“In Malaysia, courts apply the objective "but-for" test to establish medical causation.”

The slides summarising Malaysian medico‑legal principles state: “To recap, the basic rule of recovery for negligence is that the plaintiff must establish on a balance of probabilities that the defendant caused the plaintiff's injury on the "but for" test. This is a factual determination. Exceptionally, however, courts have accepted that a plaintiff may be able to recover on the basis of "material contribution to risk of injury", without showing factual "but for" causation.” The same presentation notes that the test for causation in failure‑to‑warn cases is “a subjective test”.

The clipping notes that medical personnel administered a booster vaccine dose and that authorities could not confirm causality or a relationship between the vaccine and the reported event. This is relevant because it shows Malaysian official medical communication distinguishing between reported events and proven causation, though it does not itself state the legal test used by courts.

“To establish causation, the plaintiff has to prove on a balance of probabilities that the injury would not have occurred **but for** the doctor’s negligence. Malaysian courts have applied the traditional ‘but for’ test as the primary means of determining factual causation in medical negligence claims… In appropriate circumstances, the courts may also consider whether the damage is too remote, as part of a broader legal causation inquiry.”

In discussing causation in Malaysian medical negligence, the article notes: "Far more complicated is the proof of causation. The 'but for' test only awards full compensation to plaintiffs who are successful in showing the causal link between the defendant's breach and the injury suffered." It then explains that in some cases, courts consider whether the defendant's breach made a "material contribution" to the harm where strict application of the 'but for' test is difficult. This shows that the 'but for' test is the primary test used in Malaysia to establish medical causation, but that it may not be adequate in every situation.

The Bar Council’s overview explains that a claimant in medical negligence must establish on a balance of probabilities that the defendant’s breach caused the injury. It notes that Malaysian courts apply the conventional common-law approach to causation: beginning with the 'but for' test to determine factual causation and then considering whether any legal or policy limits apply. The article also points out that in complex medical cases, the strict 'but for' test may be relaxed through doctrines such as material contribution to risk where appropriate.

This overview of Malaysian medical law states that in negligence cases, courts require proof that the doctor's breach of duty caused the patient's damage. It describes that Malaysian courts largely follow English common law principles on causation, starting with the 'but for' test to determine whether the injury would have occurred in any event. However, the paper notes that strict adherence to the 'but for' test may be problematic in some medical cases with multiple possible causes, and that courts have occasionally looked to concepts like material contribution to address such difficulties.

“Following the case of *Chua Seng Sam Realty v Say Chong Sdn Bhd* [2013] 2 MLJ 29, the High Court applied the ‘but for’ test to determine whether the damage would not have been caused but for the Respondents’ conduct/omission… The Court of Appeal… held that the ‘but for’ test was an inquiry into the facts of the case and was the first step to determine the *causa sine qua non* factors. However, a further determination must be carried out, which was a legal inquiry in order to establish the *causa causans* i.e. the effective factor… This decision… is vital as it serves as an important reminder that the ‘but for’ test is only the first step… Therefore, both the ‘but for’ test and the proximate cause test must be applied hand in hand.”

“The patient must be able prove the causal link between the defendant’s breach of his duty of care and the adverse outcome suffered by him failing which, a claim in Court may fail. **The ‘But For’ Test** – The ‘But For’ test means that if it was not for fault of the defendant, the plaintiff would have not suffered any injury, losses or damage. If, however, the adverse result would have happened just the same, fault or no fault, the defendant will not be found to have been the cause of the plaintiff’s plight.”

“The Federal Court’s decision provides a clearer legal position with regard to the distinction between diagnosis and treatment on the one hand and the duty to advise on the other… While the case centred on the appropriate standard of care test (Bolam vs Rogers v Whitaker), it also reaffirmed that, in negligence suits, causation is not determined solely by a mechanical application of the ‘but for’ test. The court emphasised that legal causation involves a normative assessment of whether the defendant’s breach should, in law, be regarded as the cause of the damage, taking into account factors such as remoteness and policy.”

This article discusses the difference between medical/scientific causation and legal causation, explaining that courts often use a factual causation inquiry such as the 'but-for' test. It is useful background on medical causation generally, but it is not specific to Malaysia.

“In *Foo Fio Na v Dr Soo Fook Mun* the Federal Court has rejected *Bolam*, apparently adopting *Rogers* as the applicable test for assessing all forms of medical negligence… Although *Foo Fio Na* is primarily concerned with the standard of care, the judgment also touches on causation, reaffirming that the plaintiff bears the burden of showing that, on a balance of probabilities, the defendant’s negligence caused the harm. This is commonly expressed in terms of the familiar ‘but for’ inquiry, but the court’s reasoning makes it clear that causation is ultimately a value-laden judgment rather than a purely mechanical test.”

The firm’s explainer states: “To prove medical negligence in Malaysia, patients must show clear evidence that: The healthcare provider had a duty to care for them; That duty was breached through unreasonable actions or omissions; The breach directly caused injury or harm. Evidence is everything, and that’s where documentation plays a vital role.” It further clarifies that negligence requires “Causation and Harm: The patient suffers injury or loss as a result of the failure,” but does not detail whether courts use any test other than the conventional but‑for approach.

The court held that the principle underlying medical negligence cases is that the court itself should decide whether the doctor was negligent after considering the standard of skill practiced by the relevant profession and the fact that a person is entitled to decide for herself about her life. The determination should be based on the overall facts of the case, not simply on expert testimony. The judgment also states that the defendant was negligent in wiring the loop, which caused pressure on the spinal cord and led to the plaintiff’s complete paralysis.

The piece describes the test: "The ‘but for’ test is a foundational tool in establishing factual causation in negligence law. It posits that a defendant’s act or omission is the cause of the claimant’s harm if, but for that act or omission, the harm would not have occurred." It adds: "This principle is widely applied across common law jurisdictions, including Malaysia… In the Malaysian context, the ‘but for’ test is consistently applied in negligence cases to determine whether a causal link exists between the defendant’s breach and the claimant’s damage." While the example given (*Ng Chun Piao v Lee Chuen Tat* (1988)) is a road accident rather than a medical case, the article asserts that Malaysian courts generally use the 'but for' test as the basic causation inquiry in negligence.

Malaysian tort law, drawing heavily on English common law, treats the ‘but for’ test as the orthodox method for determining factual causation in negligence, including medical negligence. However, courts also apply additional concepts such as proximate cause, remoteness, novus actus interveniens and policy-based limitations. As a result, the ‘but for’ test functions as a necessary factual inquiry but is not, by itself, sufficient or exclusively determinative of legal causation in medical negligence cases.

The text says that on 17 August 2004 the Sessions Court decided that the appellants were 100% liable in negligence and the action was dismissed with costs. It then notes that the High Court later fixed a date to assess damages in a medical negligence case involving former national junior athlete Nor Azleen Mohammad Mustafa. This is about negligence and damages, but it does not clearly set out a but-for causation test.