THE PARTICULARITIES OF MEDICAL LAW IN BRAZIL: DUAL JUDICIALIZATION, JUDICIAL GOVERNANCE, AND PROFESSIONAL LIABILITY

1. Introduction

Medical Law, as an applied legal field, is internationally presented mainly along two classical axes: (a) civil and criminal liability for adverse events and damages arising from healthcare delivery; and (b) ethical and professional regulation of clinical practice. In Brazil, however, the concrete experience of Medical Law has consolidated through a distinct institutional trajectory, marked by an intense constitutionalization of the right to health, large-scale litigation, and a form of jurisprudential governance that brings the Judiciary closer to functions of (indirect) coordination of public health policies.

The Federal Constitution[1] elevates health to the status of a right of all and a duty of the State in Article 196:

“Health is a right of all and a duty of the State, guaranteed through social and economic policies aimed at reducing the risk of disease and other harms and at ensuring universal and equal access to actions and services for its promotion, protection, and recovery.”

The normative density of this command—combined with structural inequality in service provision and federative fragmentation—has contributed to making the Brazilian Judiciary a recurring pathway for obtaining medicines, therapies, and procedures, both within the Unified Health System (Sistema Único de Saúde – SUS) and, in parallel, within supplementary healthcare.

This scenario reveals a first central particularity: in Brazil, Medical Law is shaped by an ecosystem of “dual judicialization,” in which (i) the judicialization of healthcare (access claims) and (ii) the judicialization of medicine (compensatory claims related to clinical practice) coexist and interact. This distinction is not merely conceptual: it delineates different subjects, evidentiary structures, decisional rationalities, and systemic effects. While access-related judicialization tends to generate distributive and budgetary impacts, judicialization of medical practice amplifies professional, reputational, and organizational risks—directly influencing standards of clinical documentation, informed consent, and defensive medicine practices.

A second relevant particularity, still insufficiently perceived by foreign readers, is the territorial asymmetry of health litigation in a country of continental dimensions. National data indicate expressive variation in litigation rates per inhabitant and, above all, when correlating the volume of lawsuits with the density of registered physicians, significantly altering the assessment of “legal risk” by region. This geography of litigation affects regulatory predictability and the way Medical Law is experienced in practice: the same healthcare act, in different institutional environments, may be subjected to distinct decisional standards and evidentiary expectations.

A third Brazilian particularity derives from the institutional response to litigation: the Judiciary, through the National Council of Justice (Conselho Nacional de Justiça – CNJ), has structured a judicial policy for health-related claims and fostered technical support instruments for judges, notably through the creation and strengthening of the Judicial Technical Support Centers (Núcleos de Apoio Técnico do Judiciário – NAT-Jus), within the framework of the State Health Committees[2], and through the consolidation of the e-NatJus system as a decision-support infrastructure in healthcare. More recently, CNJ Resolution No. 530/2023[3] established the Judicial Policy for the Adequate Resolution of Healthcare Assistance Claims and its National Plan, setting guidelines for cooperation, specialization, and statistical monitoring.

In parallel, the Supreme Federal Court (Supremo Tribunal Federal – STF) began to establish structuring theses[4] that function as minimum national parameters for the judicial granting of health technologies, as observed, for example, in Theme 6 (medicines registered with ANVISA but not incorporated into the SUS) and Theme 500 (medicines without ANVISA registration), both with direct repercussions on evidentiary design, passive legitimacy, and the exceptionality of judicial relief. In the private sphere, judicialization also manifests through tension between administrative regulation (ANS) and judicial control of coverage, with relevant milestones at the Superior Court of Justice (STJ) [5] and the STF[6] concerning treatments outside the ANS list.

Finally, a fourth particularity emerges in the multichannel accountability of physicians: in addition to judicial litigation, Brazil maintains a robust professional disciplinary system, with a significant volume of ethical-professional proceedings and relevant sanctions, increasing the regulatory risk of medical activity and influencing strategies of clinical compliance and professional communication. Added to this is the intensification of the reputational vector in the digital environment, where conflicts involving honor, image, and platform content become part of the practical field of Medical Law, often grounded in the Brazilian Internet Civil Rights Framework[7].

Against this backdrop, this article aims to present— to an international audience— the particularities of Medical Law in Brazil as a system in which: (a) access to healthcare is judicialized on a relevant scale and with systemic effects; (b) civil, criminal, and ethical accountability of physicians operates in an environment of evidentiary asymmetry and rising social expectations; and (c) sector governance is influenced by precedents of higher courts and by judicial policies of technical support.

1.1  Objectives

General objective:

To analyze the particularities of Medical Law in Brazil from the phenomenon of dual judicialization (access to healthcare and medical accountability), highlighting its normative foundations, its main jurisprudential vectors, and its institutional responses.

Specific objectives:

a) to delimit the operative concept of judicialization of healthcare and judicialization of medicine in the Brazilian context;

b) to describe empirical and institutional elements of health litigation (scale and territorial asymmetry) and their implications;

c) to examine the role of the STF in constructing criteria for the judicial provision of health technologies (Themes 6 and 500);

d) to analyze the role of the CNJ and of NAT-Jus/e-NatJus as institutional responses to decisional technical asymmetry;

e) to discuss the multichannel nature of physician accountability (civil, criminal, ethical-administrative, and reputational), with emphasis on professional communication norms and the autonomy of the medical act.

1.2 Research problem and guiding questions

The central research problem consists in understanding why and how Brazilian Medical Law has been structured as a hybrid field, shaped by intense judicialization of access to healthcare and by professional accountability across multiple spheres. To this end, the article adopts the following guiding questions:

1. Which normative and institutional factors explain the centrality of the Judiciary in the enforcement of the right to health in Brazil?

2. To what extent do STF precedents function as instruments of indirect health governance?

3. How does the CNJ’s response (judicial policy and technical support) alter decisional patterns and evidentiary design in health-related claims?

4. What are the impacts of multichannel accountability (civil, criminal, ethical, and reputational) on medical practice, especially in areas of greater exposure?

1.3 Method, scope limitations, and sources

This is a qualitative study of a descriptive-analytical nature, with complementary use of institutional evidence (reports and public databases). The method combines: (i) normative analysis (Constitution, statutes, CNJ and CFM acts); (ii) jurisprudential analysis oriented by qualified precedents (STF and STJ); and (iii) documentary-institutional analysis (CNJ/PNUD and consolidated data on judicialization), with attention to regional cutoffs and systemic implications. [8]

Scope limitations: the study focuses on access-to-healthcare litigation (SUS and supplementary healthcare) and on the multichannel accountability of physicians (civil, ethical-administrative, criminal, and reputational). In the criminal axis, the analysis does not aim to exhaust criminal dogmatics, limiting itself to indicating: (i) the most recurrent typifications in adverse events; (ii) evidentiary bottlenecks (especially expert evidence and causal nexus); and (iii) the practical interaction between criminal, civil, and disciplinary spheres. The analysis privileges recent institutional milestones (2016–2025), a period in which judicial policies (Resolutions No. 238/2016 and No. 530/2023) and jurisprudential criteria of greater impact (Themes 6 and 500) were consolidated.

2. Minimum conceptual and institutional framework for the foreign reader

Understanding the particularities of Medical Law in Brazil requires an institutional framing that, although simple, is decisive in explaining why Brazilian health litigation assumes a scale and dynamics of its own. In synthetic terms, three variables structure the field: (i) the design of the healthcare system (SUS and supplementary healthcare), under a complex federalism; (ii) the centrality of “non-codified” sources—case law and ethical-professional regulation; and (iii) an ecosystem of procedural and institutional actors that favors the capillarity of litigation (patients, the Public Prosecutor’s Office, Public Defenders, operators, physicians, and hospitals).

2.1. SUS, supplementary healthcare, and federalism: the design that shapes litigation

Brazil is the only country in the world with more than 100 million inhabitants that offers a universal public healthcare system—the Unified Health System (Sistema Único de Saúde – SUS)—as described in Article 4 of Law No. 8,080/1990[9] (the Organic Health Law):

“The set of health actions and services provided by federal, state, and municipal public bodies and institutions, of the direct and indirect Administration and of foundations maintained by the Public Authority, constitutes the Unified Health System (SUS).”

This universal public system operates in parallel with a robust supplementary healthcare market (private health plans and insurance), both permeated by regional asymmetries in service provision and by budgetary constraints. The practical consequence, from a legal standpoint, is that health-related conflict easily moves among three planes: (a) the constitutional promise of universality; (b) the concrete capacity to deliver (management, budget, infrastructure, waiting lists); and (c) judicialization as an immediate individual avenue of resolution.

Within the SUS, litigation frequently involves tension between individualized decisions (with urgent relief) and public policy guidelines, especially when the object of the claim is a high-cost technology, a medicine outside protocols, or a treatment not yet incorporated. In supplementary healthcare, by contrast, litigation tends to concentrate on extension of coverage, treatments outside the regulatory list, and conflicts between medical prescription and administrative/actuarial criteria.

An additional particularity—especially relevant for foreign readers—is litigious health federalism. The organization of the SUS involves responsibilities distributed among the Union, States, and Municipalities, and judicialization often manifests as a problem of “burden allocation”: who must provide, who must fund, who must execute. In practice, this contributes to the multiplicity of defendants and to recurring disputes over jurisdiction and enforcement, creating a procedural environment in which health litigation is not only a medical-legal conflict, but also a conflict of federative governance.

2.2. Sources of Brazilian Medical Law: Constitution, case law, and ethical regulation (beyond codification)

Unlike legal systems that concentrate rules of medical liability and health organization in codified statutes or in specialized administrative structures, Brazil operates with a layered arrangement of normative sources.

