R v Blaue [1975] 1 WLR 1411
R v Blaue applies the thin-skull rule to a victim's religious beliefs and refusal of medical treatment. The assailant could not rely on the victim's refusal of a blood transfusion to escape liability.
Facts
Blaue entered a young woman's home and asked her to have sexual intercourse with him. When she refused, he stabbed her several times. One wound penetrated her lung and caused serious bleeding. At hospital, doctors advised that a blood transfusion was needed to save her life. The victim was a Jehovah's Witness and refused blood because doing so conflicted with her religious beliefs. She understood that refusal placed her life at risk and subsequently died from blood loss. Blaue was convicted of manslaughter and argued on appeal that the victim's unreasonable refusal of effective treatment, rather than the stabbing, had caused her death and broken the chain of causation.
Legal Issue
Did the victim's informed refusal of a life-saving blood transfusion for religious reasons break the causal link between Blaue's stabbing and her death?
Held
The Court of Appeal dismissed the appeal. The stab wound remained an operating and substantial cause of death. Lawton LJ held that the assailant must take the victim as found, not only in physical characteristics but also in beliefs that influence treatment choices. The criminal court was not to judge whether the victim's religious conviction was reasonable. Her refusal did not transform the medical position created by Blaue into an independent cause that displaced his responsibility. He had inflicted a dangerous wound from which she bled to death. The thin-skull principle therefore prevented him from relying on the particular vulnerability represented by her beliefs and refusal of blood.
⭐ Legal Principle
An offender must take the victim as found, including physical conditions and sincerely held beliefs affecting medical treatment. A victim's refusal of treatment does not normally break the chain while the original injury remains an operating and substantial cause of death.
Significance
Blaue is the leading criminal application of the thin-skull rule and confirms that causation does not depend on courts approving the victim's personal decisions. It sits alongside R v Smith and R v Cheshire, which ask whether the defendant's injury remained a substantial and operating cause despite later medical events. The decision does not mean that no subsequent act can ever break the chain. A free, informed and sufficiently independent intervention may do so, but ordinary treatment choices and vulnerabilities generally leave the assailant responsible for the consequences of the injury created.
Common exam questions about this case
Why did the refusal of a blood transfusion not break the chain of causation?
The stab wound remained the source of the fatal blood loss and was still an operating and substantial cause of death. The victim's religious refusal did not erase that injury or replace it with a wholly independent cause. Under the thin-skull rule, Blaue had to accept the victim's beliefs and treatment decision as part of the person he attacked.
Does the thin-skull rule apply only to physical vulnerabilities?
No. Blaue applies it to the victim's psychological or religious characteristics as well. A defendant cannot argue that a different or more conventionally minded victim would have accepted treatment and survived. Once the relevant injury is inflicted, unusual susceptibility or beliefs may affect the extent of the consequence without removing legal causation.
Can medical events ever break the chain after a defendant injures the victim?
Yes, but the threshold is high. The original injury must cease to be an operating and substantial cause, or the later intervention must be so independent and potent that it eclipses the defendant's contribution. Refusal of treatment in Blaue did not do this. Cases such as Cheshire likewise make ordinary or even negligent treatment unlikely to relieve the attacker of responsibility.