Bioethics and Medical Litigation in France: An Exploratory Study

ABSTRACT

Aims and Objectives

Medical litigation is a matter of particular concern for hospitals. We decided to examine whether bioethics might offer additional insights into these disputes.

Method

We conducted a highly exploratory and descriptive study in empirical bioethics, relying exclusively on a sample of scientific articles addressing medical litigation in France and primarily derived from real‐world healthcare settings. Analysis proceeded manually in three stages: (i) a content analysis of the sample; (ii) a thematic analysis of the collected information; and (iii) a bio‐ethical analysis of the identified themes and codes, and collected information.

Results

We ultimately derived three broader themes, presented in descending order of importance: “Legal Claims”, “Poor Practices”, and “Specific Laws”. Informed by these themes, but also associated codes and collected information, we may already infer several ethical tensions between responsibility―but understood here as a fundamental moral value rather than a simple legal obligation to account for one's professional actions―and a wide range of health and life science practices, most of which relate to surgical interventions to dis day. However, it remains difficult to determine whether these tensions reflect a single macro‐bio‐ethical issue―that is, an ethical tension or dilemma between health and/or life science practices and moral values and/or standards at a societal or country level―or rather a set of distinct micro‐bio‐ethical issues―arising at the level of given individuals or institutions.

Conclusion

Bioethics warrants closer engagement with such disputes, insofar as they might embody bio‐ethical issues of sufficient significance.

1. Introduction

In France, a “contentieux médical” in French, or a “medical litigation” in English, refers to a specific set of legal procedures designed to adjudicate medical disputes between two individuals or between an individual and a legal entity before the competent judicial authority [1]. In other words, within the French legal framework, a “contentieux” constitutes a dispute that has progressed to formal judicial proceedings; therefore, not all disputes reach this stage. Medical litigation is of particular significance for hospitals, as it may trigger a series of legal processes that vary in severity and in their potential consequences for all parties involved. Such cases are typically managed by the hospital's legal department, alongside other disputes or claims concerning the provision of healthcare services. In this context, the executive management of our hospital adopted an innovative approach by bringing together the Legal Department and the Ethics Department to examine whether bioethics might offer additional insights into these disputes. This initiative was undertaken through a highly exploratory and descriptive study in empirical bioethics, following the protocol template outlined by Stoeklé and Hervé in Health Research Policy and Systems in June 2025 [2].

2. Method

According to the typology of empirical bioethics research approaches proposed by Stoeklé and Hervé in The New Bioethics in July 2026 [3], the research approach was primarily qualitative, descriptive, and macro‐bio‐ethical. The research team included three principal co‐investigators and two additional co‐investigators. Two principal co‐investigators are bioethicists, while the third is an administrator with experience in the subject matter. The two additional co‐investigators are legal professionals. It should be note that this article substantially draws on the section of the master's thesis in health law completed by the first co‐author that relied on a sample of scientific articles primarily derived from real‐world healthcare settings. The thesis was prepared during a 3‐month internship in the hospital's ethics department between May and August 2025. It should also be noted that the initially submitted manuscript and accompanying tables have since undergone extensive revisions in response to the constructive comments and suggestions provided by reviewers and editors.

Sampling of scientific articles was conducted manually using Google Scholar, and discontinued upon reaching thematic saturation; with saturation assessed with regard to the inferred themes rather than the codes. We included articles, published primarily in Open Access (N.B., to ensure transparency and facilitate access to our sources for peers, colleagues and stakeholders), between 2005 and 2025, in either French or English, that addressed medical litigation in France. Information was manually collected and processed using Microsoft Office and subsequently stored in hospital professional accounts. The information consisted of references and abstracts. All information supporting the findings of this study are available within the paper. Analysis proceeded manually in three stages: (i) a global content analysis of the sample based on the collected information; (ii) an inductive and reflexive thematic analysis involving the coding of the collected information, and the grouping of codes into broader themes informed by that information; and (iii) a preliminary and reflexive bio‐ethical analysis informed by the themes, codes, and information―the results of which are finally presented in the Discussion rather than in the Results section owing to the highly preliminary and reflexive nature of this third level of analysis. Both manuscript and tables were written manually in French, but the translation into English―and the subsequent English language revisions―were performed automatically using Microsoft 365 Copilot.

3. Results

Our sample comprises 28 scientific articles (n = 28), including 22 written in French (Table 1, articles #1–22), and 6 in English (Table 1, articles #23–28). The French‐language articles are predominantly published in academic journals specializing in law, with a smaller proportion appearing in journals focused on health, as well as in the humanities and social sciences. In contrast, the English‐language articles are published exclusively in health‐related journals. Notable methodological differences emerge between the two language groups. French‐language articles primarily employ strictly legal or qualitative approaches, whereas English‐language articles rely almost exclusively on quantitative methods, particularly statistical techniques. Taken together, this body of literature offers general and/or specific descriptive insights into medical litigation in France. However, its comprehensiveness cannot be asserted due to the sampling strategy employed.

Table 1.

Graphical synthesis of the collected and processed information. The articles are not arranged in any specific order, except that Articles 1–28 are written in French, whereas Articles 29–35 are written in English. All references are presented in accordance with the Vancouver citation style. To enhance transparency and facilitate the interpretation of the findings, the abstracts of the French‐language articles were translated into English.

