‘Aetiology’: the assignment of a cause; the science or philosophy of causation; that part of medical science which investigates the causes of disease — Shorter Oxford English Dictionary
2.
See [1994] 5 Med LR 54
3.
[1969] 1 QB 428
4.
See also Robinson v Post Office [1974] 2 All ER 737, where a doctor's omission properly to test for an allergic reaction to an anti-tetanus vaccination was held not to have caused the patient's subsequent allergic reaction. The reason for this was that, in the particular circumstances of the case, the test would not have revealed the patient's allergy in the usual time, and therefore the injection would still have been administered
5.
See Smith v Barking, Havering and Brentwood Health Authority (1988) [1994] 5 Med LR 285; and, for discussion of this issue in the context of failed sterilization, see Jones, MA. Failed Sterilization and Omission to Warn: The Causation Problem. Clinical Risk 1998; 4: 12–16
6.
[1994] 5 Med LR 343
7.
[1997] 4 All ER 771
8.
Though this was not uncontroversial, since the judge had already disbelieved the defendant in a conflict of evidence between the doctor and a senior nurse. In the Court of Appeal, Simon Brown L.J., in a dissenting judgment, pointed out that in these circumstances it was unsatisfactory to place much reliance upon any doctor's evidence as to what he or she would have done had they complied with their duty to attend a patient. Inevitably, if unconsciously, any doctor in that situation would tend to believe and suggest that their attendance could and would have made no difference: [1993] 4 Med LR 381, 388
9.
‘A defendant cannot escape liability by saying that the damage would have occurred in any event because he would have committed some other breach of duty thereafter.’ See also Joyce v Wandsworth Health Authority [1996] PIQR P121: the claimant underwent an operative procedure which resulted in a partially occluded artery, leading three months later to an upper brain-stem infarction, causing almost total paralysis. Although the procedure itself was not necessarily negligent the immediate follow-up care that the claimant had received was negligent, in that he was discharged from hospital without proper instructions and advice. The only thing that could have prevented the damage was if, within the first 48 hours, the claimant had been seen by a vascular surgeon and the surgeon had decided to operate to deal with the occlusion. The Court of Appeal held that to succeed on causation the claimant had to prove either that had the vascular surgeon at the hospital been summoned he would in fact have re-operated or that it would have been negligent for him not to do so
10.
Bolam v Friern Hospital Management Committee [1957] 2 All ER 118
11.
Maynard v West Midlands Regional Health Authority [1984] 1 WLR 634
12.
Cavanagh v Bristol and Weston Health Authority [1992] 3 Med LR 49, 56
13.
[1995] 4 All ER 907
14.
Pickford v Imperial Chemical Industries plc [1998] 3 All ER 462. The claimant alleged that there was a physical cause for the genuine symptoms of cramp in her hands (repetitive strain due to excessive typing) whereas her employers argued that it had a psychological cause. The claimant's claim failed because she could not prove that there was a physical cause, even though it was not proved that the cause was psychological
15.
Reay v British Nuclear Fuels plc [1994] 5 Med LR 1
16.
See, for example, Loveday v Renton [1990] 1 Med LR 117: The National Childhood Encephalopathy Study suggested that it was ‘possible’ that pertussis vaccine could cause brain damage in young children, but it was not ‘probable’ that it did. Compare Best v Wellcome Foundation Ltd [1994] 5 Med LR 81, however, where a causal link was established between pertussis vaccine and the claimant's brain damage from the fact that there was a close temporal connection between the child's first convulsion and the injection of the vaccine, and the vaccine was proved to be from a defective batch
17.
Jones v Great Western Railway Co (1930) 47 TLR 39, 45 per Lord Macmillan
18.
[1956] AC 613
19.
[1972] 3 All ER 1008
20.
[1988] 1 All ER 871
21.
Ibid, at p. 835
22.
[1987] 2 All ER 909
23.
Hotson v East Berkshire Area Health Authority [1987] 1 All ER 210, 223
24.
Though actions against solicitors for negligence in permitting a claim against a third party to be lost (e.g. through failing to issue proceedings in time) are dealt with on the basis of the claimant's ‘lost chance’ of winning the case, and this applies even where the claimant's chances of success in the initial action were less than 50%. This may be an instance where the claimant's loss depends on the hypothetical actions of an independent third party (in this case the court), as in Allied Maples Group Ltd v Simmons and Simmons [1995] 4 All ER 907. See above ‘The “but for” test' (‘Third parties’)
