El delito de comisión por omisión y las dificultades para determinar la imputación objetiva en la práctica médica ecuatoriana.

Abstract

This study analyzes how the equivalence clause of Article 28 of the Comprehensive Organic Criminal Code only allows omissions to be punished when a genuine guarantor position exists and an objective duty of care is established by law, contract, assumption of a functional role, or prior risk. Article 146, mainly designed for active conduct, does not address omissions in medical practice; therefore, it generates inconsistent outcomes. Through a documentary analysis of doctrine, legislation, and jurisprudence from 2014 to 2025, this study presents operational rules for objective attribution (ex ante avoidability in accordance with the lex artis, the principle of trust, and the prohibition of regression, and solid proof of the causal link). In this regard, the study proposes an interpretive framework that reduces decisional disparity, protects patients without criminalizing permitted risks, and strengthens the legal certainty of healthcare personnel when intervention is genuinely necessary. Keywords: commission by omission, guarantor position, lex artis, permitted risk, objective attribution