Lawsuits in health: an integrative review

Batistella, Paula Mestre Ferreira; Aroni, Patrícia; Fagundes, Alex Luís; Haddad, Maria do Carmo Fernandez Lourenço

doi:10.1590/0034-7167-2018-0551

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REVIEW • Rev. Bras. Enferm. 72 (3) • May-Jun 2019 • https://doi.org/10.1590/0034-7167-2018-0551 copy

Lawsuits in health: an integrative review

Acciones judiciales en salud: revisión integrativa

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the national and international scientific evidence available in the literature on types of judicialization of health lawsuits.

Method:

Integrative review, which selected primary studies in the PubMed, LILACS, Web of Science and Scopus databases, with the

Descriptors:

judicial decisions, health’s judicialization, Saúde (in Portuguese), Health, and the keyword: Judicial Action.

Results:

30 studies were selected. In Brazil, the majority were legal claims for medicines and the other for medical errors, requests for vaccines, supplies for diabetics, food compounds, surgical procedure, examinations, among others. In international studies, lawsuits were found for medication, benefit coverage and hospitalization for psychiatric treatment.

Conclusion:

It is evident that the most demanded type of lawsuit was access to the medication at an international level. It is still more noticeable the little discussion on this subject, demonstrating that judicialization of medicines can indicate a reality of Brazil.

Descriptors:
Health’s Judicialization; Judicial Decisions; Health; Right to Health; Public Health Policy

