R v Blaue [1975] 3 All ER 446
The Thin-Skull Rule and Causation in Criminal Law
Court
Court of Appeal (Criminal Division)
Judges
Lawton LJ, Thompson & Shaw JJ
Citation
[1975] 3 All ER 446
Judgment Date
23 June & 16 July 1975
The Facts
Jacolyn Woodhead was eighteen and deeply committed to her faith as a Jehovah's Witness. One evening Robert Blaue made an unwanted sexual advance; when she refused, he snapped and stabbed her four times. A blade punctured her lung, and she quickly began to bleed out. Paramedics rushed her to hospital, where surgeons explained that only an immediate blood transfusion could keep her alive long enough for surgery. Jacolyn listened, understood the risk, yet calmly signed the form refusing transfusion because her religion forbade it. Doctors pleaded, but she would not bend. By the next morning she was gone, the unchecked blood loss from the stab wound still the clear medical cause of death. Everyone in court accepted one heartbreaking fact: a single transfusion would almost certainly have saved her life.
Central Legal Issue
Did the victim's refusal of life-saving treatment sever the causal link between the stabbing and the death?
If so, Blaue would not be criminally responsible for homicide.
Key Reasoning (Three Steps)
1. Take Your Victim as You Find Them
The common-law "thin-skull" rule applies in criminal as well as civil law: an assailant must take the victim physically and mentally as they are. That includes religious convictions affecting medical choices.
"It is not open to an assailant to assert that the victim's beliefs were unreasonable." – Lawton LJ.
2. Operative & Substantial Cause Test
Adopting Lord Parker CJ's formula in R v Smith (1959): If the original wound is still an operative and substantial cause at the time of death, liability remains.
The lung wound was still bleeding; the refusal of a transfusion did not introduce a new, overwhelming cause.
3. Victim Autonomy Does Not Break Causation
The appeal judges put it clearly. A jury is not there to referee someone's faith. If twelve people could rule on which beliefs are reasonable, each courtroom might give a different answer. That would weaken the law's promise to respect personal autonomy. The rule therefore stays firm: an attacker must take the victim as they are. For Robert Blaue that meant accepting the young woman's refusal of a transfusion. The court saw her choice as an omission driven by conviction, not a new act that cut the causal chain.
Holding
The stabbing was still an operative cause of Jacolyn's death, so the causal chain stayed intact. The Court of Appeal dismissed Blaue's challenge and left his manslaughter conviction and life sentence undisturbed.
Key Quotes
"Those who use violence must take their victims as they find them. That means the whole person, not just the physical frame."
"The failure of the victim to accept treatment, however unwise, did not break the causal connection between the act and the death."
"Only if a subsequent cause is so overwhelming as to render the original wound merely part of history can the chain be broken."
Why the Case Matters
1. Confirms the Thin-Skull Principle in Crime
Offenders cannot blame a victim's frailty, medical condition, or religious choices for fatal outcomes.
2. Sets a Clear Causation Rule
A victim's refusal of treatment - no matter how unusual - rarely defeats liability unless it is truly overwhelming and independent.
3. Respects Victim Autonomy & Public Safety
Upholds freedom of religion while ensuring assailants remain accountable.
4. Teaching Point on "Operative Cause"
Useful for illustrating how courts decide whether an initial act remains legally significant despite later events.
Reflection
R v Blaue is a stark reminder that violence carries consequences beyond the attacker's control. Blaue intended harm, but not death; yet his victim's steadfast faith led to a fatal outcome he must legally answer for. The decision balances two important values: the sanctity of individual conscience and the community's need to hold wrongdoers responsible. It tells would-be offenders: you cannot dictate how a victim should protect their own life, and you bear the risk if your violence sets disaster in motion.