The first layer is constitutional: the right to health, as a fundamental right and a duty of the State, creates a broad legal foundation that allows multiple argumentative strategies (minimum core obligations, dignity, urgency, protection of vulnerable groups). The second layer is jurisprudential: higher courts, especially the Supreme Federal Court (STF), establish theses and criteria that function as minimum national parameters for the granting of health services, directly influencing evidentiary design and passive legitimacy in access-related claims. The third layer is ethical-regulatory: the Federal Council of Medicine (CFM) and the Regional Councils (CRMs) exercise normative and disciplinary authority with strong practical repercussions, particularly in areas such as medical advertising, consent, professional autonomy, and limits of the medical act.

This design fosters a distinctive trait of the Brazilian case: the boundary between “regulation” and “jurisdiction” is more porous. Rather than a single regulatory center, there is a dynamic construction through precedents (STF/STJ), institutional guidelines of the Judiciary (CNJ), and professional ethical norms (CFM), which explains why Brazilian Medical Law is simultaneously dogmatic and eminently pragmatic.

2.3. Litigation actors and procedural capillarity: why disputes scale up

The scale of Brazilian judicialization cannot be explained solely by norms; it depends on the ecosystem of actors and on how the justice system is mobilized.

At the institutional level, the country has developed instruments and structures to deal with health litigation. The action of the CNJ, for example, has driven committees and technical support mechanisms such as NAT-Jus/e-NatJus, aimed at reducing informational asymmetries and bringing judicial proceedings closer to technical-scientific evidence. This architecture is part of the response to a typical problem of health litigation: urgent decisions, high potential costs, and the need for technical rationality in an adversarial environment.

At the procedural level, there is strong participation of public and private actors: patients and families, the Public Prosecutor’s Office and Public Defenders, SUS managers, operators, hospitals, clinics, and physicians. Empirically, it is noteworthy that the largest share of actions proceeds before State Courts (as opposed to Federal Courts), which expands territorial capillarity and reinforces regional differences in decisional patterns. In addition, the average duration of health-related proceedings—with hundreds of days until judgment and until closure—indicates structural pressure and reinforces the centrality of urgent relief as a mechanism of immediate effectiveness.

Finally, the field of Brazilian Medical Law is permeated by a component frequently underestimated in external analyses: territorial asymmetry of legal risk. Even when litigation is measured per inhabitant, there are relevant regional differences; and when measured per physician (a criterion that directly relates to professional risk), the picture changes and reveals distinct regional profiles of legal exposure. This “geography of litigation” is central to understanding why, in Brazil, practices of clinical documentation, risk management, and defensive strategies may vary according to regional and institutional context.

3. The “size of the phenomenon”: an empirical snapshot of health litigation in Brazil

Characterizing Brazilian Medical Law requires, prior to any dogmatic debate, an understanding of the scale of health litigation. Brazil does not merely experience a relevant volume of health-related disputes; it experiences structural litigation, marked by expressive volume, extended duration, strong concentration in State Courts, and significant territorial asymmetry—elements that condition how the right to health is enforced and how medical practice is legally perceived.

3.1. Scale and trend: the “countercyclical” growth of health litigation

Consolidated data from CNJ series[10] indicate that the volume of health-related lawsuits grows in the opposite direction of the overall volume of cases, at both first and second instance levels, producing accumulation and continuous pressure on courts. This trend is reflected in the stock of pending cases: in 2024, there were 573,750 ongoing health-related proceedings, compared to 562,206 practicing physicians, corresponding to an approximate ratio of 1.02 cases per physician[11] and 2.59 cases per 1,000 inhabitants. These same indicators were also echoed by medical entities, reinforcing the interpretation of the phenomenon’s systemic scale.

For the foreign reader, the central point is not merely the absolute number, but its institutional consequence: in an environment of high volume and increasing technical complexity, the Judiciary comes to operate as a recurring channel for the enforcement of health services, influencing planning, budgeting, and regulatory access standards.

Summary table (2024 scale indicators):

a) stock of health-related cases: 573,750;

b) practicing physicians: 562,206;

c) cases per physician: 1.02;

d) cases per 1,000 inhabitants: 2.59.

3.2. Duration and response capacity: lengthy litigation in a field of urgency

Health litigation is, by its nature, marked by urgency: the protected legal interest (life/health) often cannot withstand the typical duration of judicial proceedings. Nevertheless, the observed average duration of health-related cases is high: 439 days until judgment and 747 days until closure[12]. The diagnostic itself points out that delay is influenced by case complexity, the need for technical evidence (including expert examinations), and structural limitations in producing evidence within a timeframe compatible with clinical necessity.

This combination (material urgency + procedural duration) helps explain why provisional relief (injunctions) assumes such a central role in Brazilian health litigation: in practice, a significant portion of the “outcome” of the case occurs at the outset, prior to full evidentiary development, with direct impacts on administrative execution, logistics, and costs.

3.3. Capillarity: predominance of State Courts and its effects

Another distinctive feature is the federative distribution of proceedings. According to CNJ data[13], in 2024 approximately 86.52% of health-related cases were processed in State Courts, compared to 13.48% in Federal Courts. This reinforces the idea of territorial capillarity: health litigation is predominantly situated at the state level, favoring local variations in decisional practice and in the management of enforcement.

From a comparative standpoint, this predominance is relevant because it: (i) multiplies decision-making centers; (ii) accentuates regional asymmetries; and (iii) may reduce practical uniformity of precedents, even within a system that formally seeks to consolidate guidance through theses and qualified judgments.

3.4. The geography of judicialization: regional asymmetry per inhabitant and per physician

In a continental country, analysis based on national averages may conceal markedly different realities. When litigation is observed per population, the same CNJ study indicates expressive regional differences: the South appears with 5.11 cases per 1,000 inhabitants, followed by the Southeast (3.12), Center-West (2.72), Northeast (1.85), and North (0.80).

However, for purposes of legal risk linked to professional practice, the indicator “per physician” is even more revealing. A study authored by me in 2024[14], based on CNJ and CFM data, shows that under this metric the South region remains in first place (1.75 cases per physician), but the regional ranking changes thereafter: Center-West (1.10), Northeast (1.02), Southeast (0.81), and North (0.58).

This dual metric (per inhabitant and per physician) leads to an important conclusion for the international audience: in Brazil, there is not a single “model of health litigation,” but rather regional sub-ecosystems with different intensities of risk and different pressures on professionals and services. Analysis by federative unit deepens this picture by demonstrating concentration of case stocks in certain states, such as São Paulo and Rio Grande do Sul, followed by Minas Gerais, Rio de Janeiro, and Bahia, within the cited dataset.

3.5. From numbers to legal consequences: why scale reshapes Medical Law

The scale and distribution of litigation help explain three structuring effects of Brazilian Medical Law.

(a) Centrality of urgent relief and the “first decisional act.”

The CNJ Diagnostic evidences the relevance of injunctions, reporting high grant rates in public and supplementary healthcare, reinforcing that litigation is resolved, to a large extent, under an urgency regime. The same study was produced using sampling methodology and systematization of procedural data, contributing to an institutional (rather than merely episodic) reading of the phenomenon.

(b) Pressure for technification of judicial decisions.

Volume, urgency, and complexity increase informational asymmetries in proceedings. This helps explain why the CNJ invests in policies and technical support instruments (NAT-Jus/e-NatJus) and why the use of technical notes grows in relevance in judicial practice. As an indicator of institutional maturation, the CNJ reported expressive growth in the production and use of technical notes in 2025, evidencing intensification of a strategy of “evidence-informed decision-making.”

(c) Systemic effect on medical practice and service governance.

The combination of (i) high probability of judicialization in access-related matters and (ii) multichannel accountability of physicians (civil/criminal/ethical/reputational, addressed below) induces reorganizations: greater investment in clinical documentation, informed consent, protocols, internal audits, and risk management. In other words, in Brazil, Medical Law ceases to be merely a “reaction to litigation” and becomes a permanent component of preventive clinical and business management in the healthcare sector.

4. Judicialization of access to healthcare: legal mechanisms and effects

The empirical snapshot presented in the previous chapter allows for a more precise reading of what makes the Brazilian case singular: judicialization of access to healthcare in Brazil is neither a peripheral nor an episodic phenomenon—it operates as a recurrent mechanism for the individual enforcement of the right to health, on a relevant scale, with institutional impacts on health planning, budgeting, and regulation. This reality shifts the axis of Medical Law beyond classic “malpractice” and requires understanding how access-related claims are legally structured and what effects they produce within the system.

In this context, it is useful to revisit the operative distinction between judicialization of healthcare (access to goods and services) and judicialization of medicine (accountability arising from healthcare delivery). In Brazil, although both coexist, access-related litigation tends to assume a quantitatively dominant and, above all, systemic character, because it interferes with resource allocation and the architecture of public policies—especially when judicial decisions order the provision of medicines, therapies, and procedures outside protocols, coverage lists, or administrative pathways.

4.1. Urgent relief, medical prescription, and the “first decisional act” as the core of litigation

Judicialization of access to healthcare in Brazil is strongly marked by requests for provisional urgent relief, which frequently shift the “center of gravity” of the case to its outset. This is explained by a structural dilemma: the protected legal interest (life/health) often cannot withstand the typical duration of proceedings—which, in the CNJ’s 2024 snapshot, reaches 439 days until judgment and 747 days until closure.

The practical consequence is that, in a significant portion of cases, the material effectiveness of the claim occurs prior to full evidentiary development, based on an initial evidentiary set that typically combines: (i) medical reports and opinions; (ii) prescription; (iii) proof of administrative denial; and (iv) allegations of urgency/severity. The CNJ Diagnostic confirms the centrality of urgent relief and reports relevant grant rates in both public and supplementary healthcare, as well as a low conciliation index, reinforcing the Judiciary’s role as an access-granting instance.

For the foreign reader, the distinctive point is that this procedural design tends to transform the medical prescription into both a trigger for judicialization and an object of controversy: prescription is treated as central evidence of therapeutic need, yet the system must filter it through criteria of scientific evidence, technological incorporation, cost-effectiveness, and safety—filters that are often unavailable to judges within the “time” of urgency. This is one of the reasons why Brazil invested in technical support mechanisms for the Judiciary (discussed in Chapter 6).

