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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2000 June;66(6):479-85


language: Italian

Guidelines in clinical practice. Legal considerations

Valmassoi G.

Tribunale di Treviso


The ­paper anal­y­ses the ­role and impli­ca­tions of the appli­ca­tion of ­these guide­lines ­from a ­legal ­point of ­view. After an intro­duc­tion ­based on the ­legal con­cepts of the cau­sal nex­us and ­guilt in juris­dic­tion, the ­authors high­light the ­main ­arcas of influ­ence ­that ­these guide­lines can ­have on eval­u­a­tions of a toren­sic ­nature. In juris­dic­tion­al ­terms, the ­first ­step in the eval­u­a­tion of med­i­cal con­duct is to recon­struct the cau­sal nex­us ­between the ­doctor’s con­duct (active or omis­sive) and the inju­ry/­death in ques­tion. The iden­tifi­ca­tion of the cau­sal nex­us is ­based on the appli­ca­tion of the ­laws of prob­abil­ity accord­ing to ­which it is pos­sible to ­affirm, ­with a rea­son­able mar­gin of log­i­cal and ration­al plau­sibil­ity, ­that a giv­en con­duct is the cau­sal con­di­tion of a par­tic­u­lar harm­ful ­event. With ­this in ­mind, the guide­lines ­assume the ­role of law of prob­abil­ity in the ­sense ­that ­their adop­tion, depend­ing on an eval­u­a­tion of the pro­bab­il­is­tic reg­u­lar­ity of the cau­sal ­series, ­would ­have pre­vent­ed the occur­rence of the inju­ry/­death ­that is the ­object of the ­legal ­inquiry. Another essen­tial ­step in the juris­dic­tion­al pro­cess, is the eval­u­a­tion of ­guilt. Bearing in ­mind ­that the eval­u­a­tion of ­guilt is by def­i­ni­tion ­linked not to the actu­al doc­tor in ques­tion, but to an ­abstract mod­el of a doc­tor and name­ly the knowl­edge and ­skills ­that a doc­tor is expect­ed to pos­sess, it can be ­seen ­that the adop­tion of ­these guide­lines may facil­i­tate ­this eval­u­a­tion. The appli­ca­tion of the guide­lines ­would rep­re­sent com­pli­ance ­with the ordi­nary con­di­tions of knowl­edge and ­skill expect­ed of a doc­tor to ­which ­should be log­i­cal­ly add­ed the ­need for an ade­quate moti­va­tion for any devi­a­tion ­from the indi­ca­tions ­expressed in the guide­lines. In con­clu­sion, the ­main influ­enc­es of ­these guide­lines for the doc­tor-­patient rela­tion­ship are eval­u­atcd, togeth­er ­with the ­role ­that ­these guide­lines may ­play in ­terms of ­patient infor­ma­tion and the ­informed con­sent giv­en by the lat­ter.

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