legal Case Summary
R v Malcherek and Steel [1981] 2 All ER 422
Victim requiring medical treatment – Act breaking chain of causation
Facts
Malcherek
Malcherek stabbed his wife in the abdomen. She was treated for the wound and a few days later she collapsed in hospital. She subsequently had surgery to remove a blood clot during which her heart stopped beating for thirty minutes before it was restarted by the doctors again. This thirty minute period had caused the victim to suffer irretrievable brain damage and as a result, she was placed on a life support machine. A day later, the life support machines were disconnected as there was no chance of her condition improving.
Steel
Steel attacked a girl and caused serious head injuries. She was taken to hospital and put on a life support machine almost immediately, shortly afterwards it was concluded that her brain had stopped working and the machine was disconnected.
Issues
In each case, the medical treatment that was given was considered normal and in line with approved medical practice. Both Malcherek and Steel were charged with murder. In both instances, the trial judges withdrew the issue of causation from the jury as it was clear the initial injuries inflicted were the cause of death. This direction was appealed by Malcherek and Steel.
Decision / Outcome
Appeal dismissed. The fact that the treatment was in line with medical opinion could not prevent the defendants having their guilt absolved. There was no evidence that the original injuries inflicted stopped being the operative cause of death. On this basis, it was held that the Issue was properly and appropriately withdrawn from the jury by the trial judges.
Updated 20 March 2026
This case summary accurately reflects the decision in R v Malcherek and Steel [1981] 2 All ER 422. The legal principles established in this case — that switching off a life support machine following approved medical practice does not break the chain of causation, and that the original injuries remain the operative cause of death — remain good law in England and Wales. The case continues to be cited in criminal law teaching on causation and is consistent with subsequent case law on the topic, including R v Cheshire [1991] 1 WLR 844, which further developed the principles around medical intervention and causation. No statutory changes have displaced these principles. Readers should note, however, that one sentence in the summary contains a likely drafting error: it states that medical treatment “could not prevent the defendants having their guilt absolved,” which appears to say the opposite of what was decided. The court held that the defendants’ guilt was not absolved. This does not affect the overall accuracy of the summary, but readers should be aware of the ambiguity.
