負責抑或受限的醫療 ？ 臨床指南使用於醫療過失訴訟的觀察性研究（三）【全球瞭望】 試閱
Responsible Practice or Restricted Practice? An Empirical Study of the Use of Clinical Guidelines in Medical Negligence Litigation (III)
在醫療過失訴訟中，違反義務的標準是根據反應公認做法的Bolam測試來衡量的。儘管經過長期的辯論和普通法的發展，Bolam標準仍然是該訴訟領域的試金石。臨床指南（CGs）是基於現有最佳醫學證據的發表，旨在輔助臨床決策以讓醫療結果更臻理想，達到預期的表現。然而，很少有研究考慮到CGs如何參與訴訟及其對司法推理的影響。鑑於訴訟成本不斷上升，英國國民健康署因此面臨越來越大的壓力，這些就成為重要的問題。本研究為CGs在判定違反法律義務方面的文獻提供了原創性的貢獻。透過混合研究方法，透過數個來源的數據收集與分析，以評估律師和法院對CGs的使用，從而揭露司法態度的轉變，增加了從尊重到使用Bolam測試的論述。最後，它為在合理性框架內使用CGs提供了概念基礎，並在避免對專家證詞、經驗和臨床自由裁量權行使產生限制的同時，促進其原則性使用。本研究對學術界、法律界和醫學執業者以及政策制定者具相關性。
In medical negligence litigation, the standard for breach of duty is measured against the Bolam test which reflects accepted practice. Despite protracted debate and common law development, the Bolam standard remains the touchstone for litigation in this area. Clinical guidelines （CGs）are statements based upon best available medical evidence and are designed to facilitate clinical decision making to optimise outcomes thereby reflecting expected practice. Nevertheless, there is little research that considers how CGs engage in litigation and their influence on judicial reasoning. Given the increasing pressures on the NHS amid rising costs of litigation, these are important issues. This study provides an original contribution to the literature on CGs in determining breach of duty in law. Using a mixed methods’ approach, data from multiple sources have been gathered and analysed to assess the use of CGs by lawyers and the courts thereby adding to the discourse on the judicial shift away from deference to Bolam. It concludes by offering a conceptual basis for the use of CGs within a framework for reasonableness and promotes their principled use while avoiding constraints on expert testimony, experience, and exercise of clinical discretion. This study has relevance for academics, legal and medical practitioners, and policy makers.
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