The normativity of medical guidelines and their use by medical tribunals in the Netherlands and England

The nature of the regulation of society is changing. One of the shifts of power than can be observed is the increased role of professional associations in regulating aspects of the profession mandated, directly or indirectly, by the legislator. This professional regulation often flies under the radar, hiding under innocuous terms such as ‘guidance’, thereby masqueradingthe normative effect of these types of rules. This article presents an empirical account of the study of two groups of medical guidelines in England and the Netherlands and the impact they have on medical tribunal hearings in both countries. One case study interrogates Diabetes Type 2 guidelines, while another engages with guidelines on a-specific Lower Back Pain. These medical guidelines are all called ‘evidencebased’, exuding an air of scientific objectivity, and the promise of guidance for the medical practitioner in treating patients. In reality the process of developing these guidelines is much messier than it might appear from the outside. A combination of various subjective cultural, institutional, scientific and political frames steer guideline drafting groups to various different solutions for the same medical diseases.

This in itself is an important finding, but this also opens up various other questions about the normativity of these exercises of power. Can they be used appropriately to discipline medical professionals? The term guidelines cannot hide the reality that these documents play an important role in funding decisions, quality metrics but also in front of medical tribunals, and as such deserve a greater level of critical democratic scrutiny. Further transparency of and interest in this relatively hidden world of regulation would be beneficial. The need for experts such as these medical professionals will, however, only increase with the increasing complexity of society. Difficult questions will therefore remain about the limits of technocratic rulemaking and its impact on society.