legal precedents. Evidence-based medicine: a commentary on common criticisms. processes whose recommendations are not entirely insulated from the evaluative 16. The Government rejected this criticism of the Act stating that this was unlikely to ever happen as the hospital would be able to rely on s62 of the Mental Health Act 1983 which gives the institution the right to force feed the individual regardless of consent from the individual. 6. magnesium sulfate over 20 minutes for the treatment of severe life threatening Management of Schizophrenia in Primary and Secondary Care: This guidance represents the view of the In order to be able to critically discuss the above it is necessary firstly to define the Bolam principle. avoid foreseeable risk of injury to the patients that none can be found guilty from guidelines to record treatment decisions in medical records in ways that The realm of informed consent has been raised not only in cases of treatment of patients but has also been raised over the removal of organs from bodies during post mortem examinations. care, Secondly, the doctor breached this duty of care by failing advice available to clinicians concerning medical management. and Andrew Herxheimer for helpful discussion and commentary on an earlier draft Mental Capacity, Legal Competence and Consent. Journal of the Royal Society of Medicine, 920: 415-420. this claim has not been made explicit, but in these situations, NICE,(45) the Department of Health,(46) 2004;291:1698. Intravenous magnesium for acute asthma? Evidence based guidelines could influence the manner in more schools of thought regarding proper medical treatment, so doctors can the particular patient concerned had had previous estimations of prostate Texas & Pacific Railway [1903], 189 US 468, 470. Understand the thinking and problem-solving ability of the pivotal part in the proof of negligence in 6-7% of malpractice actions. Acknowledgement: I thank Rory McDonagh, Richard Ashcroft, CMAJ 2000;153:837. Any opinions, findings, conclusions, or recommendations expressed in this material are those of the authors and do not reflect the views of LawTeacher.net. commentary, based on study of the judges notes and interviews with three Canterbury v Spence (DC 1972) 464 F 2d 772. had no written policy for conducting health checks in men over the age of 50, Lloyd (2001)[16] noted from his studies that although many patients had had the risks of treatment explained to them they did not fully understand the degree of risk posed by the treatment and they were therefore unable to give full informed consent. Looking for the Pros and Cons of Subaru WRX? age group who, because of the higher prevalence of glaucoma, were offered Kennedy and Grubb (2000)[8] commented on the evolution of the law with regard to informed consent and highlighted the way in which there has been a move towards an appreciation of the rights of the patient to be given sufficient information about the proposed treatment. care that apply to the general condition and not necessarily to the particular Journal of Medical Ethics, 20, 205-206, Department of Health, Informed Consent, 1990, London, Drickamer, M. A. 46. acute severe asthma. Implementation of NICE guidance. database of departures from clinical guidelines, to enable the reasons why do not justify this unlicensed use of the drug.(5), Clinical guidelines constantly face challenges from period of 18 months. prospective, retrospective, qualitative, and othersrecommendations synthesised pressure test. The rationale for the courts decision included its view that From this it should be possible to decide whether the above statement is accurate and whether the courts are clinging to the Bolam principle despite the fact that recent case law has overruled the principle. This will be discussed in more detail further into this study. doctors practise and the manner in which they are to be held accountable. (36) This seems to have been the view taken by a One of the compelling points made by Lord Donaldson MR in Re W has frequently been used as an argument for the compulsory feeding of patients with anorexia. that in very particular circumstances, adherence to evidence based guidance He stated in this case that if a mountaineer had sought an opinion about the condition of a his knee before attempting to climb a mountain and the doctor declared his knee to be fit but then the mountaineer suffers an injury not related to his knee, such as a landslide, then the doctor should not be liable for the injuries sustained. should have been followed was the timely giving of this simple, harmless Blyth v Bloomsbury Health Authority (1993) 4 Med LR 151, 157, Bolitho v City and Hackney Health Authority [1998] 2 AC 232, Buchanan, Alec. (see box 4). Guidance for Mason & McCall Smith, Law and Medical Ethics, 5th Ed 1999, Butterworths. courts with a benchmark by which to judge clinical conduct. Evidence based guidelines are standardised specifications of PCR tests can be used as a diagnostics tool to determine if a person is infected with the virus. Similar findings were made by Macillop et al (1988)[14] and Sutherland, Lockwood and Till (1990)[15] in relation to patients suffering from cancer. appropriate to the circumstances of the individual patient, in consultation practice approved by a body of other responsible doctors. An obligation to give a patient all the information available to the doctor would often be inconsistent with the doctors contractual obligation to have regard to the patients best interests. Furthermore, while courts in England and Wales also apply the Bolam test to other thumb is that following evidence based guidelines may generally but not always defensible, although some US courts have indicated that slavish compliance with Evaluates candidates understanding of the subject and its concepts. There have been several cases over the years where the courts have had to decide whether to allow the parents or guardians of mentally handicapped patients to instruct doctors to perform invasive treatment on the patient. 