[Practice guidelines--legal aspects]

Medical guidelines of professional institutions establish rules for good medical treatment (quality of care). They take the form of international, national, regional and local guidelines and are set up by international and national medical organisations, mainly by medical societies but also by regional (e.g. medical associations in the states) and local institutions (up to hospital departments). The rules of good medical treatment (guidelines) conform to the corresponding medical standard which is defined by scientific knowledge (evidence based medicine), practical experience and professional acceptance. The binding character of the standard for medical practice increases with the reliability of scientific evidence and practical experience. Insofar, medical guidelines which correspond to the standard fulfil a quality assurance function for medical treatment as a means of communication in the medical profession, an implementation function for the enforcement of standards and thus also a protective function for patients. Furthermore, they rationalize decisions of the courts by increasing the transparency of their medical basis and thus also contribute to the quality improvement of legal decisions on medical malpractice. Medical guidelines can also influence social law directives. On principle. Medical guidelines do not include any economic considerations (efficiency) and should be strictly separated from these (principle of separation and transparency). Medical guidelines have to be differentiated from health insurance law directives and recommendations. In addition to the quality assurance function, the function of guaranteeing the efficiency of treatment is a priority for health insurances. These objectives may be in conflict with each other. This paper is mainly concerned with the significance of medical guidelines for medical malpractice law.