Article/Country	Objective	Main Results
⁽¹¹11 Biehl J, Socal MP, Amon JJ. The judicialization of health and the quest for state accountability: evidence from 1,262 lawsuits for access to medicines in southern Brazil. Health Hum Rights [Internet]. 2016 [cited 2019 Mar 12];18(1):209-20. Available from: https://pdfs.semanticscholar.org/b787/0d87ead2460a5cb8c41059e90bf7236a271e.pdf?_ga=2.169565409.1195865572.1552323956-1942654150.1552323956 https://pdfs.semanticscholar.org/b787/0d... ⁾ Biehl, J.; Socal, M.P.; Amon J.J. The judicialization of health and the quest for state accountability: Evidence from 1,262 lawsuits for access to medicines in Southern Brazil Health and human rights, 18(1), 209. (2016) Brazil	To evaluate the claims, offering empirical evidence that myth counters prevail and claim the heterogeneity of the phenomenon of judicialization.	Most applicants are, in fact, poor and older individuals who do not live in major metropolitan areas. They also depend on the State to provide their legal representation and most of the requested medicines were already on government forms.
⁽¹²12 Cabral I, Rezende LF. [Analysis of individual lawsuits on supplying journal in São João da Boa Vista, São Paulo, Brazil]. R Dir Sanit [Internet]. 2015 [cited 2019 Mar 12];16(1):59-77. Available from: https://doi.org/10.11606/issn.2316-9044.v16i1p59-77 Portuguese. https://doi.org/10.11606/issn.2316-9044.... ⁾ Cabral, I.; Rezende, L.F. Análise das ações judiciais individuais para fornecimento de medicamentos em São João da Boa Vista Rev de Direito Sanitário. 2015; v. 16, n. 1, p. 59-77. Brazil	To analyze individual lawsuits taken to guarantee access to medicines in the municipality of São João da Boa Vista -SP.	Most of lawsuits were filed by women represented by private lawyers asking for medication.
⁽¹³13 Chieffi AL, Barata RB. [“Judicialization” of public health policy for journal of medicines]. Cad Saúde Pública [Internet]. 2009 [cited 2019 Mar 12];25(8):1839-49. Available from: http://dx.doi.org/10.1590/S0102-311X2009000800020 Portuguese. http://dx.doi.org/10.1590/S0102-311X2009... ⁾ Chieffi, A.L.; Barata, R.B. Judicialização da política pública de assistência farmacêutica e equidade Cad de Saúde Pública. 2009; v. 25, p. 1839-1849 Brazil	To analyze the lawsuit used to obtain medicines through the Department of Health of São Paulo State.	Most of the litigation was filed by private lawyers, 47% had private network prescriptions and 73% of the cases were from patients with social vulnerability.
⁽¹⁴14 Chieffi AL, Barata RCB. Legal suits: pharmaceutical industry strategies to introduce journal drugs in the brazilian public healthcare system. Rev Saúde Pública [Internet]. 2010 [cited 2019 Mar 12];44(3). Available from: http://dx.doi.org/10.1590/S0034-89102010000300005 http://dx.doi.org/10.1590/S0034-89102010... ⁾ Chieffi, A.L.; Barata, R.C.B Ações judiciais: estratégia da indústria farmacêutica para introdução de novos medicamentos Rev de Saúde Pública. 2010; v. 44, n. 3, p. 421-429. Brazil	To analyze the concentration in the distribution of lawsuits according to the medicine (manufacturer), prescribing doctor and soliciting attorney of the lawsuit.	1,309 lawsuits were for acquisition of 14 medications. Most cases were represented by private lawyers and 11 lawyers accounted for 613 (47%) cases.
⁽¹⁵15 Coelho TL, Ferré F, Neto OHC, Assis AF, Cherchiglia ML, Andrade EIG. Legal and health variations in drug litigation injunctions granted in Minas Gerais. Rev Saúde Pública [Internet]. 2014 [cited 2019 Mar 12];48(5):808-16. Available from: http://dx.doi.org/10.1590/S0034-8910.2014048005286 http://dx.doi.org/10.1590/S0034-8910.201... ⁾ Coelho et al. Variáveis jurídicas e de saúde no deferimento de liminares por medicamentos em Minas Gerais Rev de Saúde Pública. 2014; v. 48, n. 5, p. 808-816. Brazil	To investigate factors related to the deferral of injunctions by medications.	Of the 5,072 lawsuits with injunctions, 4,184 (82.5%) were deferred. The medications paroxetine, somatropin and ferrous sulfate were 100% deferred. Escitalopram, diclofenac sodium and nortriptyline obtained a reduction of less than 54.0%.
