partnerships, raising attention to the role of large commercial entities and global financial capitalism in global health research [ 21 , 22 ]. Furthermore, the power of governance organizations such as RECs to intervene in the process of AI research in global health varies widely around the world, depending on the authorities assigned to them by domestic research governance policies. These observations frame the challenges outlined in our paper, highlighting the difficulties associated with making meaningful change in this field.

Despite these overarching challenges of the global health research context, there are clear strategies for progress in this domain. Firstly, AI innovation is rapidly evolving, which means approaches to the governance of AI for health are rapidly evolving too. Such rapid evolution presents an important opportunity for governance leaders to clarify their vision and influence over AI innovation in global health research, boosting the expertise, structure, and functionality required to meet the demands of research involving AI. Secondly, the research ethics community has strong international ties, linked to a global scholarly community that is committed to sharing insights and best practices around the world. This global community can be leveraged to coordinate efforts to produce advances in the capabilities and authorities of governance leaders to meaningfully govern AI research for global health given the challenges summarized in our paper.

Limitations

Our paper includes two specific limitations that we address explicitly here. First, it is still early in the lifetime of the development of applications of AI for use in global health, and as such, the global community has had limited opportunity to learn from experience. For example, there were many fewer case studies, which detail experiences with the actual implementation of an AI technology, submitted to GFBR 2022 for consideration than was expected. In contrast, there were many more governance reports submitted, which detail the processes and outputs of governance processes that anticipate the development and dissemination of AI technologies. This observation represents both a success and a challenge. It is a success that so many groups are engaging in anticipatory governance of AI technologies, exploring evidence of their likely impacts and governing technologies in novel and well-designed ways. It is a challenge that there is little experience to build upon of the successful implementation of AI technologies in ways that have limited harms while promoting innovation. Further experience with AI technologies in global health will contribute to revising and enhancing the challenges and recommendations we have outlined in our paper.

Second, global trends in the politics and economics of AI technologies are evolving rapidly. Although some nations are advancing detailed policy approaches to regulating AI more generally, including for uses in health care and public health, the impacts of corporate investments in AI and political responses related to governance remain to be seen. The excitement around large language models (LLMs) and large multimodal models (LMMs) has drawn deeper attention to the challenges of regulating AI in any general sense, opening dialogue about health sector-specific regulations. The direction of this global dialogue, strongly linked to high-profile corporate actors and multi-national governance institutions, will strongly influence the development of boundaries around what is possible for the ethical governance of AI for global health. We have written this paper at a point when these developments are proceeding rapidly, and as such, we acknowledge that our recommendations will need updating as the broader field evolves.

Ultimately, coordination and collaboration between many stakeholders in the research ethics ecosystem will be necessary to strengthen the ethical governance of AI in global health research. The 2022 GFBR 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.

Data availability

All data and materials analyzed to produce this paper are available on the GFBR website: https://www.gfbr.global/past-meetings/16th-forum-cape-town-south-africa-29-30-november-2022/ .

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Acknowledgements

We would like to acknowledge the outstanding contributions of the attendees of GFBR 2022 in Cape Town, South Africa. This paper is authored by members of the GFBR 2022 Planning Committee. We would like to acknowledge additional members Tamra Lysaght, National University of Singapore, and Niresh Bhagwandin, South African Medical Research Council, for their input during the planning stages and as reviewers of the applications to attend the Forum.

This work was supported by Wellcome [222525/Z/21/Z], the US National Institutes of Health, the UK Medical Research Council (part of UK Research and Innovation), and the South African Medical Research Council through funding to the Global Forum on Bioethics in Research.