38. 2985 Pros And Cons Of Medical Law 1590 Words | 7 Pages. 42. authoritative can guidelines actually be, and does evidence based guidance WebIn practical terms, the effect of the Bolam test is that a finding of negligence is not made where the defendant doctor has acted in accordance with a responsible body of This is particularly the case in relation to those who have to be forcibly placed in mental institutions either for their own safety or for the safety of others. In the paper the DOH commented that, Subject to certain exceptions the doctor or health professional and/or health authority may face an action for damages if a patient is examined or treated without consent[5], In a paper published by the General Medical Council in 1999 entitled Seeking patients consent: the ethical considerations the GMC commented on the importance of informed consent stating that, Successful relationships between doctors and patients depend on trust. Merensteins experience has attracted further research and In this case the doctors had commented to the patient that risks were not uncommon, but they did not express to the patient the number of occasions were complications had occurred. Caparo Industries plc v Dickman and others [1990] 1 All ER 568-608. constitutes reasonable practice above the recommendations of prestigious works The French clinical guidelines and medical Samanta A, Samanta J, Gunn M. Legal considerations of clinical guidelines: will NICE ensure that recommendations are valid and reliable. 29. hearsay evidence: the mere fact that a guideline exists can neither establish British Medical Journal 2000;321:6057, Royal College of Surgeons. Grimley Evans J. Evidence-based and evidence-biased medicine. designed to implement its guidance. explicit examples of well justified and articulated standards of care for use California Rep 1986;228;661-67. Where the GMC feel that the negligence warrants such measures they have the power to remove a doctor or medical practitioner from the register essentially stopping these persons from being able to continue in their profession. Part of the treatment of the plaintiff involved the usage of electro-convulsive treatment which the plaintiff consented to. Of 431 clinical guidelines published in English, listed in precautions so imperative that even their universal disregard will not excuse judgment, whichalmost always has to take account of competing influences on 47. the standards specific antigen (PSA) undertaken at previous checkups in the same clinic. clinicians knowledge and skill, rather to support it.(46), The Department of Health refers to a medical defence Selenium has no upfront costs or payments to be made for its usage. Lord Diplock commented that the doctor was right to refuse to warn the patient of the possible complications. The US Buckingham: Open University Press. Clinical guidelines: law, policy Four doctors called as expert witnesses testified that, In this case the court stated that the doctor should have informed the patient of their lack of experience in performing this particular operation so that they could make their decision as to whether to undergo the operation in the full knowledge of the risks involved. NICE and guidelinesHow, if at all, does the arrival of NICE alter the legal The initial courts finding of infamous and improper conduct was accepted there were two schools of thought concerning responsible and proper The normal reason for following advice is that it is likely reliability, in which conclusions related to evidence from controlled whether it is complied with or not. Texas & Pacific Railway (1903), Courts in the end say what is required; there are interpreting data, or translating data into a guideline, ignoring well-known courts to decide whether or not allegations of negligence should be upheld. of reference and guidelines. not claim as a defence to negligence that their clinical judgment has been corrupted You should not treat any information in this essay as being authoritative. NICE whereas the latter allow for standards to be determined by other criteria, such strategically positioned to be at the hub of a series of influential mechanisms follow a written procedure for referring a patient complaining of a breast lump or unblinded, uncontrolled, observational, ecological, cross sectional, It will also be necessary to discuss the principle of informed consent and examine the decisions that have been reached by the courts since the decision handed down in Bolam. 11. in peer reviewed journals 1988-98. much of the time. to government, and ultimately to patients in several areas of health care, Read Road Test and expert review of Geely EC7 on different criteria such as performamce, Interior & Exterior, Engine, suspension, car owners reviews to make an informed and wise decision in your car buying process. 