Civil Law and UAE Medical Negligence Causation Problems

1. Introduction

Medical negligence claims in the UAE are not established merely because a patient suffers a bad medical outcome. A claimant generally has to establish medical error/negligence, damage, and a causal connection between the error and the damage.

The causation question is often the most difficult part of the case:

Did the healthcare professional’s breach actually cause the injury, or was the injury caused by the patient's underlying illness, an unavoidable complication, another doctor’s conduct, a later medical intervention, or some independent event?

This becomes particularly difficult where several doctors, nurses, hospitals and medical centres participate in treatment.

Under UAE law, medical liability is principally governed by Federal Decree-Law No. 4 of 2016 on Medical Liability, together with the Civil Transactions Law, Federal Law No. 5 of 1985, particularly the general rules concerning wrongful acts, causation and compensation. UAE courts also rely heavily on specialised medical-liability committees and expert medical evidence.

2. Meaning of Causation in Medical Negligence

Causation connects three elements:

Medical conduct → medical error → injury/damage

For example:

• Doctor fails to diagnose an infection.
• The infection remains untreated.
• The infection progresses.
• The patient loses an organ.

The claimant must demonstrate that the failure to diagnose was sufficiently connected to the eventual injury.

It is therefore insufficient to prove:

“The doctor made a mistake and the patient was injured.”

The more important question is:

“Was the injury a legally attributable consequence of that mistake?”

UAE medical-liability analysis therefore normally examines:

1. What the doctor or hospital did.
2. What the doctor or hospital should have done.
3. Whether the conduct departed from accepted medical standards.
4. What would probably have happened with proper treatment.
5. Whether another cause explains the injury.
6. Whether subsequent treatment contributed to the injury.
7. Whether the original negligence remained an operating cause.
8. Whether several defendants contributed to the same damage.

Medical experts are specifically expected to consider whether the medical standard was followed and whether the failure caused harm.

3. Legal Framework

A. Federal Decree-Law No. 4 of 2016 on Medical Liability

The Medical Liability Law provides the specialised framework for determining medical error and professional responsibility.

Medical liability can arise where a healthcare professional departs from recognised medical principles or commits negligence or other legally recognised medical error.

An important principle is that a doctor normally has an obligation of care rather than an absolute obligation to achieve a particular medical result.

Therefore:

Unsuccessful treatment ≠ automatically medical negligence.

A doctor can provide appropriate treatment even though the patient ultimately dies or develops complications.

The issue is whether the professional exercised the level of care expected in the circumstances. The Dubai Court of Cassation reiterated this principle in Judgment No. 377 of 2025.

4. Civil Transactions Law and Causation

The Civil Transactions Law provides the general framework for compensation for wrongful harm.

A central principle is that compensation corresponds to the harm suffered and consequences sufficiently connected with the wrongful act.

Article 292 is particularly important in medical-damage cases because compensation is assessed by reference to the damage suffered, including loss of profit where it is a natural consequence of the harmful act.

Where multiple persons contribute to the harmful event, Article 291 is also important. UAE jurisprudence recognises the possibility of allocating responsibility among multiple tortfeasors and, depending on the circumstances, imposing joint and several responsibility.

5. The Main Causation Problems

Problem 1: Underlying disease versus medical negligence

A patient may already have a serious illness.

The defendant may argue:

“The patient would have suffered the injury even with proper treatment.”

This creates a pre-existing condition problem.

Example

A patient has advanced heart disease. A doctor delays treatment by several hours. The patient dies.

The court must determine:

• Was the death caused by the underlying disease?
• Did the delay materially contribute to death?
• Would timely intervention probably have prevented or postponed death?
• Was the medical error merely coincidental?

The existence of a pre-existing illness does not automatically eliminate liability.

6. Problem 2: Failure to Diagnose

Failure-to-diagnose cases are among the most difficult causation cases.

The claimant must connect the diagnostic failure to the subsequent deterioration.

Example

A patient presents with symptoms of appendicitis.

The doctor:

• fails to order appropriate imaging;
• sends the patient home;
• the appendix ruptures;
• infection develops;
• emergency surgery becomes necessary.

The causal inquiry becomes:

Would timely diagnosis and treatment probably have prevented the subsequent damage?

The relevant medical evidence may therefore compare:

Actual scenario

versus

Proper-treatment scenario

This is particularly important because the doctor may argue that the disease was already too advanced for earlier treatment to change the outcome.

