From the birth of a healthy child to the birth of an unwanted child: STS (Civil) 4576/2025 of 21 October, judgment no. 1459/2025 and its impact on civil liability in healthcare and insurance law.
The evolution of case law on civil liability in healthcare has given rise to new forms of compensable damage that challenge traditional concepts of law. In particular, the transition from the recognition of damage due to the birth of a child with an undetected disability (wrongful birth) to compensation for the birth of a healthy but unwanted child (wrongful conception) raises far-reaching ethical, legal and insurance questions.
This article does not seek to address the thorny ethical and social considerations arising from the subject matter, but rather to highlight the new reality that all legal practitioners must face in light of the latest case law rulings. Nor is it intended to be an exhaustive treatise on a subject about which so much (and so well) has already been written.
At the Insurance Department of Belzuz Abogados S.L.P, we analyse the latest case law trends in Spain and the evolution of the subject, addressing the implications in the field of medical civil liability and insurance law.
Conceptual framework: types of actions to be brought for birth
Legal doctrine and case law have identified different types of actions arising from birth that involve medical liability. The following table summarises the key concepts and serves as a quick reference for understanding the differences between each type of action.
| Type of action | Definition | Typical example |
|---|---|---|
| Wrongful birth | Claim by parents for the birth of a child with an undetected disability | Failure in prenatal diagnosis |
| Wrongful conception | Claim for unwanted pregnancy following medical error, even if the child is born healthy | Failed contraception |
| Wrongful life | Claim by the child for being born with a disability (rarely accepted in Spain) | Direct action by the child |
Traditionally, legal practitioners often repeated the mantra that “the birth of a healthy child is not compensable damage”. The SAP Cádiz ruling of 17 September 2002 is usually cited as paradigmatic, on the basis of which a whole body of case law on the subject was developed.
At the same time, different actions arose in which parents sought compensation for the birth of an unwanted child in cases of failed voluntary sterilisation or contraceptives that did not fulfil their intended purpose. The damages claimed are twofold: moral damages for depriving the parents of their right not to continue the pregnancy, and financial damages for the higher cost of raising an unexpected child whose conception was not planned.
The evolution in the type of actions brought: from healthy child to unwanted child.
There has been no change in case law on the subject, but rather different actions that have been analysed individually by the courts and have given rise to disparate rulings.
What seems clear today, and all operators should be aware of, is that Spanish case law recognises compensation for the birth of a healthy but unwanted child, especially in cases of failure of sterilisation or contraception techniques. Among the most typical claims and their reflection in the courts, the following are noteworthy:
- Right to compensation for the costs of raising a healthy child after a failed vasectomy, see, for example, STS (Contentious) of 26 April 2006, SAP (Civil) Barcelona of 25 September 2014, STSJ Region of Murcia (Contentious) of 30 June 2016, STSJ Madrid (Contentious) of 23 July 2021, STSJ Region of Murcia (Contentious) of 5 May 2023, STSJ Madrid (Contentious) of 16 July 2024.
- Extension of the concept of damage to the parents’ life plans, without the need for the child to have a disability, see, for example, STS (Civil) of 15 September 2015 or SAP Barcelona of 25 July 2018.
- Confirmation of the birth of a healthy child may constitute compensable damage if it violates the parents’ reproductive will. For example, Provincial Court of Malaga ruling of 28 December 2000, Supreme Court ruling (contentious) of 26 April 2006, Provincial Court of Madrid ruling of 9 December 2024.
These rulings consolidate a trend towards the protection of reproductive autonomy as a legal right, recognising that the frustration of a life plan can give rise to civil liability.
A multifaceted civil liability
The issue addressed presents as many jurisprudential solutions as there are cases brought. The first exercise to be carried out is to locate the link in the chain of care where the alleged violation of lex artis occurred and what the malpractice consisted of. Is there a lack of information? Was there an error in the interpretation of an operator-dependent imaging test? Was the error made in the laboratory where the analytical tests were carried out? Is the controversial action attributable to the Gynaecology and Obstetrics department, the Nursing department, or the ATS? Should the possibility of a defective contraceptive product be considered? Is there always actual damage and does it coexist with moral damage?
