In Germany the ethics committees charged with delivering an expert opinion on clinical research protocols are either affiliated with university clinics or the "Landesärztekammern" (State Medical Associations) or they are established on the level of the federal states. Altogether, there are currently 52 public ethics committees that have voluntarily come together under the umbrella of the Working Group of Medical Ethics Committees in the Federal Republic of Germany (Arbeitskreis medizinischer Ethik-Kommissionen in der Bundesrepublik Deutschland).