Paul and another v Royal Wolverhampton NHS Trust [2024] UKSC 1

Claimants sought damages for psychiatric illness caused by witnessing deaths of close family members due to allegedly negligent medical treatment. The Supreme Court held that doctors do not owe a duty of care to patients' relatives to protect them from psychiatric harm caused by witnessing death from an untreated condition.

Facts

These three conjoined appeals concerned claims for compensation for psychiatric illness caused by witnessing the death of close family members. In Paul, two young daughters witnessed their father’s sudden death in a public street from a medical condition that was allegedly negligently left untreated. In Polmear, parents witnessed the death of their young daughter. In Purchase, a mother came upon her daughter shortly after her death in shocking circumstances. In each case, the death was allegedly caused by the defendant doctor or health authority’s negligence in failing to diagnose and treat a life-threatening medical condition. The defendants applied to have the claims summarily dismissed on the basis that, even assuming all facts alleged were true, the claims could not succeed as a matter of law.

Issues

The central issue was whether doctors owe a duty of care to members of a patient’s close family to protect them against the risk of psychiatric illness from witnessing the death or medical crisis of their relative, where that death or crisis results from a condition the doctor negligently failed to diagnose or treat. The claimants argued that the established exception permitting claims for psychiatric injury from witnessing accidents should be extended by analogy to medical negligence cases.

Judgment

By a majority of six to one, the Supreme Court dismissed the appeals. Lord Leggatt and Lady Rose delivered the leading judgment, with Lord Briggs, Lord Sales and Lord Richards concurring. Lord Carloway delivered a concurring judgment explaining that Scots law would reach the same result. Lord Burrows dissented.

The Majority Reasoning

The court affirmed the general common law rule that a person cannot claim compensation for the effect on them of the death or injury of another person. An exception exists for witnessing an accident (or its immediate aftermath) in which a close family member is killed or injured. However, the majority held that no valid analogy could be drawn between accident cases and cases where the claimant witnesses death or a medical crisis brought about by an untreated disease.

The majority emphasised that accidents are discrete events, making it relatively straightforward to determine whether someone was present at and directly perceived the accident. Furthermore, witnessing an accident involving a close family member may place the claimant’s own safety at risk, creating a connection to the defendant’s negligence that does not exist in medical cases.

In medical contexts, symptoms of disease may develop over extended periods, and the traumatic impact of witnessing such events is highly variable. The court rejected proposed limiting tests based on ‘sudden shock’, ‘horrifying’ events, or ‘first manifestation’ of a medical condition as unworkable.

Crucially, the court considered that the responsibilities of a doctor do not extend to protecting members of a patient’s close family from the traumatic experience of witnessing death or disease manifestation in their relative. Society has not reached the point where people can reasonably expect medical professionals to shield them from such experiences.

The Dissent

Lord Burrows dissented, arguing that the relevant event should be viewed as the death of the primary victim, and that applying established proximity factors from secondary victim cases, the duty of care was owed to the relatives. He considered that the majority’s approach would preclude claims by loved ones of patients in virtually all medical negligence circumstances, which was unwarranted.

Implications

This decision significantly restricts the scope of secondary victim claims in the context of medical negligence. It confirms that the duty of care owed by medical professionals is limited to the patient and does not extend to protecting family members from psychiatric harm caused by witnessing death or illness resulting from negligent treatment. The judgment maintains a clear distinction between accident cases and medical negligence cases for the purposes of secondary victim claims. The decision also demonstrates the court’s reluctance to extend tortious liability incrementally without clear principled justification, particularly where doing so would create difficult questions of scope and application.

Verdict: Appeals dismissed by a majority of six to one. The Court of Appeal’s order dismissing the claims was upheld. Doctors do not owe a duty of care to members of a patient’s close family to protect them against the risk of psychiatric illness from witnessing the death or medical crisis of their relative resulting from negligently untreated conditions.

Source: Paul and another (Appellants) v Royal Wolverhampton NHS Trust (Respondent)