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Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA

Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

Department of Philosophy and Classics, University of Ghana, Legon-Accra, Ghana

Caesar A. Atuire

Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK

Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

Phaik Yeong Cheah

Berkman Klein Center, Harvard University, Bogotá, Colombia

Armando Guio Español

Department of Radiology and Informatics, Emory University School of Medicine, Atlanta, GA, USA

Judy Wawira Gichoya

Health Ethics & Governance Unit, Research for Health Department, Science Division, World Health Organization, Geneva, Switzerland

Adrienne Hunt & Katherine Littler

African Center of Excellence in Bioinformatics and Data Intensive Science, Infectious Diseases Institute, Makerere University, Kampala, Uganda

Daudi Jjingo

ISI Foundation, Turin, Italy

Daniela Paolotti

Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland

Effy Vayena

Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

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JS led the writing, contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. JA contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. CA contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. PYC contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. AE contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. JWG contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. AH contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. DJ contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. KL contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. DP contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper. EV contributed to conceptualization and analysis, critically reviewed and provided feedback on drafts of this paper, and provided final approval of the paper.

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Correspondence to James Shaw .

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Shaw, J., Ali, J., Atuire, C.A. et al. Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research. BMC Med Ethics 25 , 46 (2024). https://doi.org/10.1186/s12910-024-01044-w

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Received : 31 October 2023

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DOI : https://doi.org/10.1186/s12910-024-01044-w

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Ethical Dilemma in Nursing Case Study

This essay about ethical challenges in nursing focuses on a hypothetical case involving an elderly woman named Jane, who prefers palliative care over aggressive treatment for her terminal cancer, contrary to her family’s wishes for continued medical intervention. The narrative explores the role of nurses in balancing patient autonomy with the desires of the patient’s family, highlighting the complexities of ethical decision-making in healthcare settings. Nurses often act as mediators in these situations, advocating for the patient’s wishes while also addressing the family’s concerns through effective communication and ethical deliberation. The essay underscores the importance of respecting patient rights and maintaining compassionate, patient-centered care amidst emotionally charged family dynamics. This discussion serves to illuminate the broader implications for nursing ethics and the essential ongoing dialogue within the profession about handling such conflicts.

How it works

In the heart of every hospital, ethical questions weave through the corridors just as surely as the doctors and nurses who rush from room to room. One such question sits heavily on the shoulders of those in the nursing profession: How do they balance patient autonomy with family desires, especially in end-of-life care scenarios? To explore this, we look into a hypothetical yet all too common situation faced by those in the medical field.

Imagine a scenario involving an elderly woman, let’s call her Jane, who is battling terminal cancer.

Jane has clearly expressed her wish to forego aggressive treatments that would only prolong her suffering. Instead, she chooses palliative care, hoping to spend her remaining days in peace and dignity at home surrounded by loved ones. However, Jane’s family, grappling with impending grief, insists on pursuing every possible medical intervention, driven by a mix of hope, denial, and perhaps guilt.

This dichotomy presents a profound ethical challenge for the nurses involved. On one hand, there’s the ethical duty to honor the patient’s wishes, an aspect central to the nursing code which respects patient autonomy. On the other, there is a pressing need to empathize with Jane’s family, who are not ready to let go and might view the cessation of aggressive treatment as akin to giving up.

Nurses find themselves navigating these treacherous waters, often serving as mediators between what the patient wants and what her family thinks is best. The situation calls for nurses to use their professional judgment and interpersonal skills to handle the delicate balance of providing care that respects Jane’s wishes while compassionately communicating the realities and limitations of medical treatment to her family.

Such situations are fertile ground for ethical deliberation, often involving discussions with ethics committees, multiple team meetings, and sometimes legal advice. These processes are integral to ensuring that decisions are made in the best interests of the patient while considering the emotional and ethical standpoint of the family.

The case of Jane highlights the indispensable role of nurses as advocates for their patients’ wishes. It also underscores the importance of having clear and open communication channels within families and between families and medical professionals. These discussions are never easy, but they are necessary to navigate the complex interplay between medical possibilities, ethical responsibilities, and human emotions.

In conclusion, understanding and managing ethical dilemmas like this one is crucial for maintaining the integrity of the nursing profession and ensuring patient care remains compassionate and patient-centered. Each case, while unique, adds to the broader understanding and ongoing conversation about the best practices in nursing ethics, particularly in how to handle conflicts between patient rights and family wishes effectively.

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Post Office executives played a leading role in publicly defending their organisation over the hundreds of prosecutions it brought against the sub-postmasters who ran its branches, based on the flawed Horizon accounting system.

