国际公认的原则是,应通过研究伦理委员会(RECs)的伦理审查,在与人类的研究中应用和执行伦理规范。这将REC置于保护参与者和行使其权利的系统的核心。在南非儿童研究的伦理法律框架中,同意有不同的方法。也就是说,《国家卫生法》第71条(第2003年第61号)(NHA)要求父母对儿童研究给予强制性同意,并将代理人同意的权限限制为父母和法定监护人。然而,由NHA第72条授权并由国家健康研究伦理委员会(NHREC)根据其任务授权发布的国家伦理准则(国家卫生部,2015)允许更细致的方法-即年龄较大的青少年的自我同意,只要满足某些条件,并在没有父母或法定监护人的情况下获得一系列父母替代品的同意。我们在其他地方认为,第71条中的同意方法具有不适当的限制性,并认为国家道德准则中认可的同意方法更有道理。选择批准道德准则允许的同意策略的REC实际上是选择不遵循第71条,这提出了一个问题,即对该REC可能产生的后果。本文通过责任追究的三个“线程”来研究RECs的法律责任:NHREC,主办REC的机构,和法院。我们得出的结论是:(i)如果REC根据国家道德准则而不是第71条允许的同意策略批准了儿童协议,则NHREC不太可能在面对投诉时对REC进行纪律处分-前提是REC在NHREC根据其第72条规定的国家道德准则中采取了行动,以制定国家规范和标准;(ii)如果REC在同意的指导中允许道德准则面对投诉,主办机构也不太可能对REC进行纪律处分-特别是如果该机构知道REC明确决定遵循NHA第72条授权的国家道德准则;(iii)只有在证明了几个要求苛刻的组成部分的情况下,REC才能由参与者根据违法行为提起诉讼(并承担损害赔偿责任),例如,参与者遭受的伤害直接来自REC批准该研究的特定同意策略的行为。此外,法院在确定REC的行为是否为民法责任的目的是不法行为时,很可能会参考国家道德准则。RECs不受其东道机构购买的保险的集体责任的保护。我们提出了一系列解决这一问题的建议。
It is an internationally accepted principle that ethics norms should be applied and enforced in research with humans through ethics review by research ethics committees (RECs). This places RECs at the very heart of the system for protecting participants and enforcing their rights. In the South African ethical-legal framework for child research, there are divergent approaches to consent. That is, section 71 of the National Health Act (No. 61 of 2003) (NHA) requires mandatory parental consent for child research, and limits the authority for proxy consent to parents and legal guardians. However, national ethics
guidelines authorised by section 72 of the NHA and issued by the National Health Research Ethics Council (NHREC) acting in terms of its mandate (National Department of Health, 2015) allow a more nuanced approach - i.e. self-consent by older adolescents, provided certain conditions are met, and consent by a range of parental substitutes where there are no available parents or legal guardians. We have argued elsewhere that the consent approach in section 71 is inappropriately restrictive and are of the view that the consent approach endorsed in national ethics
guidelines is more defensible. An REC that elects to approve a consent strategy allowable in ethics
guidelines is effectively electing to not follow section 71, which raises the question of what the consequences might be for that REC. This article examines the legal liability of RECs through three \'threads\' of accountability: the NHREC, the institutions hosting RECs, and the courts. We conclude that: (i) if an REC approves a child protocol with consent strategies allowable in terms of national ethics guidelinesbut not in terms of section 71, it is unlikely that the NHREC would discipline the REC in the face of a complaint - provided the REC acted within national ethics
guidelines issued by the NHREC in terms of the latter\'s section 72 mandate to set national norms and standards; (ii) if an REC approves a consent approach allowed for in ethics guidance, it is also unlikely that the host institution would discipline the REC in the face of a complaint - especially if the institution is aware of the REC\'s explicit decision to follow national ethics guidelines that are authorised by section 72 of the NHA; and (iii) an REC could only be sued by a participant in terms of the law of delict (and be liable for damages) if several demanding components are proven, such as that the harm suffered by the participant resulted directly from the REC\'s actions in approving a particular consent strategy for that research. Furthermore, the court may well look to national ethics
guidelines in making determinations about whether an REC\'s conduct was wrongful for the purposes of liability in civil law. RECs are protected from being collectively liable by insurance taken out by their host institutions. We make a series of recommendations to address this issue.