⁽¹⁶16 Leitão LCA, Silva PCDD, Simões AEO, Barbosa IC, Pinto MEB, Simões MODS. Analysis of medicine procurement lawsuits in the state journal Paraíba, Brazil. Saúde Soc [Internet]. 2016 [cited 2019 Mar 12];25(3):801-8. Available from: http://dx.doi.org/10.1590/S0104-12902016153819 http://dx.doi.org/10.1590/S0104-12902016... ⁾ Leitão et al. Análise das demandas judiciais para aquisição de medicamentos no estado da Paraíba Saúde e Sociedade. 2016; v. 25, p. 800-807. Brazil	To describe medical-scientific and health aspects of court injunctions for the supply of medicines to the Court of Paraíba against public agents.	Seventy-five claims were identified for different medications. The most frequent were the antineoplastic medications, followed by insulin and angiotensin II antagonists.
⁽¹⁷17 Lopes LC, Nascimento SMS, Camargo IA, Barberato-Filho S, Del Fiol FDS, Osorio-de-Castro CGS. Biological drugs for the treatment of psoriasis in a public health system. Rev Saúde Pública [Internet]. 2014 [cited 2019 Mar 12];48(4):651-61. Available from: http://dx.doi.org/10.1590/S0034-8910.2014048005109 http://dx.doi.org/10.1590/S0034-8910.201... ⁾ Lopes et al. Medicamentos biológicos para o tratamento de psoríase em sistema público de saúde Rev de Saúde Pública. 2014 v. 48, n. 4, p. 651-661. Brazil	To analyze the access and profile of use, by judicial means, of biological medicines for the treatment of psoriasis.	There was access by injunction (59.5%). 66% used the biological medication for 13 months, 26.6% abandoned treatment due to worsening of the condition, 20.5% had adverse effects and 13.8% did not have surgery, due to lack of efficacy.
⁽¹⁸18 journal MAA, Acurcio FDA, Brandão CMR, Faleiros DR, Guerra Jr AA, Cherchiglia ML et al. Judicialization of access to medicines in minas gerais state, southeastern brazil. Rev de Saúde Pública [Internet]. 2011 [cited 2019 Mar 12];45(3). Available from: http://dx.doi.org/10.1590/S0034-89102011005000015 http://dx.doi.org/10.1590/S0034-89102011... ⁾ Machado et al Judicialização do acesso a medicamentos no Estado de Minas Gerais, Brasil Rev de Saúde Pública. 2011; v. 45, p. 590-598. Brazil	To analyze the profile of claimants and medications pleaded in lawsuits.	Most of applicants were women, aged 60 or over, retirees, pensioners and housewives. The most requested medications were immunosuppressants.
⁽¹⁹19 Medeiros M, Diniz D, Doederlein S, Ida V. [The thesis of judicialization of health journal by the elites: medication for mucopolysaccharidosis]. Ciência & Saúde Coletiva [Internet]. 2013 [cited 2019 Mar 12];18(4):1089-98. Available from: http://dx.doi.org/10.1590/S1413-81232013000400022 Portuguese. http://dx.doi.org/10.1590/S1413-81232013... ⁾ Medeiros, M.; Diniz, D.; Doederlein, S. A tese da judicialização da saúde pelas elites: os medicamentos para mucopolissacaridose Ciência & Saúde Coletiva. 2013 v. 18, n. 4. Brazil	Evaluating the hypothesis of whether the judicialization of medications for the treatment of mucopolysaccharidoses in Brazil would be a lawsuit of economic elites.	It is not possible to refute or corroborate the thesis of judicialization by elites. There is no way to say that judicialization is a matter of class.
⁽²⁰20 Neto OHC, Acurcio FA, Machado MAA, Ferré F, Barbosa FLV, Cherchiglia ML, et al. Doctors, lawyers and pharmaceutical industry on health journal in Minas Gerais, Southeastern Brazil. Rev Saúde Pública [Internet]. 2012 [cited 2019 Mar 12];46(5):784-90. Available from: http://dx.doi.org/10.1590/S0034-89102012000500004 http://dx.doi.org/10.1590/S0034-89102012... ⁾ Neto et al. Médicos, advogados e indústria farmacêutica na judicialização da saúde em Minas Gerais, Brasil Rev de Saúde Pública. 2012; v. 46, p. 784-790. Brazil	To describe the relationships between prescriber, lawyer, and pharmaceutical industry in lawsuits against the State.	Among lawsuits of a single office, 43.6% had prescriptions from one doctor X for a medication from a specific laboratory and that same doctor was also the main prescriber of another medication, in which they were represented by two other offices.
⁽²¹21 Pepe VLE, Ventura M, Sant’ana JMB, Figueiredo TA, Souza VDRD, Simas L, Osorio-de-Castro CGS. &journal;#91;Characterization of lawsuits for the supply of “essential” medicines in the state of rio de janeiro, brazil]. Cad Saúde Pública [Internet]. 2010 [cited 2019 Mar 12];26(3):461-71. Available from: http://dx.doi.org/10.1590/S0102-311X2010000300004 Portuguese. http://dx.doi.org/10.1590/S0102-311X2010... ⁾ Pepe et al. Characterization of lawsuits for the supply of "essential" medicines in the State of Rio de Janeiro, Brazil Cad de Saúde Pública. 2010; v. 26, n. 3, p. 461-471. Brazil	To analyze individual lawsuits for medication supply, considered essential by the Court of Rio de Janeiro State in the judicial decisions of the Second Instance in 2006.	Of the 321 medications identified in lawsuits, 316 were present in the RENAME.
