Os desafios da governança da saúde pública: uma análise da participação do NATJUS nas técnicas de aperfeiçoamento das decisões judiciais do TJGO, de acordo com o Tema nº 6 do STF (RE 566.471/RN)

Abstract

The judicialization of health in Brazil has consolidated the Judiciary as a central actor in the public health policy cycle, imposing upon it the daily challenge of addressing technical and scientific issues that transcend its traditional legal training. To mitigate this epistemic asymmetry, the National Council of Justice established the Technical Support Units for the Judiciary (NATJUS), designed to technically qualify judicial decisions and align them with public health policies rather than antagonize them. It is within this institutional tension that the present study is situated, whose central objective is to analyze the role of NATJUS/GO at the Court of Justice of the State of Goiás as an instrument for rationalizing judicial decisions in cases involving medicines not incorporated into the Brazilian Unified Health System (SUS), with emphasis on the impacts produced by the binding precedent established by the Federal Supreme Court under Theme 6 (RE 566.471/RN). The theoretical framework articulates three complementary axes: the Judiciary as an external actor in the public policy cycle, NATJUS as a technical advisory mechanism oriented toward institutional dialogue, and the perspective of Holmes and Sunstein on the cost of rights, which grounds the requirement of rationality and transparency in judicial allocative choices. The methodology combines a systematic literature review, documentary research, and empirical jurisprudential analysis of 117 judgments of the TJGO, distributed across two comparative periods, before and after the consolidation of Theme 6, thereby allowing precise verification of the extent to which the normative change altered the Court's decision-making pattern. The results reveal a structurally significant continuity: the concordance rate between NATJUS opinions and judicial outcomes remains stable at 76.9% across both periods, demonstrating that the unit's influence over decisions was not substantially altered by the introduction of the new normative framework. More revealing, however, is the intersection with the Theme 6 compliance variable: in the second period, 38.5% of judgments failed to comply with the STF's binding precedent and, of these, 91.7% followed favorable NATJUS opinions without engaging in the multi-criteria reasoning required, particularly regarding unfavorable CONITEC deliberations. This finding inverts the most intuitive hypothesis: normative non-compliance does not stem from ignoring the technical input, but paradoxically from using it as a self-sufficient decisional anchor, dispensing with the articulation of the additional criteria imposed by the STF. The originality of the research lies precisely in this empirical demonstration: NATJUS, created to qualify judicial decisions, has come to replace them, progressively hollowing out CONITEC's regulatory function without express and reasoned review of its criteria. As a practical contribution, an institutional model of best practices is proposed, structured around four guidelines and a reasoning verification checklist, aimed at judges and judicial clerks of the TJGO, with the purpose of bridging the gap between consolidated decision-making patterns and the new normative framework, strengthening the robustness of judicial reasoning without restricting individual protection of the right to health.