A compassion-Based Restorative Approach in Healthcare GNM Cases Involving Systemic Failure

Prosecutions for healthcare gross negligence manslaughter (GNM) raise a persistent tension. A strict focus on individual culpability may obscure systemic failures that shape clinical work, while an exclusive focus on systemic failure may appear to weaken personal accountability. Restorative justice has been proposed as a complementary mechanism in England, yet the existing proposals emphasise process design and risk management without offering clear normative criteria for distinguishing individual fault from systemic contribution. This article develops a compassion-based restorative approach for healthcare GNM cases involving systemic failure. Drawing on Martha Nussbaum’s account of compassion as structured by three judgements (seriousness, nondesert, and the eudaimonistic judgement), it treats compassion as a normative discipline for a restorative approach that runs alongside England’s criminal process. The approach does not revisit the legal causation and culpability assessments that underpin liability under the Adomako framework. Instead, it focuses on normative criteria and shows how compassion can constrain what may be forgiven or negotiated, and how it can guide the allocation of accountability and remedial duties between individuals and healthcare systems. The article specifically applies the judgement of nondesert through two practical questions: whether the clinician has continued this behaviour as a matter of habit or choice, despite being educated, counselled, and informed by a designed system, and whether the clinician is a victim of the poorly managed healthcare system or poor working conditions. In this way, the framework resists demonisation, avoids impunity, and redirects attention towards prevention through actionable institutional responsibility.