⁽²²22 Pereira JG, Pepe VLE. &journal;#91;Judicial access to medicine in paraná: applying a methodological model for lawsuit analysis and monitoring]. R Dir Sanit [Internet]. 2014 [cited 2019 Mar 12];15(2):30-45. Available from: https://doi.org/10.11606/issn.2316-9044.v15i2p30-45 Portuguese. https://doi.org/10.11606/issn.2316-9044.... ⁾ Pereira, J.G.; Pepe, V.L.E. Acesso a medicamentos por via judicial no Paraná: aplicação de um modelo metodológico para análise e monitoramento das demandas judiciais Rev de Direito Sanitário. 2015; v. 15, n. 2, p. 30-45. Brazil	To apply the methodological model developed in the analysis of the individual judicial demands for access to medicines in Paraná State.	Results showed that the sources used in the study were not enough to identify and quantify all variables proposed in their dimensions, especially some of the indicators of sociodemographic characteristics.
⁽²³23 Portilla-Pinzón A, López JJ, Montoya-Cañon M, Machado-Alba JE. [Evaluation of prescriptions authorized between 2010 journal 2011 through judicial protection in Bogotá]. Rev Fac Med [Internet]. 2016 [cited 2019 Mar 12];64(4):679-85. Available from: http://dx.doi.org/10.15446/revfacmed.v64n4.53574 Spanish. http://dx.doi.org/10.15446/revfacmed.v64... ⁾ Portilla-Pinzón et al. Evaluation of prescriptions authorized between 2010 and 2011 through judicial protection in Bogotá Rev de la Facultad de Medicina. 2016; v. 64, n. 4, p. 679-685. Colombia	To evaluate the therapeutic rationality of prescriptions of medicines authorized by guardianship in patients affiliated to the General System of Social Security in Health.	In 75.5% of the cases, the medication was correlated with the diagnosis and 66% of the patients were exposed to risks of medication interactions.
⁽²⁴24 Provin MP, Leite SN, Amaral RG. Social inequalities in lawsuits for drugs. Braz J Pharm Sci [Internet]. 2013 [cited 2019 Mar 12];49(3):465-74. Available from: http://dx.doi.org/10.1590/S1984-82502013000300008 http://dx.doi.org/10.1590/S1984-82502013... ⁾ Provin, M.P.; Leite, S.N.; Amaral, R.G. Social inequalities in lawsuits for drugs Brazilian Journal of Pharmaceutical Sciences2013; v. 49, n. 3, p. 465-474. Brazil	To characterize lawsuits that requested medicines considering the economic profile of their impetrants.	Residents of wealthier regions were responsible for more frequent lawsuits. Lawsuit costs were four times higher in the richer regions compared to the poorer region.
⁽²⁵25 Ramos KA, Ferreira ASD. [Analysis of the demand for medicines journal off label use through lawsuits in the state health secretariat of minas gerais]. R Dir Sanit [Internet]. 2013 [cited 2019 Mar 12];14(1):98-121. Available from: https://doi.org/10.11606/issn.2316-9044.v14i1p98-121 Portuguese. https://doi.org/10.11606/issn.2316-9044.... ⁾ Ramos, K.A.; Ferreira, A.S.D. Análise da demanda de medicamentos para uso off label por meio de ações judiciais na Secretaria de Estado de Saúde de Minas Gerais Rev de Direito Sanitário. 2013; v. 14, n. 1, p. 98-121. Brazil	To investigate the occurrence of a medication court application for indications not approved by the Agência Nacional de Vigilância Sanitária (Brazilian National Sanitary Surveillance Agency) through lawsuits against Minas Gerais State in 2010.	212 applications for off-label medications were identified, of which 46% were not included in pharmaceutical assistance programs.
⁽²⁶26 Sant‘ana JMB, Pepe VLE, Figueiredo TA, Osorio-de-Castro CGS, Ventura M. Rational therapeutics: health-related elements in lawsuits journal medicines. Rev Saúde Pública [Internet]. 2011 [cited 2019 Mar 12];45(4). Available from: http://dx.doi.org/10.1590/S0034-89102011005000042 http://dx.doi.org/10.1590/S0034-89102011... ⁾ Sant'Ana et al. Rational therapeutics: health-related elements in lawsuits demanding medicines Rev de Saúde Pública. 2011; v. 45, n. 4, p. 714-721. Brazil	To characterize the main procedural, medical-scientific and health elements that support the decisions of the individual judicial demands for medicines considered essential.	All lawsuits contained prescriptions and medical certificates. The prescriptions were in discrepancy with the legislation. There were no medical examinations in any of the lawsuits and 7.4% consisted of complementary tests.