Many doubts are dispelled when the care has been provided by the public health service, as what needs to be clarified is the financial liability of the Administration for a collective action, without the need to identify specific professions.
However, when the controversial care is provided in the private healthcare system, the analysis of the answers to the above questions must be thorough, as this will have a direct impact on the procedural level due to the type of contractual or non-contractual liability, the limitation period for the action brought, the active and passive legal standing and even the jurisdiction.
Analysis from the perspective of insurance law and Supreme Court (Civil) Ruling 4576/2025 of 21 October, ruling no. 1459/2025.
A delicate task in this type of action is to determine whether the resulting compensation is covered by the corresponding civil liability policy.
Just a few weeks ago, the Civil Chamber of the Supreme Court handed down ruling no. 1459/2025 of 21 October, and as lawyers specialising in healthcare civil liability, the Insurance team at Belzuz Abogados did not want to miss the opportunity to analyse it, as we believe it will have a major impact on the market and will require extreme care in the drafting of policy clauses.
The ruling resolves an appeal lodged by the Valencian Regional Government against the refusal of the insurer QBE Insurance Europe LTD, Spanish Branch, to cover compensation arising from financial liability for medical malpractice in the public health sector.
The Valencian Regional Government, after having compensated the injured parties by means of a final judgment recognising the financial liability of the health administration for an error in prenatal diagnosis, claimed reimbursement of said compensation from its insurer in accordance with the policy taken out. The insurer refused to provide coverage, arguing that the policy excluded moral damages not directly resulting from bodily injury caused by medical malpractice, and that in this case the moral damages compensated had no such connection.
Relevant clauses of the policy:
- The policy covers moral damages arising from or related to bodily injury caused by medical malpractice (clause 1.5.4).
- It excludes moral damages unrelated to physical injury or not strictly arising from medical malpractice (clauses 3.2.8 and 3.2.20).
- This is a comprehensive liability insurance policy covering all liabilities not expressly excluded (clause 3.1).
Proven facts:
- There was a clear and inexcusable error in the assessment of a foetal MRI scan, which prevented the parents from being informed about the foetus’s condition and deprived them of the opportunity to decide on the voluntary termination of the pregnancy.
- The compensation awarded covers two types of damage: moral damage for the deprivation of information and the opportunity to decide, and financial damage resulting from the higher cost of raising the affected child.
- The child’s physical sequelae are not compensated, as they do not result from malpractice but from the condition itself.
The Supreme Court interprets that, in accordance with the contractual clauses, the insurance coverage includes both moral damages and economic damages when they result from medical malpractice, even if they are not a direct consequence of bodily injury. The exclusion of moral damages refers only to those immaterial damages unrelated to physical injury or strict malpractice, such as damage to honour or personal dignity, which is not the case here.
Furthermore, the nature of comprehensive insurance means that, unless expressly excluded, risks arising from legally recognised financial liability must be understood to be covered.
In short, the Chamber upholds the appeal, revokes the appeal judgment and confirms the first instance judgment that ordered the insurer to pay the compensation claimed. It is recognised that the policy covers moral damages and economic losses arising from proven medical malpractice, including the deprivation of the opportunity to terminate the pregnancy and the higher cost of raising the child, even if there is no direct compensable bodily injury.
This ruling clarifies the interpretation of coverage clauses in civil liability policies in the healthcare field, establishing that coverage must extend to moral and economic damages related to malpractice, even when they do not derive directly from bodily injury, provided that they are not immaterial damages that are expressly excluded.
Conclusion:
At Belzuz Abogados S.L.P. Insurance Department, as specialists in Healthcare Liability and Insurance Law, we understand that this ruling has a significant impact on the insurance market in this sector, as it reinforces the importance of drafting exclusion clauses in a clear and specific manner to avoid broad interpretations. Similarly, it is crucial to analyse how “malpractice” is defined in the policy, as well as the wording of clauses on related damages.
Ignacio Montero Pujante
Departamento de Seguros
España
BELZUZ ABOGADOS SLP, Insuralex´s Exclusive Member in Spain and Portugal
