Cutts, R v

Where causation is disputed in a murder trial, it ordinarily remains a question for the jury, even where the evidence is substantially expert medical evidence. The jury must assess the expert opinions against the factual evidence, including the deceased’s condition before and after the alleged injury.

An expert’s use of expressions such as most probable does not prevent a jury from being sure of causation. A trial judge need not withdraw the case merely because defence experts advance competing explanations. The case may remain for the jury where the Crown evidence is capable of rational acceptance and the opposing account may be tested against the proved facts.

The appellant was convicted of murder at Nottingham Crown Court before Crane J and sentenced to life imprisonment. The deceased, who had severe diabetes, died from diabetic ketoacidosis after suffering head injuries which the Crown alleged the appellant inflicted with a wine bottle.

The disputed issue was causation. The Crown case was that the injuries created metabolic stress which precipitated fatal ketoacidosis. The defence relied on expert evidence that the injuries could have had little effect and that viral encephalitis might instead have caused death.

The appellant appealed against conviction, contending that the judge should have withdrawn the case from the jury both at the close of the Crown case and after all the evidence had been heard, and that the conviction was unsafe.

1. Appeal dismissed. The judge correctly left the case to the jury both at the close of the Crown case and after the defence evidence. The conviction for murder was not unsafe.

2. Causation was a question for the jury. Although the issue was dominated by expert evidence, the jury had to evaluate the medical opinions against factual evidence about the deceased’s functioning before and after the injuries. The Crown expert’s opinion that injury-related stress was the most probable explanation was capable of supporting a finding of causation. His language was not a legal formula, and the criminal standard did not require an assertion of absolute certainty.

3. The subsequent defence evidence did not require withdrawal of the case. A trial may reach a stage during defence evidence at which a judge must stop it proceeding and a contrary verdict would be unsafe. However, that did not occur here. The jury could rationally prefer the Crown evidence because the defence theory of natural decline conflicted with evidence that the deceased had continued to function shortly before the assault. It could also regard the suggested equivalence between the stress of head injuries and mental arithmetic as unpersuasive.

4. The jury was likewise entitled to prefer the pathologist’s evidence to the evidence that viral encephalitis was a self-sufficient cause of death. The latter theory was contested, might itself have resulted from ketoacidosis, and did not exclude injury as a cause. A short deliberation, without more, gave no basis for finding that the jury had failed properly to consider the evidence.

• Court of Appeal (Criminal Division): The appeal against conviction was dismissed in [2003] EWCA Crim 28.
• Nottingham Crown Court: Crane J convicted the appellant of murder on 14 May 2001 and imposed life imprisonment. No citation for that decision is stated in the judgment.