Articles	References	Abstracts
# 1	Rougé‐Maillart C, Visseaux G, Gaudin A, Jousset N. Un revirement jurisprudentiel important en matière de responsabilité médicale pour défaut d'information. La Revue de Médecine Légale. 2011;2(1):22–7	“The decision handed down on June 3, 2010, by the First Civil Chamber of the Court of Cassation constitutes a pivotal precedent in the realm of medical liability for failure to disclose information. The ruling affirms that compensation may be awarded for harm resulting from a lack of patient disclosure regarding potential risks — even where awareness of such risks would not have altered the patient's consent. Furthermore, it marks a significant step toward recognizing the right to information as an enforceable subjective right under the law.”
# 2	Ben Amar W, Karray N, Siala H, Zribi M, Lebkem H, Hammami Z, et al. Réflexions sur la responsabilité médicale pénale pour non‐assistance à personne en péril dans le contexte de la pandémie COVID‐19. La Revue de Médecine Légale. 2021;12(3):136–40.	“COVID‐19 infection represents an emerging pathology that can be severe and, in some cases, fatal. Since its onset, this disease has given rise to numerous clinical situations in which a patient's life or physical integrity is at imminent risk, necessitating the physician's urgent and life‐saving intervention. Such emergency assistance to an individual in peril constitutes, above all, a moral obligation, but also an ethical, professional, and legal duty. Indeed, failure to render aid to a person in danger is classified as a criminal offense and is subject to significant legal sanctions. Nevertheless, within the context of the COVID‐19 pandemic, ambiguity persists regarding this complex infraction, particularly with respect to assessing the degree of peril and evaluating the risk posed to oneself or to others. This study therefore seeks to examine the distinctive characteristics of the offense of failing to assist a person in danger during the COVID‐19 pandemic and to elucidate the judicial implications in criminal law arising from this violation.”
# 3	El Banna S, Beauthier F, Beauthier J‐P. Réflexions sur l'accident médical et ses implications médico‐légales. Le consentement éclairé. Revue médicale de Bruxelles. 2013;34:469–78.	“Contemporary jurisprudence demonstrates an increasingly rigorous stance toward physicians, particularly regarding the obligation to inform patients. In the absence of objective liability in medical matters and where no technical fault can be established, legal practitioners have, in recent years, persistently emphasized deficiencies in patient information as a basis for liability. In France, reference is made to Article 16‐3 of the Civil Code, which provides: “No infringement may be made upon the integrity of the human body except in cases of medical necessity for the individual or, exceptionally, for the therapeutic benefit of another. The consent of the person concerned must be obtained beforehand, except where their condition necessitates an urgent therapeutic intervention to which they are unable to consent.” Similarly, in Belgium, Chapter III of the Law of 22 August 2002 concerning “patients' rights” reiterates in Article 8 the patient's entitlement to informed consent prior to any medical intervention, contingent upon the provision of adequate prior information. In light of this evolving legal framework, the authors propose—following an analysis of medical accidents and their medico‐legal implications—to furnish readers with the essential principles for effectively managing patient information. The objective is to secure free and informed consent and thereby mitigate the adverse consequences associated with inadequate disclosure.”
# 4	Lantero C. Nouvelles précisions sur la notion de cause étrangère dans les infections nosocomiales et le recours des tiers lorsque l'ONIAM indemnise. Actualité juridique Droit administratif. 2011.	“New Clarifications on the Concept of “External Cause” in Hospital‐Acquired Infections and on Third‐Party Payer Claims When ONIAM Provides Compensation CE, October 10, 2011, Angers University Hospital, No. 328500, A. In September 2011, a 19‐year‐old patient suffering from severe headaches, dizziness, and hearing problems was admitted for a complex surgical procedure: removal of a left acoustic neuroma via a translabyrinthine approach, with placement of an autologous fat graft. A week later, following a sudden and dramatic decline in her condition, a lumbar puncture revealed pneumococcal meningitis. She quickly fell into an irreversible coma and died three days after the diagnosis. In 2004, after a medical expert review was ordered, her family filed a claim with the Nantes Administrative Court, seeking to hold Angers University Hospital liable. The hospital argued, as is common, that the infection was caused by an endogenous germ, which would exclude it from being classified as a hospital‐acquired infection. The hospital also advised the plaintiffs to turn to the National Office for Compensation of Medical Accidents, Iatrogenic Conditions, and Hospital‐Acquired Infections (ONIAM). During proceedings before the trial court, the plaintiffs stated they had contacted the Regional Conciliation and Compensation Commission (CRCI). After receiving compensation from ONIAM, they withdrew their claim, and the Nantes Administrative Court acknowledged this withdrawal in an order dated February 5, 2008. The Sarthe Primary Health Insurance Fund (CPAM) appealed, and the Nantes Administrative Court of Appeal ruled in its favor, finding that the fund had not been properly included in the original proceedings and that the order was therefore invalid. Angers University Hospital then filed a petition for review with the Council of State, which held that the appellate court had erred in fact because the fund had indeed been properly included. However, the Council also found that the trial court's order was irregular because the plaintiffs' withdrawal did not end the dispute—the third‐party payer's claims still needed to be addressed. Deciding the case on the merits, the Council of State moved even further away from considerations about whether germs are endogenous or exogenous when determining if an infection is hospital‐acquired. It also clarified the scope of third‐party payers' subrogation rights when ONIAM provides compensation. I) The End of “Endogenous Germ” as Proof of External Cause. Under Article L. 1142‐1 of the French Public Health Code, as introduced by the March 4, 2002 law, healthcare professionals are liable for harm caused by hospital‐acquired infections “unless they can prove an external cause.” In this case, only Article L. 1142‐1 applies, since the automatic compensation scheme by ONIAM—triggered when the permanent disability rate exceeds 25% or in the event of death—was created by the December 30, 2002 law and codified in Article L. 1142‐1‐1, which was not yet in force at the time. Therefore, liability here is based on fault, and ONIAM is only required to compensate if the hospital can prove an external cause.”