7. Problem 3: Delay in Treatment

Delay cases create a counterfactual causation problem.

The claimant effectively asks:

“What would have happened if the doctor had acted correctly at the earlier time?”

The answer normally requires medical evidence.

A court may need to determine:

• when the deterioration began;
• when treatment should have started;
• whether earlier intervention was medically possible;
• whether earlier intervention would probably have changed the result.

A 2015 Abu Dhabi case illustrates this type of issue. The court found a hospital responsible after evidence indicated that a patient's developing stroke had not been treated appropriately and that the treatment and diagnostic approach fell below applicable standards.

8. Problem 4: Multiple Doctors

Causation becomes significantly harder where several healthcare professionals participate.

For example:

Doctor A → Doctor B → Doctor C → Hospital → Patient's injury

The claimant cannot simply establish that every doctor made some mistake.

The court must examine:

What exactly did each person's conduct contribute to the damage?

This issue was strongly emphasised by the UAE Federal Supreme Court in Appeals Nos. 479, 592 and 597 of 2024.

The Court required the lower court to establish a sufficiently clear and direct causal connection between each defendant's conduct and the relevant harm. It also criticised insufficient analysis of whether one person's negligence constituted such an important operating cause that it affected the responsibility attributable to other participants.

Legal significance

This prevents the reasoning:

“Several doctors were negligent, therefore all are automatically responsible for the entire injury.”

Instead, the causal contribution of each participant requires examination.

9. Problem 5: Concurrent Causes

Two or more causes may operate simultaneously.

Example

A patient has:

• severe underlying disease;
• negligent delay by Doctor A;
• medication error by Doctor B.

The patient subsequently dies.

The court may need to determine whether:

1. the disease alone caused death;
2. Doctor A caused the deterioration;
3. Doctor B independently caused the final injury;
4. A + B + underlying disease together caused the outcome.

This is known as a multiple-causation problem.

The UAE approach does not necessarily require one single physical cause. The crucial question is the legally relevant contribution of the defendant's conduct to the damage.

10. Problem 6: Subsequent Medical Treatment

One of the most difficult questions is whether later treatment breaks the causal chain.

Example

Doctor A performs negligent surgery.

The patient later goes to Hospital B.

Hospital B performs another procedure.

The patient's condition worsens.

Doctor A may argue:

“The later treatment caused the injury, not my original conduct.”

The court must investigate whether the subsequent treatment:

• merely responded to the original injury;
• aggravated an existing injury;
• independently caused new damage; or
• was so independent that the original negligence no longer legally explains the final harm.

This issue arose prominently in Dubai Court of Cassation Judgment No. 377 of 2025.

The defendants argued that later medical interventions broke the causal connection because the patient had stabilised for a period after the original surgery. The Court nevertheless upheld the finding of gross medical negligence based on the Medical Liability Committee's conclusions concerning the original treatment and resulting permanent impairment.

11. Problem 7: Known Medical Complications

Not every complication establishes negligence.

Under the Medical Liability framework, recognised medical complications can be relevant to exclusion of liability where the doctor acted according to accepted medical principles.

Therefore, courts must distinguish:

Negligent complication

A complication resulting from departure from accepted medical practice.

Non-negligent complication

A recognised risk or side effect occurring despite appropriate medical care.

This distinction is fundamental to causation.

The question is not simply:

“Did the operation cause the injury?”

It is:

“Did negligent conduct cause the injury?”

The distinction between a medical complication and negligence is recognised in UAE medical-liability analysis.

12. Problem 8: Patient's Own Conduct

Patient conduct can complicate causation.

Examples include:

• refusing prescribed treatment;
• failing to return for follow-up;
• concealing relevant medical information;
• ignoring medical instructions;
• leaving the hospital against advice.

The medical-liability framework recognises circumstances in which damage results from the patient's own conduct or an external cause.

However, the mere presence of patient conduct does not automatically eliminate liability.

The court must ask:

Did the patient's conduct actually contribute to the injury?

13. Problem 9: Hospital and Doctor Liability

A further causation problem arises when responsibility is alleged against both:

• the individual doctor; and
• the hospital or medical centre.

The causal analysis must distinguish:

Doctor's medical error

from

Institutional negligence

Institutional negligence might include:

• inadequate staffing;
• lack of appropriate specialists;
• inadequate equipment;
• poor supervision;
• defective systems;
• failure to maintain appropriate emergency procedures.

