## Facts

- Holland unlawfully assaulted Thomas Garland and inflicted multiple wounds, including a serious cut to a finger or thumb.
- The wound became dangerously infected, creating a substantial risk of death.
- A surgeon advised prompt amputation of the injured digit to avoid fatal consequences and warned death was likely without it.
- Garland refused the recommended operation for a period of time.
- Garland’s condition worsened (including development of a severe systemic condition such as lockjaw/tetanus or gangrene).
- An amputation was eventually performed, but too late to prevent Garland’s death.
- Medical testimony indicated Garland probably would have survived had the amputation been performed when first advised.
- Holland was indicted for murder; the trial judge instructed the jury that the victim’s refusal of treatment did not excuse the defendant if the wound caused death.

## Issues

1. Whether a defendant who inflicts a dangerous wound is criminally liable for homicide when the victim refuses recommended medical treatment that likely would have prevented death.
2. Whether the victim’s refusal of amputation constitutes a superseding intervening act (novus actus interveniens) that breaks the chain of causation.

## Decision

- The court upheld the homicide conviction.
- The court held that the victim’s refusal of medical treatment did not break the chain of causation.
- The court approved the instruction that it was immaterial whether the wound was immediately mortal or became fatal because the victim did not accept the best available remedy, so long as the wound caused the death.

## Legal Principles

- A defendant is criminally responsible for homicide if the unlawful wound inflicted is a legal cause of death, even if death might have been avoided by proper medical treatment.
- A victim’s refusal of recommended medical or surgical treatment, without more, is not a superseding intervening act that relieves the assailant of liability.
- Causation focuses on whether the defendant’s wrongful act remained the operative cause of death; the victim’s medically unwise choices ordinarily do not transfer responsibility from the wrongdoer.

## Conclusion

The court affirmed that when an assailant unlawfully inflicts a wound that results in death, the victim’s refusal to undergo recommended treatment—even treatment likely to prevent death—does not ordinarily sever causation, leaving the assailant liable for homicide.


Regina v. Holland, 174 Eng. Rep. 313 (K.B. 1841)