Balancing protection and progress: is New Zealand's ethical review framework appropriate for low-risk research?

Clinical audits, observational studies and patient registries are essential for evaluating healthcare quality, identifying inequities and improving patient outcomes. New Zealand's ethics system plays an essential role in protecting participants and maintaining public trust and includes pathways for expedited review of low-risk research. However, New Zealand already has proportionate review mechanisms. The difficulty is that, in practice, studies requiring temporary access to identifiable information often receive the same level of scrutiny regardless of their actual participant risk, creating barriers that can prevent valuable studies from proceeding. The cost of these barriers is overlooked. When low-risk research is delayed or abandoned, opportunities to improve care are lost. Important questions affecting Māori and Pacific communities may remain unanswered, inequities may persist and New Zealand risks contributing less to international research efforts. The burden also falls on clinicians, particularly early-career doctors, who may become discouraged from undertaking research altogether. We argue that more consistent application of existing principles of proportionate review would maintain appropriate ethical oversight while supporting a health system that learns from everyday practice and continually improves care for all New Zealanders.