This paper draws attention to a simple distinction that, when ignored, considerably distorts discussion of what should be subject to what form of ethical review and by whom. The distinction is between two types of ethical questions that can be asked about any investigation, and indeed about many other types of activity. First, there are questions of the kind: Is it ethical to conduct this investigation at all? Second, there are questions such as: How can this investigation be conducted in (...) an ethical way? Consideration of these questions and of the categorization of research based on study design can lead to a model for triage, however the aim of the paper is not so much to make a real practical suggestion but rather the to highlight the distinction between two types of ethical question. It is clear thinking on the relationship between the two types of question that might lead to some practical suggestions and serve to better define the scope of research ethics review. (shrink)