What is the thin skull (egg-shell skull) rule from Regina v Blaue?

A defendant must take the victim as found, including beliefs and vulnerabilities. If the original injury remains an operating and substantial cause, liability stands.

Did the victim’s refusal of blood break the chain of causation?

No. The Court of Appeal held the refusal did not break causation. The stab wound was still the operating and substantial cause of death.

Which court decided Regina v Blaue and what was the year?

The Court of Appeal (Criminal Division), England and Wales, decided it in 1975, citation [1975] 1 WLR 1411.

How do I cite Regina v Blaue in an answer?

Write it as R v Blaue [1975] 1 WLR 1411 (CA). Mention the thin skull rule and that refusal of treatment did not break causation.

What exam hook can I use for this case?

Use “Wound Wins”. If the wound is still operating and substantial, the chain remains. Beliefs do not excuse the attacker.

Regina v. Robert Konrad Blaue

CASE_TITLE: Regina v. Robert Konrad Blaue

PRIMARY_KEYWORDS: Regina v Blaue, R v Blaue, thin skull rule, novus actus, causation

SECONDARY_KEYWORDS: chain of causation, Jehovah’s Witness, manslaughter, diminished responsibility, Court of Appeal

PUBLISH_DATE: 02 Nov 2025 · AUTHOR_NAME: Gulzar Hashmi · LOCATION: India

Quick Summary

This case is about criminal causation. The accused stabbed an 18-year-old girl. Doctors needed a blood transfusion before surgery. She refused it due to her faith as a Jehovah’s Witness, even after being told she could die. She died. The defence said her refusal was a new intervening act (novus actus) that broke the chain of causation. The Court of Appeal said no: the stab wound remained the operating and substantial cause of death. In criminal law, you take your victim as you find them — beliefs included.

Issues

Did refusal of a life-saving transfusion break the chain of causation?
Was the original wound still the operating and substantial cause of death?

Rules

Operating & Substantial Cause Rule: If, at the time of death, the original wound is still operating and is a substantial cause, the death is the result of that wound, even if other factors are also present.

Thin Skull Rule: The perpetrator must take the victim as found — physical, mental, and religious characteristics included.

Facts (Timeline)

Timeline illustration for Regina v Blaue

3 May 1974 (late afternoon): The appellant entered the victim’s home, demanded sex, and stabbed her when she refused. One wound pierced her lung.

~7:30 pm: She was taken by ambulance to hospital.

~8:30 pm: Doctors recommended emergency surgery. A blood transfusion was required first.

Refusal: The victim, a Jehovah’s Witness, refused the transfusion for religious reasons despite warnings she might die.

Proceedings: The appellant faced charges including manslaughter (on diminished responsibility), wounding, indecent assault, and assaults on others. He was convicted at Teesside Crown Court and sentenced to life imprisonment.

Appeal: He appealed against the manslaughter conviction, arguing the chain of causation was broken by the refusal.

Arguments

Appellant

The victim’s refusal of transfusion was a novus actus interveniens.
Therefore, the chain of causation was broken; the death should not be attributed to the stabbing.

Respondent

The stab wound remained the operating and substantial cause of death.
Under the thin skull rule, the attacker must accept the victim’s religious stance.

Judgment

Appeal dismissed. The Court of Appeal held that the refusal did not break the chain of causation. The stab wound was still the operating and substantial cause of death.

A defendant cannot avoid liability by saying the victim could have lived if they had accepted recommended medical care — including blood transfusion — when the original injury is still a major cause.

Ratio

Core principle: Where a wound remains operative and substantial at death, liability for homicide remains, even if the victim’s choices (medical or religious) contribute to the outcome.

Thin skull rule extended: “Take your victim as you find them” covers beliefs and values, not just physical condition.

Why It Matters

Clarifies causation where medical refusal is based on sincere religious belief.
Strengthens the thin skull rule beyond physical fragility to personal convictions.
Guides exam answers on novus actus interveniens and medical treatment cases.

Key Takeaways

Causation stands if the wound is still operating and substantial.
Refusal of treatment (for faith or choice) does not break the chain.
Take your victim as found — beliefs, vulnerabilities, and risks included.

Mnemonic + 3-Step Hook

Mnemonic: “WOUND WINS”

Wound first: Ask if the wound is still operating.
Substantial cause: If yes, causation survives.
Victim as found: Beliefs don’t excuse the attacker.

IRAC Outline

Issue

Did the victim’s refusal of a transfusion break the chain of causation?

Rule

Operating & substantial cause; thin skull rule applies to beliefs.

Application

The stabbing caused life-threatening injury. Refusal flowed from sincere faith. The wound remained the main cause of death.

Conclusion

No break in causation. Conviction for manslaughter stands.

Glossary

Novus actus interveniens: A new intervening act that breaks the causal chain.
Thin skull rule: You take your victim as you find them, including beliefs and weaknesses.
Operating and substantial cause: A major, continuing cause at the time of death.