14. Case Law 1 — Dubai Court of Cassation, Judgment No. 377 of 2025

Facts

The patient underwent a mini gastric bypass procedure.

After surgery she experienced severe haemorrhaging and subsequently required treatment at several hospitals.

The Medical Liability Committee found gross medical negligence associated with the surgery and concluded that the patient's stomach function had been permanently and severely impaired.

The defendants argued, among other things, that subsequent medical treatment had interrupted causation.

Holding / Principle

The Dubai Court of Cassation upheld the finding of medical negligence and treated the Medical Liability Committee's findings as establishing the relevant medical error and resulting injury.

The Court also explained that a doctor is not required to guarantee a particular result; the professional duty is to exercise appropriate and vigilant medical care consistent with established medical principles.

Importance for causation

This case demonstrates that:

The occurrence of later medical treatment does not automatically break the causal chain.

The court must examine the entire medical sequence.

15. Case Law 2 — UAE Federal Supreme Court, Appeals Nos. 479, 592 and 597 of 2024

This is particularly important for multiple-defendant causation.

The underlying matter involved an incorrect medical decision concerning an iron infusion administered to a pregnant woman and the subsequent death of the foetus.

Several medical professionals were implicated.

The Federal Supreme Court emphasised that the courts needed to establish a clear and direct causal relationship between each person's conduct and the harm.

It also held that simply establishing negligence was insufficient without properly analysing the causal contribution of each defendant.

Principle

The court must ask:

Who was negligent?

and separately:

What did that particular negligence cause?

Importance

This is one of the clearest modern UAE authorities on the problem of individual causal attribution in multi-doctor cases.

16. Case Law 3 — Dubai Court of Cassation, Varicose-Veins Surgery Case

A Dubai Court of Cassation case concerned surgery for varicose veins.

During the operation, the doctor cut a nerve responsible for movement of the patient's leg.

The patient suffered approximately 20% physical disability.

The lower court proceedings resulted in compensation, with the Court of Appeal reducing the amount before the matter reached the Court of Cassation.

Principle

The doctor does not guarantee a successful medical result.

However, the doctor must provide competent medical care in accordance with recognised scientific and technical principles.

Causation significance

The physical injury was sufficiently connected to the surgical error because the medical evidence identified the nerve injury as the consequence of the operation.

This demonstrates relatively straightforward direct causation compared with delayed-diagnosis cases.

17. Case Law 4 — Abu Dhabi Cerebral-Stroke Case

In an Abu Dhabi case, a 65-year-old patient was treated in hospital after suffering symptoms consistent with a developing cerebral stroke.

The evidence indicated that the CT scan showed developing stroke symptoms but treatment was delayed or inadequate.

A medical responsibility committee concluded that the diagnosis, treatment plan and treatment methods fell below appropriate standards.

The court ultimately held the hospital responsible and awarded compensation to the patient's family.

Causation principle

The case demonstrates the importance of establishing:

diagnostic failure → delay/inadequate treatment → deterioration → death

The medical evidence was important in connecting the breach to the eventual death.

18. Case Law 5 — Abu Dhabi Surgical-Error Case

An Abu Dhabi patient underwent surgery and subsequently continued to suffer from the relevant medical problem.

The patient obtained treatment abroad, where doctors identified an error associated with the earlier procedure.

Medical experts appointed during the UAE proceedings confirmed that the first procedure involved medical error and that the patient required another operation.

The Abu Dhabi courts awarded compensation against the hospital and doctor.

Causation significance

This illustrates a relatively clear chain:

Initial operation → surgical error → continuing problem → corrective operation → additional damage/expense.

It also demonstrates the evidentiary value of subsequent medical records and expert assessments.

19. Case Law 6 — Abu Dhabi Stillbirth Case, 2025

In a 2025 Dubai/Abu Dhabi-reported medical-liability dispute concerning a stillbirth, four healthcare workers were found responsible following failures concerning fetal monitoring and recognition of warning signs.

The Medical Liability Committee apportioned responsibility among the caregivers.

The defendants argued that the death could have resulted from other causes, including an umbilical-cord complication or genetic factors.

The court relied on the medical-liability findings and concluded that the medical negligence directly caused the fetal death.

Causation significance

This is an important example of:

• alternative causation;
• multiple healthcare providers;
• expert medical evidence;
• apportionment of responsibility.

It shows why courts must distinguish possible alternative causes from causes established by the medical evidence.