4.2. Micro-decision and macro-impact: distributive, budgetary, and regulatory effects

Judicialization of access in Brazil produces a recurring paradox: it operates as a mechanism of micro-justice (protection of the individual case, often urgent and dramatic), yet generates macro-impact effects on health governance. In practical terms, judicial orders may alter waiting-list priorities, reallocate resources, impose acquisitions outside planning, and stimulate claims for technologies not incorporated or not foreseen in regular flows.

This phenomenon is especially sensitive when litigation involves high-cost medicines, innovative therapies, or non-standardized procedures. The Brazilian justice system therefore had to evolve from a merely declaratory logic (“right to health”) to a logic of criteria and governance, which explains the structuring role of higher courts in building parameters of exceptionality (Chapter 5) and the CNJ’s judicial policy aimed at decisional rationalization and qualification (Chapter 6). The very creation of instruments such as NAT-Jus and e-NatJus—designed to support decisions through technical notes—derives from this effort to reduce informational asymmetry and mitigate evidence-detached decisions in an urgent environment.

Another distinctive element is that macro-impact is not limited to the public sector: judicialization also reshapes the behavior of operators and providers in supplementary healthcare, since individual decisions may, in practice, revise the regulatory balance between coverage, actuarial predictability, and administrative limits defined by the regulatory agency—a topic addressed specifically in Chapter 7, based on milestones set by the STJ and the STF.

4.3. Litigious federalism: multiplicity of defendants, enforcement, and governance conflicts

Judicialization of access in Brazil is permeated by a decisive institutional factor: health federalism, which distributes operational and financial responsibilities among the Union, States, and Municipalities. In practice, this produces litigation in which the question “who must provide?” is often as relevant as “must it be provided?”. The consequence is the frequent formation of joinder of defendants and the multiplicity of parties, as well as disputes over jurisdiction and, above all, over enforcement (who purchases, who delivers, who reimburses).

This aspect connects to two pieces of evidence presented earlier: (i) the predominance of State Courts (86.52% of cases in the analyzed snapshot), which increases capillarity and multiplies decision-making centers; and (ii) territorial asymmetry of litigation, indicating distinct regional patterns of judicialization per inhabitant and per physician. In practical terms, the same type of claim may generate different response patterns and different enforcement difficulties depending on the state, the healthcare network, and the local administrative structure.

Recognizing these challenges, the CNJ established normative instruments aimed at governing the issue, including the Judicial Policy for the Adequate Resolution of Healthcare Assistance Claims (Resolution No. 530/2023) and specific recommendations on strategies for the proper enforcement of judicial decisions in public healthcare. The explicit objective is to reduce institutional frictions and increase the Judiciary’s capacity to coordinate, with minimum technical and operational rationality, a type of litigation that directly impacts logistics, budgeting, and continuity of care.

Once the legal mechanisms (urgency, initial proof, federative enforcement) and systemic effects (distribution and budget) are understood, it becomes possible to assess the next singularity: the way in which the STF consolidated theses that function as national standards of exceptionality, structuring the “applicable law” to access and acting as an axis of jurisprudential governance of the system.

5. The Supreme Federal Court and the “jurisprudential governance” of the right to health in Brazil

Whereas in several Latin American countries health litigation tends to concentrate on structural failures in service provision, in Brazil the scale and capillarity of health-related disputes led the Supreme Federal Court (Supremo Tribunal Federal – STF) to perform an uncommon function: that of stabilizing national criteria for access decisions, operating as a kind of “indirect manager” of the system through binding precedents (general repercussion) and binding súmulas.

In recent years, this movement has intensified with the establishment of theses aimed not only at the merits (when provision is due), but also at jurisdiction, the organization of administrative flows, and the federative allocation of responsibilities. In this context, three milestones deserve special attention for their practical relevance and comparative potential: Theme 6, Theme 500, and Theme 1234, which consolidate part of these guidelines.

5.1. From “fundamental right” to “decisional architecture”: why the STF began to modulate access

As seen, Brazilian judicialization of access to healthcare shifts the weight of proceedings to the initial phase, especially through urgent relief, while average processing time may exceed one year until judgment and even longer until closure. This mismatch between clinical urgency and procedural time encourages decisions based on asymmetric initial evidence, reinforcing the need for replicable criteria, under penalty of intense regional variability and the risk of replacing health planning with micro-decisions.

The Brazilian institutional response came to include, in addition to judicial policies (Chapter 6), a tightening of binding parameters regarding medicines: (i) not incorporated but registered; (ii) without sanitary registration; and (iii) the definition of jurisdiction and inter-federative flow for relevant claims.

5.2. Theme 6: medicine registered with ANVISA but not incorporated into the SUS

Theme 6[15] addresses the judicial provision of medicines registered with ANVISA but outside the SUS lists. The central point of the thesis is as follows: lack of incorporation generally prevents judicial provision, regardless of cost; however, exceptionality is admitted provided cumulative requirements are met, with the burden of proof resting on the claimant.

In practical terms, the established criteria converge toward a logic of “evidence-based medicine + incorporation governance,” requiring, among other points:

1. Prior administrative denial (observing the flow established in Theme 1234);

2. Demonstration that there is illegality in the non-incorporation act, absence of an incorporation request, or undue delay in analysis by CONITEC, considering legal and regulatory deadlines;

3. Impossibility of substitution by a therapeutic alternative already available within the SUS (lists and Clinical Protocols and Therapeutic Guidelines – PCDT);

4. Proof of efficacy, accuracy, effectiveness, and safety in light of robust scientific evidence;

5. Clinical indispensability demonstrated by a reasoned medical report;

6. The patient’s financial inability to bear the cost of treatment.

A Brazilian singularity of relevance to the international reader is that the STF did not merely reaffirm the right to health; it normativized the mode of decision-making, conditioning judicial relief on an itinerary that passes through technology incorporation and scientific evidence. In practice, this produces a “test” that transforms judicialization—at least in non-incorporated cases—into an analysis of legality and health rationality, rather than merely of individual urgency.

5.3. Theme 500: medicine without ANVISA registration, experimental status, and strict exceptions

Theme 500[16] addresses the most sensitive hypothesis: judicial provision of a medicine without sanitary registration. The thesis states that: (i) the State cannot be compelled to provide experimental medicines; (ii) lack of registration generally prevents provision by judicial decision; and (iii) exception exists only in a scenario of unreasonable delay by ANVISA in analyzing the registration request (exceeding the timeframe set forth in Law No. 13,411/2016), provided cumulative requirements are met.

Among the highlighted requirements are: the existence of a registration request in Brazil (with an exception for orphan medicines for rare and ultra-rare diseases), registration with reputable foreign regulatory agencies, and the absence of a therapeutic substitute with registration in the country.

In addition, the thesis establishes a procedural effect of major impact: actions seeking medicines without registration must necessarily be brought against the Union.

Why this distinguishes Brazil: Brazilian health litigation incorporated, at a constitutional and binding level, a strong “regulatory filter,” connecting access to healthcare with sanitary regulation (ANVISA) and with the federative allocation of competences—a combination less common in models where litigation concentrates on private insurance, professional error, or specialized health courts.

5.4. Theme 1234: jurisdiction, the Union as defendant, and inter-federative governance

Theme 1234[17] is particularly revealing for Latin American comparison because it addresses a typically Brazilian problem: federalism + mass litigation + decentralized enforcement. It concerns the passive legitimacy of the Union and jurisdiction (Federal or State Courts) in claims involving SUS medicines, and was operationalized through inter-federative agreements ratified by the STF.

In summary, in the most frequently cited aspect of Theme 1234, an objective criterion was established for determining jurisdiction in claims involving non-incorporated medicines that are registered with ANVISA: Federal Court jurisdiction applies when the annual cost of treatment (based on PMVG/CMED) is equal to or greater than 210 minimum wages.

There is also an element of great practical importance: modulation of effects regarding jurisdiction, applying the change, as a rule, to actions filed after publication of the merits decision.

Finally, Theme 1234 also signals a rare institutional engineering: beyond criteria of jurisdiction and inter-federative reimbursement, there are guidelines aimed at implementing standardized administrative flows and at creating/using a national information platform for administrative and judicial medicine claims, within a logic of collaborative governance with the justice system.

5.5. Impacts and tensions: technical predictability versus access barriers and procedural complexity

The STF’s binding precedents produce three structuring effects:

1. Standardization of the merits: they restrict judicial intervention to exceptional and conditioned hypotheses, requiring evidence, prior administrative attempt, and demonstration of indispensability;

2. Standardization of jurisdiction: they shift a relevant portion of high economic-impact litigation to the Federal Courts and redefine the Union’s presence as a defendant in specific hypotheses;

3. Transformation of the Judiciary into a governance actor: they consolidate flows, agreements, and mechanisms of inter-federative coordination, bringing litigation closer to a logic of judicially conditioned public management.

On the other hand, relevant tensions arise: (i) increased procedural complexity (jurisdiction, defendants, economic-actuarial criteria); (ii) risk of asymmetry for vulnerable litigants; and (iii) the need for consistent technical support so that criteria do not degenerate into mere formalities. These tensions explain the growing role of the CNJ and of judicial technical support centers, the subject of the following chapter.

From these theses onward, Brazil becomes even more dependent on instruments that assist judges in deciding with technical support and data—NAT-Jus/e-NatJus, technical notes, protocols, and policies for managing health litigation.

6. CNJ, NAT-Jus and e-NatJus: the technification of health litigation in Brazil

The high volume of health-related litigation in Brazil, combined with the extremely urgent nature of a significant portion of claims, exposed a structural problem within the justice system: the informational asymmetry between the technical-scientific knowledge required for decision-making and the judicial process’s ability to produce qualified evidence within a timeframe compatible with therapeutic urgency. In this context, a Brazilian institutional response—of direct interest to foreign readers—was the creation of a national judicial policy, coordinated by the National Council of Justice (Conselho Nacional de Justiça – CNJ), aimed at technically qualifying judicial decisions and standardizing practices for dealing with healthcare assistance claims.

