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Causation In Fact & Law 
By Arron Cullen  on 21/10/2013 
Causation is the connection between conduct and result. That is to say that causation provides a means of connecting conduct with a resulting effect, typically an injury or death of a person. Within criminal law, causation is defined as the actus reus, the action/offence, from which the specific injury or other effect arose and is combined with mens rea, the mental thought/ideation.
This can be a  tricky topic to understand and can take a few attempts to understand thoroughly. There are two main parts to Causation that you have to take into consideration. Causation in fact and Causation in law. You must establish both causation in fact and causation in law.

Causation in Fact:
You must carry out the ‘But for test’. In order to establish causation it is vital to firstly ask if the defendant in fact caused the consequence of the offence. This test requires to ask a question like; But for what the defendant did would the consequences have occurred?

Cases which have used the ‘But for test’:
R v Blaue (1975) Jehovah’s Witness stabbed, refused blood transfusion.
R v Jordan (1956) Stabbed, then given “palpably” wrong medical treatment.
R v Dalloway (1847) driver of cart not holding reins, would have made no difference.

Causation in Law:
The ‘de minimis’ rule; The conduct must have made a significant contribution to causing the death and not be such a minimal cause that it should be ignored.
Intervening acts break the chain of causation with three exceptions:

◾The original injury was an operative and significant cause
◾The original act was reasonably foreseeable
◾The thin skill test 

The Thin or “Eggshell” Skull
The “Thin” or “Egg Shell Skull” Rule is a well established Legal Doctrine which holds a person  liable for all consequences resulting from his/her tortious (usually negligent) activities leading to an injury to another person, even if the victim suffers an unusually high level of damage e.g. due to a pre-existing vulnerability or medical condition.  The application of this rule does not distinguish between whether or not the fragility or thin skull characteristic of a tort victim is obvious. The term applies that if a person has a skull as delicate as the shell of an egg, and a tortfeasor who was unaware of the condition, injures that person’s head, causing the skull unexpectedly to break, the Defendant would be held liable for all damages resulting from the wrongful contact, even if
 a: such damage was not reasonably foreseeable or
 b: the tortfeasor did not intend to cause such a severe injury.

The doctrine is applied in all areas of tort, including negligence and strict liability cases, as well as in criminal law. Essentially the Courts do not want the accused or the Defendant to rely on the victim or Plaintiff’s own vulnerability to avoid liability. The tortfeasor takes his victim as he finds them. He compensates for all damage he caused, even if damages are elevated compared to the norm, because the Plaintiff was thin-skulled.

The principle appears to have been established in the 1901 English case of Dulieu V White & Sons 2KB 669 where it was stated:
“If a man is negligently runs over or otherwise negligently injures another, it is no answer to the sufferers claim for damage that he would have suffered less injury, or no injury at all, if he had not had an unusually thin skull or an unusually weak heart”

In the case of Harrison V Toombs heard by Her Honour Judge McReynolds in Craigavon County Court on 27th January 2010, the doctrine of the thin or “Eggshell” skull was applied by the Court. Primary liability was not in dispute in this case, however, the case was prepared for contest by the Defendant on a minimal impact basis (i.e. a low velocity accident which could not have caused injury to the Plaintiff).

Essentially the facts of the case were that the Defendant had nudged the rear of the Plaintiff’s vehicle as the two vehicles edged forwards in heavy traffic onto a roundabout. Notwithstanding the minor nature of the impact and the subsequent low level of damage caused to the vehicles, the judge was satisfied that the Plaintiff had sustained personal injuries, which contributed to the early onset of long-term neck problems. An MRI Scan showed that the Plaintiff had pre-existing degenerative pathology in her neck, which was essentially dormant at the time of the accident. The Judge considered that this relatively minor road traffic accident was an early activator of the problem, which would have occurred in any event, and affirmed that the Defendant must take his Plaintiff as he finds her. Notwithstanding that, the Defendant could not have been aware of the Plaintiff’s underlying neck condition, he was nonetheless responsible for the injuries which resulted from his negligent act, even though the Plaintiff’s injuries were more severe than one would normally have expected in an accident of such minor nature. The Judge cited the thin skull rule in awarding the Plaintiff damages in the sum of £3500.

