The case of R v Adomako [1994] UKHL 6; [1995] 1 AC 171 is a landmark decision in English criminal law, particularly in the area of gross negligence manslaughter. The House of Lords in this case clarified the elements necessary to establish liability where a person, through a serious breach of duty, causes another’s death. It endorsed the existing common law test and provided judicial guidance on how gross negligence should be assessed, solidifying its place in English jurisprudence.
Facts of R v Adomako Case
On 4 January 1987, the victim, Alan Loveland, underwent surgery for a detached retina. The procedure required him to be placed under general anaesthesia, with an endotracheal tube inserted so that a mechanical ventilator could supply oxygen. Initially, a registrar anaesthetist and his assistant supervised the procedure, but midway, responsibility was transferred to Dr John Adomako, a locum anaesthetist.
During the operation, the endotracheal tube became disconnected from the ventilator. This crucial disconnection meant that the patient was not receiving oxygen. Alarmingly, Dr Adomako failed to notice the disconnection for a prolonged period, despite an alarm from a blood pressure monitoring device signalling that something was wrong. Instead of checking the basic equipment, he examined other apparatus, overlooking the most obvious source of danger.
The patient was deprived of oxygen for over four minutes, resulting in hypoxia. This caused cardiac arrest and eventually led to severe brain damage. Though the patient was resuscitated, he never regained consciousness and died six months later. The surgeon performing the operation was the one who ultimately noticed that the ventilator was disconnected.
Dr Adomako was prosecuted and convicted of gross negligence manslaughter in January 1990 by a majority jury verdict. He appealed against this conviction, arguing that a mere breach of duty should not have sufficed to amount to criminal liability. His appeal, however, was dismissed, and the conviction upheld.
Legal Issue
The key legal question in R v Adomako was whether the defendant’s conduct, which involved a breach of duty of care resulting in death, could amount to manslaughter by gross negligence. Specifically:
- What standard should be applied in determining gross negligence manslaughter?
- Should the definition of recklessness, as previously considered in other cases, apply instead?
- Was it proper to leave to the jury the question of whether the breach was sufficiently serious to constitute a criminal offence?
R v Adomako Judgement
The House of Lords dismissed Adomako’s appeal. Delivering the leading speech, Lord Mackay of Clashfern confirmed that ordinary principles of negligence law applied to cases of involuntary manslaughter by breach of duty. He clarified that once a breach of duty was established and shown to have caused death, the crucial issue was whether the negligence was so serious, in all the circumstances, that it should be characterised as criminal.
The court reaffirmed the earlier decisions in R v Bateman (1925) and Andrews v DPP [1937] AC 576, both of which emphasised that liability required a gross departure from the standard of care expected of a reasonable person.
Thus, in R v Adomako, the House of Lords approved the test that would later be known as the “Adomako test”, which became the definitive framework for gross negligence manslaughter.
The Adomako Test
The judgement established a four-part test to determine liability for gross negligence manslaughter:
- Existence of a duty of care owed by the defendant to the deceased.
- Breach of that duty by the defendant.
- Causation: the breach must have caused or significantly contributed to the death.
- Gross negligence: the breach was so gross, considering the risk of death, that it should be judged as a crime.
The fourth element was crucial, as it set apart ordinary negligence from criminal liability. It was left for the jury to decide whether the conduct was so reprehensible as to be criminal.
Lord Mackay explained that the assessment required examining whether the defendant’s actions departed so far from the proper standard of care that they created a risk of death, and whether this departure was serious enough to warrant criminal sanction.
Application of the Test
Applying this framework, the court concluded:
- Duty of care: Dr Adomako clearly owed a duty of care to his patient as the supervising anaesthetist.
- Breach: He failed to act as a reasonable anaesthetist would have in monitoring the patient’s vital signs and ventilator connection.
- Causation: His omission directly caused the hypoxia and cardiac arrest, ultimately leading to the patient’s death.
- Gross negligence: The failure to notice a disconnected ventilator tube for several minutes during surgery was such a serious departure from expected professional standards that it constituted gross negligence.
Thus, the conviction was upheld.
Conclusion
R v Adomako is a cornerstone of English criminal law on gross negligence manslaughter. The House of Lords confirmed that ordinary negligence principles apply, but liability requires that negligence be so serious as to be characterised as criminal. The four-part test—duty, breach, causation, and grossness—has become the definitive framework for such cases.
The decision underscores the importance of professional responsibility, especially in high-stakes contexts like medicine, and it highlights the role of the jury in evaluating whether conduct crosses the threshold into criminality.
Although subject to criticism for its circularity and potential for subjectivity, R v Adomako remains the leading authority in this area of law. It demonstrates the law’s balancing act between ensuring accountability for serious negligence and avoiding the criminalisation of mere professional mistakes.