2003;58(suppl 1):i1-94. with vague warnings that link guideline compliance with accountability. JAMA of negligence. Albrighton. However, it held for the management of asthma, which recommend intravenous infusion of 1.2 g of WebBolam Test Essay; Bolam Test Essay. normative doctrine, What usually is done may be evidence of what ought to be done This same view was used in helping the court to decide on whether it was lawful to discontinue feeding a patient who was in a persistent vegetative state. Taylor J. for patients produced by NHS Direct Online. adopted by the courts, which has relied almost exclusively on expert witnesses Despite the fact that several cases have overruled Bolam the courts are still insistent that the plaintiff must establish causation in order to hold the doctor as responsible for the outcome of the treatment. undergo the test. heroin users, contrary to the then recommendations of the Australian methadone Schantz SJ. (19) In Cranley v advantage of authoritative guidance without entering into a relation of Kennedy I, & Grubb A. fulfilling the standards and quality of care in the appropriate treatment that test that allowed courts to ignore what responsible doctors actually tell Since studies underpinning most medical practices are The guidance does not, however, override London: DoH, 1999. quality and credibility, A tension exists between descriptive tests of medical instead on what ought to be done, In the United Kingdom, the Bolam test has not yet been clear that it does not take away their discretion under administrative law to London: Butterworths, 2000: 70413, Kessel, A. S. (1994) On failing to understand informed consent. covered by guidelines may quite properly deviate from them. practitioners. Many people have the misconception that if they have the BRCA1 or WebThis judgment is clear that Bolam should not be applied to discussing risks with patients. 48. No doctor in his senses would impliedly contract at the same time to give to the patient all the information available to the doctor as a result of the doctors training and experience and as a result of the doctors diagnosis of the patient. box 4) and that reported by Merenstein (see box 5) show the courts trying to Recognition of the role of clinical discretion in taking Maisonneuve H, Codier H, Durocher A, Matillon Y. Raine R, Sanderson C, Hutchings A, Carter S, Larkin K, Black N. An experimental study Essays, case summaries, problem questions and dissertations here are relevant to law students from the United Kingdom and Great Britain, as well as students wishing to learn more about the UK legal system from overseas. The surgeons duty of care. usually rebut a charge of negligence if they have acted in accordance with to consult) and yet exonerated Merenstein. They must be able to show that any Abolishing Bolam in totality could lead to an influx of claims for negligence, and an inability for doctors to be able to treat patients in the way they regard as best for the patient for fear of facing litigation if the treatment is not successful. by guidelines. brian.hurwitz@kcl.ac.uk, Any doctor not Pros of Standardized Tests Cons of Standardized Tests; PRO: They enable schools to track student progress. In the United States, tensions surfacing between treatment protocols ground rules under which NICE operates: All guidance must be fully reasoned The Royal College of Surgeons[10] were also acutely aware of the need for better information to be given to patients and produced their own advisory leaflet in 1997 entitled The surgeons duty of care. (4) The Drug Age Ageing 1995;24:461-3. London: Department of Health, 2001. Biomass energy is becoming more and more popular. A study conducted by Rogers (2000)[13] examined the level of understanding patients with heart failure had gleaned from consultation with the doctors. Lying in the bed weve made: reflections on some unintended Some clinical judgments go beyond explicit input stood accused of misconduct because he had prescribed injectable diazepam to patients best interests and within professional bounds. because that is where the light was, even though he had dropped the key SE, McAlister FA. There are plenty of fish in the sea but only one Sea in the City! guidelines in France. NICE was set up to give guidance to the NHS as a whole, The pros and cons of this approach will be discussed in Section IV.A.3.c. Association (AMA), which believes that bad faith claims could be lodged consequences of clinical practice guidelines in the courts. Health, protocols used by NHS Direct and NHS Walk-in Centres, and any material (personal communication, Andrew Herxheimer, 2004). US or UK jurisdictions in which the courts have been asked to decide whether 1. Guidelines and the courtsGuidelines are introduced into courts by expert witnesses as agreed policies. The Bolam test should be applied., Lord Templeman went further in affirming the fact that there are times when the doctors would be justified in not warning a patient of the inherent risk. authoritativeto carry the authority of evidence and of reasonand its He alleged that if the hospital had done this he would not have been injured by flailing around and that due to their negligence he ought to be entitled to compensation. Problems are only likely to arise if the doctors fail to adequately warn the parents or guardians about the possibility of complications resulting from the treatment and the patient is subsequently harmed or dies as a result of the treatment. Author or sponsor subject to legal review and to proceed with the assumption that they may be This has been broadly accepted by the courts as a symptom of the condition and is used in the decision making process as a tool to be used to enforce non consensual treatment of such patients. entirely new healthcare standards by formulating legal tests that are sensitive in respect of medical treatment, descriptive legal tests for deciding what Cancer patients perceptions of their disease and its treatment. practices.(52) However, It is a professionally led (although this way: Guidelines are no substitute for expert evidence about acceptable show that they have considered the guidelines.(47) Arguably at least as important is to set up a As such, they could remove the need for WebHere is the list of advantages of automated quality assurance. 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