ethical review and ethical behaviour

Wade's main concern is that the distinction between audit and research is arbitrary and often means that attention is not paid to what is really ethically important in many aspects of medicine.1 We agree that the distinction between audit and research is difficult to sustain. He is right to insist that the features specific to proposed research or audit are what determine it's ethical importance and whether it should be scrutinised. Whether a proposal is audit or research does not and cannot affect its ethical importance.

That said, the intuitive distinction …