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Until now, medical practice in the United Kingdom has, unlike in medical research, largely resisted ethics committee scrutiny of clinical audit. I support this position. On what grounds do I do so? Are there sufficient differences between medical research and medical audit to reliably sustain this thesis? I shall argue that research ethics committees may be operating under philosophical constraints which, in the main, go unrecognised; they therefore have no, as it were, prima facie rights and their potential involvement in medical audit raises serious questions, not least because audit is a creature of an entirely different nature from research. For me, the situation is straightforward but others, of course, are welcome to refute my assertions.
It is said that research is finding out how one should be doing something, and audit whether one is actually doing it, or, as Rawlins says, “Research discovers the right thing to do: audit ensures that it is done right.”1 He explains the view of the British Medical Association's clinical audit committee and calls for a scrutiny of proposed audit projects by audit ethics committees, rather than ethics research committees. But he rather begs the question of the validity of this position by suggesting that, otherwise, ethics research committees would be overburdened by work. Taking the contrary view, the Royal College of Physicians clearly states that medical audit (among other activities such as epidemiological surveillance and morbidity and mortality reviews) is medical practice and, as such, does not require ethical review.2 Kinn disagrees with most definitions of medical audit, believing that the purpose of audit is to “raise general clinical standards” (and thus, I interpret her to say, has more in common with research) yet refers only to specific instances where audit must be based on sound ethical principles.3
I suggest …
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