PROXIMATE CAUSE..."BUT FOR"?

One of the thorniest issues in proving medical negligence is identifying the proximate cause of injury to the plaintiff. Without such proof, there is no medical negligence.

The plaintiff must produce proof that the proximate (direct and legal) cause of the injury was a breach of conduct by the defendant. Thus, proximate cause is an event sufficiently related to a legally recognizable injury to be held the cause of that injury. Proximate cause is the primary cause of an injury. It is not necessarily the closest cause in time or space nor the first event, but it is the determining event.

The "but-for" test states that but for the action, the result would not have happened.  More definitively, the courts have devised the "but for" or "sine qua non" rule, which considers the question: “but for the defendant’s actions, would the plaintiff’s injuries still have occurred?” The finding that an injury would not have occurred “but for” a defendant's negligent act establishes that the particular act or omission is the proximate cause of the harm. However, it does not necessarily establish liability since a variety of other factors can come into play.

As society, technology, and case law have evolved, circumstances that lend themselves to such a black-and-white view of causation have grown fewer.  Sometimes one’s actions impact another, but as a contributing factor rather than a sole producing cause.  The notion that one must be totally responsible or not at all responsible in producing an injury is less valid today because it would permit too many an opportunity to avoid responsibility for conduct that plays a significant role in producing an injury.

Complicated? You bet! 

Next time we will look at some refinements of proximate cause.