Department of Orthopaedics and Rehabilitation, Yale University, New Haven, CT, USA.
Clin Orthop Relat Res. 2012 May;470(5):1357-64. doi: 10.1007/s11999-012-2280-0.
The term "standard of care" has been used in law and medicine to determine whether medical care is negligent. However, the precise meaning of this concept is often unclear for both medical and legal professionals.
QUESTIONS/PURPOSES: Our purposes are to (1) examine the limitations of using standard of care as a measure of negligence, (2) propose the use of the legal concepts of justification and excuse in developing a new model of examining medical conduct, and (3) outline the framework of this model.
We applied the principles of tort liability set forth in the clinical and legal literature to describe the difficulty in applying standard of care in medical negligence cases. Using the concepts of justification and excuse, we propose a judicial model that may promote fair and just jury verdicts in medical negligence cases.
Contrary to conventional understanding, medical negligence is not simply nonconformity to norms. Two additional concepts of legal liability, ie, justification and excuse, must also be considered to properly judge medical conduct. Medical conduct is justified when the benefits outweigh the risks; the law sanctions the conduct and encourages future conduct under similar circumstances. Excuse, on the other hand, relieves a doctor of legal liability under specific circumstances even though his/her conduct was not justified.
Standard of care is an inaccurate measure of medical negligence because it is premised on the faulty notion of conformity to norms. An alternative judicial model to determine medical negligence would (1) eliminate standard of care in medical malpractice law, (2) reframe the court instruction to jurors, and (3) establish an ongoing consensus committee on orthopaedic principles of negligence.
“标准治疗”一词在法律和医学领域被用来确定医疗护理是否存在疏忽。然而，对于医疗和法律专业人员来说，这个概念的确切含义往往并不清楚。
问题/目的：我们的目的是（1）检查将标准治疗作为过失衡量标准的局限性，（2）提出在制定新的医疗行为检查模型时使用法律上的正当理由和辩解概念，以及（3）概述该模型的框架。
我们应用临床和法律文献中规定的侵权责任原则来描述在医疗过失案件中应用标准治疗的困难。通过使用正当理由和辩解的概念，我们提出了一个司法模型，该模型可能会促进医疗过失案件中公平公正的陪审团裁决。
与传统理解相反，医疗过失不仅仅是不符合规范。还必须考虑法律责任的另外两个概念，即正当理由和辩解，以正确判断医疗行为。当收益超过风险时，医疗行为是正当的；法律制裁这种行为，并鼓励在类似情况下进行类似的行为。另一方面，辩解在特定情况下免除医生的法律责任，即使他/她的行为没有正当理由。
标准治疗是衡量医疗过失的不准确方法，因为它基于符合规范的错误概念。确定医疗过失的替代司法模型将（1）在医疗事故法中消除标准治疗，（2）重新调整对陪审员的法庭指示，以及（3）建立一个关于骨科过失原则的持续共识委员会。
