Court of Appeal (Criminal Division) · Court of Appeal (Criminal Division); judgment of the court delivered by Beldam LJ.
Facts
After an argument in a fish and chip shop, Cheshire shot the victim in the thigh and stomach. The victim was treated in hospital, including by a tracheotomy, and appeared to be recovering. Some two months later he died of cardiac arrest brought on by a narrowing of the windpipe at the site of the tracheotomy, a complication that the doctors treating him negligently failed to diagnose. By then the original wounds were no longer life-threatening.
History
The appellant was convicted of murder at trial. He appealed against conviction, arguing that the medical treatment (the tracheotomy and its mismanagement) broke the chain of causation.
Issue
Whether negligent medical treatment, specifically a tracheotomy and its subsequent mismanagement, breaks the chain of causation between the defendant's initial wounding and the victim's death.
Held
Appeal dismissed. The conviction for murder was upheld. The original gunshot wounds remained an operating and substantial cause of death.
Ratio
- Medical treatment does not break the chain of causation unless it is so independent of the defendant's acts and so potent in causing death that the defendant's acts become insignificant. The original wound need only be a substantial and operating cause at the time of death.
The judgments
Beldam LJ (lead)
Beldam LJ gave the judgment of the court. He treated Jordan as a decision on very unusual facts and held that medical treatment, even if negligent, will not break the chain of causation unless it is so independent of the defendant's acts and so potent in causing death that the jury regard the contribution of the original wounds as insignificant. Here the complication was a recognised consequence of the treatment of the wounds, so the shooting remained an operating and substantial cause of death.
Key reasoning
- Jordan was treated as an exceptional case on its own facts. Medical treatment will rarely break the chain of causation, because treatment of the wound is a natural and foreseeable response to the defendant's attack.
- The focus is on whether the original injury continues to be a substantial and operating cause at the moment of death, not on the quality of medical care.
- Negligence in medical treatment, even gross negligence, does not automatically sever causation unless it is so overwhelming that the original wound is merely the setting for the death.
Where it fits in the module
This case is central to Topic 1 on causation in the actus reus. It restates the approach to negligent medical treatment as a possible novus actus interveniens, explaining the earlier decisions in Smith (1959) and Jordan (1956), the latter being treated as an exceptional case. It contrasts with Blaue (1975) on refusal of treatment and sits with the later decision in Kennedy (No 2) (2007) on intervening voluntary acts.
Criticisms
- The operating and substantial cause test is vague and gives juries wide discretion, potentially leading to inconsistent verdicts.
- It effectively makes defendants liable for deaths caused by negligent medical care, which some argue is unfair when the treatment is grossly incompetent.
- The distinction between substantial cause and palpably wrong treatment is difficult to apply in practice and may collapse into a distinction without a difference.
- The rule may discourage medical professionals from taking responsibility for errors, knowing the original assailant will bear criminal liability.
Written with AI (nvidia/nemotron-3-ultra-550b-a55b) on 1 November 2026, reviewed for errors by a second model (claude-sonnet-5.5 (Claude Code reviewer)). Read the case itself at [1991] 3 All ER 670, [1991] Crim. L.R. 709. Spotted an error? Tell us.