The role of clinical guidelines in medical malpractice litigation

The medico-legal status of clinical practice guidelines is a frequently raised question. Since guidelines are not issued by legislative bodies, they are not legal rules. However, they may have or acquire legal significance, for instance when they are applied by a court as auxiliary standards to decide a case of professional misconduct or malpractice. However guidelines are not likely to be used as the sole basis for evaluating negligence, and in many jurisdictions, they may not even be seen as having a special status in law. Usually the perceived value of guidelines in a court will be conditional on several factors, in particular the extent to which they are based on scientific evidence, reflect a consensus among peers, and are issued by a group or institution with authority. Basically, guidelines will not provide definite answers even when they do not allow for much flexibility in application. A particular course of action must be judged in the light of the specific health problem and the specific circumstances of a given patient. Sometimes, there can be competing guidelines, for instance developed in different hospitals or regions in other cases, expert testimony may be used in a court to challenge the authority of a guideline. For all these reasons, the courts will not automatically equate compliance with guidelines with good medical practice. Mere deviation from a guideline is unlikely to be considered as negligent, unless the practice concerned is so well established that no responsible doctor would fail to adhere to it.