Causation and Intervening Acts in Criminal Law

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According to Robin J.A. in Malette v Shulman[1], “the right of self-determination which underlies the doctrine of informed consent also obviously encompasses the right to refuse medical treatment. A competent adult is generally entitled to reject a specific treatment or all treatment, or to select an alternate form of treatment, even if the decision may entail risks as serious as death…The doctrine of informed consent is plainly intended to ensure the freedom of individuals to make choices concerning their medical care. For this freedom to be meaningful, people must have the right to make choices that accord with their own values regardless of how unwise or foolish those choices may appear to others.”[2] R v Blaue[3], a famous causation case in criminal law, brings to foreground a thought-provoking debate about whether an individual’s religious beliefs and other psychological values could be included in the ‘thin skull’ rule and whether the refusal to take lifesaving medical treatment breaks the chain of causation that exists between the defendant’s wrongdoing and the purported outcome of that wrongdoing. The facts of the case are as follows - Blaue, the defendant, stabbed a woman numerous times after she refused to have sexual intercourse with him. She was a Jehovah’s Witness and was therefore not in favour of blood transfusions. After the stabbing, she was taken to a hospital and was told that she urgently needed to have a blood transfusion, without which she would die. Owing to her religious beliefs, she refused to consent with the suggested treatment. As a result, she died in the hospital. While giving the judgment, Lawton L.J. stated that “those who use violence on other people must take their victims as they find them.”[4] This, according to him, not only includes victims’ physical characteristics, but also their emotional, psychological and spiritual values and beliefs. This decision has proved to be extremely controversial and gives rise to various debates. Most understand the rationale behind the court’s judgment and agree that the defendant is, as a matter of fact, criminally liable for causing the injury. After all, the victim was at the receiving end of several stabbings, imposed by the defendant, who clearly had an intention of causing serious bodily harm, if not death. However, some feel that the death was the result of the victim’s refusal to carry out the blood transfusion. They feel that the defendant should not be responsible for the unusual, irrational and unjustified religious beliefs of the victim. In addition, the defendant could not have possibly foreseen her backing out of receiving medical treatment in the hospital. The Blaue case creates many doubts about the doctrine of causation in criminal law. Was Blaue responsible for the victim’s death or was it an act of the victim, since it was her decision to refuse a blood transfusion? If we conclude that Blaue is indeed responsible for her death, another question comes to mind: Why is the victim not responsible for her own death? First and foremost, it is a fact that the victim sustained injuries due to numerous stabbings and it was Blaue who had inflicted them upon her. Her not taking any steps to save herself did not instigate her death. Secondly, there is an application of the ‘thin skull’ rule in this case. An important principle of the law of causation is that defendants must ‘take their victims as they find them.’ This means that if a defendant pushes someone and because they have a thin skull, they crack their head and die, the defendant will be liable for causing their death. The Court of Appeal in Blaue indicated that the decision could be seen as a ‘thin skull’ example. It was established that the ‘thin skull’ rule goes beyond the physical characteristics of individuals, also including a person’s moral and religious beliefs. Thirdly, the victim’s decision to not undergo blood transfusion, which would have clearly saved her life, was based on...
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