But, behind the scenes, it was in-house lawyers who took on the task of briefing senior executives on the robustness of its Horizon software. They were also responsible for commissioning relevant audits and setting out the UK state-owned organisation’s approach to litigation. 

More than 900 people were convicted of a range of offences, including theft and false accounting, in cases involving data from Fujitsu’s flawed Horizon system, which was introduced in 1999. More than 700 prosecutions were brought by the Post Office itself.

However, it was another lawyer — James Hartley, partner and head of dispute resolution at law firm Freeths — who represented 555 of the sub-postmasters in a landmark 2019 High Court case in which the extent of the IT scandal emerged. The judge ruled that several “bugs, errors and defects” meant there was a “material risk” that the Horizon system was to blame for faulty data used in the Post Office prosecutions.

“It’s quite a complex web of obligation, responsibility and culpability,” says Hartley, reflecting on the reach of the affair into the legal profession. “Somewhere along the way, lawyers have stepped over the red line.”

Now, a public inquiry into the scandal is gaining momentum as it takes evidence from senior Post Office executives, government ministers and figures from Fujitsu, ahead of its conclusion this summer.

In the coming months, the inquiry will hear testimony from several former general counsel at the Post Office, each of whom will give evidence against the backdrop of a debate about whether the role of an in-house lawyer needs to be more strictly regulated.

Susan Crichton, the Post Office’s general counsel between 2010 and 2013, will appear today at Aldwych House in London to respond to claims that, under her watch, the business brought prosecutions against sub-postmasters despite concerns surrounding Horizon.

Audio recordings shared with the inquiry, of conversations between Crichton and forensic accountants Second Sight in 2013, suggest she briefed the company’s chief executive that claims made by accused sub-postmasters about the Horizon system were, in fact, true.

Their discussions include the detail, long denied by the Post Office, that third parties could access systems remotely and alter transaction data. Sub-postmasters successfully argued in court that they could not be held solely responsible for any shortfalls because of this third-party access.

Crichton’s evidence is also expected to spell out some of the difficulties that existed for general counsel in raising concerns, particularly when executives fail to act in response.

Chris Aujard, Crichton’s successor, is scheduled to appear at the inquiry tomorrow. Jane MacLeod, who succeeded Aujard, is due to appear in June, shortly after current counsel Ben Foat takes the stand.

Somewhere along the way, lawyers have stepped over the red line James Hartley, Freeths

Contemporaneous documents suggest that there may have been opportunities for the Post Office to prevent litigation.

The Post Office’s general counsel were involved in commissioning half a dozen reports and reviews by external auditors and consultants, including BAE Systems, Deloitte, EY, and Second Sight, in the decade leading up to the 2019 High Court case.

Some of these reports found faults with internal systems and how they were managed. External lawyers in 2013 warned the Post Office that the business was at risk of breaching its obligations as a prosecutor over improper practices, if any decision were made to shred documents, which prevented disclosure.

Richard Moorhead, a professor of law and professional ethics at the University of Exeter, says matters should be reported “up the ladder” and that general counsel need to act as a “moral compass” within an organisation. “They need to speak up if they think things are being done which are improper and ensure the client hears those things,” he says.

Moorhead, who sits on the government-appointed Horizon Compensation Advisory Board, is a vocal critic of the lawyers involved in the Post Office Horizon scandal.

He adds that there were occasions when in-house lawyers at the Post Office should have sought to “blow the whistle” once it became obvious that errors in the Horizon system could account for shortfalls.

General counsel play a prominent role in shaping the legal strategy of a company or organisation and advising executives on the best approach to compliance and handling legal risk. But there is sometimes tension between serving the business and acting in the public’s interest. 

In the aftermath of the Enron and WorldCom fraud scandals in the early 2000s, US regulators introduced new security laws that required general counsel to report adverse information to audit committees, directors and other officials when senior leadership was unresponsive.

