The Medical Expert in Court: Towards “Evidence-Based Medical Dispute Resolution”

ABSTRACT

We advocate a systematic approach to evaluating scientific evidence in a particular context, that of law, adjudication and public policy which we call “evidence-based medical dispute resolution”. The approach adapts methods of evidence- based medicine and “critical appraisal” that are now well accepted in health care to assist a court or an adjudicating body, as in workers’ compensation, to weigh evidence in disputes involving health risks. Health and medical knowledge are essential to the resolution of disputes in law and administrative applications (such as workers’ compensation) and provide essential input into public policy decisions. There are no socially agreed-upon rules for the application of this knowledge except the law. Even within the legal system, courts vary and adjudication systems based on tort law do not always work well, even when the interpretation of scientific evidence is agreed upon by all sides. However, a big part of the variability and inconsistency could be removed if there were agreement on the interpretation of scientific evidence. This cannot be done by rigid rules, of course, because the law does not work this way. It has to be done by social convention.