Meadow W, Lantos J D
Department of Pediatrics, MacLean Center for Clinical Medical Ethics, University of Chicago, Illinois, USA.
Clin Perinatol. 1996 Sep;23(3):583-95.
Sunstein has written, "First, and most obviously, judgments about specific cases must be made consistent with one another. A requirement of coherence, or principled consistency, is a hallmark of analogic reasoning (as it is of reasoning of almost all sorts)." In cases of alleged medical negligence, our current system of malpractice litigation supports the possibility that inaccurate anecdotal testimony by expert witnesses may be credited equally or even preferred to more accurate testimony based on empiric data. This condition lends itself to inconsistent outcomes that violate basic principles of justice. In our view, the standard of medical care ought not be described by the idiosyncratic postulation of single behavior (analogous to promulgating the equation of a single line on a Cartesian plane). Rather, the standard of medical care is best viewed as a distribution of behaviors (family of lines) that can be empirically determined to account for most practice decisions in comparable cases. The recent Daubert formulation of admissibility of expert testimony can be interpreted as providing judicial support for a hierarchy of expert testimony in cases of alleged medical negligence. On this view, testable comparisons of the behavior in question against reliably documented distributions of standard medical behavior in similar circumstances rank higher than untestable comparisons using unreliable anecdotal recollections of individual expert's undocumented experience. We believe that widespread adoption by the medical community of the principle that the value of expert testimony describing the standard of medical care increases in direct proportion to its congruence with a data-based determination of the distribution of skill and care ordinarily provided in similar circumstances would significantly reduce the potential for injustice visited on plaintiff and defendant alike.
“首先，也是最明显的一点，对具体案例的判断必须相互一致。连贯性要求，即有原则的一致性，是类比推理的一个标志（几乎所有类型的推理都是如此）。”在医疗过失指控案件中，我们目前的医疗事故诉讼制度支持这样一种可能性，即专家证人不准确的轶事性证词可能被同等看待，甚至比基于实证数据的更准确的证词更受青睐。这种情况容易导致违反基本正义原则的不一致结果。我们认为，医疗护理标准不应由单一行为的特殊假设来描述（类似于在笛卡尔平面上公布一条单一的直线方程）。相反，医疗护理标准最好被视为一种行为分布（直线族），可以通过实证确定，以解释类似案例中的大多数实践决策。最近关于专家证词可采性的道伯特规则可以被解释为在医疗过失指控案件中为专家证词的等级制度提供司法支持。按照这种观点，将有争议的行为与类似情况下可靠记录的标准医疗行为分布进行可测试的比较，比使用个别专家无记录经验的不可靠轶事回忆进行不可测试的比较更具说服力。我们相信，医学界广泛采用这样一个原则，即描述医疗护理标准的专家证词的价值与其与基于数据确定的类似情况下通常提供的技能和护理分布的一致性成正比，将显著降低原告和被告遭受不公正待遇的可能性。
