Landmark UK Supreme Court ruling restricts damages for psychiatric illness in medical negligence cases

Citation: [2024] UKSC 1
Judgment on


The case of Paul and another v Royal Wolverhampton NHS Trust and related appeals presented before the UK Supreme Court in 2024 raised significant legal questions concerning the recoverability of damages for psychiatric illness suffered by secondary victims as a result of witnessing the death of a close relative due to medical negligence. This landmark judgment grapples with the extension of the duty of care beyond primary victims and the control mechanisms established by prior case law.

Key Facts

The consolidated appeals involve close family members claiming damages for psychiatric illnesses alleged to have been caused by witnessing the deaths of their relatives, or the immediate aftermath, where such deaths were due to negligently undiagnosed and untreated medical conditions. The key issue was whether a medical practitioner owes a duty of care to the family members of a patient to prevent psychiatric illness from such witnessing.

The legal principles revolve around determining the scope and existence of a duty of care towards secondary victims in medical negligence cases—an area previously carved out for cases involving accidents. Established case law, including McLoughlin v O’Brian, Alcock v Chief Constable of South Yorkshire Police, and Frost v Chief Constable of South Yorkshire, framed the controlling factors for secondary victim claims, necessitating a close relationship to the primary victim, proximity to the event causing injury, direct perception of the event, and resulting injury needing to be a recognized psychiatric illness.

The Court meticulously analyzed the “event” concept, drawing a distinction between “accidents,” typically external and traumatic events, and medical crises, which do not fit the traditional mold of accidents as they are often internal to the primary victim. The Taylor v A Novo (UK) Ltd decision underpins this deliberation, affirming that a secondary victim can claim for psychiatric injury only if the injury was caused by witnessing the event or its immediate aftermath.


The judgment is multifaceted: Lords Briggs, Sales, Leggatt, Burrows, Lady Rose, and Lord Richards conclude no duty of care extends to secondary victims in the context of medical negligence that does not involve an “accident” as defined by case law. However, Lord Burrows, dissenting, argues that the Court should not be restrained by the earlier decision in Novo and should allow incremental development of the law by extending recovery to the context of witnessed medical crises. In contrast, Lord Carloway, concurring with Lady Rose and Lord Leggatt, suggests that while Scots law would traditionally permit such claims, under the common law framework as applied in England, no duty of care exists without the presence of an accident.


The decision distinctly confines the scope of duty for medical professionals, essentially precluding liability for psychiatric injury to relatives of patients absent an “accident”. Despite dissenting opinions advocating a broader approach to duty and recognizing evolving societal expectations, the majority holds steadfast to legal precedents requiring proximity to an accidental event. Significantly, this judgment reinforces and perhaps heightens the demarcation between compensable psychiatric injuries in traditional “accident” scenarios versus medical negligence, underscoring the reluctance to extend duty of care to non-accidental contexts.

For legal practitioners, this remains a complex and nuanced area of tort law, one that balances the principles of duty, foreseeability, and proximity against policy considerations and concerns about the scope of liability. It also flags the need for continued vigilance when counseling clients on the potential outcomes of psychiatric injury claims linked to medical negligence.