University of Helsinki, Finland.
Tampere University, Finland.
Soc Sci Med. 2021 Apr;275:113805. doi: 10.1016/j.socscimed.2021.113805. Epub 2021 Feb 26.
This article examines clinical practice guidelines (CPG) in the courtroom. The guidelines in question are Finnish national current care guidelines for brain injuries, and the case context is traffic insurance compensation cases contested in the Helsinki district court. We analyse 11 case verdicts qualitatively, drawing from earlier sociological and theoretical accounts of clinical practice guidelines and evidence-based medicine. What makes the case-type relevant for studying clinical practice guidelines is the fact that the cases, which feature a medical dispute concerning traumatic brain injury, involve highly specialized expertise and contradictory expert claims, but the cases are decided in a generalist court by non-expert judges. What we show in the article is how the guidelines structure, sequence and initiate temporal reworking in the judges' representation of medical evidence and testimony, and how the plaintiffs' delayed diagnoses complicate the application of the CPG in the evaluation. We further discuss the guidelines' epistemic authority in the verdicts and finish by comparing the 2008 and 2017 editions of Finnish CPGs for brain injuries, suggesting a multifaceted, courtroom-mediated feedback loop between the patient-plaintiffs and the clinical practice guidelines.
本文探讨了法庭上的临床实践指南（CPG）。所讨论的指南是芬兰国家针对脑损伤的当前护理指南，案例背景是在赫尔辛基地区法院争议的交通保险赔偿案件。我们从早期关于临床实践指南和循证医学的社会学和理论论述中，对 11 个案例裁决进行了定性分析。使这种案例类型适合研究临床实践指南的原因是，这些案例涉及到涉及外伤性脑损伤的医学争议，涉及到高度专业化的专业知识和相互矛盾的专家主张，但这些案例是由非专业法官在综合法院裁决的。我们在文章中展示的是，指南如何在法官对医学证据和证词的表述中构造、顺序和启动时间上的重新处理，以及原告的延迟诊断如何使 CPG 在评估中的应用变得复杂。我们进一步讨论了指南在裁决中的认识论权威，并通过比较 2008 年和 2017 年版芬兰脑损伤 CPG，提出了一个在患者-原告和临床实践指南之间存在多方面的、法庭介导的反馈循环。