# 5	Winance M, Barbot J. Le travail probatoire des experts médicaux. Une étude de la mise à l'épreuve de la plainte des patients. Droit et société. 2022;N° 110(1):53–69.	“This article analyzes contexts of medical expertise in which physicians, acting as expert witnesses, evaluate patient complaints. The analysis draws on interviews with experts and on expert reports collected within the compensation framework for medical accidents established by the March 4, 2002 statute. We advance a pragmatic perspective on the evidentiary practices of these medical experts—specifically, the processes of factualization they employ to test complaints within a historically situated institutional setting. The article contrasts the ways in which experts engage with distinct orders of reality through which complaints are examined (facts, clinical care, and bodies) and the manner in which they construct various constellations of presumptive evidence. In doing so, it opens new avenues for theorizing the interplay between medicine and law.”
# 6	Lantero C. “Les consolidations du droit de la responsabilité hospitalière”, AJDA, Dalloz, 2020, n° 13, p. 714. Actualité juridique Droit administratif. 2020(n° 13):p. 714.	“The law governing hospital liability underwent profound transformations culminating in the enactment of the Kouchner Act in 2002. Since that time, an examination of judicial decisions reveals a nuanced reconciliation between the advancement of patients' rights and the pragmatic considerations inherent in administrative liability mechanisms. Within this domain—where the judge simultaneously assumes the role of a litigator's experimenter, an arbiter of human concerns, and an architect of compensation frameworks—the eighteen years since the statute's adoption correspond to the full maturation of a jurisprudence characterized by equilibrium and coherence.”
# 7	Lantero C. “Le préjudice causé par la mort d'un proche”, RFDA Revue française de droit administratif, Dalloz, 2019, n° 6, p. 1115 sq. Revue française de droit administratif. 2019(n° 6):p. 1115 sq.	“The Harm Caused by the Death of a Loved One. CE, Sect., June 3, 2019, FOUGERE‐DEROUET and M. MIEZ, No. 414098, RFDA December 2019, p. 1115. Caroline Lantero, Associate Professor of Public Law, UCA, EA 4232. In a remarkably concise decision—used here as a springboard for a discussion on compensating the emotional harm suffered by loved ones in the event of death—the French Council of State takes advantage of legislative silence to broaden the concept of beneficiaries eligible for compensation through national solidarity in cases of non‐fault medical accidents, and to clarify the scope of their damages. When a child whose parents are separated dies as a result of a non‐fault medical accident, can the spouses of each parent claim beneficiary status and receive compensation for emotional distress through national solidarity? The question is straightforward, and the Council of State's affirmative answer seems just as simple. The reasoning behind it, however, is anything but.”
# 8	Robin J. Le droit de refuser un traitement médical invoqué par une personne victime d'emprise mentale. Droit, Déontologie & Soin. 2021;21(4):532–9.	“When an individual is physically and mentally weakened, they may become vulnerable to external influence, potentially leading to the refusal of treatment that is critical for survival. This scenario necessitates an examination of the applicable legal framework. Under French law, the patient's right to refuse medical treatment is fully recognized as an extension of the principles of human dignity and freedom of conscience. However, this right is subject to limitations justified by considerations of public interest. Furthermore, the exercise of this right presupposes that the patient provides “informed consent,” which raises complex questions regarding the impact of possible psychological coercion and the legal implications of such influence.”
# 9	Chopard B, Roussey L. Judiciarisation de la santé et incitations à la prévention des professionnels et établissements de santé: une réflexion sur l'évolution du droit français. Revue économique. 2020; Vol. 71(3):479–501.	“The Kouchner Law of March 4, 2002 sought to foster the amicable resolution of medical disputes through the establishment of new extrajudicial bodies: the Regional Commissions for Conciliation and Compensation. Concurrently, it codified fault‐based liability as the prevailing principle for healthcare professionals and institutions. This article investigates how these procedural reforms in dispute resolution may have shaped the preventive behavior of healthcare providers and facilities—particularly through the compensatory mechanisms implemented and the incentives influencing patients' propensity to litigate—within a context characterized by informational asymmetry regarding the precise value of damages awarded to patients in the event of litigation.”
# 10	Collet L. [Abnormal consequences of non‐faulty medical accidents: Jurisprudence of the Conseil d'État]. Bull Acad Natl Med. 2020;204(6):598–603.	“Compensation for medical accidents without fault by healthcare professionals or facilities is provided for under Article L. 1142‐1 of the French Public Health Code, established by the law of March 4, 2002, concerning patients' rights and the quality of the healthcare system. This article sets out the conditions for liability, as well as the clinical and severity criteria. Among these clinical criteria: “A medical accident (…) entitles the patient to compensation for harm (…) under the principle of national solidarity, when (…) the consequences for the patient were abnormal in light of their health condition and its foreseeable progression (…)”. Courts have had to define what constitutes this “abnormality of consequences.” According to a ruling by the French Council of State on December 12, 2014, the abnormality condition is always met “when the medical procedure caused consequences significantly more severe than those the patient was sufficiently likely to face without treatment.” If that is not the case, “the consequences cannot be considered abnormal unless, under the circumstances of the procedure, the likelihood of harm was very low; thus, they cannot be considered abnormal given the patient's condition when the severity of that condition required a procedure involving high risks, and those risks materialized.” The Council of State clarified in 2019 that a 3% likelihood of occurrence qualifies as a low probability.”
# 11	Haboubi C. Accident médical dans la prise en charge d'une dysplasie spondylo‐épiphysaire. Droit, Déontologie & Soin. 2020;20(1):24–7	“The occurrence of a medical accident only leads to compensation by ONIAM if the resulting harm meets regulatory criteria regarding its severity, its abnormal nature, and the likelihood of its occurrence. A case decided by the Bordeaux Administrative Court of Appeal on December 30, 2019, involving a neurosurgical procedure to address complications from spondyloepiphyseal dysplasia, sheds light on how judges apply these criteria (CAA Bordeaux, December 30, 2019, Nos. 16BX02903 and 16BX03124).”
