This document discusses the ethical considerations around implementing evidence-based practices and generating new evidence through research. It notes that while the goals of improving healthcare quality are ethical, evidence-based quality initiatives can sometimes conflict with ethical principles if they harm some patients or waste resources. There is debate around whether quality improvement activities should have the same regulatory standards as research given they involve human participants. The differences between quality improvement and research are also examined, especially around issues like informed consent and independent review. The document concludes that while external review may be needed in some cases, most quality improvement projects can be reviewed internally through clinical leadership and management structures.