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The Supreme Court's Examination of Psychiatric Harm in Medical Negligence: The Cases of Paul, Polmear, and Purchase


The Supreme Court's landmark judgments in Paul v Royal Wolverhampton NHS Trust, Polmear v Royal Cornwall Hospitals NHS Trust, and Purchase v Ahmed signal a watershed moment in the legal recognition of psychiatric injury claims within medical negligence, focusing particularly on the experiences of secondary victims. These judgments arise from tragic cases that underscore the profound psychological impact of medical mismanagement on patients' families.


The Appellants' Plight: A Case-by-Case Examination:

Each appellant's story is testimony to the psychiatric toll exacted by medical negligence:


  • In Paul v Royal Wolverhampton NHS Trust, a family grappled with a preventable death due to misdiagnosed cancer, which inflicted deep psychological scars.

  • Polmear v Royal Cornwall Hospitals NHS Trust involved the negligent treatment of a child, which not only led to a premature death but also left the anguished parents behind. This case probes the ethical and legal obligations of healthcare providers towards a patient's relatives.

A photo of the victim in the Polmear v Royal Cornwall Hospitals NHS Trust case

  • Purchase v Ahmed presented the consequences of suboptimal surgical care that escalated to fatal complications, thereby raising questions about the legal system's acknowledgment of a family's suffering in the wake of such tragedy.

Evolution of Psychiatric Illness Claims: Landmark Cases: 

The historical tapestry of psychiatric injury claims is woven through several pivotal cases, each contributing a distinct thread to the legal fabric:


  1. McLoughlin v O'Brian first recognised the trauma inflicted on immediate family members who witness or come upon a catastrophic event.

  2. Alcock v Chief Constable of South Yorkshire Police refined these principles, setting the proximity and relationship criteria as key factors in the pattern of claims.

  3. Frost v Chief Constable of South Yorkshire Police stretched the boundaries, testing the fabric in the context of large-scale negligence and the plight of secondary victims.


Secondary Victims in Medical Negligence: A Legal Journey:

The trajectory of legal thought regarding secondary victims in medical negligence has been critically shaped by several cases:


  1. Taylor and Somerset laid the groundwork for proximity requirements, emphasising the spatial and temporal dimensions of witnessing harm.

  2. Sion examined the aftermath of negligent medical care, bringing into focus the immediate psychological impact on the family.

  3. Walters took a broader view of 'immediacy,' recognising the unfolding sequence of events as part of the traumatic experience.

  4. Shorter scrutinised the intimate connections that bind primary and secondary victims, acknowledging the shared emotional landscapes.

  5. Ronayne establiushed the contours of liability, underscoring the limitations and bounds of legal responsibility in psychiatric injury claims.


Taylor v Novo: A Cornerstone Case:

Taylor v Novo (UK) Ltd stands as a cornerstone case, its significance emanating from the exploration of how time intersects with trauma. The Supreme Court's analysis of this case became a lens through which the current cases were viewed, particularly in discerning the intricate relationship between an act of negligence and the resultant psychiatric harm to secondary victims.


Supreme Court's Judgement: Analysis and Implications:

The Supreme Court, in a nuanced judgement, affirmed that while the shock from medical negligence could indeed be profound, the legal duty of care does not extend indefinitely. Through careful consideration of legal precedents, the Court delineated the scope of duty, highlighting the importance of a direct and immediate perception of harm. The Justices emphasised that the law guards against an overextension that could make the practice of medicine untenably burdensome.



The rulings in Paul, Polmear, and Purchase (combined) have set pivotal legal precedents, underscoring the need for a delicate balance between the acknowledgment of psychiatric harm and the practicalities of healthcare provision.  While the general principle remains that the doctor patient relationship does not involve the doctor taking on responsibility for the health of the patient’s family, these judgments serve as pointers for future cases, guiding the legal and medical professionals alike in navigating the intricate and often emotionally charged domain of medical negligence.


A photo of Scott-Harding-Lister, Director at Apex Health Associates


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