# 12	Desmoulin‐Canselier S. La France à « l'ère du neurodroit »? La neuro‐imagerie dans le contentieux civil français. Droit et société. 2019;N° 101(1):115–35.	“The enactment of the July 7, 2011 statute, which introduced initial provisions on the judicial application of neuroimaging into the French Civil Code, is often regarded as marking France's entry into the “era of neuro‐law.” Scholarly and professional discourse has raised concerns regarding a potential “fascination effect” associated with the evidentiary use of such technology. This empirical study seeks to illuminate prevailing practices through a systematic analysis of civil litigation. It undertakes both quantitative and qualitative examination of appellate and Supreme Court decisions in civil matters rendered between January 1, 2007, and December 31, 2016. The findings indicate a notable increase in the use of neuroimaging in civil proceedings; however, they also demonstrate that civil judges generally succeed in circumscribing the probative value of this evidence and situating it within a convergent evidentiary framework.”
# 13	Bernard M‐H. L'expertise en Santé: Pourquoi? Comment? Perspectives? Journal de droit de la santé et de l'assurance maladie. 2020(27).	“The author offers a comprehensive analysis of the position of health experts within judicial proceedings, delineating the functions they are expected to perform during litigation and examining the distinctive relationship that emerges between the judge and the expert.”
# 14	Devers KB. Une décision de justice pas à pas. Défaut d'information, accident médical et indemnisation. Droit, Déontologie & Soin. 2013;13(4):492–500.	“A judgment rendered by the Nantes Administrative Court on July 18, 2013 (Case No. 12NT01828) provides an opportunity to clarify the complex circumstances that intertwine fault‐based liability with compensation for medical accidents.”
# 15	Bonniol V, Ganne M. Is the protection of hospital medical records an utopia? Protéger le secret du dossier médical hospitalier: une utopie? Revue droit & santé: la revue juridique des entreprises de santé. 2016.	“The medical record of a hospitalized patient has become a major issue in the management of healthcare facilities. In theory, access to it and the protection of personally identifiable medical data are safeguarded against unauthorized viewing or tampering. In practice, however, the reality on the ground tells a very different story. A survey conducted among several volunteer healthcare institutions highlighted the challenges and reluctance they face in strictly upholding medical confidentiality.”
# 16	Augier‐Francia É. “Medical law and risks” “Le droit médical face aux risques”. La Revue du Centre Michel de l'Hospital [édition électronique]. 2024(n° 28).	“Public health prevention has indisputably constituted a central priority within our healthcare system since the onset of the 21st century. This development accounts for the emergence of a genuine framework for managing risks associated with medical care. A wide array of measures has been implemented to achieve this objective and thereby safeguard patient safety. Nevertheless, these measures remain insufficient in several respects. Despite the efforts undertaken, medical accidents may still occur, necessitating the activation of a compensatory mechanism. Law No. 2002‐303 of March 4, 2002, concerning patients' rights and the quality of the healthcare system — commonly referred to as the “Kouchner Law” — serves as the principal foundation of medical liability. However, notwithstanding its significant advancements, this legislation now reveals certain shortcomings that warrant a reconsideration of its parameters to ensure compensation that is both equitable and effective for victims.”
# 17	Manaouil C. La santé du chef de l'État, le secret médical et l'information dans une démocratie. Droit, Déontologie & Soin. 2007;7(2):148–68.	“The Gubler case, named after François Mitterrand's personal physician, was reviewed by the European Court of Human Rights (ECHR) on July 27, 2006. Medical confidentiality does not end with the patient's death. No doctor can break that confidentiality, not even if the patient's death or last wishes seem to allow it. The pressing question today is whether this absolute and general obligation of secrecy can be relaxed when the public interest demands it.”
# 18	Vila C. Affaire Vincent L…: Plus de trois ans de contentieux. Droit, Déontologie & Soin. 2018;18(1):30–41.	“After three years of litigation, the Vincent L… case helped establish the first boundaries of a case law framework for challenging medical decisions related to end‐of‐life care. This precedent is now becoming a procedural tool in a type of litigation that is expected to grow, whose main distinctive feature was the challenge—before an administrative court—of decisions made by physicians.”
# 19	Barbot J. Aux frontières de l'irresponsabilité médicale. Les médecins en procès au début du xixe siècle. Sciences sociales et santé. 2018; Vol. 36(4):65–92.	“This article investigates the debates concerning the legitimacy of judicial intervention in medical practice in France during the early nineteenth century. These debates represent an initial stage in the consolidation of normative work by key actors — physicians and jurists — around the concept of medical liability in the modern era. Drawing on a corpus of texts published in connection with the Hélie and Thouret‐Noroy cases, the study examines conflicts surrounding two fundamental questions: Was it appropriate to subject physicians to the jurisdiction of ordinary courts? And could a tribunal render an adequately informed judgment on medical practices within its institutional framework? At the intersection of these questions emerged competing conceptions of medical responsibility and, conversely, of the boundaries of physicians' immunity from legal accountability. By mobilizing an analytical framework derived from sociological research on the exercise of judgment, this article seeks to offer a novel contribution to the study of the evolving relationship between medicine and law and its long‐term transformations.”
# 20	Haboubi C. Hospitalisation sous contrainte: en contentieux de la mainlevée et non de l'annulation, la vanité des moyens de forme. Santé mentale et Droit. 2024;24(1):45–50.	“The laws governing involuntary hospitalization are a legal maze, and teams are constantly worried about procedural mistakes. But in proceedings to lift the hospitalization order—rather than to annul it—procedural irregularities are only penalized if they actually compromised the patient's rights. Here's a practical example: a ruling by the Paris Court of Appeal that dismissed nine procedural arguments (Paris Court of Appeal, November 22, 2023, No. 23/00583).”
