Patient’s Death Alone Cannot Make a Doctor Criminally Liable: Supreme Court

Independently written and published by Shahbaz Shah Legal Journal.

The Supreme Court of Pakistan has held that a patient’s death during or after treatment cannot, by itself, make the treating doctors criminally liable. The prosecution must establish a duty of care, a breach that caused the death and a departure from professional standards serious enough to amount to gross negligence. Judgment, paragraphs 3–5.

In Amjad Ali v. Dr. Taqdees Naqaish and others, the Court refused leave to appeal against the acquittal of doctors associated with Shifa Hospital, Islamabad. Justice Ishtiaq Ibrahim wrote the judgment for a bench also comprising Justice Muhammad Hashim Khan Kakkar. The decision, dated 6 October 2026, also explains why consent to treatment is relevant without giving a doctor unrestricted protection from criminal liability. Judgment, case heading and paragraphs 7–9.

The complaint and the acquittals

Amjad Ali’s wife was taken to the hospital with labour pain and gave birth to twin daughters following an operation. His allegation was that the doctors administered spinal anaesthesia despite his request for an epidural. He attributed her subsequent back pain, deterioration and death to the treatment. That was the complaint the courts examined; the Supreme Court did not accept the alleged causal connection as proved. Judgment, paragraphs 2–3 and 6.

The judgment records that an earlier FIR concerning the same allegations had been cancelled after investigation. A private complaint followed on 16 December 2016 under Sections 319, 322 and 34 of the Pakistan Penal Code. The Judicial Magistrate, Section 30, Islamabad-West, acquitted the accused on 25 October 2017 under Section 249-A CrPC. The Islamabad High Court upheld that result on 16 July 2020 in Criminal Appeal No. 193/2017. Judgment, paragraphs 1 and 3.

The complainant challenged the acquittal as premature. His case before the Supreme Court centred on Qatl-i-Khata under Section 318 PPC, for which Section 319 provides punishment. The question was whether the material disclosed the criminal negligence necessary to justify disturbing the acquittals. Judgment, paragraph 3.

A poor outcome is not the legal test

The Court began with the ordinary components of negligence: a duty owed to the patient, breach of that duty and resulting harm. The connection between the alleged lapse and the injury matters. Showing that treatment was followed by a death does not, without the necessary evidence, establish that the treatment unlawfully caused it. Judgment, paragraph 3.

For medical professionals, the standard is reasonable competence in the relevant field. Applying the Bolam approach, the Court explained that a doctor is assessed against an ordinarily competent practitioner exercising the relevant professional skill. The law does not demand the skill of the most experienced specialist in every case. Judgment, paragraph 4.

Nor does a different available treatment automatically prove that the chosen course was negligent. The inquiry concerns accepted medical practice and the care reasonably required at the time. Hindsight may reveal that another precaution could have prevented harm, but that alone does not establish that the doctor fell below the applicable standard. Judgment, paragraph 4.

This does not remove professional accountability. The judgment recognises negligence where the necessary skill is absent or where an existing skill is not exercised with reasonable competence. It requires the allegation to be tested against the actual treatment and circumstances. Judgment, paragraph 4.

Why criminal liability requires more

The decisive distinction is the degree of negligence. Conduct that may support a civil claim does not necessarily amount to a criminal offence. For criminal responsibility, the departure from the required standard must be gross or reckless to a degree sufficiently serious to justify penal consequences. Judgment, paragraph 5.

The Court directed attention to the nature of the duty, the surrounding circumstances, the precautions reasonably required and the seriousness of the departure. The risk must be sufficiently foreseeable, and the conduct must show a grave disregard for the patient’s safety. An ordinary lapse in care cannot become a criminal offence simply because the eventual injury was severe. Judgment, paragraph 5.

For a treatment-related death under Section 319, the judgment identifies three matters the prosecution must prove:

• The medical professional owed a duty of care.
• A breach of that duty caused the death.
• The breach amounted to gross negligence.

The causal requirement and the seriousness of the breach must both be established. Proof of death cannot stand in for proof of either. Judgment, paragraph 5.

Why the evidence did not meet that standard

The Supreme Court recorded that the postoperative complications had been managed under standard medical protocols. It also noted that the initial regulatory censure had later been withdrawn after a finding of no medical negligence. These were part of the record against which it assessed the criminal complaint. Judgment, paragraph 6.

