2: Recommendations for the reform of ethical review

Recommendation 1:	There should be widespread discussion of the dangers of an adversarial system. It is now commonly recognised in regulatory circles that regulation can often be counterproductive: that the area is prone to a variety of paradoxical effects whereby tougher regulation — in particular, adversarial regulation — means less compliance rather than more.12 Those who have assumed responsibility for the ethical review of research on humans, and indeed the ethical review of other enterprises too, need to recognise that similar effects are likely to plague their own areas of concern.
Recommendation 2:	Ethics committees should make a sustained attempt to convince their relevant research communities that they do not see themselves in an oppositional role, but, rather, that their aim is to cooperate with those communities so as to facilitate ethically informed research. This effect can probably be best achieved by the adoption of some of the initiatives outlined in illustrating what a posture of trust would involve (see section on The goal of ethical review).
Recommendation 3:	Institutional changes need to be made that would provide incentives for ethics committees to be less adversarial and that would signal a less adversarial disposition to research communities. In particular, there should clearly be incentives in place to make ethics committees reluctant to turn a proposal down without serious consideration and negotiation. For example, researchers might have a right to appeal against a committee decision; in which case a committee that turned down a proposal would run the risk of having the decision overturned or of being asked to think again. Certainly, every committee should be required to present an annual report to its host institution in which it has to document its record in approving research projects and in negotiating about any reservations that it may have had.
Recommendation 4:	Appointments to ethics committees should be made in a systematic and careful way and not on the basis of who happens to express an interest in the job. Those institutions that have ethics committees should seek nominations for vacancies, and there should be a serious attempt to make sure that those appointed are aware of the nature of the exercise and are not motivated by any personal agenda of promoting research at any cost, or do not have a moralistic cast. Institutions might look, in particular, for representatives of community and consumer groups with an interest in the unimpeded pursuit of various forms of research: the presence of such a member on a committee might serve to downplay the polarity between reviewers and researchers.
Recommendation 5:	The professional bodies that represent research communities should take a much more active part in the business of ethical reflection and evaluation. There are some obvious steps that might be taken: the development and regular review of professional guidelines on the ethics of research; the education of young researchers in the ethical discussion of the questions they are likely to face; the introduction of a session on ethical issues at the annual conference of each profession; the development of a suitable complaints procedure within every profession; and so on.

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