The role of civil liability in healthcare relations.

Civil liability occupies a prominent position in contemporary law as it represents an important instrument for protecting individual rights and repairing damages caused in social relations. Essentially, it is the legal duty to compensate for losses resulting from unlawful conduct, whether committed through action or omission. Depending on the specific case, these damages may affect not only the victim's assets but also their physical, emotional, moral, and psychological integrity. In a society marked by increasingly complex relationships and growing access to information and the judiciary, civil liability has assumed a fundamental role in preserving the dignity of the human person and in balancing legal relations.

In this context, medical civil liability has begun to receive special attention from legal scholars and courts. Advances in medicine, the expansion of healthcare services, and greater patient awareness of their rights have contributed to increased discussions involving medical malpractice, hospital failures, and defects in healthcare service delivery. Frequently, cases involving unsuccessful procedures, delays in diagnosis, surgical errors, or failures in hospital care gain media attention and reinforce the debate about the limits of medical practice and the duty to provide compensation. While medical activity has undeniable social relevance, it also involves inherent risks, complex technical decisions, and extremely sensitive situations, requiring careful and individualized analysis in each case.

Subjective Liability of the Physician: Fault and Causal Link

In Brazil, the prevailing understanding is that a doctor's civil liability is generally subjective in nature. This means that the mere existence of an unfavorable outcome is not sufficient to generate a duty to compensate. For liability to be established, it is necessary to demonstrate that the professional acted negligently, recklessly, or incompetently, in addition to proving the damage and the causal link between the medical conduct and the harm alleged by the patient. Jurisprudence has also consolidated the understanding that the obligation assumed by the doctor is generally one of means, not of result. This means that the professional is required to act diligently, technically, and in accordance with available scientific knowledge, without an absolute guarantee of cure or therapeutic success. However, there are exceptions recognized by legal doctrine and jurisprudence. In the case of non-reconstructive aesthetic plastic surgery, the prevailing understanding is that the obligation assumed by the professional is one of result, considering that the patient seeks the procedure with a legitimate expectation of obtaining a specific aesthetic result previously desired.

The centrality of expert technical evidence.

Analyzing these claims requires caution precisely because medicine is not an exact science. Many adverse outcomes result from the disease's own progression, scientific limitations, specific conditions of the patient's organism, or risks inherent in the procedures performed. However, this does not mean that every complication should automatically be treated as an inevitable event. There are situations where the harm actually stems from avoidable failures, such as incorrect diagnoses, unjustified delays in care, lack of necessary tests, medication errors, failures in post-operative follow-up, or structural deficiencies in healthcare institutions. It is precisely for this reason that expert evidence plays a central role in medical malpractice lawsuits, assisting the Judiciary in verifying the existence (or not) of a technical failure capable of justifying potential liability.

Strict Liability of Hospitals and Healthcare Institutions

Regarding hospitals and healthcare institutions, legal treatment often presents relevant particularities. In many cases, especially in relationships governed by the Consumer Protection Code, the institutions' liability is considered objective, requiring only proof of a defect in the service provided and the damage suffered by the patient. Situations involving structural failures, lack of adequate equipment, administrative problems, preventable hospital infections, or deficiencies in care can generate liability regardless of proof of direct fault on the part of the institution.

Conclusion: A balance between patient rights and legal certainty.

Given this scenario, medical civil liability demands a technical, balanced, and multidisciplinary analysis. Protecting patient rights is essential, especially in cases of actual failures in healthcare service delivery, but it is also necessary to avoid hasty conclusions that disregard the inherent complexity of medical practice. More than seeking automatic liability, the law must act judiciously, promoting fair solutions compatible with the reality of the facts, preserving both the patient's dignity and the legal security indispensable to the practice of medicine.

Article written by: Leonardo Neri and Nicoly Crepaldi.

“"The increasing judicialization of healthcare demonstrates an important shift in the doctor-patient relationship, now marked by greater awareness of rights and responsibilities."”

“"Medical civil liability requires balance: not every complication constitutes medical malpractice, but avoidable errors cannot be treated as mere risks inherent to medical practice."”

“"Brazilian courts have emphasized that hospitals and healthcare institutions have their own responsibilities, and it is not possible to automatically transfer all responsibility to the doctor."”

“"Expert evidence plays a central role in medical malpractice lawsuits, precisely because of the need for technical analysis regarding the existence of fault and causal link."”

References:

• SCHULZE, SANDRO. LEGAL CONSULTANT (Conjur). Medical malpractice: what the courts are really saying about hospitals and doctors.
• MOTA, ROBERTO. LEGAL CONSULTANT (Conjur). Medical civil liability: why the "captain of the ship" theory doesn't hold up..
• CORREIA-LIMA, FERNANDO GOMES. Medical malpractice and civil liability.
• STJ – AgInt in AREsp: 1933556 DF 2021/0207736-4, Rapporteur: RAUL ARAÚJO, Judgment Date: 11/28/2022, T4 – FOURTH PANEL, Publication Date: DJe 12/01/2022
• STJ – REsp: 2173636 MT 2023/0164545-5, Rapporteur: Minister MARIA ISABEL GALLOTTI, Judgment Date: 10/12/2024, T4 – FOURTH PANEL, Publication Date: DJEN 18/12/2024