Double standards in clinical practice ethics

Is the researcher held to a higher standard than the clinician?

Human research ethics committees (HRECs) are now firmly entrenched in the research environment. Clinical research, including quality improvement activities, can only be performed and published with HREC approval. Clinical practice, however, is not subject to such approval, yet the risk of harm (to the individual and to society) from clinical practice may be considerable.1 Are researchers being held to a higher standard than clinicians? Has our concentration on ethical standards for clinical research led to an ethical blind spot for clinical practice?