## Facts

- The defendant entered an 18-year-old woman’s flat, demanded sexual intercourse, and stabbed her four times after she refused; one wound punctured her lung.
- The victim, a Jehovah’s Witness, was taken to hospital in critical condition and advised she needed an immediate blood transfusion to survive.
- She refused the transfusion for religious reasons.
- Medical evidence indicated she would have lived if she had accepted the transfusion; she died from the stab wound without the transfusion.
- The defendant was charged with murder but was convicted of manslaughter on the basis of diminished responsibility.
- He appealed, arguing the victim’s refusal of treatment was a new intervening act that broke the chain of causation.

## Issues

1. Whether a victim’s refusal of potentially life-saving medical treatment for religious reasons constitutes a novus actus interveniens that breaks the chain of causation between the defendant’s unlawful act and the victim’s death.
2. Whether the defendant’s stabbing remained an operating and substantial cause of death notwithstanding the refusal of treatment.

## Decision

- The Court of Appeal (Criminal Division) dismissed the appeal and affirmed the manslaughter conviction.
- The victim’s refusal of a blood transfusion did not break the chain of causation.
- The stab wound remained an operating and substantial cause of the victim’s death.

## Legal Principles

- Causation is satisfied where, at death, the original injury remains an operating and substantial cause, even if other factors contribute.
- A defendant must take the victim as found; this principle applies to the victim’s characteristics and beliefs as well as physical condition.
- A victim is not required to mitigate harm by accepting medical treatment; refusal of treatment, even if viewed as unreasonable, will not relieve the assailant of liability when the original injury remains operative.
- The reasonable-foreseeability analysis used for a victim’s affirmative acts is less apt where the victim’s conduct is an omission such as declining treatment; in such cases the “take the victim as found” principle controls.

## Conclusion

Because the lung stab wound remained a substantial, operative cause of death, the victim’s religiously motivated refusal of a blood transfusion did not sever causation, and the defendant remained criminally responsible for homicide.


Regina v. Blaue, [1975] 3 All E.R. 446 (Eng. C.A. Crim. Div. 1975)