This movement does not replace the substantive debate on the right to health, but it profoundly alters the “mode of decision-making” in health litigation: instead of relying exclusively on private expert reports and intuitive decisions under urgent conditions, the Judiciary began to encourage (i) structured technical support, (ii) national evidence bases, and (iii) enforcement flows designed to reduce inter-federative and operational frictions.

6.1. CNJ Resolution No. 238/2016: State Health Committees and the genesis of NAT-Jus

CNJ Resolution No. 238/2016[18] is a landmark in the institutionalization of the subject, as it provides for the creation and maintenance of State Health Committees, whose responsibilities include assisting courts in the establishment of Judicial Technical Support Centers (NAT-Jus), composed of healthcare professionals tasked with issuing opinions and providing technical support.

From a comparative perspective, the relevance of this design is twofold:

1. it formally acknowledges that judicial decision-making in healthcare requires a technical substrate; and

2. it creates an institutional environment of cooperation (Judiciary–health managers–technical experts), reducing judicial dependence on unilateral sources within the proceedings.

In other words, Brazilian judicial policy began to treat health litigation not merely as a legal problem, but as a socio-institutional one, whose resolution requires structure, governance, and protocols.

6.2. e-NatJus as a “national infrastructure” of evidence for healthcare decisions

Decisional technification evolved from local action (committees and support centers) to a national infrastructure: the e-NatJus System, designed to host and make available technical notes and technical-scientific opinions prepared on the basis of scientific evidence, aimed at supporting judges and court staff in decision-making.

e-NatJus thus presents itself as an applied knowledge repository: it allows public consultation and search filters by diagnosis, technology (medicine/procedure/product), ANVISA registration status, and inclusion in the SUS, among other parameters. This set of functionalities addresses precisely the typical dilemma of health litigation: urgent decisions that must consider (i) efficacy and safety; (ii) regulatory status; (iii) availability within the SUS; and (iv) therapeutic alternatives.

The CNJ has also developed complementary platforms and initiatives, such as the NatJus Network and the National NatJus, integrated into the ecosystem of the National Judiciary Forum for Health (Fórum Nacional do Judiciário para a Saúde – Fonajus), with the aim of disseminating information and strengthening technical support at scale.

6.3. CNJ Resolution No. 530/2023: Judicial Policy for the Adequate Resolution of Healthcare Assistance Claims

The institutionalization of the subject is consolidated with CNJ Resolution No. 530/2023[19], which establishes the Judicial Policy for the Adequate Resolution of Healthcare Assistance Claims and its National Plan (2024–2029). The normative act expressly sets forth principles and guidelines such as: guaranteeing access to justice; unification of guidelines with decentralized management; inter-institutional cooperation; specialization of judicial structures; and continuous training.

From a comparative standpoint, this policy reveals a singularity: Brazilian judicialization was not addressed solely through legislative reforms or binding jurisprudence (Chapter 5), but also through administrative governance within the Judiciary itself, guiding courts to structure specialization, data management, cooperation, and technical support mechanisms.

6.4. CNJ Recommendation No. 146/2023: proper enforcement and operational rationalization of decisions

A recurring problem in healthcare claims is enforcement: purchasing, delivering, importing, funding, reimbursing, and organizing flows within a federal context, with the risk of budget sequestration and administrative disorganization. CNJ Recommendation No. 146/2023[20] addresses strategies for the proper enforcement of judicial decisions in public healthcare and was approved by the CNJ Plenary precisely to mitigate frictions and standardize practices.

The Recommendation is part of a broader set of normative acts issued within the scope of Fonajus and dialogues with initiatives aimed at organizing enforcement flows (including antecedents in working groups established by CNJ ordinances). For the foreign reader, the point is clear: Brazil needed to move beyond the debate of “grant or deny” and address the “how to enforce” question institutionally, under penalty of collapsing logistics and planning.

6.5. Evidence of maturation: growth in the use of technical notes and the scale of e-NatJus

The consolidation of this ecosystem is not merely normative; there is evidence of increasing use. The CNJ reported that the use of technical notes to support judicial decisions in healthcare grew by approximately 32% in 2025 and disclosed the scale of the e-NatJus repository.

In addition, the CNJ itself has disseminated system improvements and new functionalities, reinforcing the strategy of transforming e-NatJus into an operational tool to reduce technical asymmetry in health litigation.

6.6. Limits and challenges: technification does not eliminate conflict, but qualifies the decisional standard

Despite its relevance, technification alone does not resolve three structural tensions:

1. Time versus evidence: clinical urgency may persist as a decisive factor even with technical support, especially when the production of technical notes does not keep pace with litigation;

2. Uniformization versus judicial autonomy: even with guidelines and technical bases, courts and judges may diverge in the valuation of evidence and in the application of precedents (particularly in distinct regional realities);

3. Access and inequality: technical instruments qualify decisions, but do not eliminate disparities in access to the justice system or differences in procedural mobilization capacity, a sensitive issue in countries marked by inequality and informational asymmetry.

Still, for understanding the particularities of Brazilian Medical Law, the central point is that the country developed a rare institutional response: a national judicial health policy, with structured technical support (NAT-Jus) and an evidence base (e-NatJus), aimed at reducing decisional randomness and bringing judicial decisions closer to technical-scientific criteria and administrative flows.

Once the mechanisms of technification and management of litigation in the public sphere have been presented, it becomes necessary to examine the second major arena of access-related litigation in Brazil: supplementary (private) healthcare, where administrative regulation (ANS) and judicial control (STJ/STF) interact in defining coverage, especially after the controversy surrounding the ANS coverage list.

7. Supplementary (Private) Healthcare and Judicialization: ANS, STJ and STF (coverage list, exceptions and coverage criteria)

Brazilian supplementary healthcare (private health plans and insurance) constitutes a distinct litigation arena, with dynamics different from those of the SUS, yet equally relevant for understanding the particularities of Medical Law in Brazil. In this field, the core of the conflict usually concerns the scope of healthcare coverage, marked by tension between: (i) the prescription issued by the attending physician; (ii) the contractual and actuarial limits of the insurance product; and (iii) the administrative regulation exercised by the National Agency for Supplementary Health (Agência Nacional de Saúde Suplementar – ANS), especially through the List of Health Procedures and Events (Rol de Procedimentos e Eventos em Saúde).

This arena gained particular legal density following the controversy over the legal nature of the ANS list (whether exhaustive or illustrative) and over the circumstances under which procedures, exams, and therapies not listed must be covered. Significant milestones emerged at the Superior Court of Justice (STJ) in 2022, at the legislative level with Law No. 14,454/2022, and more recently at the Federal Supreme Court (STF) in 2025, which established nationwide criteria for judicially ordering (or imposing) coverage outside the list.

7.1. The ANS list as a regulatory parameter and the core legal issue

The ANS list is essentially an instrument of healthcare regulation: it defines a mandatory minimum set of coverages, seeking to balance access, contractual predictability, and the economic-financial sustainability of the system. In judicial proceedings, however, the list has become a recurring “friction point,” as many disputes reach the courts under strong urgency and informational asymmetry—partly similar to SUS litigation, but with a distinct contractual and regulatory nature.

The Brazilian particularity in this area stems from decisional triangulation: coverage is effectively defined through the interaction between administrative regulation (ANS), case law (STJ/STF), and legislative response (Law No. 14,454/2022), creating an environment in which sector predictability depends on alignment among these three normative layers.

7.2. The STJ landmark (2022): the “mitigated exhaustive list” and its requirements

In June 2022, the Second Section of the Superior Court of Justice, when adjudicating EREsp 1,886,929/SP and 1,889,704/SP[21], held that the ANS list is, as a rule, exhaustive, while admitting exceptional mitigation subject to objective criteria.

This decision is relevant to Medical Law for two main reasons: (i) it shifts the debate from a binary “covered/not covered” approach to a test of exceptionality; and (ii) it brings supplementary healthcare litigation closer to technical elements (scientific evidence, available alternatives, clinical justification), reducing the space for decisions based solely on medical prescriptions without minimal filtering.

7.3. Legislative response: Law No. 14,454/2022 and the reconfiguration of the debate

Following the STJ ruling, the legislature enacted Law No. 14,454/2022[22], amending the Health Insurance Act to provide criteria enabling coverage of treatments and exams not included in the ANS list, under specific conditions.

From an institutional perspective, this law reflects a characteristic of the Brazilian model: when controversies in supplementary healthcare gain scale and social visibility, there is a tendency toward “normative reaction” to reduce legal uncertainty, without fully abandoning technical parameters. The result is a hybrid model: the list remains a central reference, but the system allows conditioned exceptions, requiring greater sophistication in evidence and judicial reasoning.

7.4. The STF (2025): nationwide criteria for coverage outside the list and regulatory–jurisprudential convergence

In September 2025, in the judgment of ADI 7,265[23], the Federal Supreme Court addressed the issue under abstract judicial review and established criteria for requiring health plans to cover treatments outside the ANS list. The Court recognized the constitutionality of exceptional coverage but conditioned it upon the fulfillment of cumulative requirements.   

The significance of this precedent is structural: the STF did not merely “authorize” coverage outside the list; it standardized the decisional framework, establishing filters that combine (a) prescription by a duly qualified professional, (b) absence of an adequate alternative within the list, (c) high-quality scientific evidence, and (d) regulatory elements (such as sanitary registration and evaluation status), according to the formulation adopted in the judgment.

For an international audience, this represents a relevant particularity: rather than leaving the controversy solely at the contractual level (freedom of contract versus good faith) or within a purely consumer-law framework, the Brazilian system converges toward a model in which imposing coverage outside the list depends on a technical-legal test designed to balance patient protection with system sustainability.

