R v Blaue

Facts

The defendant, Blaue, stabbed an eighteen year old woman, Jacqueline Woodhead, after she refused his sexual advances; the knife penetrated her lung. She was taken to hospital where doctors said an immediate blood transfusion was needed to save her. She was a devout Jehovah Witness and refused the transfusion on religious grounds, and she died from the wound a short time later. Blaue was charged with murder.

History

Blaue was charged with murder and was convicted of manslaughter on the basis of diminished responsibility, the trial judge having ruled that the victim refusal of the transfusion did not relieve him of liability. He appealed against conviction, arguing that her refusal was a novus actus interveniens that broke the chain of causation.

Issue

Whether the victim's refusal of life-saving medical treatment on religious grounds breaks the chain of causation between the defendant's unlawful act and the victim's death, such that the defendant is not liable for manslaughter.

Held

Appeal dismissed; conviction for manslaughter upheld.

Ratio

• The chain of causation is not broken by a victim's refusal of medical treatment on religious grounds; the defendant must take the victim as he finds them, including their religious beliefs and the consequences that flow from them.

The judgments

Key reasoning

• The court applied the principle that a defendant must take the victim as he finds them, extending the 'thin skull' rule to cover religious convictions that affect medical decisions.
• The victim's refusal was not an independent, voluntary act that overwhelmed the defendant's contribution; it was a response to the injury inflicted by the defendant.
• The original wound inflicted by the defendant was still an operating and substantial cause of death when the victim died, satisfying the legal test for causation in homicide.

Where it fits in the module

Blaue is a foundational case for the causation topic in Criminal Law Mods Topic 1. It illustrates the thin skull rule extending beyond physical frailty to the belief system of the victim, and contrasts with Jordan, an earlier case where palpably wrong medical treatment broke the chain. It sits alongside Roberts and Pagett in defining the limits of novus actus interveniens, and Cheshire, a later case, again held that medical treatment would break the chain only if so independent of the defendant act as to make it insignificant.

Criticisms

• The decision may undervalue the victim's bodily autonomy by treating a competent adult's informed refusal of treatment as legally irrelevant to causation.
• It creates tension with civil law principles where a patient's refusal of treatment is respected and can break the chain of causation in negligence.
• The reasoning blurs the distinction between a pre-existing condition (the classic thin skull) and a contemporaneous decision made after the injury.
• It raises difficult questions about where to draw the line: would a victim's refusal of any treatment, however irrational, always fail to break causation?