20. Case Law 7 — Abu Dhabi Malpractice Case, 2025

A 2025 Abu Dhabi Family, Civil and Administrative Cases Court case involved a child who was treated for persistent pain.

The allegations included failure to repeat appropriate tests, failure to conduct a CT scan and failure to prescribe the appropriate antibiotic.

The Higher Medical Liability Committee confirmed medical error and negligence.

The court awarded AED 75,000 in compensation.

Causation significance

The case illustrates how failure to investigate and failure to take appropriate follow-up measures can become causally relevant where the medical evidence connects those omissions to subsequent physical and emotional harm.

21. Case Law 8 — Dubai Medical Peer-Review Case

A Dubai civil proceeding involved conflicting medical assessments concerning treatment for a serious intestinal condition.

The court referred the technical questions to a specialist medical panel.

The panel was specifically instructed to determine:

1. whether a medical error occurred;
2. who was responsible;
3. whether there was a causal connection between the error and the alleged harm.

The panel ultimately found that the relevant treatment deficiencies occurred in subsequent overseas treatment rather than the treatment provided by the defendants in Dubai.

The civil claim against the Dubai doctor and hospital was therefore dismissed.

Causation significance

This case is particularly useful because it demonstrates:

Medical error somewhere in the patient's treatment history does not necessarily establish causation against the particular defendant being sued.

The claimant must connect the defendant's conduct to the claimant's damage.

22. Case Law 9 — Dubai Gastric-Surgery Death Case, 2026

A Dubai court awarded AED 1.1 million following the death of a patient after gastric-sleeve surgery.

The medical findings reportedly identified failure to adequately manage a postoperative gastric leak, persistent infection and inflammation, delays in critical diagnostic procedures, and failure to adopt alternative treatment or transfer the patient to a specialised facility.

The medical report connected these failures with multiple organ failure and death.

Causation significance

The case demonstrates cumulative causation:

initial complication → inadequate management → persistent infection → deterioration → organ failure → death

Thus, causation can involve a continuing sequence of negligent omissions rather than one isolated medical error.

23. Medical Expert Evidence and Causation

Medical causation is highly technical.

Courts therefore frequently require expert evidence concerning:

• accepted medical standards;
• diagnosis;
• treatment options;
• timing;
• prognosis;
• probability of recovery;
• alternative causes;
• effect of pre-existing conditions;
• subsequent treatment;
• extent of disability.

The expert should not merely say:

“There was negligence.”

The important questions include:

“What was the error?”

“What harm did it cause?”

“Would the harm probably have occurred without the error?”

“Did another event intervene?”

The Dubai peer-review case demonstrates the importance of instructing medical experts specifically on the causal connection between alleged error and harm.

24. Medical Liability Committee and Judicial Assessment

The Medical Liability Committee plays an important statutory role.

Under the current UAE framework, the Committee assesses medical complaints and determines whether medical negligence occurred and its degree of seriousness.

Dubai Court of Cassation Judgment No. 377 of 2025 confirmed the significance of the Committee's reports and the statutory mechanism governing their finality.

However, the Federal Supreme Court's 2024 decision also demonstrates the importance of judicial reasoning concerning causation, particularly where several defendants are involved. The court criticised insufficient independent analysis of how each defendant's conduct caused the relevant harm.

Thus:

Medical Committee evidence is extremely important, but causal attribution must still be legally analysed by the court.

25. Breaking the Chain of Causation

A defendant may argue that the causal chain was broken by:

1. Independent medical condition

The injury resulted from the patient's underlying disease.

2. Patient's conduct

The patient refused or abandoned appropriate treatment.

3. Independent doctor's negligence

A subsequent doctor's conduct became the dominant cause.

4. Known complication

The injury was a recognised consequence of properly performed treatment.

5. External event

An unrelated event caused the injury.

6. Unavoidable deterioration

The patient would have suffered the same outcome despite proper treatment.

The court must assess these arguments against the medical evidence rather than assuming that temporal sequence alone establishes causation.

26. Direct Causation vs Contributory Causation

Direct causation

Example:

Incorrect surgical technique → severed nerve → permanent disability

This is comparatively straightforward.

Contributory causation

Example:

Underlying disease + diagnostic delay + treatment delay → permanent organ damage

Here, the negligence may be one of several causes.

Multiple-defendant causation

Example:

Doctor A's diagnostic error + Doctor B's treatment error + hospital staffing failure → patient's death

The Federal Supreme Court's 2024 decision is particularly relevant because the court required analysis of the causal responsibility attributable to each defendant.

