The research is developed with the use of deductive and descriptive analytical methods used to obtain information on doctrine and jurisprudence and to establish and describe specific situations in the field of Ecuadorian Medical Law respectively. The main objective is to provide scientific and doctrinal tools to understand guilt in cases of omissive conduct in Ecuadorian medical practice, as well as its comparison with other countries such as Colombia, Mexico, Cuba and Argentina, the results of the research show that the (...) doctrine in the relationship to the categories of Omission, Guilt, Guarantor Position and Permitted Risk is broad and is based on scientific-doctrinal advances of the Normative Conception of Guilt comprised between 1995 and 2022. To establish useful criteria and conclusions, the discussion focuses on defining what is considered “guilty” in the context of Medical Law, highlighting the importance of elements such as the objective duty, the harmful result and the analysis of the concomitant circumstances, emphasizing the importance of considering the context and development of the facts in cases of omissive conduct in medicine and not only the result. In relation to omissions in criminal law, a distinction is made between proper and improper and finally, it concludes by suggesting the modification of article 146 of the Organic Integral Criminal Code to guarantee due process and a effective judicial protection in matters related to health in Ecuador, specifically with regard to causality in cases of omissive conduct. (shrink)