Why Medical Justice in the UK Must Change: The Case for an Inquisitorial System

When medical care goes wrong, people are not looking for a fight. Patients and families want answers, honesty, and reassurance that lessons will be learned. Yet the UK’s adversarial justice system treats medical cases as battles to be won, rather than truths to be understood. Nowhere is this mismatch more damaging than in healthcare — and especially in cases involving allegations of serious criminal wrongdoing by medical professionals.

It is time to recognise that the adversarial system is fundamentally ill-suited to medical justice, and that a more inquisitorial approach is urgently needed.

Medicine Does Not Fit an Adversarial Model

Medicine is complex, uncertain, and often imperfect. Outcomes can be tragic even when clinicians act in good faith and in line with accepted practice. The adversarial system, however, forces medical cases into a binary framework: one side must be right, the other wrong.

This encourages legal tactics rather than genuine understanding. Hospitals and clinicians are advised to defend, deny, and disclose as little as possible. Patients are required to frame their suffering in legal terms rather than human ones. In the process, truth becomes secondary to strategy.

An inquisitorial system, where the judge actively investigates the facts, is far better suited to the realities of healthcare. Its purpose is not to “win” a case, but to understand what happened and why.

Inequality and Power Imbalances

Medical cases expose deep inequalities in the current system. NHS trusts and defence organisations have extensive legal and expert resources. Patients and families — often grieving, injured, or exhausted — must somehow match this firepower to be heard.

When cases hinge on complex medical evidence, outcomes can depend on which side can afford the more persuasive expert, not which explanation is more accurate. An inquisitorial approach would allow judges to appoint independent experts and ensure that all relevant evidence is properly examined, regardless of who it favours.

Trauma, Delay, and Defensive Medicine

Adversarial proceedings are often slow, hostile, and deeply distressing. Families may endure years of litigation, aggressive cross-examination, and repeated challenges to their credibility. Clinicians, meanwhile, practise within a culture of fear, encouraged to remain silent rather than open after adverse events.

An inquisitorial system offers a different path. By separating fact-finding from blame, it encourages openness, reduces re-traumatisation, and supports learning rather than concealment.

The Critical Importance in Medical Murder Allegations

The need for reform is most acute in cases involving allegations of medical murder. These cases rely heavily on disputed medical science, statistical interpretation, and retrospective judgments about clinical decisions made under pressure.

The adversarial system pushes prosecutors and defence teams into rigid, opposing narratives: intentional harm versus complete innocence. This binary approach is dangerously inappropriate for medicine, where uncertainty is inherent and rare outcomes do occur without criminal intent.

There is a real risk that misunderstood data, normal clinical variation, or systemic failure is reframed as evidence of malice. Juries, lacking specialist medical knowledge, may be swayed by confident expert testimony or emotive narratives rather than balanced analysis.

An inquisitorial system would allow judges to commission independent medical experts, explore alternative explanations fully, and ensure that criminal intent is not assumed where medical uncertainty exists. This does not weaken accountability — it strengthens it by reducing the risk of catastrophic miscarriages of justice.

Learning Rather Than Scapegoating

Many medical harms arise from systemic pressures: staffing shortages, poor communication, flawed protocols, or organisational failure. The adversarial system’s focus on individual blame often obscures these wider causes.

Inquisitorial justice is better equipped to examine systems as well as individuals, supporting meaningful reform rather than isolated punishment.

A Necessary Change

The UK already recognises the value of inquisitorial approaches through coroners’ inquests and public inquiries. Extending these principles to medical justice is a logical and necessary step.

Patients deserve answers. Clinicians deserve fairness. Society deserves a healthcare system that learns from harm rather than hides it. In medical cases — particularly those involving the gravest accusations — justice must be about truth, not tactics.