⁽²⁷27 Silva EM, de Almeida, KC, Pessoa GSC. [Analysis of drug expenditure with judicialization journal the federal district, brazil]. Cad Ibero-Amer Dir Sanit [Internet]. 2017 [cited 2019 Mar 12];6(1):112-26. Available from: http://dx.doi.org/10.17566/ciads.v6i1.358 Portuguese. http://dx.doi.org/10.17566/ciads.v6i1.35... ⁾ Silva, E.; de Almeida, K.C.; Pessoa, G.S.C Análise do gasto com judicialização de medicamentos no Distrito Federal, Brasil Cadernos Ibero-Americanos de Direito Sanitário, 2017; 6(1), 112-126. Brazil	To analyze the profile of public health spending in the Federal District with non-standard medications occurs at this location.	Total expenses were 43.7 million reais. Among the medications with the highest expenditure, the recombinant factor IX (haemophilia treatment) was observed as the most responsible (22.53%).
⁽²⁸28 Souza ÍP, Bellato R, Araújo LFS, Almeida KBB, Nepomuceno MAS, Mufato LF. [Right to health in the court journal justice: demand for oncology drugs]. Rev RENE [Internet]. 2012 [cited 2019 Mar 12];13(4):919-28. Available from: https://www.redalyc.org/pdf/3240/324027983022.pdf Portuguese. https://www.redalyc.org/pdf/3240/3240279... ⁾ Souza et al. Direito à saúde no tribunal de justiça: demanda por medicações em oncologia Rev da Rede de Enfermagem do Nordeste. 2012; v. 13, n. 4. Brazil	To describe the demand for the right to health in the Court of Mato Grosso State on medicines for people with cancer.	There were 25 lawsuits for cancer medications, 32% cited the amount of medicine needed, 60% determined the medication delivery period, 16% brought the dosage and 4% contained the deadline to meet the demand determined by the judge.
⁽²⁹29 Stamford A, Cavalcanti M. Legal decisions on access to medicines in journal northeastern brazil. Rev Saúde Pública [Internet]. 2012 [cited 2019 Mar 12];46(5). Available from: http://dx.doi.org/10.1590/S0034-89102012000500005 http://dx.doi.org/10.1590/S0034-89102012... ⁾ Stamford, A.; Cavalcanti, M. Decisões judiciais sobre acesso aos medicamentos em Pernambuco Rev de Saúde Pública. 2012; v. 46, p. 791-799. Brazil	To analyze the decisions of the legal system on access of the population to medicines in the Sistema Único de Saúde (Brazilian Unified Health) System by judicial means regarding decision criteria and possible political and economic pressures.	The Federal Constitution and medical prescription were identified as a decision criterion in lawsuits.
⁽³⁰30 Vieira FS, Zucchi P. Distortions to national drug policy caused by lawsuits journal brazil. Rev Saúde Pública [Internet]. 2007 [cited 2019 Mar 12];41(2). Available from: http://dx.doi.org/10.1590/S0034-89102007000200007 http://dx.doi.org/10.1590/S0034-89102007... ⁾ Vieira, F.S.; Zucchi, P. Distorções causadas pelas ações judiciais à política de medicamentos no Brasil Rev de Saúde Pública. 2007; v. 41, p. 214-222. Brazil	To describe the effects of lawsuits that requires the supply of medications, in relation to aspects of the national medication policy.	The total expense was of 876 thousand reais (Brazilian currency) for items that are not part of the Municipal Relation of Essential Medicines. Of the total expenditure, 75% were allocated to the acquisition of antineoplastic agents and two of these medications were not registered in Brazil.
⁽³¹31 Wang DWL, Vasconcelos NP, Oliveira VE, Terrazas FV. [The impacts of health care judicialization journal the city of Sao Paulo: public expenditure and federal organization]. Rev Adm Pública [Internet]. 2014 [cited 2019 Mar 12];48(5):1191-1206. Available from: http://dx.doi.org/10.1590/0034-76121666 Portuguese. http://dx.doi.org/10.1590/0034-76121666... ⁾ Wang et al. Os impactos da judicialização da saúde no município de São Paulo: gasto público e organização federativa Rev de Administração Pública-RAP. 2014; v. 48, n. 5. Brazil	To analyze the impact of health judicialization in the city of São Paulo.	Approximately 55% of health care expenditures are spent on the supply of State or Union medicines and 45% on non-contemplated SUS (Unified Health System) treatments.