27. Loss of Chance and Medical Causation

Another difficult question is the lost-chance problem.

Suppose:

• a patient has a 70% chance of recovery;
• the doctor delays treatment;
• the patient's condition becomes irreversible.

The legal question becomes:

Did the negligence cause the injury itself, or did it reduce the patient's chance of avoiding the injury?

UAE medical cases require careful medical evidence on this issue. The claimant should not assume that merely showing a reduced possibility of recovery automatically establishes the entire ultimate injury as caused by the doctor.

The evidence should address the patient's condition at the relevant time and the probable effect of timely treatment.

28. Causation and Compensation

Once causation is established, the claimant may seek compensation for appropriate categories of damage.

Depending on the circumstances, these can include:

Material damage

• medical expenses;
• rehabilitation costs;
• future treatment;
• loss of earnings;
• loss of earning capacity;
• other provable financial losses.

Moral damage

• physical pain;
• psychological suffering;
• loss of normal enjoyment of life;
• consequences of permanent disability;
• family suffering in appropriate cases.

The Dubai Court of Cassation in Judgment No. 377 of 2025 confirmed that bodily injury can generate compensable physical and moral damage and that compensation is not necessarily restricted to the Sharia-based concepts of Diya or Arsh where applicable statutory provisions provide another basis for assessing actual damage.

29. Causation Matrix for UAE Medical Negligence

30. Practical Example

Facts

A patient arrives at a UAE hospital with severe abdominal pain.

Doctor A:

• fails to order appropriate imaging;
• diagnoses a minor condition;
• discharges the patient.

Two days later:

• the appendix ruptures;
• the patient develops sepsis;
• emergency surgery is performed;
• permanent complications result.

Legal analysis

Step 1 — Duty

The doctor owed professional duties to the patient.

Step 2 — Breach

Medical experts determine whether the doctor's conduct departed from accepted medical standards.

Step 3 — Injury

The patient suffered sepsis and permanent complications.

Step 4 — Causation

The court asks whether timely diagnosis would probably have prevented the rupture or materially reduced the resulting harm.

Step 5 — Alternative cause

The doctor may argue that the patient's underlying condition was already sufficiently advanced.

Step 6 — Subsequent treatment

If another hospital made an additional error, the court must determine whether that error independently caused new damage or merely aggravated damage arising from the original negligence.

Step 7 — Compensation

Compensation is then assessed according to the damage legally attributable to the defendants.

31. Key Legal Principles

Principle 1

A bad medical result does not automatically establish negligence.

Principle 2

The doctor generally owes an obligation of proper professional care, not a guarantee of cure.

Principle 3

Medical error and causation are separate questions.

Principle 4

The claimant must connect the defendant's conduct with the particular injury.

Principle 5

Pre-existing disease can complicate but does not automatically defeat causation.

Principle 6

Multiple negligent actors require individual causal analysis.

Principle 7

Later medical treatment does not automatically break causation.

Principle 8

Known medical complications must be distinguished from negligent complications.

Principle 9

Medical expert evidence is particularly important in establishing technical causation.

Principle 10

The court must distinguish negligence that merely exists from negligence that actually caused compensable damage.

32. Case-Law Revision Table

33. Conclusion

The central difficulty in UAE medical-negligence litigation is often not proving that something went wrong, but proving what legally caused the damage.

The strongest causation analysis therefore separates:

Medical error → causal contribution → actual injury → compensable damage.

UAE jurisprudence particularly demonstrates the importance of causation where there are multiple doctors, pre-existing conditions, delayed diagnosis, subsequent treatment, competing medical explanations and conflicting expert evidence. The Federal Supreme Court's 2024 decision is especially significant because it requires courts to identify the causal responsibility of individual medical professionals rather than treating collective negligence as sufficient by itself.

Quick Revision

UAE Medical Negligence Causation =

Duty + Medical Error + Damage + Causal Link + Legally Attributable Harm

Remember the main causation questions:

1. What exactly was the medical error?
2. What injury actually occurred?
3. Would the injury have occurred without the error?
4. Did the underlying disease contribute?
5. Did another doctor contribute?
6. Did subsequent treatment break the chain?
7. Was the complication medically unavoidable?
8. What did the medical expert/committee conclude?
9. What did each defendant individually cause?
10. What damage is legally compensable?