In Belgium, the development of clinical ethics took place in several phases. During the initial phase the establishment of ethics committees was mainly a matter of internal regulation. After some local initiatives, the Belgian Order of Physicians took over the initiative in 1984 by publishing a guideline which stated that, in line with international standards, every research protocol that involved human subjects had to be evaluated by a REC beforehand.
In 1992 the Order of Physicians’ National Council published a second guideline on the functioning of ethics committees which significantly extended the role of ethics committees: from then on ethics committees had to provide the space for systematic reflection on the ethical and philosophical aspects of healthcare practice. However, the Order of Physicians at that time did not consider it appropriate to entrust a separate committee with this task: "It is superfluous to enlarge the committees for ethics indefinitely by establishing extraordinary committees for ethical reflection. Thus, members of the ethics committees which are concerned with experiments on humans and with scientific research can participate in ethical reflection [...]."4 As a result, Belgian ethics committees had to combine the tasks of both the REC and HEC.