The complainant had not identified a specific illegal act or gross professional indifference attributable to the doctors that could establish the criminal mistake of act or fact alleged. The disagreement about spinal rather than epidural anaesthesia did not fill that gap. Judgment, paragraph 6.

A treatment choice followed by an unfortunate result was insufficient without reliable, legally admissible evidence of the required criminal culpability. On this record, the Supreme Court found that evidence lacking. It did not announce that spinal anaesthesia is always appropriate, or decide the clinical merits of that technique for every patient. Its conclusion concerned the failure to establish the offence alleged in this case. Judgment, paragraph 6.

Section 88: consent is relevant, but not decisive

The Court also considered Section 88 PPC, which addresses acts done with the relevant consent, in good faith and for a person’s benefit, without an intention to cause death. Its surgical illustration recognises that a known risk may materialise even though the operation was undertaken for the patient’s benefit. Judgment, paragraph 7.

The judgment expressly rejects treating that protection as absolute. A consent form does not settle the criminal inquiry. Benefit, good faith, absence of an intention to cause death and the requisite consent must coexist; the court must examine whether the act falls within the provision and whether the evidence establishes criminal culpability. Judgment, paragraph 7.

Here, the Court recorded that the complainant’s consent had been obtained before the operation. The procedure was undertaken for the patient’s medical benefit, and the record did not establish bad faith, an intention to cause death or other circumstances taking the doctors outside Section 88’s protection. Judgment, paragraphs 6–8.

The ruling therefore preserves two separate inquiries: whether there was the required consent, and whether the treatment was performed within the statutory protection. Consent does not answer the second question automatically. Judgment, paragraphs 7–8.

The acquittals remained in place

The Supreme Court found that the trial court and the High Court had given convincing reasons for the acquittals under Section 249-A CrPC. No material misreading, non-reading, perversity or illegality had been shown that called for interference. It dismissed the petition and refused leave to appeal. Judgment, paragraph 9.

For lawyers handling a similar complaint, the practical focus is evidence identifying the particular professional failure, its causal connection with the death and the basis for calling it gross. A disagreement over treatment, even after a tragic outcome, does not establish those matters by itself. Equally, a doctor relying on consent must still meet Section 88’s conditions. Those are the two sides of the standard the Court applied. Judgment, paragraphs 3–8.

For the civil side of the subject, see the Journal’s analysis of Bibi Hanifa’s retained surgical sponges case.

Sources

• Amjad Ali v. Dr. Taqdees Naqaish and others, Crl.P.L.A. 955 of 2020, Supreme Court of Pakistan, 6 October 2026.
• Searchable judgment summary and full case details.
• Pakistan Penal Code, 1860, including Sections 88, 318 and 319.

Frequently asked questions

Does a patient’s death automatically establish criminal medical negligence?

No. The Supreme Court required proof of a duty of care, a breach causing death and negligence serious enough to be classed as gross. An adverse outcome alone cannot establish those elements. Judgment, paragraphs 3–5.

What is the difference between civil and criminal medical negligence?

Civil negligence and criminal negligence have different thresholds. A lapse capable of supporting civil liability does not necessarily justify criminal punishment; the criminal case requires a gross and culpable departure from the required professional standard. Judgment, paragraph 5.

Does a consent form protect a doctor from every criminal charge?

No. Section 88 PPC requires the relevant consent, good faith, treatment for the person’s benefit and absence of an intention to cause death. Consent alone does not supply all those conditions or excuse criminally culpable treatment. Judgment, paragraphs 7–8.

Did the Court declare spinal anaesthesia negligent?

No. It held that choosing spinal anaesthesia instead of the requested epidural did not by itself establish a criminal offence. Reliable evidence of criminally culpable treatment and its connection with the death was missing in this case. Judgment, paragraph 6.

Which PPC provisions were central to the judgment?

The Court examined Qatl-i-Khata under Section 318, punishable under Section 319, and the good-faith protection in Section 88. The underlying private complaint had been brought under Sections 319, 322 and 34 PPC. Judgment, paragraphs 1, 3 and 7.

What happened to Amjad Ali’s petition?

The Supreme Court dismissed Crl.P.L.A. 955 of 2020 and refused leave to appeal on 6 October 2026. The doctors’ acquittal under Section 249-A CrPC, already upheld by the Islamabad High Court, remained in place. Judgment, paragraph 9.