Prospective trials

Prospective trials

One of the most problematic elements of the civil trial is the retrospective analysis of the appropriateness of actions, which is inevitably influenced by hindsight. It is well known that the recollections of patients and families is influenced by outcomes, for example. The outcome of medical treatment will also influence the judgment of the medical treatment given. We see this time after time in medico-legal suits, as my recent blog about Davies v UHNS demonstrates. Although this action failed, its origins lie in the eventual diagnosis of a brain tumour. Such actions tend to encourage positive defensive medicine. 

It's ironic that those who believe so strongly in the prospective randomised controlled trial have so much faith in the retrospective legal trial. Simms v Simms is a rare instance of an innovative treatment being judged appropriate by the court prior to its administration to sufferers from nvCJD. It is a reasonable inference that one of the reasons that the hospital trust were reluctant to administer the treatment despite the families' ardent wish that the treatment be tried was the potential for medico-legal liability. 

In this respect, the approach of the Medical Innovation Bill makes sense. The appropriateness of an innovative treatment is judged prospectively, prior to the outcome.