Rethinking ethical reflexivity and oversight in health research through an ecosystem approach: A workshop report

As the scope of morally relevant considerations widens and new challenges emerge at the frontiers of health innovation, there are questions about the appropriate role and remit for research ethics review, within the broader context of the whole health research ecosystem. Drawing on discussion at a satellite meeting at the 2022 Global Forum on Bioethics in Research in Cape Town, we argue that the ethical conduct of research is the responsibility of all stakeholders in the research ecosystem - from funders, governments and research institutions to individual research teams and ethics committees. As a research community we need to espouse, and take action to achieve, more distributed approaches to ethical scrutiny and reflexivity. A crucial element of such a shift should be the development of collaborative and non-adversarial relationships between researchers and ethics committees that recognise and respect the mutual responsibilities of all parties to promote ethical research conduct. In tandem with the development of systems to support the exercise of ethical responsibilities across the research ecosystem, committees need to reconceptualise their role, in partnership with communities, as one of providing accountability through a focus on how research promotes participant agency and the common good.