E. 已升高的風險，但尚未造成實害：
除非能證明有顯而易見的極大可能性，否則｢將來的｣損害賠償請求，多會遭法院駁回；但亦有少數醫糾案例或以｢可能性酌減｣准予請求。(如：D，醫生，因疏失造成P有20%之可能性罹患他病，P可據此病之可能損害之20%向D求償)
F. 不確定多數被告：
因被告過失致多人受損傷，現已通過｢團體訴訟｣行為，當事人僅須釋明當時身處由被告所提供之有害環境、遭致相同之損害，即便不能舉證其損害與被告行為有相當因果關係，仍能有效求償。(如：隆乳者集體爆奶，團訴求償成立)

II. 最近原因說：
A. 通則：
被告因過失造成原告損害，但並不意味著被告須賠償因該過失行為衍生出的｢一切的｣損害結果；僅論以某結果之｢最近原因｣是否為行為人當時之｢決意｣而定，且被告之行為態樣、可責性，於此在所不問。如：D駕車不慎，與X所駕駛之車輛相撞，D不知X車上載有炸藥，引爆後導致十個街區外之一婦人受驚嚇，掉落所抱持之嬰兒P致受傷。D不負其損害賠償責任，因P受傷之最近原因非為D之駕車不慎，且D不能預見 (詳下段)。
1. 多重近因可能性：最近原因可能不只一個。如：兩車因過失互撞而致路人P受傷，最近原因可能為：共同侵權 (故意)、其中一司機單一過失、雙方與有過失。

III. 最近原因說之可預見性：
A. 通則：
多數實務見解認為，行為人客觀上於行為時點須有｢預見｣該結果發生之可能，方具可責性。如：例如：D船翻覆，漏油滿覆P碼頭，碼頭工人因焊接引燃浮油，油火連燒旁邊棉製品，轉而大火，燒燬碼頭。則稱該漏油過失，除非行為人能預見漏油事件將(因棉製品)導致燒燬碼頭一結果，否則該行為不能論以該損害之最近原因。
B. 不可預見之被告免責性：
除被告行為時須可預見之外，客觀上，被告本身尚須可預見。如：D侵害X，但間接使P受損，若P不能預見存有一加害人D之某行為而致P受損，P不得請求D損賠。
例：
X搭乘D公司列車，遭D員工推擠而掉落一裝有煙火爆裂物之行李並引爆，爆震導致月台後方坍塌，壓傷P。且D當時不能預見該行李中有煙火爆裂物。實務見解：P不能向D求償。理由為：D侵害X，但對P而言，實不能預見遠方之D對X之某行為將製造P之損害；D不知有爆裂物，不能預見月台坍塌而壓傷P，單純的推擠，客觀上不致引起P被月台壓傷，故非其最近原因而免責。
C. 衍生性身體傷害非預見免責的三個例外：
此為A之例外規定，對身體傷害而言，超過行為人可預見之後續性衍生傷害，行為人仍須負責。
1. 蛋殼頭骨理論：
可預見部分損害之侵權行為在先，但事實上所致損害遠大於客觀上所能預見之損害，行為人仍須負損賠責任。
D. 傷害預見，但手段未預見：
已預見該行為有致受傷之可能，傷害發生，但未依其預見之手段達成，行為人仍須負責。
例：
D將一把上膛手槍交與八歲之X，請其轉交予P。交付過程中，X不慎將槍滑落，砸傷赤腳之室友Y，又因Y腳趾勾到扳機，使該槍走火擊發，P中槍受傷。D雖不可預見Y的腳那麼帥，還能摳扳機射到P，但能預見一把上膛的手槍客觀上傷人的危險性，故仍須負侵權責任。至於Y之腳傷，D則不須負責，因交付槍枝之行為會砸傷赤腳之Y，客觀上應認該傷害不可預見。
E. 不特定侵權客體，行為人之可責性：
該侵權行為之明確客體，或為不可預見，但對行為人而言為可預見存有且客觀上相關聯者，該領域專業人須負損賠責任。
例：
D駕船過失停靠河岸，致船損壞，並撞上分離式吊橋，堤防崩壞，引發洪水沖毀沿岸若干居民財產。實務認縱D不能預見特定侵權行為客體，但能預見停靠船舶的過失將導致河岸周邊事物的損害，故仍應負侵權責任。