Clinical Practice Guidelines as Part of Evidence-Based Medicine and Related Legal Implications: An Analysis

Abstract

‘Evidence-based medicine (EBM)’ describes the application of the best available scientific evidence in the treatment of patients. It is defined by the integration of best available research evidence with clinical expertise and patient values. A product of EBM is ‘clinical practice guidelines (CPG).’ Such guidelines include statements, informed by a systematic review of evidence, that outline recommendations to optimise patient care. The main focus of the present research is the use of clinical guidelines as a ‘standard of care’ in the context of medical malpractice litigation. Major challenges associated with the use of such guidelines include the multiplicity of guidelines for a given condition, and multimorbidity in patients (whereas guidelines typically address a single condition). Rigid adherence to CPG may also contribute to the erosion of professional autonomy and the development of ‘cookbook medicine’. Furthermore, concerning liability, the developers of such guidelines may be held indirectly liable, alongside professional caregivers, for harm incurred by patients. This paper adopts a qualitative methodology, including descriptive and critical analysis of the literature and case laws. Its findings recognise the potential of clinical guidelines to promote uniformity provided that ‘competent medical practice’, based on relevance, reliability, and authenticity, can overcome the issue of multiplicity. However, strict adherence to such guidelines is associated with the erosion of professional autonomy and professional judgement.