[GCs] need to speak up if they think things are being done which are improper and ensure the client hears those things Richard Moorhead, University of Exeter

Brian Cheffins, a professor of corporate law at the University of Cambridge, says the new rules produced a playbook for in-house lawyers who had been “stonewalled internally”, particularly as these individuals could find themselves in “deep water” when misgovernance became evident.

But Cheffins is opposed to plans to set out general counsel’s obligations formally, and warns that doing so risks duplicating duties that already exist elsewhere.

General counsel in the UK operate under the same rules as any solicitor or barrister advising a client, which stipulate acting with integrity in ensuring that senior figures are briefed on unpalatable information. The Horizon affair has reminded lawyers of their duties when advising executives.

Hartley says: “In-house lawyers need to recalibrate their thinking on where that red line is so they know when to turn around to the person they’re advising and say, ‘No, we cannot do that’.”

Post Office general counsel: in the spotlight

Susan Crichton In 2012-2013 she was involved in instructing Second Sight to conduct an independent investigation into Horizon. The forensic accountants raised concerns but these were not actioned by the business despite executives being briefed. Crichton left the Post Office to take on a similar role at TSB Bank in 2013; she retired in 2018.

Chris Aujard After becoming general counsel in 2013, he was tasked with winding down a mediation scheme set up for affected sub-postmasters and removing Second Sight from its role investigating the Post Office. Meeting minutes from 2014 showed he was present when executives discussed setting aside £1mn in “token payments” to mitigate any reputational damage.

Jane MacLeod In position as general counsel when 555 sub-postmasters brought a suit against the Post Office, MacLeod was responsible for overseeing the business’s initial response. The public inquiry will explore her handling of disclosure and response to litigation when she gives evidence in June. She resigned from the Post Office in 2019.

Ben Foat Appointed to general counsel in 2019, Foat previously served as the business’s legal director. He appeared at the inquiry in the middle of last year after widespread disclosure failures resulted in weeks of delays to evidence. Sir Wyn Williams, chair of the inquiry, has since threatened officials with criminal penalties if such problems recur.

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Safety of RSV Vaccine among Pregnant Individuals: A Real-World Pharmacovigilance Study Using Vaccine Adverse Event Reporting System

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Objectives To describe the post-marketing safety of RSVPreF among pregnant individuals.

Design This case series study analyzed adverse event (AE) reports submitted to the U.S. Food and Drug Administration’s Vaccine Adverse Event Reporting System (VAERS) database following RSVPreF immunization from September 1, 2023, to February 23, 2024.

Setting VAERS, as a national spontaneous vaccine safety surveillance system, provides insights into the safety profile of the RSVPreF vaccine in a real-world setting.

Participants Surveillance data included all AE reports submitted to VAERS for pregnant individuals following vaccination.

Exposure Receipt of RSVPreF vaccine among pregnant individuals in the U.S.

Primary and secondary outcome measures Descriptive statistics assessed all AE reports with RSVPreF, including frequency, gestational age at vaccination, time to AE onset, and serious report proportions. The Bayesian Confidence Propagation Neural Network (BCPNN) was utilized, estimating the information component (IC) to identify disproportionate reporting of RSVPreF–event pairs.

Results VAERS received 77 reports pertained to RSVPreF vaccination in pregnant individuals, with 42 (54.55%) classified as serious. The most reported non-pregnancy-specific AEs were headache, injection site erythema, and injection site pain. Preterm birth was the most frequently reported pregnancy-specific AE, followed by preterm premature rupture of membranes, cesarean section, cervical dilatation, and hemorrhage during pregnancy. The median time from immunization to reported preterm birth was 3 days, with two-thirds of cases within a week. Disproportionality analysis indicated a significant signal for various AEs, particularly highlighting preterm birth with an IC of 2.18 (95%CI, 1.54-2.63), suggesting that reports of preterm birth associated with RSVPreF vaccination occurred more frequently than statistically expected.

Conclusions While reported AEs were generally consistent with the safety profile observed in prelicensure studies, this study highlights ongoing concern about preterm birth among pregnant individuals following RSVPreF vaccination. Comprehensive longitudinal follow-up, including prospective pregnancy registries and infant follow-up studies is urgently required.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

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