Facts
Robert Blaue stabbed an 18-year-old woman four times, piercing her lung. She was taken to hospital, where doctors told her she needed a blood transfusion and would probably die without one. As a Jehovah's Witness, she refused, on religious grounds. She died the next day. A transfusion would almost certainly have saved her.
Blaue was convicted of manslaughter, on the ground of diminished responsibility. He appealed, arguing that her refusal of treatment broke the chain of causation between the stabbing and her death.
Issue
Did the victim's refusal of a blood transfusion break the chain of causation, so that Blaue didn't cause her death?
Decision
The Court of Appeal dismissed the appeal. The stab wound remained the cause of death, and the conviction stood. Lawton LJ gave the judgment of the court.
Reasoning
Take your victim as you find them. It has long been the policy of the law that those who use violence on other people must take their victims as they find them. Lawton LJ said this means the whole person, not just their physical condition. It includes their religious beliefs and values.
No question of reasonableness. Blaue argued that the victim's refusal was unreasonable. The court rejected the idea that it should decide whether her beliefs were reasonable. Her refusal flowed from her faith, and Blaue couldn't complain that she wasn't the kind of victim he'd have preferred.
Operating and substantial cause. The physical cause of death was bleeding into the pleural cavity, caused by the stab wound. That wound was still an operating and substantial cause of death when she died, so the chain of causation wasn't broken.
Why it matters
Blaue extends the thin skull rule from physical conditions, such as a thin skull or a weak heart, to the victim's beliefs and characteristics. It's a key authority on whether a victim's own conduct can amount to a novus actus interveniens, an intervening act that breaks the chain of causation.
It sits within a group of causation cases:
- Medical treatment. R v Smith [1959] 2 QB 35 and R v Cheshire [1991] 1 WLR 844 hold that negligent treatment rarely breaks the chain. It must be so independent and so potent that the original wound becomes insignificant. R v Jordan (1956) 40 Cr App R 152 is the rare example where it did.
- Victim's escape. In R v Roberts (1971) 56 Cr App R 95, a woman injured jumping from a moving car to escape an assault didn't break the chain, because her reaction was foreseeable. Only a "daft" reaction would (R v Williams [1992] 1 WLR 380).
- Free, deliberate and informed acts. In R v Kennedy (No 2) [2007] UKHL 38, a supplier of heroin didn't cause the death of an adult who freely injected himself.
How it comes up in exams
For causation in homicide or assault, work through:
- Factual causation: but for D's conduct, would the result have occurred (R v White [1910] 2 KB 124)?
- Legal causation: was D's conduct an operating and substantial cause (R v Smith)?
- Intervening acts: medical treatment (Cheshire), the victim's reaction (Roberts), the victim's own free choice (Kennedy), or a third party's act.
- Thin skull rule: any vulnerability or belief of the victim is D's risk (Blaue).
Frequently asked questions
What was decided in R v Blaue?
The Court of Appeal held that a victim's refusal of a blood transfusion, because of her religious beliefs, didn't break the chain of causation between the stabbing and her death. The defendant had to take his victim as he found her.
What is the thin skull rule?
A defendant must take their victim as they find them. If the victim has a condition, physical or otherwise, that makes the harm worse than expected, the defendant is still responsible for the full consequences.
Can a victim's own conduct ever break the chain of causation?
Yes, if it is a free, deliberate and informed act, as in R v Kennedy (No 2) [2007] UKHL 38, or if the victim's reaction to the defendant's attack is so daft as to be unforeseeable (R v Roberts (1971); R v Williams [1992] 1 WLR 380).
Does poor medical treatment break the chain of causation?
Rarely. In R v Cheshire [1991] 1 WLR 844, the court held that negligent treatment breaks the chain only if it is so independent of the defendant's acts, and so potent in causing death, that the original injury is insignificant.