Profesinių diagnostinių ir gydymo standartų privalomumo gydytojui problema

Abstract

Professional guidelines in Lithuania are legal documents that include the sets of recommendations supposed to direct diagnosing or treatment  doctors actions. Their legal meanings are rather obscure. In some cases they are seen as usual legal norms. Their violation implies criminal, civil or administrative sanctions. In the other cases they are seen as some kind of advice on the most preferred way of actions. In the third ones - as a legal permission  to take some actions. This  multivaluedness of medical guidelines is caused by ambivalent concepts that are used to formulate medical recommendations (“is indicated”, “should be considered”, “is recommended”, “can be reasonable”, etc.).

The first step in specification of these concepts has been done by classification of medical recommendations, developed by Feinstein A. R. and Cochrane A.. They specified these concepts by specification every such concept with only one kind(class) of recommendations. The next step is should be further specification of doctor‘s actions he supposed to commit depending on the class of recommendation and its wording.

From the legal point of view, the most important seems to be the difference between actions that must be taken in the case of „strong“ and „weak“ recommendations. In the first case, the recommendation is obligatory and must be followed. In the second one the decision to follow or not belongs to doctor‘s discretion. Doctor‘s duty in this situation is to consider all related scientific knowledge on factors both promoting and preventing the effectiveness of recommendation have been considered.