title: Reconsidering 'ethics' and 'quality' in healthcare research: the case for an iterative ethical paradigm.
abstract: BACKGROUND
  UK-based research conducted within a healthcare setting generally requires approval from the National Research Ethics Service. Research ethics committees are required to assess a vast range of proposals, differing in both their topic and methodology. We argue the methodological benchmarks with which research ethics committees are generally familiar and which form the basis of assessments of quality do not fit with the aims and objectives of many forms of qualitative inquiry and their more iterative goals of describing social processes/mechanisms and making visible the complexities of social practices. We review current debates in the literature related to ethical review and social research, and illustrate the importance of re-visiting the notion of ethics in healthcare research.
  
  
  CONCLUSIONS
  We present an analysis of two contrasting paradigms of ethics. We argue that the first of these is characteristic of the ways that NHS ethics boards currently tend to operate, and the second is an alternative paradigm, that we have labelled the 'iterative' paradigm, which draws explicitly on methodological issues in qualitative research to produce an alternative vision of ethics. We suggest that there is an urgent need to re-think the ways that ethical issues are conceptualised in NHS ethical procedures. In particular, we argue that embedded in the current paradigm is a restricted notion of 'quality', which frames how ethics are developed and worked through. Specific, pre-defined outcome measures are generally seen as the traditional marker of quality, which means that research questions that focus on processes rather than on 'outcomes' may be regarded as problematic. We show that the alternative 'iterative' paradigm offers a useful starting point for moving beyond these limited views.
  
  
  CONCLUSIONS
  We conclude that a 'one size fits all' standardisation of ethical procedures and approach to ethical review acts against the production of knowledge about healthcare and dramatically restricts what can be known about the social practices and conditions of healthcare. Our central argument is that assessment of ethical implications is important, but that the current paradigm does not facilitate an adequate understanding of the very issues it aims to invigilate.
authors.affiliation: Research Department of Primary Care and Population Health, UCL, Rowland Hill Street, London, NW3 2PF, UK. f.stevenson@ucl.ac.uk.
authors.forename: Fiona A
authors.initials: FA
authors.lastname: Stevenson
authors.affiliation: Department of Culture, Communication and Media, Institute of Education, 20 Bedford Way, London, WC1H 0AL, UK. w.gibson@ioe.ac.uk.
authors.forename: William
authors.initials: W
authors.lastname: Gibson
authors.affiliation: Department of Lifelong and Comparative Education, Institute of Education, 20 Bedford Way, London, WC1H 0AL, UK. c.pelletier@ioe.ac.uk.
authors.forename: Caroline
authors.initials: C
authors.lastname: Pelletier
authors.affiliation: Research Department of Primary Care and Population Health, UCL, Rowland Hill Street, London, NW3 2PF, UK. v.chrysikou@ucl.ac.uk.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Chrysikou
authors.affiliation: Research Department of Primary Care and Population Health, UCL, Rowland Hill Street, London, NW3 2PF, UK. Sophie.park@ucl.ac.uk.
authors.forename: Sophie
authors.initials: S
authors.lastname: Park
mesh_terms: D003695:Delivery of Health Care; D026724:Ethical Review; D028744:Ethics Committees, Research; D032984:Ethics, Research; D006296:Health Services; D006302:Health Services Research / Q000941:ethics* / Q000592:standards; D006801:Humans; D007258:Informed Consent; D017063:Outcome Assessment, Health Care; D036301:Qualitative Research; D012107:Research Design / Q000592:standards*; D013222:State Medicine; D006113:United Kingdom