Article/Country	Objective	Main Results
⁽³²32 Arruda SC. &journal;#91;Analysis of the legalization of health in the state of mato grosso in the period 2011-2012]. Cad Íbero Amer Dir Sanit [Internet]. 2017 [cited 2019 Mar 12];6(1):86-111. Available from: http://dx.doi.org/10.17566/ciads.v6i1.308 Portuguese http://dx.doi.org/10.17566/ciads.v6i1.30... ⁾ Arruda Análise sobre a judicialização da saúde no estado de mato grosso no período de 2011-2012 Cad Íbero-Americanos de Direito Sanitário. 2017; v. 6, n. 1, p. 86-111. Brazil	To understand the phenomenon of the judicialization of access to public health in Mato Grosso State.	Population is more aware of their rights and requires it through judicial decisions.
⁽³³33 Asensi FD, Aidar A, Ramos F, Pinheiro R. &journal;#91;Judicialization, right to health and prevention]. Rev Eletron de Comun Inf Inov Saúde [Internet]. 2015 [cited 2019 Mar 12];9(1). Available from: http://dx.doi.org/10.29397/reciis.v9i1.935 Portuguese. http://dx.doi.org/10.29397/reciis.v9i1.9... ⁾ Asensi et al. Judicialização, direito à saúde e prevenção Rev Eletron de Comun Inf Inov Saúde. 2015 jan-mar; 9(1). Brazil	To analyze the practice of preventive medicine, with regard to vaccination, resulting from the intervention of the Judiciary.	110 cases were identified, 25 of which were about the supply of vaccines to specific individuals. They emphasized that they did not find lawsuits that sought to force the State to act in a preventive way.
⁽³⁴34 Gomes TR. &journal;#91;The medical error under the eyes of the Judiciary: an investigation at the court of justice of federal district and territories]. Cad Íbero-Amer Dir Sanit [Internet]. 2017 [cited 2019 Mar 12];6(1):72-85. Available from: http://dx.doi.org/10.17566/ciads.v6i1.362 Portuguese. http://dx.doi.org/10.17566/ciads.v6i1.36... ⁾ Gomes O Erro médico sob o olhar do Judiciário: uma investigação no Tribunal de Justiça do Distrito Federal e Territórios Cad. Íbero-Americanos de Direito Sanitário. 2017; v. 6, n. 1, p. 72-85. Brazil	To know judicial decisions from the Second Instance on medical errors.	It resulted in 202 civil cases, being the specialty with the largest number of cases in Gynecology/Obstetrics.
⁽³⁵35 Gomes FDFC, Cherchiglia ML, Machado CD, Santos VCD, Acurcio FDA, Andrade EIG. [Access to medium and high-complexity journal in the brazilian unified national health system: a matter of judicialization]. Cad Saúde Pública [Internet]. 2014 [cited 2019 Mar 12];30(1):31-43. Available from: http://dx.doi.org/10.1590/0102-311X00176812 Portuguese. http://dx.doi.org/10.1590/0102-311X00176... ⁾ Gomes et al. Acesso aos procedimentos de média e alta complexidade no Sistema Único de Saúde: uma questão de judicialização Cad de Saúde Pública. 2014; v. 30, p. 31-43. Brazil	To investigate lawsuits for access to outpatient and hospital procedures in Minas Gerais State, Brazil, from 1999 to 2009.	The most requested procedures were hospitalizations in common beds, Intensive Care Unit and surgeries of the circulatory system.
⁽³⁶36 Gotlieb V, Yavich N, Báscolo E. [Litigation and the right to health journal argentina]. Cad Saúde Pública [Internet]. 2016 [cited 2019 Mar 12];32(1):e00121114. Available from: http://dx.doi.org/10.1590/0102-311X00121114 Spanish. http://dx.doi.org/10.1590/0102-311X00121... ⁾ Gotlieb, V.; Yavich, N.; Báscolo, E. Litigio judicial y el derecho a la salud en Argentina Cad de Saúde Pública. 2016. v. 32, n. 1 Argentina	To explore the profile of litigation for access to health care processed before the Supreme Court of Argentina.	A predominance of lawsuits was observed by individual applicants (88%) and private insurance applicants (64%). 87% claimed coverage of a medical service.
