A case for clarity in causation?

The decision in the Bailey v. Ministry of Defence case raises some interesting issues in relation to the causal concept of ‘material contribution to harm’ and its applicability in the context of medical negligence. The Court of Appeal considered that the ‘material contribution to harm’ test of causation is a departure from the ‘but for’ test but that it is a departure the court is entitled to make in medical negligence cases in the same way as in cases involving any other type of negligence. The Court appears to have achieved the correct result in concluding that causation in this case was established on the basis that the negligence made a material contribution to the harm, but while the outcome seems to be correct, the Court's conclusion that material contribution to harm is a departure from ‘but for’ causation is not convincing. Moreover, the case highlights the need for greater clarity and analysis in courts' approaches to causal problems. In particular, in light of the recent focus on the development of risk-based conceptions of causation, this case is a welcome reminder that less complex causal chains do in fact exist. In addition to this, Waller L.J.'s remark that ‘one cannot draw a distinction between medical negligence cases and others’ is deserving of particular attention. It will be argued that this statement is too broad and, while it is applicable to the facts of Bailey, there exists an exceptional category of medical negligence cases, such as Hotson and Gregg, that do require a distinct approach to causation. [Introduction]