7.5. Practical implications for Medical Law: evidence, clinical governance and risk management

The consolidation of this regime (STJ + Law No. 14,454/2022 + STF) produces direct effects on medical practice and litigation:

1. Strengthening of technical evidence: medical prescription remains central, but there is increasing demand for well-founded clinical justification, scientific evidence, and demonstration of the inadequacy of covered alternatives.

2. Greater sophistication of litigation: judicial debate tends to migrate toward (i) evidentiary standards, (ii) therapeutic comparators, (iii) clinical guidelines, and (iv) regulatory rationality—bringing supplementary healthcare litigation closer to technology-incorporation discussions.

3. Pressure for healthcare governance and compliance: hospitals, clinics, and operators increasingly value protocols, audits, documentation, and internal decision-making pathways to handle requests outside the list, reducing legal and reputational risk.

4. Partial standardization without elimination of asymmetries: national criteria reduce volatility but do not eliminate local divergences in evidentiary assessment and concrete application, especially in urgent decisions.

With the axis of access-related judicialization (SUS and supplementary healthcare) clarified, the article turns to the second phenomenon of Brazil’s “dual judicialization”: medical civil liability, with its particular evidentiary challenges, social expectations, and jurisprudential trends.

7.6 Criminal liability of physicians: typicity, evidence and the limits of criminalization

Criminal liability of physicians[24], although less frequent than civil litigation and ethical-disciplinary proceedings, is part of the Brazilian ecosystem of legal risk and must be understood as an element of the multichannel vector. In terms of criminal typicity, indictments in healthcare contexts tend to concentrate on cases involving serious adverse events (death or bodily injury), in which allegations of negligent homicide and negligent bodily injury arise, pursuant to provisions of the Brazilian Criminal Code:

Article 121. To kill someone:

Penalty – imprisonment, from six to twenty years.

(…)

§ 3. If the homicide is negligent:

Penalty – detention, from one to three years.

Article 129. To offend the bodily integrity or health of another person:

Penalty – detention, from three months to one year.

(…)

§ 6. If the injury is negligent:

Penalty – detention, from two months to one year.

In specific situations, indictments may also include exposure of another’s life or health to danger and omission of assistance, particularly when the procedural narrative is shaped under strong social and media pressure:

Article 132. To expose another’s life or health to direct and imminent danger:

Penalty – detention, from three months to one year, if the act does not constitute a more serious crime.

Article 135. To fail to provide assistance, when it is possible to do so without personal risk, to an abandoned or lost child, or to an injured or incapacitated person, helpless or in grave and imminent danger; or to fail, in such cases, to request assistance from the public authorities:

Penalty – detention, from one to six months, or a fine.

From an evidentiary standpoint, the decisive—and often underestimated—particularity for foreign readers is that criminal prosecution in medical matters in Brazil is highly sensitive to the quality of expert evidence and to the reconstruction of causation, in an environment in which adverse clinical outcomes may result from inherent procedural risks, comorbidities, uncontrollable variables, and therapeutic limits. This produces a “funnel effect”: many investigations begin at the stage of criminal reports and inquiries, but the sustainability of prosecution depends on consistent technical grounding under the guarantees of due criminal process[25].

In practical terms, early technical defense and proper organization of clinical documentation play a strategic role, as criminal proceedings often interact, directly or indirectly, with other channels (civil and disciplinary), whether through shared narratives or reuse of evidentiary elements.

There is also an area of intersection between criminal liability and the reputational/digital axis addressed earlier in this study: attacks on physicians’ honor on platforms and social networks may generate, in addition to civil reparation and content removal, criminal liability of offenders, especially in cases involving crimes against honor (false accusation, defamation, and insult), without prejudice to related charges depending on case dynamics:

Article 138. False accusation (Calumny)

To falsely accuse someone of a fact defined as a crime:

Penalty – detention, from six months to two years, and a fine.

Article 139. Defamation

To defame someone by imputing a fact offensive to their reputation:

Penalty – detention, from three months to one year, and a fine.

Article 140. Insult (Injury)

To insult someone, offending their dignity or decorum:

Penalty – detention, from one to six months, or a fine.

This overlap reinforces a singular feature of the Brazilian scenario: even when litigation originates as a reputational dispute, it may escalate into multiple legal spheres, increasing costs, risks, and incentives toward defensive medicine and preventive crisis management.

8. Medical civil liability in Brazil: the subjective rule and the “practical objectification” of risk

Although judicialization of access to healthcare represents the quantitative epicenter of Brazilian health-related litigation, the physician’s civil liability remains a structuring dimension of Medical Law, particularly due to its direct effects on reputation, compliance costs, defensive practices, and the organization of healthcare services. For the foreign reader, the distinctive point is that this liability develops within an environment already strained by access-related judicialization—namely, an ecosystem in which the Judiciary is frequently mobilized and in which the discourse of patient protection is strongly shaped by social expectations, evidentiary asymmetry, and digital exposure.

8.1. Regra dogmática: responsabilidade subjetiva, prova pericial e nexo causal

From a dogmatic standpoint, the Brazilian model, as a rule, is grounded on subjective (fault-based) liability, requiring proof of culpable conduct (negligence, recklessness, or lack of technical skill), damage, and causation, in line with the general structure of civil liability. In medical litigation, the natural consequence is the centrality of expert evidence, since assessing fault—and often the very existence of causation—depends on technical evaluation.

This point is relevant comparatively because, despite the large volume of claims, Brazil does not, as a rule, have specialized medical courts or permanent technical chambers, and many disputes are decided by generalist judges, which makes the quality of expert evidence and the framing of the expert questions (quesitos) decisive for the rationality of judgments. This reality contributes to a recurring feature of litigation: disputes not only about “error” or “damage,” but about the standard of diligence required in specific clinical contexts, the management of complications, and the adequacy of the information provided to the patient.

From an appellate perspective, most medical civil liability claims end at the second instance (State Courts of Justice and Federal Regional Courts). This occurs because access to the higher courts—STJ (special appeal) and STF (extraordinary appeal)—is strictly limited to questions of law, whereas the typical subject matter of these disputes depends, as a rule, on the factual-evidentiary record, especially expert evidence. For that reason, appellate attempts often run into the well-known summary obstacles that bar reexamination of evidence.[26][27]

8.2. Trends of “practical objectification”: when fault becomes presumed

Despite the subjective rule, forensic practice reveals a tendency toward functional objectification in certain scenarios, that is, situations in which fault ceases to be treated as an element requiring rigorous proof and begins to be inferred from factual presumptions, outcome narratives, or documentary failures.

This practical objectification tends to intensify in three contexts:

(a) Procedures with strong outcome expectations (aesthetics, plastic surgery, assisted reproduction). In such cases, Brazilian experience shows an increase in claims where the debate shifts toward the “promised result,” even when the legal obligation is not automatically one of result. In practical terms, the risk increases that the case will be decided based on “frustration of outcome” and consumer narratives, especially when clinical documentation is fragile.

(b) Gaps in documentation and informed consent. A particular feature of Brazilian litigation is that many cases are decided less by technical aspects and more by the capacity to demonstrate: (i) the duty to inform; (ii) risk warnings; (iii) records of follow-up and clinical conduct; and (iv) timely management of complications. The absence of a robust medical record may produce an inversion of plausibility: error is not proven, but failure is presumed, because “what is not documented did not occur”—a factual logic that gains strength when the adjudicator is a generalist judge.

(c) The digital environment and the “post-medical error” narrative. The exposure of cases on social networks, rating platforms, and the press creates a scenario of reputational pre-judgment, capable of shaping expectations and perceptions of the judge and of the litigation dynamics itself. This phenomenon is relevant because it shifts part of the dispute into the narrative and moral field, making the evidentiary component (expert examination) even more essential as an instrument of rationality.

8.3. Evidence and decisional rationality: expert examinations, protocols, and the centrality of the medical record

The maturation of Brazilian Medical Law has encouraged decisions that value the need for specialized expert examinations and that recognize that foreseeable complications are not synonymous with malpractice. However, this evolution coexists with territorial heterogeneity and with asymmetries in the quality of expert work across regions.

In this context, the medical record and informed consent (TCLE) assume a core role for three reasons:

1. Proof of the duty to inform and shared decision-making (patient autonomy);

2. Proof of conduct and follow-up (standard of diligence and monitoring);

3. Proof of causation or its disruption (recording concurrent factors and clinical evolution).

For international purposes, this documentary centrality can be presented as a “point of convergence” among law, ethics, and clinical governance: in Brazil, civil litigation is often resolved by a combined assessment of (i) the quality of information; (ii) compliance of documentation; and (iii) technical-scientific coherence of clinical conduct in the face of complications.

8.4. Systemic effects: defensive medicine, clinical compliance, and indirect costs

Civil liability, in an environment of high litigation levels and reputational exposure, tends to produce systemic effects on medical practice. Among the most relevant are:

• Defensive medicine: increased ordering of tests, referrals, and recordkeeping to reduce legal risk, even though this does not always increase the quality of care;

• Clinical compliance and standardization: protocols, checklists, medical record audits, consent management, and decision pathways;

• Indirect costs: administrative time, insurance, crisis governance, and reputation management.

These effects connect to the “dual judicialization”: a system in which the Judiciary is frequently mobilized both for access and for liability generates expanded compliance incentives, increasing the legal dimension of clinical practice.

If civil liability is the classic channel of accountability, in Brazil it coexists with a channel of growing relevance: ethical-professional accountability and the autarchic regulation exercised by Medical Councils, which, in certain areas (such as advertising), becomes an autonomous vector of litigation and regulatory risk.

9. Ethical accountability and professional regulation: the physician’s “second layer of litigation” in Brazil

One of the most relevant particularities of Brazilian Medical Law—and one that is often underestimated in foreign analyses—is that physician accountability is not exhausted within the Judiciary. It operates through multiple channels, with particular emphasis on the ethical-professional sphere, conducted by the Medical Councils (Federal Council of Medicine – CFM, and Regional Medical Councils – CRMs), which exercise normative and disciplinary authority of an autarchic nature, with concrete impacts on professional practice, reputation, and the healthcare market.

