Clinical practice guidelines in courts' representation of medical evidence and testimony.

Abstract

This article examines clinical practice guidelines (CPG) in the courtroom. The guidelines in question are Finnish national current care guidelines for brain injuries, and the case context is traffic insurance compensation cases contested in the Helsinki district court. We analyse 11 case verdicts qualitatively, drawing from earlier sociological and theoretical accounts of clinical practice guidelines and evidence-based medicine. What makes the case-type relevant for studying clinical practice guidelines is the fact that the cases, which feature a medical dispute concerning traumatic brain injury, involve highly specialized expertise and contradictory expert claims, but the cases are decided in a generalist court by non-expert judges. What we show in the article is how the guidelines structure, sequence and initiate temporal reworking in the judges' representation of medical evidence and testimony, and how the plaintiffs' delayed diagnoses complicate the application of the CPG in the evaluation. We further discuss the guidelines' epistemic authority in the verdicts and finish by comparing the 2008 and 2017 editions of Finnish CPGs for brain injuries, suggesting a multifaceted, courtroom-mediated feedback loop between the patient-plaintiffs and the clinical practice guidelines.