R v Blaue (1975) 61 Cr App R 271

An 18-year-old Jehovah’s Witness refused a life-saving blood transfusion after being stabbed by the appellant and died. The Court of Appeal held that her refusal did not break the chain of causation; the stab wound remained an operative cause of death, so the manslaughter conviction stood.

Facts

The appellant, Robert Konrad Blaue, was tried at Teesside Crown Court for offences arising from an attack on an 18-year-old girl, Jacolyn Woodhead, a Jehovah’s Witness who lived according to the tenets of her faith.

On 3 May 1974, he entered her house and asked for sexual intercourse. When she refused, he attacked her with a knife, inflicting four serious wounds, one of which pierced her lung. He then fled. The victim staggered into the road, collapsed, and was taken by ambulance to hospital, arriving around 7.30 p.m. She was admitted to the intensive care ward and examined by a surgical registrar at about 8.30 p.m., who determined that serious injury required surgery and, due to significant blood loss, a prior blood transfusion.

Upon realising a transfusion was proposed, the victim refused it, stating it would be contrary to her beliefs as a Jehovah’s Witness. She was told she would die without it, and replied that she did not care if she died. She signed a written acknowledgement that she refused transfusion under any circumstances. It was admitted by the prosecution that, had the transfusion been given as advised, she would not have died. She died at 12.45 a.m. the following day.

The evidence showed she was conscious, deliberate in her decision, and aware of its consequences. The prosecution accepted in closing that her refusal of a blood transfusion was a cause of death. The defence of diminished responsibility was not contested by the prosecution.

The appellant was acquitted of murder but convicted of manslaughter on the ground of diminished responsibility (count 1), wounding with intent to cause grievous bodily harm (count 2), and indecent assault on her (count 3). He also pleaded guilty to indecently assaulting two other women (counts 4 and 5). He received life imprisonment on counts 1 and 2 and concurrent twelve-month sentences on counts 3, 4 and 5.

Issues

The primary issue on appeal was whether the victim’s refusal of a life-saving blood transfusion, on religious grounds, broke the chain of causation between the appellant’s stabbing and her death, such that he could not be held criminally liable for homicide.

The appellant contended that:

• The refusal of treatment constituted a novus actus interveniens breaking the chain of causation.
• Alternatively, the question of whether causation had been broken should have been left wholly and neutrally to the jury without effective direction.

The Crown argued that, on the undisputed facts, the only proper verdict was that the stab wound remained an operative and substantial cause of death and the judge could properly direct the jury accordingly.

Judgment

Trial judge’s direction

Towards the end of the trial, counsel addressed the judge on how causation should be put to the jury. Defence counsel asked that the jury be directed to acquit on the homicide charge on the basis that the victim’s refusal of transfusion broke the chain of causation; alternatively, that the jury should be left to decide if the chain was broken. The prosecution submitted that the jury should effectively be directed to convict of manslaughter by reason of diminished responsibility.

In summing up, the judge told the jury to apply common sense and referred them to the authorities of R v Smith and R v Holland, placing particular reliance on Maule J’s approach in Holland. He told the jury the decision in that case might be:

“most material and most helpful”

and continued:

“This is one of those relatively rare cases, you may think, with very little option open to you but to reach the conclusion that was reached by your predecessors as members of the jury in the Queen against Holland, namely ‘yes’ to the question of causation that the stabb was still, at the time of this girl’s death, the operative cause of death – or a substantial cause of death. However, that is a matter for you to determine after you have withdrawn to consider your verdict.”

On appeal, Mr Comyn QC criticised this direction on three grounds: that Holland was no longer good law; that Smith envisaged unreasonable conduct by the victim breaking the chain; and that the judge in reality directed the jury to find causation, despite ostensibly leaving it to them.

Authorities on causation

The Court of Appeal, per Lawton LJ, reviewed the earlier authorities. In R v Holland, the accused injured the victim’s finger; a surgeon advised amputation to avoid life-threatening complications, but the victim refused and later died of lockjaw. Lawton LJ cited Maule J’s direction:

“The real question is”, said Maule, J., “whether in the end the wound inflicted by the prisoner was the cause of death.”

The jury there, as in the present case, were left to decide this factual question using common sense, without need for specialised philosophical or theological analysis.

Lawton LJ observed that this approach reflected the common law position, derived from Hale, that a wrongdoer could not excuse himself on the basis that the victim could have avoided death by better self-care. He noted that while the law on homicide had been moderated in favour of the accused, this had occurred through development of the concept of intent, not by changing the approach to causation.

