Assessing Juridical Responsibility in Medical Practice in Romania: A Legal Medicine Perspective

Background: Medical malpractice is situated at the intersection of clinical uncertainty, expert evidence and legal liability. This narrative review analyses the Romanian framework from a forensic perspective and compares it with selected European approaches, focusing on adverse outcome, professional negligence, standard of care, causation, expert assessment, legal establishment of liability and reparation of damage. Objectives: This narrative synthesis aims to clarify the distinction between adverse outcome, medical error, therapeutic complication and professional negligence; to examine the evidentiary role and limits of forensic assessment; and to comparatively interpret the Romanian framework of medical liability in terms of the ways in which the functions of scientific establishment of facts, attribution of legal liability and reparation of damage are distributed. Methods: The review was guided by SANRA, while PRISMA 2020 was used exclusively as a reporting tool for the source selection process. Searches conducted in PubMed, Scopus and Web of Science identified 273 records; after screening and eligibility assessment, 33 publications were included in the final synthesis. Results: The existence of an adverse outcome was not sufficient to establish malpractice in the absence of a professionally relevant deviation from the applicable standard of care and a causal relationship to the harm. Forensic and other medical experts contributed to the scientific reconstruction of the facts and the interpretation of causation, without replacing the competent authority to establish legal liability. The comparative analysis indicates that Romania is not only distinguished by the coexistence of multiple avenues of liability or redress; the more relevant difference lies in how jurisdictions distribute the functions of fact-finding, attribution of fault, and compensation. Conclusions: A function-based framework, which separates scientific assessment, legal attribution, and reparation, can provide a clearer basis for the analysis of malpractice and for comparison across jurisdictions.