From a comparative perspective, the distinctive feature is not merely the existence of professional councils (which are common in many countries), but rather the combination of three factors: (i) detailed normative production, through resolutions that directly influence medical practice and market dynamics; (ii) effective sanctioning capacity, including severe penalties; and (iii) increasing interaction with judicial litigation, whether as evidentiary material or as a reputational and economic “trigger.”

9.1. Ethical-professional proceedings: nature, procedure, and practical impact

Ethical-professional proceedings have a sanctioning and educational character, are judged by peers, and follow specific rules of confidentiality. In practice, they function as a mechanism for controlling clinical and professional conduct and often become an autonomous vector of risk, even when the medical act has not resulted in judicial liability.

Recent indicators point to a significant increase in ethical litigation: within the cited period, there was an approximate 1,077% growth in the number of ethical-professional proceedings over 20 years, along with a relevant rise in convictions. This reinforces the perception of maturation—and intensification—of ethical-professional enforcement in Brazil. In addition, the distribution of cases by specialty indicates greater exposure in certain areas, notably internal medicine, plastic surgery, gynecology and obstetrics, orthopedics, and anesthesiology, among others. This is a relevant datum, as it allows the reader to understand that ethical risk is also structurally asymmetric.

At the decisional level, the data show that although many proceedings are dismissed, there are significant percentages of sanctions imposed by the Federal Council (Chambers and Plenary), including penalties considered severe (such as suspension and revocation of professional registration). This demonstrates that the Brazilian disciplinary system does not operate merely as a symbolic mechanism.

9.2. Normative regulation by the CFM and market effects: advertising and autonomy of the medical act

The normative output of the CFM plays a structuring role in Brazilian Medical Law, particularly in areas where the boundary between information, advertising, and improper client solicitation has become blurred due to social networks and digital platforms. Resolution CFM No. 2,336/2023[28], which regulates medical advertising and publicity, reorganizes permissions and prohibitions, directly impacting the communication practices of professionals and clinics and expanding the potential for ethical-disciplinary and judicial conflicts.

In practical terms, this detailed regulation intensifies two dynamics:

1. Disciplinary litigation related to advertising: disputes involving before-and-after images, exposure of patients, implicit promises of results, sensationalist language, and the commercial use of educational content;

2. Interaction with civil litigation: advertising rules are invoked in damages claims as behavioral standards, particularly when allegations involve inducement of expectations, promises of results, or breaches of the duty to inform.

Another relevant regulation, Resolution CFM No. 2,416/2024[29], addresses physicians’ exclusive acts, professional autonomy, limits, responsibility, and legal framing. It affects interprofessional debates and disputes over scope of practice and also serves as an argumentative reference in regulatory and judicial conflicts.

9.3. Interaction between ethics and the Judiciary: reciprocal influence and risks

Although the ethical and civil spheres are formally independent, practice reveals multiple points of interaction. On the one hand, ethical decisions and elements of disciplinary proceedings may be used as indicia in civil claims (subject to access and confidentiality limits), influencing the judge’s perception of the standard of conduct. On the other hand, judicialization and public exposure of an adverse event frequently prompt complaints before the Medical Councils, expanding the physician’s multichannel risk.

This feature distinguishes Brazil from models in which professional discipline is more succinct and less interventionist. In the Brazilian context, ethical regulation is often part of the “hard core” of applied Medical Law, with significant economic and reputational repercussions.

9.4. Territorial asymmetry and uniformity: an additional challenge

Another Brazilian particularity lies in the territorial dimension of the disciplinary system: Regional Medical Councils (CRMs) operate with administrative autonomy within their jurisdictions, which may generate interpretative variations and differences in sanctioning intensity. In emerging areas—such as advertising on social networks, telemedicine, and consent in innovative procedures—this asymmetry can be perceived as a source of regulatory uncertainty for professionals who operate nationally or maintain a strong digital presence.

From a comparative standpoint, this reinforces the idea that Brazilian Medical Law combines: (i) high levels of judicial litigation; (ii) robust ethical enforcement; and (iii) regional variation—an ensemble that increases the complexity of the legal environment for physicians and healthcare organizations.

The intensification of the reputational vector and the centrality of social networks have produced a related phenomenon: physicians increasingly initiate legal actions against patients, platforms, and third parties for defamation and damage to reputation, bringing Medical Law closer to Digital Law and to the framework established by the Brazilian Internet Civil Rights Act[30].

10. The physician as claimant and digital reputation: the intersection between Medical Law and Digital Law in Brazil

The intensification of public exposure of healthcare services—driven by social networks, review platforms, and viral content—has produced a significant shift within Brazilian Medical Law. Beyond appearing as defendants in damages claims and being subject to ethical-professional proceedings, physicians (as well as clinics and hospitals) have increasingly emerged as claimants in actions aimed at protecting professional honor, image, and reputation.

This trend is particularly relevant in Brazil because it is superimposed on an environment already characterized by high litigation rates, detailed ethical regulation (especially regarding medical advertising), and strong social sensitivity to narratives of “medical error.” The result is a zone of friction in which freedom of expression, the patient’s or consumer’s right to criticize, data protection, and medical confidentiality coexist with legal mechanisms for content removal, right of reply, and compensation.

10.1. Reputation as a legal and economic risk in contemporary medicine

In practice, reputational conflicts involving physicians in Brazil usually fall into three main patterns:

a) Public accusations of medical error (with or without ongoing litigation) on social networks and review platforms;

b) Campaigns of discredit or “digital lynching” following adverse clinical outcomes;

c) Improper disclosure of clinical information, images, or conversations, impacting the privacy of both patient and physician.

In any of these scenarios, litigation tends to be marked by urgency: content spreads rapidly, and reputational harm may become irreversible even when judicial proceedings extend over months.

10.2. Applicable legal framework: the Internet Civil Rights Act, right of reply, and civil liability

The central normative framework is the Brazilian Internet Civil Rights Act[31] (Marco Civil da Internet), which structures the liability regime for internet service providers and the logic governing content takedown. In particular, Article 19 establishes the model whereby, as a general rule, civil liability of application providers for third-party content requires noncompliance with a specific judicial order. This approach seeks to balance protection against harm with freedom of expression and the prevention of private censorship:

Article 19. In order to ensure freedom of expression and prevent censorship, the internet application provider may only be held civilly liable for damages arising from third-party content if, after a specific court order, it fails to take the measures necessary—within the scope and technical limits of its service and within the prescribed time—to render the allegedly infringing content unavailable, except as otherwise provided by law.

§ 1. The judicial order referred to in the caput must contain, under penalty of nullity, clear and specific identification of the content alleged to be infringing, allowing its unequivocal location.

§ 2. The application of this article to infringements of copyright or related rights depends on specific legal provision, which must respect freedom of expression and other guarantees provided in Article 5 of the Federal Constitution.

§ 3. Claims involving civil liability for damages arising from content made available on the internet may be brought before small claims courts.

This framework has two direct implications for conflicts involving physicians:

1. The appropriate route generally begins with the Judiciary when the objective is to hold the platform liable for failing to remove third-party content;

2. Litigation tends to focus on injunctive or urgent relief (content removal), followed by potential compensation for moral or material damages, with emphasis on proof of the content, authorship (when identifiable), and the extent of dissemination.

In addition to civil remedies (content removal or rectification, right of reply, and damages), reputational disputes involving physicians often extend into the criminal sphere with respect to the offenders. Brazilian practice shows frequent application of crimes against honor—defamation, slander, and insult—and, depending on the circumstances, offenses such as threat and stalking, as defined in the Criminal Code:

Article 147. Threat

To threaten someone, by word, writing, gesture, or any other symbolic means, with unjust and serious harm:

Penalty – detention from one to six months, or a fine.

Article 147-A. Stalking

To persecute someone repeatedly and by any means, threatening their physical or psychological integrity, restricting their freedom of movement, or otherwise invading or disturbing their sphere of liberty or privacy:

Penalty – imprisonment from six months to two years, and a fine.

Accordingly, reputational litigation involving physicians in Brazil tends to assume a hybrid character, combining civil injunctive or compensatory relief with criminal prosecution when the attack on professional image exceeds the bounds of legitimate dissent.

In parallel, Brazilian law provides a specific framework for the right of reply[32], which may be invoked in cases of offense disseminated by mass media outlets, without prejudice to compensation. In the digital environment, this instrument is not always operationally simple—given the nature and dispersion of platforms—but it remains part of the repertoire of reputational protection, particularly when dissemination resembles journalistic content.

It is also relevant to note that platforms may remove content that violates their own terms of service, regardless of a court order. This reality affects physicians’ strategic choices: in certain cases, administrative channels within the platform may provide a faster solution than judicial proceedings.

10.3. Evidentiary and procedural particularities in medical reputational disputes

Reputational cases connected to medical practice present specific challenges:

• Ephemerality and volatility of evidence: content may be deleted, edited, or replicated, increasing the need for rapid evidence preservation and urgent measures;

• Identification of the author: anonymous or false profiles hinder direct accountability, often splitting litigation between (i) content removal and (ii) identification of the responsible party, when legally feasible;

• Risk of the “Streisand effect”: judicial action may amplify visibility of the content, requiring careful communication and crisis management strategies.

10.4. A sensitive point in Medical Law: professional confidentiality and communicational asymmetry

In reputational conflicts, one element distinguishes medicine from other economic activities: professional confidentiality. Even in the face of public accusations, physicians face significant limitations in defending themselves on the same communicational plane as the accuser, since they cannot freely disclose clinical data, examinations, or details of care without ethical and legal risks.

This creates an asymmetry: the patient may publicly narrate their version, while the physician must respond with caution, often resorting to generic language and institutional avenues (Medical Councils, Judiciary). This factor reinforces why, in Brazil, digital reputation has come to be understood as an integral component of applied Medical Law, rather than as a peripheral issue of consumer law or digital law alone.

