Who Gets a Seat at the Ethics Table?

When we talk about the quality of research ethics review, we tend to focus on standards.

What principles does the committee apply? What processes are followed? What does the application ask researchers to demonstrate?

But there is another, much more human part of the system: Who is actually sitting around the table?

Research ethics standards don't review research. People do. And the people involved inevitably influence the questions that are asked, the risks that are noticed, the assumptions that are challenged and, ultimately, the decisions that are made.

Committee composition isn't just an administrative exercise

Aotearoa New Zealand has thought about this question for some time.

The Health Research Council's Guidelines for Approval of Ethics Committees, published in 2012, establish expectations around ethics committee membership. The underlying principle is important: collectively, a committee should have the expertise, skills, knowledge and perspectives required to conduct robust ethics review.

That is more than filling prescribed positions.

A researcher may identify a methodological problem. A lawyer may see an issue with privacy or consent. A health professional may recognise a participant risk. Someone with lived experience may identify that the proposed approach simply won't work for the people involved. Cultural expertise may expose assumptions that others haven't noticed.

None replaces the others. The value comes from bringing different perspectives into the same ethical conversation.

Composition on paper isn't participation in practice

However, having different people around the table only works if they can genuinely influence the discussion.

A committee can meet its membership requirements even when discussion remains dominated by senior or highly technical members. Discussion can stray (quite easily) from the realms of ethical review if a Chair cannot keep the review on track. And committees can appoint one person from a particular community and implicitly expect them to speak for an enormous diversity of experiences. This is particularly important when thinking about Māori membership.

Good committee design is therefore also about training, chairing, and process culture.

Training matters too

Committee members need to be supported to develop as ethics reviewers.

Research ethics review is a particular skill. Subject-matter expertise, lived experience, legal or community knowledge can bring an important perspective to deliberation, but none automatically teaches someone how to apply ethical standards, assess proportionality, distinguish material ethical issues from personal preference, or contribute effectively to collective decision-making.

Further, committees are increasingly considering artificial intelligence, linked administrative data, genomics, digital platforms, biometrics and increasingly sophisticated forms of data analysis. Research also crosses into new realms in ways that don't always fit traditional disciplinary categories.

Training therefore needs to extend beyond induction. As research methods, technologies and ethical challenges change, committees need opportunities for ongoing learning, discussion and calibration. This might include formal training, case-based discussion, observing experienced reviewers, or bringing in specialist expertise when new issues emerge.

However, no committee can permanently contain every form of expertise contemporary research might require. Which raises a different question:

Rather than only asking who should belong to an ethics committee, should we also ask who this particular research needs around the table?

What if the table changed with the research?

There are different ways committees can respond to the ever-evolving environment we find ourselves in. Some maintain relatively fixed membership and seek specialist advice when needed. Others can draw different reviewers from a wider membership pool.

At the Independent Human Research Ethics Collective, we use the latter approach.

Our wider committee includes people with different professional, methodological, cultural, community and lived experience. For each application, we establish a panel based on the nature of the research and the ethical issues it is likely to raise.

A project involving sensitive health information may require a different combination of expertise from community-based qualitative research. Complex data research may require particular data or privacy expertise. Research involving particular populations require knowledge and perspectives relevant to those communities.

The principle is straightforward:

The expertise required for good ethics review is partly determined by the research being reviewed.

Our model isn't without challenges. It requires a broad reviewer pool, careful panel selection, conflict management and enough consistency between panels that the same ethical standards are being applied. We also aim to constantly up-skill. Our monthly drop-ins and newsletters to our members provide an avenue for this ; but there is always more to do!

Our process has reinforced something important for us: committee composition should be thought about as a capability, rather than simply a membership list.

Knowing when someone is missing

Perhaps one of the most important capabilities of a contemporary ethics committee is knowing when it doesn't have the expertise it needs. A good committee doesn't need to know everything. It needs to know when it doesn't know enough.

Sometimes that means seeking specialist advice. Sometimes it means bringing another perspective into the review. Occasionally, it may mean acknowledging that another committee is better equipped to consider the research.

There is no perfect formula for ethics committee composition. Different committees will reasonably structure themselves differently. But the underlying quality question should be the same:

Did the people reviewing this research collectively have what they needed to review it well?

That means enough expertise to understand the research, enough independence to challenge it, and enough diversity of perspective to identify issues that researchers (and other reviewers) may not see.

Because ultimately, the quality of ethics review depends on more than the standards written on the page.

It depends on who we put around the table, and whether we recognise when someone is still missing.