Clinise Jackson

Research Ethics Committees (RECs) are frequently a focus of complaints from researchers, but evidence about the operation and decisions of RECs tends to be anecdotal. We conducted a systematic study to identify and compare the ethical issues raised in 54 letters to researchers about the same 18 applications submitted to three RECs over one year. The most common type of ethical trouble identified in REC letters related to informed consent, followed by scientific design and conduct, care and protection of research participants, confidentiality, recruitment and documentation. Community considerations were least frequently raised. There was evidence of variability in the ethical troubles identified and the remedies recommended. This analysis suggests that some principles may be more institutionalized than others, and offers some evidence of inconsistency between RECs. Inconsistency is often treated as evidence of incompetence and caprice, but a more sophisticated understanding of the role of RECs and their functioning is required

Although there has been critical analysis of how the informed consent process functions in relation to participation in research and particular ethical 'dilemmas', there has been little examination of consenting to more routine medical procedures. We report a qualitative study of 25 women who consented to surgery. Of these, nine were ambivalent or opposed to having an operation. When faced with a consent form, women's accounts suggest that they rarely do anything other than obey professionals' requests for a signature. An interactionist analysis suggests that women's capacity to act is reduced by the hospital structure of tacit, socially-imposed rules of conduct. Bourdieu's concepts of habitus, capital and symbolic power/violence show how the practical logic that women apply confers a 'sense of place' relative to professionals. Women experience deficits in capital that constrain their ability to exercise choice. This work demonstrates the weakness of the consent process as a safeguard of autonomy