# 21	Bacache M, Lequillerier C, Morlet‐Haïdara L, Welsch S. Faute médicale et perte de chance: quelle place pour l'indemnisation par l'ONIAM? Journal de droit de la santé et de l'assurance maladie. 2023(17).	“The ruling by the First Civil Chamber of the Court of Cassation on November 16, 2016 highlights the challenges in striking a proper balance between the civil liability of healthcare professionals and compensation through national solidarity. The author points out that the balance intended by lawmakers is maintained: only faults that caused the harm exclude compensation by ONIAM. If the harm stems from a fault, only the healthcare professional's liability is engaged. If the harm results from a risk inherent to the procedure, ONIAM may cover it fully or partially, either exclusively or as a supplement. This approach can be endorsed because it restores the true meaning of subsidiarity, limiting it to cases where technical faults caused the harm. Conversely, subsidiarity does not apply in the case of a medical accident—that is, when inherent risks materialize—regardless of whether a medical fault occurs alongside the accident, whether it involves failure to inform about the risk or an error after the fact.”
# 22	Hafiz C‐E. Critères de mise en examen d'un établissement de santé: chute d'une patiente avec une barrière de lit non relevée. Droit, Déontologie & Soin. 2017;17(4):424–33	“The indictment is based on the presence of serious and consistent evidence, and requesting the annulment of an indictment on the grounds of no wrongdoing is ineffective. A detailed review of the circumstances under which a hospital was indicted for failing to adequately ensure compliance with procedures, specifically regarding the use of bed rails (Court of Appeal of Montpellier, Investigating Chamber, April 20, 2017, No. 17/00037).”
# 23	Claudot F, Alla F, Villemot JP, Aliot E, Coudane H, Juillière Y. Analysis of patient claims related to care in a university cardiology department over the period 2003–2007. Arch Cardiovasc Dis. 2010;103(11–12):595–602.	“Background: In Europe, the increase in numbers of patients making legal claims might be due to better knowledge of their rights. In France, a law passed in 2002 provided new opportunities for claims. Aim: To assess patient claims related to care in a French cardiology department. Methods: From 2003 to 2007, claims brought before the courts and actions of conciliation within the scope of the hospital were collected by year. Cardiology department claims were individualized and compared with those for other departments. Characteristics of patients at the time of the care that prompted the claim, percentage of deaths, reasons for claims and claim results were collected. Results: During the 4‐year study period, 14% (n = 45,272) of hospital admissions concerned cardiology, uniformly distributed across the years. In the same period, 845 procedures were recorded, 81 of which related to cardiology. The complaints index was 2.59/1000 patients for the general population and 1.79/1000 for cardiology. The 81 cardiology complaints (52 mediations; 29 litigations) concerned patients aged 62 ± 13 years (68% men). The number of cardiology claims remained stable from 2003 to 2007. Compared with claims concerning other departments, the nature of the plaintiff (more often heirs or husband/wife) and the reason for the claim (less frequently medical care problems; more often death and nosocomial infections) were statistically different. Conclusion: Claims related to cardiology care were low and relatively stable over the past 4 years. Nosocomial infections prompted a high proportion of claims and should lead physicians to be vigilant. Cardiology remains relatively protected from litigation. A national registry of hospital claims might be valuable.”
# 24	Belghiti J, Cauchy F, Antoine C, Cheron G, Matignon M. Solid Organ Transplant Litigation at One of Europe's Largest University Hospitals. Transpl Int. 2024;37:12439.	“Due to its intrinsic complexity and the principle of collective solidarity that governs it, solid organ transplantation (SOT) seems to have been spared from the increase in litigation related to medical activity. Litigation relating to solid organ transplantation that took place in the 29 units of the Assistance Publique‐Hôpitaux de Paris and was the subject of a judicial decision between 2015 and 2022 was studied. A total of 52 cases of SOT were recorded, all in adults, representing 1.1% of all cases and increasing from 0.71% to 1.5% over 7 years. The organs transplanted were 25 kidneys (48%), 19 livers (37%), 5 hearts (9%) and 3 lungs (6%). For kidney transplants, 11 complaints (44%) were related to living donor procedures and 6 to donors. The main causes of complaints were early post‐operative complications in 31 cases (60%) and late complications in 13 cases (25%). The verdicts were in favour of the institution in 41 cases (79%). Solid organ transplants are increasingly the subject of litigation. Although the medical institution was not held liable in almost 80% of cases, this study makes a strong case for patients, living donors and their relatives to be better informed about SOT.”
# 25	Agout C, Rosset P, Druon J, Brilhault J, Favard L. Epidemiology of malpractice claims in the orthopedic and trauma surgery department of a French teaching hospital: A 10‐year retrospective study. Orthop Traumatol Surg Res. 2018;104(1):11–5.	“Introduction: Orthopedic and trauma surgery is the specialty for which claims for compensation aremost often filed. Little data exists on the subject in France, especially in a teaching hospital. We conducted a retrospective study aimed at (1) identifying the epidemiological characteristics of patients filingclaims against the orthopedic surgery and traumatology department of a teaching hospital in France, (2)analyzing the surgical procedures involved, the type of legal proceedings, and the financial consequences. Hypothesis: The epidemiological profile of proceedings seeking damages in France is consistent with thedata from European and American studies. Materials and methods: An observational, retrospective, single‐center study of all claims for damagesbetween 2007 and 2016 involving the orthopedic and trauma surgery department of a teaching hospitalwas carried out. Patients' epidemiological data, the surgical procedure, type of legal proceeding, andfinancial consequences were analyzed. Results: Of the 51,582 surgical procedures performed, 71 claims (0.0014%) were analyzed (i.e., 1/726procedures). A significant increase in the number of cases (p = 0.040) was found over a 10‐year period. Ofthese, 36/71 (53.7%) were submitted to the French regional conciliation and compensation commission(CRCI), 23/71 (32.8%) were filed with the administrative court, and 12/71 (13.4%) were submitted for anamicable settlement. The most common reason for which patients filed claims was hospital‐acquiredinfections, with 36/71 (50.7%) cases. Twenty‐nine complaints (40.8%) resulted in monetary damagesbeing awarded to the patient, with an average award of D 28,301 (D 2,400–299,508). Damage awardswere significantly higher (p < 0.05) for cases involving surgery on a lower limb than those involving anupper limb. Conclusion: Claims against orthopedic surgeons have been increasing significantly over the last 10 years. Although rare, they represent a significant cost to society. Hospital‐acquired infections are the mainreason for disputes in our specialization.”
