R v Adomako [1995] 1 AC 171

Adomako was the anaesthetist during an eye operation. A tube in the anaesthetic equipment became disconnected, stopping the patient's oxygen supply. Adomako failed for several minutes to notice either the disconnection or obvious signs that the patient was not receiving oxygen. The patient suffered a cardiac arrest and later died from the resulting brain damage. Expert evidence described Adomako's failure to recognise and respond to the disconnection as exceptionally serious. He was convicted of gross negligence manslaughter. On appeal he argued that the offence had been inadequately defined and that the jury needed a more elaborate direction about recklessness or the degree of fault required.

What elements establish gross negligence manslaughter, and how should a jury decide whether a negligent breach of duty is sufficiently serious to be criminal?

The House of Lords dismissed the appeal. Lord Mackay LC held that the ordinary principles of negligence provide the framework. The prosecution must prove that the defendant owed the deceased a duty of care, breached it, and thereby caused death. The jury must then decide whether, having regard to the risk of death and all the circumstances, the breach was so gross as to justify criminal liability. The question is whether the conduct departed from the proper standard so seriously that it should be characterised as a crime deserving punishment, not merely as a matter for civil compensation. A separate Caldwell recklessness direction was unnecessary. On the evidence, Adomako's prolonged failure to notice the disconnected tube was capable of satisfying that high threshold.

Gross negligence manslaughter requires a duty of care, breach, causation of death, a serious and obvious risk of death that was reasonably foreseeable at the time of breach, and negligence so exceptionally serious that the jury considers the conduct criminal. Ordinary carelessness or civil negligence alone is insufficient.

Adomako remains the leading authority for deaths caused by grossly negligent acts or omissions, including professional and workplace failures. Later Court of Appeal decisions make explicit that a serious and obvious risk of death must have been reasonably foreseeable at the time of breach; foresight of some injury is insufficient. The final assessment of grossness is for the jury under proper legal direction. The offence differs from unlawful-act manslaughter, which requires an objectively dangerous criminal act rather than breach of a duty of care.