10.5 Synthesis: a Brazilian particularity with systemic effects

The growing judicialization of reputational disputes involving physicians reinforces a defining feature of the Brazilian model: professional accountability is multichannel (civil, criminal, ethical, and reputational/digital) and tends to interact with high levels of health litigation. The result is an increase in compliance costs (documentation, communication, crisis management) and the need for institutional and organizational responses that engage with the digital ecosystem.

Having examined the two major axes (access to healthcare and professional accountability) and the expansion of the digital vector, the article turns to contemporary challenges: telemedicine, artificial intelligence, shared liability, and regulatory effects, identifying risks and comparative lessons for Latin America.

11. Contemporary challenges and perspectives: telemedicine, artificial intelligence, data, and shared liability

The most recent phase of Brazilian Medical Law is marked by a set of vectors that, although global in nature (digitalization, platforms, artificial intelligence), assume specific contours in Brazil due to the already described phenomenon of “dual judicialization”: a system in which (i) access to healthcare is litigated on a large scale, and (ii) professional accountability operates through multiple channels (civil, ethical, and reputational). As a result, healthcare innovations are discussed not only as technical advances but as systemic legal risks, requiring governance, evidentiary structures, and regulatory design.

11.1. Telemedicine: from the “emergency regime” to regulatory normalization

The emergency legal framework for telemedicine in Brazil was established by Law No. 13,989/2020[33], which authorized its use for the duration of the COVID-19 public health crisis. This emergency nature is, in itself, a relevant peculiarity: the practice expanded rapidly out of necessity, and the legal system had to pursue minimum standardization after the fact.

At the professional-regulatory level, the Federal Council of Medicine regulated telemedicine through Resolution CFM No. 2,314/2022[34], establishing concepts, principles, and conditions for technology-mediated medical services, while preserving in-person consultation as the “gold standard” and imposing requirements related to security, identification, and qualified digital signatures, among others.

A Brazilian particularity worth highlighting for an international audience is that telemedicine operates within an environment where access-related litigation is massive and ethical-professional disputes are intense. This context tends to generate three recurring legal challenges:

a) Evidence and medical records (quality of documentation in remote care settings);

b) Consent and the duty to inform (specific limits and risks of the medium);

c) Liability for technological failures (platforms, connectivity, integrity, and confidentiality).

11.2. Artificial intelligence in healthcare: broad regulatory gaps and judicialization through “algorithmic liability”

The debate on artificial intelligence in Brazil is advancing in parallel but remains under normative construction. Bill No. 2,338/2023[35], which addresses the use of artificial intelligence, was introduced and processed in the Federal Senate and has since been forwarded to the Chamber of Deputies for review, where it remains under consideration.

For Medical Law, AI is likely to generate litigation along three main fronts:

1. AI-assisted clinical decision-making and diagnostic or conduct errors: disputes over the applicable standard of care when physicians use decision-support systems;

2. Governance and explainability: the need to justify why a tool was (or was not) used and how its recommendations were evaluated;

3. Shared liability: physicians, hospitals or clinics, developers, and technology providers become part of a single risk chain.

A Brazilian singularity lies in the combination of high access-related judicialization and strong pressure for urgent judicial relief. In this context, AI tools may be invoked both to expand access (triage, prioritization, tele-assistance) and to challenge conduct (allegations that the physician “should have used” a certain technology or, conversely, “should not have relied” on it). In such scenarios, legal certainty and evidentiary rationality tend to require:

• audit trails (logs);

• internal protocols for use;

• validation and continuous monitoring;

• effective human supervision.

11.3. Health data, the LGPD, and the new core of professional confidentiality

The digitalization of healthcare and system interoperability have shifted the center of medical confidentiality toward data governance. Law No. 13,709/2018[36] (the Brazilian General Data Protection Law – LGPD) regulates the processing of personal data, with direct relevance to sensitive health data.

In the medical field, this translates into legal risks that already manifest in institutional practice:

a) security incidents and data breaches;

b) excessive data sharing with vendors and platforms;

c) secondary use of data for marketing and patient acquisition;

d) conflicts between transparency, patient access to medical records, and the preservation of clinical or therapeutic secrets.

11.4. Strengthening the regulatory vector: exclusive medical acts and documentation with legal value

The contemporary environment also reinforces debates on professional autonomy and exclusive medical acts, particularly in interdisciplinary contexts and those involving digital platforms. Law No. 12,842/2013[37] (the Medical Practice Act) remains a structuring reference for the exercise of medicine. In addition, recent normative acts issued by the CFM (such as Resolution No. 2,416/2024) reinforce the centrality of medical-legal documentation and the definition of acts exclusive to physicians in patient care, with direct impact on litigation and on the allocation of responsibilities in digital and corporate healthcare services.

11.5. Perspectives: comparative lessons for Latin America

The Brazilian experience suggests two main lessons for Latin American countries observing the expansion of Medical Law:

1. Judicialization migrates with technology: telemedicine and artificial intelligence do not automatically reduce litigation; they reconfigure it (evidence, liability chains, governance).

2. Without technical support and criteria, urgency prevails: Brazil had to create technification infrastructure (NAT-Jus/e-NatJus) and structuring precedents within the Supreme Federal Court to mitigate decisional randomness—yet persistent tensions remain.

Conclusion

Medical Law in Brazil has consolidated as a singular legal field not because it is governed by a specific “code” or by a centralized normative architecture, but because it has been historically shaped by the convergence of three institutional forces: (i) the intense constitutionalization of the right to health; (ii) large-scale judicialization with territorial capillarity and distributive impact; and (iii) the multiplicity of arenas of medical professional accountability, which transcends classical civil litigation and extends into the ethical-professional sphere and, increasingly, the digital-reputational dimension. From this combination, the Brazilian case demonstrates that “Medical Law” cannot be reduced to the physician–patient relationship; rather, it projects itself onto the governance of health systems, the regulatory design of technologies, and the institutional sustainability of both public and private healthcare models.

The first Brazilian particularity—and the one that best explains the departure from the foreign paradigm centered on malpractice—is the existence of dual judicialization. On the one hand, there is litigation aimed at access to healthcare goods and services; on the other, litigation concerning accountability for alleged harm arising from medical practice. This duality is not merely classificatory; it determines distinct decisional rationalities and produces specific systemic effects. In the access axis, judicial protection tends to operate under conditions of urgency and to generate distributive consequences (micro-justice with macro-impact), influencing administrative priorities, logistics, budgeting, and technology incorporation. In the accountability axis, litigation projects itself onto professional and organizational behavior, inducing reinforced documentation, protocols, and defensive strategies, within a context of evidentiary asymmetry and reputational pressure.

The second particularity, of major comparative relevance, is that Brazil has developed a jurisprudential governance of the right to health, led by the Supreme Federal Court (STF) through binding precedents and general repercussion theses. The Court has come to establish criteria not only regarding whether the State must provide a given technology, but also how judicial access should be structured, who must be included on the defendant side, and where the claim should be adjudicated. In doing so, the STF acts as a stabilizer of a federative litigious system, establishing filters of exceptionality that connect judicial proceedings to scientific evidence, regulatory status, and the dynamics of health technology incorporation. This feature is uncommon in models in which health litigation remains predominantly contractual, consumer-based, or concentrated in specialized courts.

The third particularity lies in the administrative response of the Judiciary itself. Faced with high volume, urgency, and technical complexity, Brazil instituted a national judicial policy (through the National Council of Justice – CNJ) and structured mechanisms of technical support (NAT-Jus/e-NatJus), aimed at reducing informational asymmetry and promoting decisions more closely aligned with evidence. This technification does not eliminate controversy nor replace public policy choices, but it constitutes a distinctive institutional trait: Brazilian health litigation has come to be treated as a governance problem, not merely as case-by-case adjudication. From a comparative perspective, this offers a potentially replicable model—subject to adaptation—for systems facing growth in health litigation without timely expert evidence, specialized structures, or predictable administrative flows.

In the field of supplementary (private) healthcare, the fourth particularity resides in the normative triangulation among the National Supplementary Health Agency (ANS), the Superior Court of Justice (STJ), the Supreme Federal Court (STF), and the legislature, producing an environment in which the practical definition of coverage depends on convergence between administrative regulation, jurisprudential parameters, and legal criteria of exceptionality. The debate over the ANS coverage list and its mitigation under specific conditions illustrates how Brazilian Medical Law becomes simultaneously regulatory and jurisdictional, requiring the interpreter to integrate scientific evidence, system sustainability, and patient protection, with direct repercussions on clinical practice and healthcare governance.

The fifth particularity concerns the multichannel nature of medical accountability. Beyond civil and criminal litigation, the ethical-professional sphere—with detailed normativity and effective sanctioning capacity—forms part of the core of Brazilian Medical Law. Combined with reputational pressure in the digital environment (in which physicians may become plaintiffs to protect honor and image, under constraints imposed by professional secrecy), this configuration expands the legal and economic risk of medical activity and demands responses in the form of clinical compliance, documentary governance, and communication management. Thus, in Brazil, a physician’s legal security does not depend solely on success in a single damages lawsuit, but on an institutional strategy of protection across multiple fronts.

Against this backdrop, the primary contribution of this study is to demonstrate that the “Brazilian case” cannot be explained by a single factor (such as judicial activism or deficiencies in public policy), but rather by a systemic arrangement in which fundamental rights, structural inequalities, federalism, the supplementary health market, and professional regulation interact under conditions of intense judicialization. Comparative analysis must therefore avoid simplifications: judicialization of access is not merely a pathology—it also functions as a mechanism of concrete protection in situations of administrative failure; at the same time, without technical filters, it may produce distributive inequality and budgetary disorganization. Likewise, civil and ethical accountability is not merely an obstacle to professional practice—it is also an instrument of accountability and patient safety; however, without evidentiary rationality and technical standardization, it may stimulate disproportionate decisions and defensive medicine.