# 26	Delaunay F, Delaunay T, Van Vyve E, Cardin JL. Analysis of malpractice claims: The Franco‐Belgian “Cœlio Club” experience. J Visc Surg. 2019;156 Suppl 1:S33–S9.	“Malpractice claims are a regularly increasing concern in gastrointestinal surgery. The goal of this study was to compare the current status of claims in two different French‐speaking communities by a retrospective descriptive study of surgeons' experiences, from the beginning of their practice up until December 31 2014. Data included the number, the reasons, and the results of medicolegal claims and their jurisdictions. Forty‐three surgeons participated in this study. Two hundred medicolegal claims were analyzed. The mean number was 5.8 per surgeon. Bariatric surgery, colorectal surgery and parietal surgery were the most exposed. Forty‐six (23%) faults were noted, while no fault was pronounced in 139 (69.5%) cases. The main reasons for lodging complaints were nosocomial infections, anastomotic leaks, poor postoperative care, hollow organ perforation, peripheral neurologic complication, and insufficient preoperative information. Forty‐four percent of the complaints were analyzed by the conciliation and compensation commissions and 43.5% by the High Court. In the French‐speaking group, there were 13 complaints, two of which gave rise to compensation. French surgeons are highly exposed to complaints: in French law, clumsiness or technical maladdress is considered as a fault. The patient should be informed preoperatively of all possible severe risks of a medical procedure. In Belgium, complications are exceptional and are considered random therapeutic events. Adhering to the recommendations emanating from the French High Authority of Health and Learned Societies as well as accreditation issued by the same High Authority should allow to decrease the number of undesirable events related to care and malpractice.”
# 27	Cardin JL, Johanet H. Malpractice claims and abdominal wall hernia repair. J Visc Surg. 2019;156 Suppl 1:S57–S60.	“Purpose. To present factual data on the medico‐legal aspects of medicolegal claims after abdominal wall surgery in France. Method. Analysis of the complaints following parietal surgery that were addressed to a company that specializes in medical malpractice insurance between 2010 and 2016. Results. Of 209 files, 180 were analyzable; these included 75 women and 105 men with a mean age of 51 years and a mean BMI of 29.8. Cases were mainly heard by the Conciliation and Compensation Commission (CCI) (82 patients) and the High Court (79 patients). The surgical procedures concerned were groin hernias (85 patients) or anterior abdominal wall hernias (95 patients). Conventional open surgery was performed in 123 patients and laparoscopic surgery in 57 patients. The incidents motivating patient complaints after groin hernia surgery were chronic pain (27 patients), infection (24 patients), testicular damage (10 patients). Seven patients died as a result of this surgery (including one fetus). Claims after ventral hernia repair were motivated by infections (46 patients) and post‐operative peritonitis or bowel obstruction (12 patients). Nine patients died following these ventral hernia repairs. Surgical error was identified in 59 of the 168 cases analyzed (35.1%); 44% of recognized faults were surgical site infections, 27% linked to delay in re‐operation, and 20% were related to the operating room environment. Conclusion. Hernia surgery, although an everyday event for many practitioners, requires the same rigor as all other visceral surgery.”
# 28	Aheri A, Daerqaoui MA, Belamine F, Belhouss A, Benyaich H. Handling Complaints Related to Diagnostic Faults Before Disciplinary Bodies: Analysis of French Ordinal Jurisprudence. Cureus. 2025;17(2):e79564.	“Introduction. Diagnostic faults are a major source of medical litigation, potentially engaging the disciplinary responsibility of physicians. The distinction between diagnostic fault and diagnostic error is often misunderstood, which can lead to unjustified sanctions or ignorance of ethical obligations. This study aims to clarify the concept of diagnostic fault as an ethical breach and to identify situations that may engage the physician's disciplinary responsibility. It further highlights the ethical and medicolegal challenges posed by diagnostic errors, providing insights into their implications for deontological and legal frameworks. Materials and methods. This is a descriptive and analytical retrospective study of 73 disciplinary procedures for diagnostic faults judged by the National Disciplinary Chamber of the French Medical Council between 2012 and 2020. Data were collected from the jurisprudence database of the National Council of the French Medical Council. Inclusion criteria included cases where a diagnostic fault was invoked. Cases in which no diagnostic fault or delay was alleged at the outset against the physician were excluded from the analysis. A descriptive statistical analysis was performed. Results. Among the 73 cases reviewed by the disciplinary chamber, several involved multiple complainants. General practitioners were the most frequently implicated, accounting for 45% of cases. Of the cases examined, 33 (45%) were dismissed due to insufficient evidence or absence of fault. Delayed diagnoses (22%) and erroneous diagnoses (21%) emerged as the most frequently retained reasons. Finally, firm suspensions, ranging from 8 days to 2 years, were the most common sanction, imposed in 15 cases (21%). Discussion. Diagnostic faults represent a significant portion of disciplinary litigation. Situations leading to these faults can be classified into three categories: lack of attention during diagnosis, absence of appropriate complementary investigations, and failure to consult a competent third party. Comparison with Moroccan legislation reveals differences in disciplinary procedures, particularly in terms of transparency and procedural safeguards. Conclusion. A diagnostic fault is an ethical breach that can engage the physician's disciplinary responsibility. A better understanding of ethical obligations and continuous training is essential to reduce these faults. Disciplinary procedures should be revised to include guarantees of a more transparent and equitable process.”

