Samanta Ash, Samanta Jo
Leicester Royal Infirmary.
Clin Med (Lond). 2003 Sep-Oct;3(5):443-6. doi: 10.7861/clinmedicine.3-5-443.
An essential component of an action in negligence against a doctor is proof that the doctor failed to provide the required standard of care under the circumstances. Traditionally the standard of care in law has been determined according to the Bolam test. This is based on the principle that a doctor does not breach the legal standard of care, and is therefore not negligent, if the practice is supported by a responsible body of similar professionals. The Bolam principle, however, has been perceived as being excessively reliant upon medical testimony supporting the defendant. The judgment given by the House of Lords in the recent case of Bolitho imposes a requirement that the standard proclaimed must be justified on a logical basis and must have considered the risks and benefits of competing options. The effect of Bolitho is that the court will take a more enquiring stance to test the medical evidence offered by both parties in litigation, in order to reach its own conclusions. Recent case law shows how the court has applied the Bolitho approach in determining the standard of care in cases of clinical negligence. An understanding of this approach and of the shift from the traditional Bolam test is relevant to all medical practitioners, particularly in a climate that is increasingly litigious.
对医生提起过失诉讼的一个关键要素是证明医生在当时的情况下未能提供所需的护理标准。传统上，法律上的护理标准是根据博勒姆测试来确定的。这一测试基于这样一个原则：如果一种做法得到了负责任的同类专业人士群体的支持，那么医生就没有违反护理的法律标准，因此也就不存在过失。然而，博勒姆原则被认为过度依赖支持被告的医学证词。上议院在最近的博利索案中做出的判决规定，所宣称的标准必须在逻辑上站得住脚，并且必须考虑到相互竞争的选择的风险和益处。博利索案的影响是，法院将采取更具探究性的立场，以检验诉讼双方提供的医学证据，从而得出自己的结论。最近的判例法显示了法院如何在临床过失案件中运用博利索方法来确定护理标准。理解这种方法以及从传统的博勒姆测试的转变，对所有医疗从业者都很重要，尤其是在诉讼日益增多的环境下。
