## Facts

- The defendant stabbed the victim four times after she refused his sexual advances.
- The victim, a Jehovah's Witness, refused a blood transfusion required to treat her injuries due to her religious beliefs.
- She was informed that refusing the transfusion would likely result in death but maintained her refusal.
- The victim died as a result of her injuries and refusal of treatment.
- The defendant was charged with manslaughter.
- The key issue was whether the victim’s refusal of medical treatment constituted a novus actus interveniens, potentially breaking the chain of causation from the defendant’s act to her death.

## Issues

1. Whether the victim’s refusal of a potentially lifesaving blood transfusion, on religious grounds, broke the chain of causation between the stabbing and her death.
2. Whether the "thin skull" rule extends beyond physical conditions to non-physical characteristics such as religious beliefs.
3. Whether the defendant could be held criminally liable for manslaughter despite the victim’s omission in accepting treatment.

## Decision

- The Court of Appeal upheld the manslaughter conviction.
- The court determined that the victim’s refusal of medical treatment did not break the chain of causation.
- The "thin skull" rule was applied to include not just physical conditions, but also the victim’s religious beliefs.
- Lawton LJ stated that those who use violence must take their victims as they find them, meaning the whole person—including non-physical attributes.
- The court regarded the victim’s refusal as an omission, not an intervening act, and thus not a novus actus interveniens.

## Legal Principles

- The "thin skull" rule requires defendants to take their victims as they find them, extending to all vulnerabilities, including religious beliefs.
- Causation in criminal law involves both factual causation (the "but for" test) and legal causation (assessing if the defendant’s act was a substantial and operating cause and whether any intervening acts broke the chain).
- A victim’s omission (refusal of treatment due to personal beliefs) does not necessarily constitute a novus actus interveniens.
- Legal accountability is maintained even if the victim’s vulnerabilities or responses are unusual or unforeseen.

## Conclusion

R v Blaue affirmed that defendants are fully liable for the outcomes of their actions, regardless of a victim’s pre-existing physical or non-physical conditions, firmly applying the "thin skull" rule to religious beliefs and ensuring the chain of causation remains intact in such cases.


R v Blaue [1975] 3 All ER 446