[Medical decisions, cost considerations and clinical practice guidelines; comments from the legal point of view]

Physicians are expected to take into account the cost of medical decisions. From a legal point of view, this need not to be problematic as long as it does not detract from good care. A controversial issue is whether a doctor may offer a less effective treatment than would be possible, because of financial constraints. At present, the courts in the Netherlands would seem to leave only marginal room for that, although they do not require a maximization of care. This means that clinical practice guidelines cannot be based, at least not to an unlimited extent; on cost-effectiveness, if they are to retain their professional character. If this restriction is not respected and cost-effectiveness based guidelines are not distinguished from professional ones, a likely result is confusion over their legal status and over the professional duties and liability of physicians.