Table of Contents
Acknowledgements v
Introduction 1
1 Theoretical and Doctrinal Framework 5
I The Theoretical Basis of Negligence 6
A Prioritising Coherence 6
B Corrective and Distributive Justice 8
C The Moral Basis of Corrective Justice: Aristotelian Corrective Justice and Kantian Right 10
D Incoherence of Consequentialist Theories 12
E Moving Beyond Formalism to the Legal System-Combining Kantian Right and Societal Morality 16
F The Place of Causation in Corrective Justice-Based Interpersonal Responsibility 20
II The Doctrinal Framework 21
A Identifying Issues of Interpersonal Responsibility in the Duty of Care 22
B Distinguishing Damage, Causation and Quantification 24
C Framing the Causation Question: Breach of Duty 29
III Conclusion 29
2 Identifying the Proper Function of Causation 31
Part I Identifying the Function of Causation in Negligence 32
I The Demands on Causation 32
A The Limited Role of Causation in Negligence 33
B The Robustness of the Philosophical Account 36
II Causation in the Philosophy of Hume and Mill 37
A Hume: Contiguity, Priority, Constant Conjunction and Necessity 37
B Mill: The Addition of 'Plurality' and 'Complexity' 39
i Complexity of Causes 39
ii Plurality of Causes 41
Part II Tests for Causation 42
I Complexity and Plurality of Causes as Necessary and Sufficient Conditions 43
A But-For and NESS in Simple Cases 44
B Over-determined Causation 47
i But-For, NESS and Pre-Emption 47
ii But-For, NESS and Duplication 48
II Overcoming Potential Problems with NESS 50
A Defining Key Causal Terms 51
B Applying NESS to Indivisible Damage: The Problem of Asymmetrical Duplication 53
i The Solution to Asymmetrical Duplication 54
ii Indivisible Damage: The Question of Apportionment 58
C Applying NESS to Divisible Damage 61
i Calculating Apportionment of Divisible Damage 63
Part III Using NESS to Overcome Common Problems with Exceptional Legal Tests 65
I The Current State of the Wardlaw Test 66
A The Facts of Bonnington Castings v Wardlaw 66
II Defining Damage: Divisibility of Damage or Divisibility of Trigger? 68
A Divisibility of Damage in Wardlaw 68
B Divisibility of Exposures to Harmful Agent 69
III Using NESS to Clarify the Material Contribution to Harm Test 71
A Asking the Right Questions: The Limits of the But-For Test 71
B Evidential Element: A Material Contribution to Harm 72
C Conceptual Element: A Material Contribution to Harm 73
D Applying NESS to Divisible Damage 74
E Applying NESS to Indivisible Damage 75
F Over-determined Indivisible Damage: Causation in Bailey 76
IV Conclusion 80
3 Proof of Causation 81
I Standards of Proof in Science and Law 83
A The Balance of Probabilities Standard of Proof 83
B Scientific Standards of Proof 88
i The Standards of Proof in Law and Science 88
ii The Nature of the Legal and Scientific Inquiries 91
II Epidemiological Evidence 93
A Epidemiological Studies: Design 95
B The Relative Risk 96
C The p-value and Confidence Intervals 97
D Moving from Association to Causation: The Bradford Hill Criteria 99
E Expert Evidence 101
i Expert Witnesses 101
ii Avoiding Judges' Guesswork 103
III Using (and Misusing) Epidemiological Evidence in Negligence 105
A Misusing Epidemiological Evidence: The Flaws of the 'More than Doubles the Risk' Test 105
i The Conflation of the Conceptual and Evidential Elements of Causation in the 'Doubles the Risk' Approach 107
ii Doubling of Risk in Epidemiology 108
B Using Epidemiological Evidence: The Place of Epidemiological Evidence in Standard Tests of Causation 113
i Admissibility 113
ii Personalising the Evidence: The Straw Man of 'Naked Statistics' 115
iii Personalising the Evidence: Using Epidemiological Evidence in Proof of Individual Causation 117
IV Conclusion 121
4 Loss of a Chance 122
Part I Loss of a Chance: Proportionate Recovery for Physical Harm 123
I Orthodox Negligence Principles Hotson and Gregg 124
A The Facts of Hotson 124
B Distinguishing Damage, Causation and Quantification 125
C The 'Hook' Argument 126
D The Vicissitudes Principle 127
E The Facts of Gregg v Scott 129
F Pain and Suffering 130
G Loss of Life Expectancy 131
II Loss of a Chance and the Balance of Probabilities Standard of Proof 133
A Resolving Hotson and Gregg on the Balance of Probabilities 134
B Proof in Hotson 136
C Proof in Gregg 137
D Reliability of the Evidence in Gregg 138
E Personalising the Evidence in Gregg 139
F Rejecting 'Chance' Conceived as a Proportion of the Physical Outcome 140
Part II The 'Lost Opportunity' as Damage 145
I The Patient's Autonomy Interest 146
A The Loss Suffered by the Claimant 148
B The Place of Autonomy within the Doctor-Patient Relationship 153
i The Focus of the Doctor's Duty of Care 153
ii The Nature and Extent of the Uncertainty 155
C The Limited Scope of Loss of Opportunity as Damage 156
II Orthodox Application of the Remaining Negligence Doctrines 158
A Quantifying the Loss 159
5 The Evidentiary Gap 164
I Defining the Evidentiary Gap 165
A The Evidentiary Gap Relating to Dermatitis: McGhee v National Coal Board 166
B The Evidentiary Gap Relating to Mesothelioma: Fairchild v Glenhaven Funeral Services 167
C Analysis of the Evidentiary Gap 169
i NESS and Identifying the Problem: Locating the Evidentiary Gap 170
ii NESS: Separating the Conceptual from the Evidential Aspects of the Legal Solution 172
II Evidential Solutions: The Inferential Approach 173
A The Inferential Approach to McGhee 175
B The Issues Concealed by an Inferential Approach 177
C Closing the Evidentiary Gap 180
III Risk of Harm as the Gist of the Negligence Action: Barker v Corus (UK) plc 182
A The Decision in Barker v Cor its 182
B Analysis of the 'Risk as Gist' Approach 186
i The Inconsistency of the Physical Harm Requirement 186
ii Physical Harm and Risk: A Shift in Perspectives 189
iii What is 'Risk'? 189
iv Can Risk Constitute Damage? 191
v Calculating Risk and Probability 191
vi 'Increase in Risk' or 'Contribution to Risk'? 193
C Can Risk Constitute Damage in Corrective Justice? 194
i Objective Risk: The Evidentiary Gap Prevents Proof that the Defendant Created an Objective Risk 195
ii Subjective/Epistemic Risk: Lacks the Moral Significance to be Damage 196
iii The Difficulty of Explaining Why Epistemic Risk Deserves Compensation 197
D Epistemic Risk: The Conflation of Breach and Damage 200
IV Theoretical Approaches to the 'Evidentiary Gap' 201
A Dispelling Possible Misconceptions 202
i McGhee: The Defendant Definitely Caused the Damage 202
ii Fairchild: The 'Innocent Claimant' Argument 203
iii Reformulating Damage in the Innocent Claimant Argument 206
B Where Next? 210
i Mesothelioma 210
ii Other Diseases Involving an Evidentiary Gap 211
iii The Single Harmful Agent Rule: Wilsher v Essex Area Health Authority 212
iv What is a Single Harmful Agent? 214
v Limiting the Fairchild Exception to Mesothelioma 216
V Conclusion 222
Conclusion 223
Bibliography 227
Index 237
