Paul v Royal Wolverhampton NHS Trust [2024] UKSC 1

The Supreme Court heard three conjoined clinical-negligence appeals. In each, a defendant allegedly failed to diagnose or treat a life-threatening condition. Months later, close family members witnessed the patient suffer a sudden death or collapse and developed recognised psychiatric illnesses. In Mr Paul's case, his young daughters saw him collapse and die from a heart attack fourteen months after an allegedly negligent failure to diagnose coronary disease. The claimants argued that they had witnessed the first horrifying manifestation of the injury caused by the earlier negligence and satisfied the established requirements for secondary victims. The healthcare defendants contended that the law did not impose a duty to protect relatives from the psychiatric consequences of witnessing illness or death not caused by an accident.

Can a close relative recover as a secondary victim for psychiatric illness caused by witnessing a patient's death or medical crisis resulting from an earlier negligent failure to diagnose or treat disease?

By a majority, the Supreme Court dismissed the appeals. The established exception for secondary victims concerns psychiatric injury caused by witnessing an accident, or its immediate aftermath, in which the defendant's negligence kills, injures or imperils the primary victim. A patient's later death or medical crisis from disease is not such an accident merely because earlier clinical negligence contributed to it. Doctors owe duties to protect patients from physical harm, but they do not ordinarily undertake responsibility to protect family members from the psychiatric effect of witnessing the patient's condition. The Court rejected the proposed rule based on the first manifestation of actionable damage, which was artificial and uncertain. Lord Burrows dissented, considering the claims capable of falling within the established controls.

A secondary victim generally cannot recover for psychiatric illness caused by witnessing the death or medical crisis of a relative resulting from an earlier failure to diagnose or treat disease. The recognised duty is confined to witnessing an accident caused by the defendant, or its immediate aftermath, which injures or endangers the primary victim.

The decision resolves conflicting clinical-negligence authority and substantially restricts secondary-victim claims in that setting. It preserves the Alcock control mechanisms but adds that the relevant shocking event must be an accident caused by the defendant, not the later consequence of an untreated disease. The ruling also explains Page v Smith as a primary-victim accident case. Close family ties and direct perception remain necessary but are not sufficient. The majority acknowledged the potentially arbitrary boundaries, while treating any broader reform as a matter for Parliament rather than incremental judicial expansion.