We ultimately induced 26 combinations of codes (Table 2a). Based on these codes and informed by the associated collected information, we ultimately derived three broader themes, presented here in descending order of importance: “Legal Claims”, “Poor Practices”, and “Specific Laws” (Table 2b). The first theme, “Legal Claims”, reflects the majority of codes and associated information, and relates primarily to legal consequences of poor practices (N.B., this notably includes the code “Medical Accident”, but also “Nosocomial Infection”). The second theme, “Poor Practices”, reflects a smaller number of codes and associated information, and concerns poor practices themselves (N.B., this includes the codes “Mental Manipulation” and “Medical Confidentiality”). The third theme, “Specific Laws”, reflects the fewest codes and associated information and focuses primarily on a specific area of law rather than directly on poor practices themselves or their legal consequences (N.B., this especially includes the code “Hospital Liability”).

Table 2.

Graphical synthesis of (a) the codes (n = 26) and (b) the themes (n = 2). Codes are listed in alphabetical order, and linked to the corresponding sampled scientific articles. Themes are listed in order of importance.

a. Codes	Articles	b. Themes
Civil Justice, Brain Imaging	# 12	Legal Claims
Failure to Assist a Person in Danger, COVID‐19	# 2	Poor Practices
Gubler Case, Medical Confidentiality	# 17	Specific Laws
Informed Consent, Mental Manipulation	# 8
Informed Consent, Psychiatry	# 20
Kouchner Law, Hospital Liability	# 6
Kouchner Law, Health Safety	# 16
Kouchner Law, Information Asymmetry	# 9
Malpractice Claims, Digestive Surgery	# 26, 27
Medical Accident, Compensation	# 14
Medical Accident, Compliance with Procedures	# 22
Medical Accident, Damage Irregularity	# 10
Medical Accident, Emotional Distress	# 7
Medical Accident, Informed Consent	# 1, 3
Medical Accident, Medical Expert Review	# 5
Medical Accident, Misdiagnosis	# 28
Medical Accident, Neurosurgery	# 11
Medical Accident, Orthopedic and Trauma Surgery	# 21
Medical Expert Review, Judge–Expert Relationship	# 13
Medical Liability, General Jurisdiction	# 19
Medical Records, Medical Confidentiality	# 15
Nosocomial Infection, Cardiology	# 23
Nosocomial Infection, ENT (Otolaryngology)	# 4
Nosocomial Infection, Orthopedic and Trauma Surgery	# 25
Transplant, Post‐Operative Complications	# 24
Vincent Lambert Case, Medical Decision	# 18

