(In the USA, Institutional Review Boards.) Various types of ethics committee operate in the UK, fulﬁlling four main functions: the monitoring of research; debate of diﬃcult patient cases; establishing norms of practice; and publishing ethical guidance.
The most common – Local Research Ethics Committees (LRECs) – have provided a monitoring system of research on humans since the late 1960s. Established by NHS health authorities, LRECs were primarily perceived as exercising authority over research carried out on NHS patients or on NHS premises or using NHS records. Their power and signiﬁcance, however, developed considerably in the 1980s and 90s when national and international guidance made approval by an ‘appropriately constituted’ ethics committee obligatory for any research project involving humans or human tissue. The work of LRECs is supplemented by so-called ‘independent’ ethics committees usually set up by pharmaceutical companies, and since 1997 by multicentre research ethics committees (MRECs). An MREC is responsible for considering all health-related research which will be conducted within ﬁve or more locations. LRECs have become indispensable to the conduct of research, and are doubtless partly responsible for the lack of demand in the UK for legislation governing research. A plethora of guidelines is available, and LRECs which fail to comply with recognised standards could incur legal liability. They are increasingly governed by international standards of practice. In 1997, guidelines produced by the International Committee on Harmonisation of Good Clinical Practice (ICH-GCP) were introduced into the UK. These provide a uniﬁed standard for research conducted in the European Union, Japan and United States to ensure the mutual acceptance of clinical data by the regulatory authorities in these countries.
Other categories of ethics committee include Ethics Advisory Committees, which debate difﬁcult patient cases. Most are attached to specialised health facilities such as fertility clinics or children’s care facilities. The 1990s have seen a greatly increased interest in professional ethics and the establishment of many new ethics committees, including some like that of the National Council for Hospice and Specialist Palliative Care Services which cross professional boundaries. Guidance on professional and ethical standards is produced by these new bodies and by the well-established ethics committees of regulatory or representative bodies, such as the medical and nursing Royal Colleges, the General Medical Council, United Kingdom Central Council for Nursing, Midwifery and Health Visiting, British Medical Association (see APPENDIX 8: PROFESSIONAL ORGANISATIONS) and bodies representing paramedics and professions supplementary to medicine. Their guidance ranges from general codes of practice to detailed analysis of single topics such as EUTHANASIA or surrogacy.
LRECs are now supervised by a central body
– COREC (www.corec.gov.org.uk).