He also considered Regina v Jordan, where the conviction was quashed after evidence showed death resulted from abnormal medical treatment rather than the original wound. The Court accepted that Jordan was probably correctly decided on its facts, emphasising that the injury had almost healed before the abnormal treatment began, and endorsed Lord Parker’s view that it should not be seen as relaxing the common law principles of causation generally.

In R v Smith, the deceased would probably not have died but for a series of mishaps following the stabbing. The argument there was that such mishaps broke the chain of causation. Lawton LJ quoted Lord Parker CJ’s formulation:

“It seems to the Court that if, at the time of death, the original wound is still an operating cause and a substantial cause then the death can properly be said to be the result of the wound albeit that some other cause of death is also operating. Only if it can be said that the original wounding is merely the setting in which another cause operates can it be said that the death does not flow from the wound. Putting it another way, only if the second cause is so overwhelming as to make the original wound merely part of the history can it be said that the death does not flow from the wound.”

Applying this, Lawton LJ noted that in the present case the physical cause of death was bleeding into the pleural cavity arising from penetration of the lung, which was brought about by the stab wound, not by the deceased’s decision.

Victim’s refusal of treatment and reasonableness

The defence argument sought to introduce a standard of reasonableness into the victim’s decision: if the refusal of a blood transfusion was unreasonable, then the chain of causation would be broken. Lawton LJ rejected this approach, asking:

‘Reasonable by whose standards?’ He identified the difficulty of measuring reasonableness by differing religious or secular perspectives and observed that different juries in different localities might reach inconsistent conclusions about similar religiously motivated refusals, which was not consistent with the settled common law approach.

Lawton LJ restated the long-standing policy of the law:

“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. This in our judgment means the whole man, not just the physical man. It does not lie in the mouth of the assailant to say that his victim’s religious beliefs which inhibited him from accepting certain kinds of treatment were unreasonable.”

Accordingly, the question remained simply what caused the deceased’s death; the answer, in the Court’s view, was the stab wound. The fact that the victim refused to prevent that consequence did not sever the causal link.

Distinction from civil law principles

Lawton LJ contrasted the criminal and civil approaches to consequential loss. In civil cases, particularly claims by a victim’s representatives for compensation, foreseeability and mitigation of loss may operate in favour of the wrongdoer. A victim may be expected to accept normal treatment to mitigate damage. He cited Stelle v R. George and Co. Ltd as an example.

However, he noted that the criminal law serves different purposes: the maintenance of law and order and protection of the public. Thus, civil rules on foreseeability and mitigation were not necessarily suitable for criminal causation analysis, and were held not to be appropriate here.

Role of the judge and the jury

The Court affirmed that the issue of cause of death in murder or manslaughter trials is, in principle, a question of fact for the jury. However, where there is no evidential dispute and the jury’s function is to apply law to agreed facts, the judge may properly indicate the result of that application.

Lawton LJ held that in the present case the judge would have been entitled to state directly that the stab wound was an operative cause of death. The summing-up, even as delivered, was not erroneous in law.

Outcome and certification

The Court concluded that the girl’s refusal of a blood transfusion did not break the chain of causation and that the stab wound remained an operative and substantial cause of death. Lawton LJ stated:

“The appeal fails.”

Counsel for the appellant requested certification of a point of law of general public importance. The Court refused:

“We have given consideration to your submission, Mr. Comyn, and we have come to the conclusion that this does not come within the terms of the Act because in our judgment what we have decided is settled law, and it has been settled for a long time. Accordingly we refuse to certify.”

Implications

This decision confirms and clarifies the ‘take your victim as you find him’ principle in criminal law, extending it expressly beyond purely physical characteristics to encompass religious beliefs and personal characteristics affecting acceptance of medical treatment.

The case affirms that a victim’s informed refusal of life-saving treatment, even when causally contributing to death and motivated by religious conviction, does not relieve the assailant of criminal responsibility if the original injury remains an operating and substantial cause of death.

It also reinforces that, in the absence of evidential conflict, trial judges may direct juries on the proper legal conclusion regarding causation, and that attempts to introduce a standard of ‘reasonableness’ of the victim’s conduct into criminal causation are inconsistent with long-settled common law principles.

Verdict: The Court of Appeal dismissed the appeal against the conviction for manslaughter, holding that the stab wound remained an operative cause of death and that the victim’s refusal of a blood transfusion did not break the chain of causation. The Court also refused to certify a point of law of general public importance.

Source: R v Blaue (1975) 61 Cr App R 271