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Clinical Guidelines and the Law. Negligence, Discretion and Judgment.Hurwitz B. (Pp 152, paperback; £19.95.) Oxford: Radcliffe Medical Press, 1998. ISBN 1 857 75044 6 .
Brian Hurwitz is a general practitioner and in this small book he has linked literature on clinical guidelines with views on how these might be applied in a legal context. He contrasts the views of the British Medical Association in 1946, which were that individual doctors retain full responsibility for the care of the patient, practising medicine according to its traditions, standards, and knowledge but with freedom of judgment and without interference in professional work, with patterns of practice that pertain today.
In discussing the nature and context of clinical guidance, Hurwitz briefly reviews the large variety of terms in use ranging from protocols to codes of practice, and concludes that there is no single definition or guideline and, moreover, that guidelines vary in their quality and in the standards of health care they seek to establish.
He offers helpful criteria on how the authority of guidelines can be assessed and then goes on to discuss their developing legal status. He quotes examples of interaction between statute law and clinical guidelines in the UK, Europe, and the USA, emphasising the higher degree of development and sophistication of this interaction in the USA compared to Europe.
He then applies this interaction to negligence case law, focusing particularly on UK practice. He concludes that guidelines are regarded by the courts as hearsay evidence only and are not a substitute for expert testimony. He nevertheless very reasonably raises the issue that doctors acting outside guidelines are exposed to the possibility of being found to be negligent in their practice.
There is a particularly interesting discussion on the potential liability of authors or sponsors, such as Royal Colleges, which recommends that the legal status of recommendations from bodies such as these should be made clearer to doctors. In contrast, he goes on to make the reasonable points that autonomous clinical thought is undermined by unthinking conformity and that despite pressure from purchasers, rigid adherence to guidelines cannot and should not be a formal managerial or legal expectation in the National Health Service.
While the issues presented and discussed by Hurwitz are of particular relevance to doctors with an interest in medicolegal practice, no paediatrician can be immune from an involvement with the issues he details.
This is a relevant and lucid exposition of the current status of clinical guidelines and how they can be, and are, applied in the legal situation. Its content is wholly applicable to paediatric practice and the book deserves to be widely read.