Davies Jonathan
Med Law. 2009 Dec;28(4):603-13.
Clinical guidelines are statements that have been systematically developed and which aim to assist clinicians in making decisions about treatment for specific conditions. They are linked to evidence and are meant to facilitate good medical practice. A key issue that follows is how lawyers and the courts might use such guidelinesin medical litigation. The multiplicity of opinions and scientific professions requiring expertise might influence the expert submitting an opinion to base his opinion on scientific theses which have not been recognized scientifically, are not based on facts and are not supported by professional literature. Medical evidence has to be methodically based and reliable. In recent years the medical community has developed a new field called "Evidence Based Medicine", meaning, use of medical information based on the best information in the medical literature relevant to the condition being treated. Evidence Based Medicine distinguishes between recognized scientific theories and what is called "Junk Science". Clinical Guidelines are of value in systematizing medical procedures, mainly those which may have legal implications. In other procedures Guidelines may serve the Court as a source of sound information, provided they are the product of a recognized professional body, and proven to bear no relation to a body which may have interests in the delivery of healthcare. Clinical guidelines are set as normative standards and used as a tool to indicate the standard of care at the time. They can be used as a tool for assessment of the questionable conduct. Guidelines are consulted by courts because they provide evidence of standards justified in relation to evidence rather than custom, this helps the courts test the expert evidence that radically strengthen the normative dynamic of the law in actions alleging medical negligence. As clinical practice guidelines become more and more prevalent, some authors believe they will define the requisite "standard of care" for medical treatment and impact medical malpractice litigation. They may even replace expert testimony.
临床指南是经过系统制定的声明，旨在帮助临床医生针对特定病症做出治疗决策。它们与证据相关联，意在促进良好的医疗实践。随之而来的一个关键问题是，律师和法院在医疗诉讼中可能如何使用此类指南。意见的多样性以及需要专业知识的科学专业领域可能会影响提供意见的专家，使其基于未得到科学认可、不以事实为依据且未得到专业文献支持的科学论点来发表意见。医学证据必须有系统的依据且可靠。近年来，医学界发展出了一个名为“循证医学”的新领域，即基于与所治疗病症相关的医学文献中的最佳信息来使用医学信息。循证医学区分了公认的科学理论和所谓的“垃圾科学”。临床指南在使医疗程序系统化方面具有价值，主要是那些可能具有法律影响的程序。在其他程序中，只要指南是公认专业机构的产物，且经证明与可能在医疗保健提供方面存在利益关系的机构无关，那么指南就可以作为可靠信息来源供法院参考。临床指南被设定为规范性标准，并用作表明当时护理标准的工具。它们可被用作评估可疑行为的工具。法院会参考指南，因为它们提供了与证据而非惯例相关的合理标准的证据，这有助于法院检验专家证据，从而从根本上加强法律在医疗过失指控行动中的规范性动态。随着临床实践指南越来越普遍，一些作者认为它们将界定医疗治疗所需的“护理标准”并影响医疗事故诉讼。它们甚至可能取代专家证词。