⁽³⁷37 Massaú GC, Bainy AK. &journal;#91;Impact of healthcare legal enforcement in pelotas district]. R Dir Sanit [Internet]. 2015 [cited 2019 Mar 12];15(2):46-65. Available from: https://doi.org/10.11606/issn.2316-9044.v15i2p46-65 Portuguese. https://doi.org/10.11606/issn.2316-9044.... ⁾ Massaú, G.C.; Bainy, A.K. O Impacto da judicialização da saúde na comarca de Pelotas Rev de Direito Sanitário. 2015; v. 15, n. 2, p. 46-65 Brazil	To unveil the impact of health judicialization in Pelotas District.	The budget deficit of the Municipality of Pelotas is of the same value of the judicial demands, that is, the budgetary demands exceeded 2,699,939.44 reais due to the judicial decisions.
⁽³⁸38 Nunes CFO, & Ramos Jr AN. [Judicialization of the right to health journal the brazilian northeastern region: dimensions and challenges]. Cad Saúde Colet [Internet]. 2016 [cited 2019 Mar 12];24(2):192-9. Available from: http://dx.doi.org/10.1590/1414-462X201600020070 Portuguese. http://dx.doi.org/10.1590/1414-462X20160... ⁾ Nunes, C.F.O.; Ramos Junior, A.N. Judicialização do direito à saúde na região Nordeste, Brasil: dimensões e desafios Cad. Saúde Colet., (Rio J.), 2016. 24(2), 192-199. Brazil	To characterize the judicialization of the right to health in Ceará State, to size its magnitude and to describe the profile of the subjects, pathologies and objects demanded.	74% of requests were for medicines, the median age of the authors was 57.8 years and 68% were represented by private lawyers. 76% of the prescriptions came from the public network and the most requested goods were Mabthera, Spiriva, Lantus and other supplies for diabetes.
⁽³⁹39 Petean E, Araújo LFS, Bellato R, Wunsch CG, Mufato LF, Nepomuceno MAS. &journal;#91;The right to health: a demand for supplements in the court of justice]. Rev Eletr Enf [Internet]. 2012 [cited 2019 Mar 12];14(1):68-76. Available from: https://doi.org/10.5216/ree.v14i1.12369 Portuguese. https://doi.org/10.5216/ree.v14i1.12369... ⁾ Petean et al. Direito à saúde: demanda por suplementos no Tribunal de Justiça Rev Eletr de Enfermagem. 2012; v. 14, n. 1, p. 68-76. Brazil	To know the origin, the motive, the object, the plaintiff subject and the resolution of the judicial decisions.	Lawsuits were mostly requests for food compounds from glycemic control tapes. All medical prescriptions requested for trademarks and pediatric food allergy was the main reason for the lawsuit.
⁽⁴⁰40 Salvatori RT, Ventura CAA. [Civil non-voluntary hospitalizations by reason journal mental disorders at Catalonia: an analysis of judicial decisions in light of bioethics]. Physis [Internet]. 2013 [cited 2019 Mar 12];23(2):531-552. Available from: http://dx.doi.org/10.1590/S0103-73312013000200011 Portuguese. http://dx.doi.org/10.1590/S0103-73312013... ⁾ Salvatori, R.T.; Ventura. C.A.A. Internamentos não voluntários civis por razão de transtorno psíquico na Catalunha: uma análise das decisões judiciais à luz da bioética Physis: Rev de Saúde Coletiva. 2013; v. 23, p. 531-552. Spain	To investigate the jurisprudence of Provincial Hearings of the Autonomous Region of Catalonia, Spain, on the requests for non-voluntary hospitalization of persons with psychic disorders.	Fifteen central ideas were identified in judicial decisions, analyzed according to principles of mainstream bioethics. The benevolent principle of non-voluntary hospitalization seems to prevail over all others.

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[1] Corresponding Author: Paula Mestre Ferreira Batistella. E-mail: paulamestrebatistella@hotmail.com