## Facts

- R v Malcherek was heard alongside R v Steel, both involving similar circumstances.
- In Malcherek, the accused stabbed his wife, causing severe brain damage; she was placed on life support, which was later withdrawn after the doctors determined she was brain dead.
- In Steel, the accused attacked a woman, inflicting serious head injuries; she was also placed on life support, which was discontinued after brain death was confirmed.
- In both cases, the defendants were convicted of murder.
- The defendants appealed, claiming that the doctors’ actions in withdrawing life support constituted a new intervening act breaking the chain of causation.

## Issues

1. Whether the withdrawal of life support by medical professionals, following a finding of brain death, broke the chain of causation between the accused's act and the victim’s death.
2. Whether the original violent acts or the subsequent medical actions constituted the legal cause of death.

## Decision

- The Court of Appeal dismissed both appeals and upheld the murder convictions.
- The court determined that the original injuries inflicted by the accused were the effective and main cause of death.
- It was held that the medical teams acted properly and their actions did not interrupt the causal chain.
- Stopping life support after brain death did not amount to a new cause of death.
- The court accepted brain death, defined as the cessation of all brain function including the brain stem, as the legal definition of death.

## Legal Principles

- The chain of causation in homicide is not broken by the withdrawal of life support where brain death has been properly diagnosed.
- The "effective and main cause" test requires that the accused’s original act remains a substantial cause of death.
- Proper and competent medical treatment, including withdrawal of life support after brain death, does not override the accused’s causal responsibility.
- Only grossly negligent, independent medical treatment may potentially break the chain of causation.
- The case reaffirmed principles from earlier decisions such as R v Smith [1959] 2 QB 35, and influenced the development of the law in later cases including R v Cheshire [1991] 3 All ER 670 and Airedale NHS Trust v Bland [1993] AC 789.

## Conclusion

R v Malcherek established that lawful withdrawal of life support following a declaration of brain death does not constitute a new intervening cause and does not absolve the accused of responsibility; the accused’s original act remains the effective and main cause of death, thereby sustaining liability for homicide.


R v Malcherek [1981] 2 All ER 422