Legal causation, Factual causation

'The Ambulance Crew and the liability for the death of Anthony and Bella'

What is the position of the ambulance crew, who after receiving the call took 45 minutes to arrive as they finished a game of chess first? There is no doubt that the in the Law of Tort the crew would be found to be in breach of their duty of care and thus be negligent. They would be liable for damages, not to mention at grave risk of losing their jobs. Can they be punished with criminal sanctions? Where the death of another is caused by a person's negligence, and this negligence is so severe to deserve punishment under the criminal law, this is described as gross negligence, and can give rise to gross negligence manslaughter. The leading case in this area is of R v Adomako 1 ; here it was stated that the normal principles of negligence would apply in deciding whether or not there was a duty of care. Then the seriousness of the breach would decide if it could be characterised as gross negligence. The jury should be directed to look at whether the extent to which the defendants conduct departed from the proper standard of care incumbent upon him, involving as it must have done a risk to the death of the patient, was such as to be judged criminal. In addition there must be the common elements of all homicide offences present. Mainly a human being, death and causation.

It is on the issue of causation that the prosecution of the ambulance crew will turn. The prosecution must prove that the death was caused by the Defendant's act. There must be legal and factual causation present. In order to prove factual causation two things must be proved, firstly that but for the conduct of the accused the victim would not have died when they did, so if the defendant would have died at the same time regardless of the act or omission of the accused the accused will not be found guilty. In my opinion the death of Anthony would likely not have occurred as soon as it did but for the negligence of the crew as the need for a blood transfusion may have been avoided, but of course this is rather dependant on the facts. The same can also be said for Bella who refused transfer in anger of what happened to Anthony. In addition the original injury arising from the defendant's conduct must be more than the minimal cause of the death - the de minimis principle. Again this will turn on the facts, but the 45 minute wait is likely not to be held as minimal cause of the death of Anthony or Bella, as it caused them to lose a lot more blood than they otherwise would have.

If factual causation is proved then legal causation must be shown. It must be asked whether or not the initial injuries were the operative and significant cause of death. If they were this will help to bolster the case of the crew, In R v Smith 2 a patient was stabbed by the accused. A doctor mistakenly thought the case was not urgent, and upon the victim eventually receiving treatment it was inappropriate. It was held that this did not break the chain of causation and the accused was found guilty of murder. In the case of Cheshire 3 it was held that negligent medical treatment could only break the chain of causation if it was so independent of the accused's acts and such a powerful cause of death in itself that the contribution made by the defendants (i.e. Harold and Ivor) were insignificant. Thus even incompetent or even grossly abnormal treatment will not suffice to break the chain. It seems that here only medical expertise will suffice to show what was the substantial cause of the deaths of Anthony and Bella.

An intervening act that was not reasonably foreseeable can break the chain however. Thus a person that leaves a victim unconscious on the seashore when the tide is coming in will be guilty of murder, but one that leaves a victim unconscious in a field and they were run over and killed by a car involved in an accident on a nearby road they will not be guilty of murder. It is likely the court will hold that Bellas refusal of treatment was not reasonably foreseeable and will break the chain.

Finally the eggshell skull principle is of relevance. The principle provides that the accused must take their victim as they find them. In the case of R v Blaue 4the victim of a stabbing was a Jehovahs Witness, so refused a blood transfusion. The victim died as a result of the refusal, but the chain was not broken, as the accused had to take the victim as they found her.

[1994] 3 All ER 79 HL[^ Return]
[1959] 1 QB 35[^ Return]
[1991] 3 All ER 670 CA[^ Return]
[1975] 3 All ER 446[^ Return]