R v Cheshire (David William) [1991] 1 WLR 844

Chain of causation – Death in hospital following shooting


Cheshire shot a man during the course of an argument. The victim was taken to hospital to have surgery and shortly after developed respiratory issues. The doctors inserted a tracheotomy tube, which remained in place for four weeks and initially improved the victim’s condition. Several days later the victim complained of respiratory issues, his condition soon worsened and he died shortly afterwards. The post-mortem found that the victim’s windpipe had narrowed near the location where the tracheotomy pipe had been inserted. Cheshire was subsequently charged with murder and convicted. The decision was appealed.


A key issue in this case was whether the accused’s acts of shooting the victim had caused the death or whether the chain of causation was broken by the negligent medical treatment that the victim had received following being injured by the shooting. The judge in this case directed the jury to decide whether Cheshire’s acts could have made a ‘significant contribution’ to the victim’s death. Importantly, the judge directed the jury that the acts need not be the sole or even main cause of death.


Appeal dismissed. The jury was not required to evaluate the competing causes of death and therefore the judge was right to direct them as he did in the first instance. It was clear that the negligent medical treatment in this case was the immediate cause of the victim’s death but that did not absolve the accused unless the treatment was so independent the accused’s act to regard the contribution as insignificant.