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This article examines the inclusion of a health approach in judicial decisions through an analysis of legal proceedings whereby defendants, judges and lawyers use health issues during criminal trials. Based on observations conducted over the course of a year in three sections of a summary trial (magistrates’) court and the creation of a database from these observations (n = 290), this article shows that illness is an approach explored by magistrates who, following a rationale of individualizing punishment, encourage defendants to reveal their “health problems.” Those who are shown to be ill are then systematically questioned on whether or not they are receiving medical care. Regression analysis reveals that this care strongly determines the criminal punishment. Defendants undergoing medical treatment are “protected” from prison while those who are not receiving treatment are more often sent straight to prison at the end of their trials. These results and the analysis of arguments in which “health problems” are used in the course of hearings, emphasize the suppositions on which judges base their decisions, and which take the form of three normative imperatives affecting all defendants. This leads to the over-incarceration of the most marginalized, and among them, the sick who are not undergoing treatment.