Gregg v Scott

Application of the all-or-nothing balance of probability approach in the 'Gregg' type of cases would not achieve this object. In such cases the law should therefore put aside this approach when considering what would have happened had there been no negligence. It cannot be right to adopt a procedure having the effect that, in law, a patient's prospects of recovery are treated as non-existent whenever they exist but fall short of 50%. If the law were to proceed in this way it would deserve to be likened to the proverbial ass. Where a patient's condition is attended with such uncertainty that medical opinion assesses the patient's recovery prospects in percentage terms, the law should do likewise. The law should not, by adopting the all-or-nothing balance of probability approach, assume certainty where none in truth exists: see Deane J in Commonwealth of Australia v Amann Aviation Pty Ltd (1991) 66 ALJR 123, 147. The difference between good and poor prospects is a matter going to the amount of compensation fairly payable, not to liability to make payment at all. As Dore J said in Herskovits v Group Health Cooperative of Puget Sound (1983) 664 P 2d 474, 477:

'To decide otherwise would be a blanket release from liability for doctors and hospitals any time there was less than a 50 per cent chance of survival, regardless of how flagrant the negligence.'

The way ahead must surely be to recognise that where a patient is suffering from illness or injury and his prospects of recovery are attended with a significant degree of medical uncertainty, and he suffers a significant diminution of his prospects of recovery by reason of medical negligence whether of diagnosis or treatment, that diminution constitutes actionable damage. This is so whether the patient's prospects immediately before the negligence exceeded or fell short of 50%. 'Medical uncertainty' is uncertainty inherent in the patient's condition, uncertainty which medical opinion cannot resolve. This is to be contrasted with uncertainties arising solely from differences of view expressed by witnesses. Evidential uncertainties of this character should be resolved in the usual way.

This approach would represent a development of the law. So be it. If the common law is to retain its legitimacy it must remain capable of development. It must recognise the great advances made in medical knowledge and skills. It must recognise also the medical uncertainties which still exist. The law must strive to achieve a result which is fair to both parties in present-day conditions. The common law's ability to develop in this way is its proudest boast. But the present state of the law on this aspect of medical negligence, far from meeting present-day requirements of fairness, generates continuing instinctive judicial unease, exemplified in this country post-Hotson by Latham LJ's dissenting judgment in the present case, and observations of Andrew Smith J in Smith v National Health Service Litigation [2001] Lloyd's Med Rep 90 and the Court of Appeal in Coudert Brothers v Normans Bay Ltd (27 February 2004, unreported). In the latter case Waller LJ and Carnwath LJ expressed 'disquiet' at the Court of Appeal decision in the present case. Laws LJ said he was 'driven to an unhappy sense that the common law has lost its way': paragraphs 32, 66-68 and 69.

The reason for this disquiet is not far to seek. The present state of the law is crude to an extent bordering on arbitrariness. It means that a patient with a 60% chance of recovery reduced to a 40% prospect by medical negligence can obtain compensation. But he can obtain nothing if his prospects were reduced from 40% to nil. This is rough justice indeed. By way of contrast, the approach set out above meets the perceived need for an appropriate remedy in both these situations and does no more than reflect fairly and rationally the loss suffered by a patient in these situations.^[2]