As a forward-looking agenda, Brazil offers two main lessons to the Latin American community: (i) the need for institutional infrastructures of technification (technical support, evidence bases, administrative workflows, and compliance governance) to prevent urgency from replacing rationality; and (ii) the importance of calibrating judicial enforcement of the right to health through criteria that simultaneously preserve patient dignity, system sustainability, and professional legal certainty. In sum, Brazilian Medical Law demonstrates that harmonization among access, quality of care, and physician protection depends not merely on new norms, but on institutional design, qualified evidence, and legally stable and technically justified decisions.

[1] BRASIL. Constituição (1988). Constituição da República Federativa do Brasil de 1988. Brasília, DF: Presidência da República, 1988.

[2] CONSELHO NACIONAL DE JUSTIÇA (CNJ). Resolução nº 238, de 6 de setembro de 2016. Dispõe sobre Comitês Estaduais de Saúde e apoio técnico (NAT-Jus). Brasília, DF: CNJ, 2016.

[3] CONSELHO NACIONAL DE JUSTIÇA (CNJ). Resolução nº 530, de 10 de novembro de 2023. Institui a Política Judiciária de Resolução Adequada das Demandas de Assistência à Saúde. Brasília, DF: CNJ, 2023.

[4] SUPREMO TRIBUNAL FEDERAL (STF). Repercussão Geral: Temas 6, 500 e 1234 (parâmetros para fornecimento judicial de tecnologias em saúde e racionalização do contencioso). Brasília, DF: STF, s.d.

[5] SUPERIOR TRIBUNAL DE JUSTIÇA (STJ). Rol da ANS é, em regra, taxativo, com possibilidade de cobertura excepcional (EREsp 1.886.929/SP e EREsp 1.889.704/SP). Brasília, DF: STJ, 2022.

[6] SUPREMO TRIBUNAL FEDERAL (STF). Repercussão Geral: Tema 1234 (critérios de competência/polo passivo e racionalização do contencioso de saúde). Brasília, DF: STF, s.d.

[7] BRASIL. Lei nº 12.965, de 23 de abril de 2014. Marco Civil da Internet. Diário Oficial da União: Brasília, DF, 24 abr. 2014.

[8] CONSELHO NACIONAL DE JUSTIÇA (CNJ). Justiça em Números 2025 (ano-base 2024). Brasília, DF: CNJ, 2025.

[9] BRASIL. Lei nº 8.080, de 19 de setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes. Diário Oficial da União: Brasília, DF, 20 set. 1990.

[10] CONSELHO NACIONAL DE JUSTIÇA (CNJ). Justiça em Números 2025 (ano-base 2024). Brasília, DF: CNJ, 2025.

[11] ASSIS, Renato. Análise estatística da judicialização da medicina e da saúde no Brasil em 2024. Disponível em: <https://renatoassis.com.br/estatistica-da-judicializacao-da-medicina/>.

[12] CONSELHO NACIONAL DE JUSTIÇA (CNJ). Justiça em Números 2025 (ano-base 2024). Brasília, DF: CNJ, 2025.

[13] CONSELHO NACIONAL DE JUSTIÇA (CNJ). Justiça em Números 2025 (ano-base 2024). Brasília, DF: CNJ, 2025.

[14] ASSIS, Renato. Análise estatística da judicialização da medicina e da saúde no Brasil em 2024. Disponível em: <https://renatoassis.com.br/estatistica-da-judicializacao-da-medicina/>.

[15] SUPREMO TRIBUNAL FEDERAL (STF). Tema de Repercussão Geral nº 6 (RE 566.471/RN): dever do Estado de fornecer medicamento de alto custo a portador de doença grave que não possui condições financeiras para comprá-lo. Brasília, DF: STF, 2024.

[16] SUPREMO TRIBUNAL FEDERAL (STF). Tema de Repercussão Geral nº 500 (RE 657.718/MG): dever do Estado de fornecer medicamento não registrado pela Agência Nacional de Vigilância Sanitária (ANVISA). Brasília, DF: STF, 2024.

[17] SUPREMO TRIBUNAL FEDERAL (STF). Tema de Repercussão Geral nº 1.234 (RE 1.366.243): legitimidade passiva da União e competência da Justiça Federal nas demandas que versem sobre fornecimento de medicamentos registrados na Agência Nacional de Vigilância Sanitária (ANVISA), mas não padronizados no Sistema Único de Saúde (SUS). Brasília, DF: STF, 2024.

[18] CONSELHO NACIONAL DE JUSTIÇA (CNJ). Resolução nº 238, de 6 de setembro de 2016. Dispõe sobre Comitês Estaduais de Saúde e apoio técnico (NAT-Jus). Brasília, DF: CNJ, 2016.

[19] CONSELHO NACIONAL DE JUSTIÇA (CNJ). Resolução nº 530, de 10 de novembro de 2023. Institui a Política Judiciária de Resolução Adequada das Demandas de Assistência à Saúde. Brasília, DF: CNJ, 2023.

[20] CONSELHO NACIONAL DE JUSTIÇA (CNJ). Recomendação nº 146, de 28 de novembro de 2023. Dispõe sobre estratégias para o cumprimento adequado das decisões judiciais nas demandas de saúde pública. Diário da Justiça Eletrônico: CNJ, 30 nov. 2023, p. 3-6.

[21] SUPERIOR TRIBUNAL DE JUSTIÇA (STJ), Segunda Seção. EREsp nº 1.886.929/SP e EREsp nº 1.889.704/SP. Julgados em 08 jun. 2022. Tese sobre a natureza taxativa, em regra, do Rol de Procedimentos e Eventos em Saúde Suplementar da Agência Nacional de Saúde Suplementar (ANS), admitindo, de forma excepcional, cobertura de tratamentos não previstos no rol quando preenchidos requisitos técnicos e legais. Brasília, DF: STJ, 2022.

[22] BRASIL. Lei nº 14.454, de 21 de setembro de 2022. Altera a Lei nº 9.656, de 3 de junho de 1998, que dispõe sobre os planos privados de assistência à saúde, para estabelecer critérios que permitam a cobertura de exames ou tratamentos de saúde não incluídos no rol de procedimentos e eventos em saúde suplementar. Diário Oficial da União: Seção 1, Brasília, DF, 22 set. 2022, p. 9.

[23] SUPREMO TRIBUNAL FEDERAL (STF). Ação Direta de Inconstitucionalidade nº 7.265: decisão que fixa critérios para cobertura de tratamentos e procedimentos de saúde fora do rol da Agência Nacional de Saúde Suplementar (ANS). Brasília, DF: STF, 18 set. 2025.

[24] BRASIL. Decreto-Lei nº 2.848, de 7 de dezembro de 1940. Código Penal. Diário Oficial da União: Rio de Janeiro, DF, 31 dez. 1940.

[25] BRASIL. Decreto-Lei nº 3.689, de 3 de outubro de 1941. Código de Processo Penal. Diário Oficial da União: Rio de Janeiro, DF, 13 out. 1941.

[26] SUPERIOR TRIBUNAL DE JUSTIÇA (STJ). Súmula nº 7. A pretensão de simples reexame de prova não enseja recurso especial. Brasília, DF: Superior Tribunal de Justiça, 1990.

[27] SUPREMO TRIBUNAL FEDERAL (STF). Súmula nº 279. Para simples reexame de prova não cabe recurso extraordinário. Brasília, DF: Supremo Tribunal Federal, 1963.

[28] CONSELHO FEDERAL DE MEDICINA (CFM). Resolução CFM nº 2.336, de 13 de julho de 2023. Dispõe sobre a publicidade e propaganda médicas. Brasília, DF: Conselho Federal de Medicina, 2023.

[29] CONSELHO FEDERAL DE MEDICINA (CFM). Resolução CFM nº 2.416, de 26 de setembro de 2024. Dispõe sobre atos médicos privativos, práticas vedadas e demais balizas éticas para o exercício da medicina. Brasília, DF: Conselho Federal de Medicina, 2024.

[30] BRASIL. Lei nº 12.965, de 23 de abril de 2014. Estabelece princípios, garantias, direitos e deveres para o uso da Internet no Brasil (Marco Civil da Internet). Diário Oficial da União: Brasília, DF, 24 abr. 2014.

[31] BRASIL. Lei nº 12.965, de 23 de abril de 2014. Estabelece princípios, garantias, direitos e deveres para o uso da Internet no Brasil (Marco Civil da Internet). Diário Oficial da União: Brasília, DF, 24 abr. 2014.

[32] BRASIL. Lei nº 13.188, de 11 de novembro de 2015. Dispõe sobre o direito de resposta ou retificação, em medida proporcional ao agravo. Diário Oficial da União: Brasília, DF, 12 nov. 2015.

[33] BRASIL. Lei nº 13.989, de 15 de abril de 2020. Dispõe sobre o uso da telemedicina durante a crise causada pelo coronavírus (SARS-CoV-2). Diário Oficial da União: Brasília, DF, 16 abr. 2020.

[34] CONSELHO FEDERAL DE MEDICINA (CFM). Resolução CFM nº 2.314, de 20 de abril de 2022. Define e regulamenta a telemedicina como forma de serviços médicos mediados por tecnologias de comunicação. Brasília, DF: Conselho Federal de Medicina, 2022.

[35] BRASIL. Congresso Nacional. Projeto de Lei nº 2.338, de 2023. Dispõe sobre o uso da Inteligência Artificial no Brasil. Brasília, DF: Congresso Nacional, 2023.

[36] BRASIL. Lei nº 13.709, de 14 de agosto de 2018. Lei Geral de Proteção de Dados Pessoais (LGPD). Diário Oficial da União: Brasília, DF, 15 ago. 2018.

[37] BRASIL. Lei nº 12.842, de 10 de julho de 2013. Dispõe sobre o exercício da Medicina (Lei do Ato Médico). Diário Oficial da União: Brasília, DF, 11 jul. 2013.