R v Blaue  1 WLR 1411, Court of Appeal
Full case judgment: The reported judgment, cited as  1 WLR 1411, is available from the ICLR. Alternatively, you can view the full judgment for this case, cited as  EWCA Crim 3, on the open-access BAILII website, http://www.bailii.org/ew/cases/EWCA/Crim/1975/3.html
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Ronald Blaue was convicted of the manslaughter of Jacolyn Woodhead on the grounds of diminished responsibility, wounding with intent to do grievous bodily harm, and indecent assault. He appealed against the conviction for manslaughter.
Woodhead was aged 18 and a devout Jehovah’s Witness. The defendant came into her house and asked for sex, which she refused. He attacked her with a knife, inflicting four serious wounds, including one that pierced her lung. She was taken to hospital, and the doctor determined that she needed surgery and that there had been such a loss of blood that she needed a blood transfusion. Ms Woodhead refused to have one, explaining that it was contrary to her beliefs as a Jehovah’s Witness. She maintained her refusal even when it was carefully explained to her that she would die without a transfusion. She signed a statement refusing the treatment under any circumstances. She died. The prosecution accepted that, had the victim had a blood transfusion, she would have survived.
At the trial, the defendant argued that he did not cause her death because her refusal to have blood transfusion broke the chain of causation. The trial judge urged the jury to apply their common sense to the issue and told them that they would be entitled to reach the conclusion that the defendant’s stab wound was an operating cause of death.
The defendant appealed.
Counsel for the appellant relied on two primary arguments to criticize the direction of the judge: the first was that the unreasonable conduct of the victim should break the chain of causation; the second was that the judge should have left the question of causation completely to the jury.
On the first question, the judge had referred to R v Holland (1841) 2 Mood & R 351, in which a defendant had injured the victim. The victim had been encouraged by a doctor to have surgery to remove a finger and thereby avoid infection spreading. The victim refused and later died from the infection. It was held in Holland that the defendant could be said to have caused the death of the victim. The Court of Appeal in Blaue agreed with that approach.
Counsel’s proposal that the jury should consider whether or not the victim’s response was reasonable was flawed for two reasons. The first related to how the jury was to decide whether the victim was being unreasonable? As Lawton LJ put it: ‘At once the question arises—reasonable by whose standards? Those of Jehovah’s Witnesses? Humanists? Roman Catholics? Protestants of Anglo-Saxon descent? The man on the Clapham omnibus?’ As he explained, the danger would be that two cases with the same facts could be viewed differently depending on the observer’s attitudes towards religion.
Second, the Court of Appeal confirmed a key principle: ‘[T]hose who use violence on other people must take their victims as they find them.’ This means not only the victim in their physical state, but also ‘the whole person’. As a result, ‘[i]t 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’.
The jury were consequently perfectly entitled to conclude as they did and there was no valid objection to the trial judge’s direction.
The appeal failed.
This case is typically used as the leading authority on the ‘thin skull’ rule, as it is commonly known—that is, that the defendants must take victims as they find them and cannot complain about the victim’s unusual physical, or religious, or psychological states nor about the failure of the victim to receive treatment. This case develops this principle in two ways: first, it is clear that the principle is not limited to physical vulnerabilities of the victim, but extends to the ‘whole person’, including their religious beliefs; and second, there is no room to claim that the victim making decisions in accordance with their religion or personality is acting unreasonably or unforeseeably. The defendant must take the victim as they are, however unusual or unreasonable other people may find the victim to be.
Opponents of the case argue that it is unfair that a defendant is held to have caused a result that they could not have foreseen. In the vast majority of cases, if a defendant had stabbed a victim in the way that the defendant had, the victim would have received a blood transfusion and survived. Should the defendant suffer a manslaughter conviction because, by chance, his victim had a particular religious belief? Supporters will reply that if you stab someone, you can never know what the outcome will be. It was no thanks to defendant that the victim reached hospital and treatment became an option.
In all of the debates over the case, it can be easy to lose sight of the key question: what caused the death? The answer to that question is easy. As Lawton LJ stated:
A major issue left unresolved by this case is whether it is limited to cases in which the victim fails to act and lets the defendant’s wound develop or whether it can be used in cases in which the defendant performs an act that introduces a new cause. For example, what would happen if the defendant were to rape a victim whose religion teaches her that she must commit suicide because she has been raped and she does so? Lawton LJ’s emphasis on the fact that the death was medically caused by the stab wound, rather than by anything the victim had done, may suggest that it does not apply in such a case.
A second issue is whether the case can be used where the victim is acting out of a clearly disreputable motive. For example, if the victim refuses treatment out of spite or to make a political point, does the principle still apply? It seems that it does, because the Court of Appeal made it clear that it saw the ‘unreasonableness’ approach as unacceptable. It would become very difficult for the courts to distinguish cases in which a victim refused treatment on religious grounds and those in which they relied on non-religious reasons. It is hard to see the courts being tempted to go down that road.
A third question is what the theoretical basis for the law on causation is. Complex academic opinions have been mooted. These include an approach asking whether the result was the reasonably foreseeable consequences of the defendant’s act; or whether the result was a natural consequence of the defendant’s acts. However, the courts seem to take the view that causation questions involve a mixture of moral, public policy, and jurisprudence questions. The law cannot be reduced to a single theory, but involves a balance of different factors.