RECONSTRUCTING MEDICAL NEGLIGENCE FOR AI DRIVEN CARE: TOWARD A NIGERIAN STANDARD OF REASONED JUSTIFICATION

Abstract

Artificial intelligence (AI) is rapidly reshaping clinical judgment in Nigeria, yet it operates 
within a medico-legal framework designed for exclusively human decision-making. Existing 
negligence doctrines, Bolam, Bolitho, Montgomery, and their Nigerian articulation in 
Okonkwo v Medical and Dental Practitioners Disciplinary Tribunal, remain foundational but 
insufficient for hybrid human–machine clinical environments. As AI systems increasingly 
influence diagnosis, triage, and treatment, responsibility becomes distributed across 
clinicians, hospitals, and developers, exposing gaps in duty of care, causation, consent, and 
institutional accountability. This article argues that Nigerian health law must evolve from 
professional deference to reasoned accountability grounded in both constitutional values and 
African bioethics.
To address these emerging gaps, the article proposes the Standard of Reasoned Justification 
(SRJ), a four-pillar normative framework, empirical competence, logical defensibility, 
respect for autonomy, and institutional responsibility, rooted in Okonkwo’s mandate that 
practitioners act “competently, conscientiously, and guided by reason.” The SRJ provides a 
unified standard for evaluating AI-mediated clinical decisions, bridging doctrinal evolution 
with modern demands for transparency, explainability, and patient-centred governance.
The article demonstrates how AI challenges existing statutory regimes, including the National 
Health Act 2014, the Medical and Dental Practitioners Act, and the Nigeria Data Protection 
Act 2023, and identifies the structural weaknesses of Nigeria’s fragmented regulatory 
ecosystem. It concludes by recommending legislative and institutional reforms, including 
amendments to the Evidence Act 2011 and the National Health Insurance Authority Act 
2022, and the establishment of a National Health Artificial Intelligence Governance 
Framework. Together, these measures would embed the SRJ into Nigeria’s legal order ensuring that technological innovation remains accountable to the constitutional imperatives 
of dignity, autonomy, and justice.