Double standards in clinical practice ethics
Is the researcher held to a higher standard than the clinician?
Human research ethics committees (HRECs) are now firmly entrenched in the research environment. Clinical research, including quality improvement activities, can only be performed and published with HREC approval. Clinical practice, however, is not subject to such approval, yet the risk of harm (to the individual and to society) from clinical practice may be considerable.1 Are researchers being held to a higher standard than clinicians? Has our concentration on ethical standards for clinical research led to an ethical blind spot for clinical practice?
Instances of research-related harm led to the development of ethics committees.2 Rightly, such committees have considerable control over research. However, this control does not extend to clinical practice ethics at their institutions.
Systematic follow-up of treated patients (research) needs ethics approval, yet clinicians can use new techniques and new prostheses (practice) without such approval, provided they do not wish to publish their results. Researchers cannot seek…