THE ETHICS OF PRACTICE GUIDELINES

Practice guidelines, which are assistive tools for clinicians, have a long tradition in clinical medicine. Traditionally, these documents we re developed by physicians to improve quality of care and can provide practitioners with valuable medical information and improve objectivit y in medical decision making. Guideline development by nonphysician gr oups is increasing. Guidelines are now intended to assist in decreasin g costs, in reducing liability risk, and in utilization review, among other activities. Despite this enthusiasm for guidelines, their develo pment is variable and validity remains largely untested. The intended clinical and nonclinical applications of guidelines require critical a nalysis. Practice guidelines are not inherently unethical. However, ap plications of nonmedical values combined with intense pressures on hea lth care provision create an environment for guideline misuse. The eth ical implications of practice guidelines are examined in our article.