4. Discussion

We could reasonably expect this sample to consist mostly of scientific articles published in specialized, French‐language legal journals (Table 1). At least initially, medical litigation is undeniably a legal matter, typically with country‐specific legal nuances. It therefore makes sense that researchers in France would primarily publish their findings in such journals. What we did not necessarily expect, however, might be the predominance of the theme “Legal Claims” over that of “Poor Practices”. After all, one or more instances of poor practice—real or alleged, intentional or unintentional—are usually the first explicit cause of this type of complaint, as suggested by the strong presence of the code “medical accident”. Yet it seems that legal consequences of poor practices could attract more interest than poor practices themselves. That seems entirely appropriate given the topic. Still, it would be just as valuable to pay more attention to ways of preventing the causes of such litigation—chiefly poor practice, even when presumed and/or unintentional.

Informed by these themes, codes and information, we may already infer several ethical tensions between responsibility―but understood here as a fundamental moral value rather than a simple legal obligation to account for one's professional actions―and a wide range of health and life science practices. Notably, two medical specialties, namely digestive surgery (Table 2a, “Malpractice Claims, Digestive Surgery” and “Nosocomial Infection, Digestive Surgery”) and orthopedic and trauma surgery (Table 2a, “Medical Accident, Orthopedic and Trauma Surgery” and “Nosocomial Infection, Orthopedic and Trauma Surgery”), are represented by more than one combination of codes. By contrast, other identifiable specialties are represented by only a single combination, namely neurosurgery (Table 2a, “Medical Accident, Neurosurgery”) and otorhinolaryngology (Table 2a, “Nosocomial Infection, ENT (Otolaryngology)”), to which transplantation may also be added (Table 2a, “Transplant, Post‐Operative Complications”). In other words, most of the identified practices relate to surgical interventions to this day.

It remains difficult to determine whether these tensions reflect a single macro‐bio‐ethical issue―that is, an ethical tension or dilemma between health and/or life science practices and moral values and/or standards at a societal or country level―or rather a set of distinct micro‐bio‐ethical issues―arising at the level of given individuals or institutions. This distinction is far from trivial, as the challenge may then lie not in resolving a single bio‐ethical issue but several, albeit closely related, ones. This is, in our view, one of the main limitations of the present study (N.B., beyond the non‐exhaustive nature of the sampling strategy, or the highly reflexive nature of the inductive thematic and preliminary bio‐ethical analysis), likely because our analysis relied on information, namely published analyses of primary and/or secondary data, rather than on the data themselves. Furthermore, empirical material directly consisting of data, and gathered across multiple centers, would appear better suited to the implementation of a normative approach (N.B., indeed, as explained in the Methods section, and consistently applied throughout the study, we restricted our analysis to a descriptive approach, namely the identification and description of one or more bio‐ethical issues, without proposing specific solutions or recommendations based on the application of any particular ethical theory).

5. Conclusion

Admittedly, medical litigation has not traditionally been regarded as falling within the domain of bioethics. Nevertheless, our findings suggest that bioethics warrants closer engagement with such disputes, insofar as they may embody bio‐ethical issues of sufficient significance. One might envisage addressing these issues through a two‐tiered approach: first, through local ethics committees, and second, through empirical bioethics studies. In this respect, local ethics committees may operate primarily in the short term, whereas empirical bioethics studies may contribute over the longer term. In hospital settings, for example, when such issues are, explicitly or implicitly, raised by healthcare professionals and/or members of executive management, the role of the local ethics committee would be to bring together the stakeholders involved, or potentially involved, in these issues in order, first, to clarify their nature and origins and, second, to develop solutions or recommendations that are both appropriate and broadly acceptable. The role of empirical bioethics studies would then be to deepen understanding of these issues, thereby refining, complementing, and potentially generalizing the solutions or recommendations proposed in practice.

Conflicts of Interest

The authors declare no conflicts of interest.

Nader R., Stoeklé H.‐C., Shehba L. S., Jazat P., and Hervé C., “Bioethics and medical litigation in France: an exploratory study,” Journal of Evaluation in Clinical Practice 32 (2026): e70618. 10.1111/jep.70618.

Data Availability Statement

The author has nothing to report.