Wilsher v Essex Area Health Authority [1988]

Wilsher v Essex Area Health Authority [1988] AC 1074 is a significant English tort law case that addresses the "material increase of risk" test for causation. The case highlights the claimant's burden of proving likely causation in negligence claims, particularly in the context of medical negligence.

An infant was born prematurely and was administered oxygen by a junior doctor, who accidentally provided an excessive amount. The infant was later diagnosed with a retinal condition that severely impaired his vision. Medical experts identified five potential causes for the condition, four of which were related to the infant's premature birth, while the fifth was linked to the excessive oxygen administered by the junior doctor.

The primary issues in this case were whether the health authority, for which the junior doctor worked, could be held liable for the infant's injuries despite the inability to definitively pinpoint the exact cause of the injury. Additionally, the case questioned whether a junior doctor should be held to the same professional standards as a fully qualified doctor and whether the burden of proof regarding the relationship between the negligent actions and the injuries should rest with the claimant or the defendant.

Initially, the Court of Appeal found the defendant, Essex Area Health Authority, liable for the infant's injuries, relying on the precedent set by McGhee v National Coal Board [1973] 1 WLR 1. The Court of Appeal held that in cases with multiple possible causes, the burden fell on the defendant to prove that his actions were not the "but for" or material cause of the injury.

However, the House of Lords overturned this judgment upon appeal. They stated that while the health authority could be held liable for the actions of the junior doctor, as junior doctors owe the same duty of care as fully qualified doctors, the interpretation of McGhee by lower courts was incorrect. The House of Lords clarified that regardless of the number of potential causes, the burden of proof for establishing the likelihood of causation always falls on the claimant. Thus, the claimant must demonstrate that it was more likely than not that the defendant's negligence caused the injury. The House of Lords also clarified that McGhee did not establish a new rule of law but was rather based on a robust inference of fact. This interpretation of McGhee was later rejected in Fairchild v Glenhaven Funeral Services Ltd [2002] UKHL 22.

Wilsher v Essex Area Health Authority is pivotal in the realm of medical negligence and causation. It reaffirms the principle that claimants bear the burden of proving causation on the balance of probabilities. This case highlights the complexities involved in proving causation when multiple potential factors could contribute to the injury, emphasising the stringent requirements for claimants in negligence cases.
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