Which statement best describes actual causation in medical malpractice?

• A. Actual causation links the breach to the injury.
• B. Proximate causation assesses foreseeability and legal causation for damages.
• C. Actual causation is the same as punitive damages.
• D. Actual causation concerns only damages.

Answer: (A)

Actual causation in medical malpractice is the direct, fact-based connection between the clinician’s breach of the standard of care and the patient’s injury. It answers the question: but for the breach, would the injury have occurred? If the injury would not have happened without the negligent act, there is actual causation. This is the factual link, separate from legal questions about whether liability should extend to damages based on foreseeability.

This differs from proximate causation, which is about the foreseeability and the legal relationship between the breach and the harm—whether the harm was a natural and probable consequence of the breach and within the scope of liability. Proximate causation thus deals with legal responsibility and limits on liability, not the pure fact of whether the breach caused the injury.

It’s also distinct from punitive damages, which are a separate remedy aimed at punishment rather than establishing the factual cause of harm. And it isn’t about damages themselves—damages are the harm suffered, while actual causation is about the causal link between the breach and that harm.

Therefore, the statement that actual causation links the breach to the injury accurately captures the concept.