Medical Negligence and Causation in Criminal Homicide

Medical Negligence and Causation in Criminal Homicide

Introduction

Few causation questions in criminal law are more difficult than this:

If a defendant injures a victim, and the victim later dies because medical treatment was negligent, is the original defendant guilty of homicide?

At first glance, the answer might appear obvious.

The defendant caused the injury.
The victim went to the hospital.
A medical professional made a serious mistake.
The victim died.

But criminal law cannot resolve the question simply by identifying the last person whose conduct contributed to the death.

The law must determine whether the defendant’s original conduct remained a legally sufficient cause of death or whether the medical negligence became an intervening or superseding cause that broke the chain of causation.

This distinction is particularly important because criminal homicide requires more than proof that the defendant acted wrongfully. Where the charged offense requires a particular result, the prosecution generally must establish both actual causation and legal causation.

The Supreme Court explained this two-part concept of causation in Burrage v. United States, stating that when a crime requires conduct to produce a specified result, the defendant generally must be both the actual and legal cause of that result. Cornell Legal Information Institute — Burrage v. United States

Medical negligence therefore does not automatically relieve the original defendant of responsibility.

Nor does the defendant automatically remain responsible simply because the original injury began the chain of events.

The difficult question is where the law draws the line.

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1. The Basic Medical Causation Problem

Consider a simple hypothetical.

A shoots B.

B survives the shooting but requires emergency surgery.

During surgery, the surgeon makes a serious error.

B dies.

Who caused B’s death?

There are several possible answers:

• A caused the original injury.
• The surgeon caused the fatal complication.
• Both contributed to the death.
• The original shooting remained the legal cause despite the medical error.
• The medical error became a superseding cause.

The law must therefore examine the entire causal sequence.

The basic structure is:

Defendant’s conduct → injury → medical treatment → complication → death

The existence of several stages does not itself establish a break in causation.

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2. Actual Cause and Legal Cause

The first distinction is between actual cause and legal cause.

Actual causation asks:

Would the victim have suffered the death without the defendant’s conduct?

Legal causation asks:

Is the defendant’s conduct sufficiently connected to the death that the law should attribute the result to the defendant?

Cornell’s Legal Information Institute explains that actual cause is generally established through the but-for test, although alternative approaches may exist in some criminal cases. Cornell Legal Information Institute — Actual Cause

Proximate cause, meanwhile, concerns whether the actual cause is legally sufficient to support responsibility. Cornell Legal Information Institute — Proximate Cause

Medical negligence can therefore affect either part of the analysis, but it most often becomes controversial at the stage of legal causation.

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3. The Defendant May Remain a Cause Even After Medical Intervention

One of the most important principles is that medical treatment does not automatically erase the causal significance of the original injury.

Suppose A stabs B.

B is transported to a hospital.

Doctors treat B.

B dies from complications associated with the wound.

The doctors’ actions occurred after A’s conduct.

But A’s conduct may remain a cause of death because the medical treatment occurred precisely because A created the need for treatment.

The causal sequence may therefore remain:

A’s attack → B’s injury → necessary treatment → complications → death

The fact that doctors became involved does not necessarily make their involvement an independent cause.

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4. Medical Treatment Is Often a Foreseeable Response

When a defendant seriously injures a victim, medical treatment is normally a foreseeable response.

This matters because foreseeable intervening events are less likely to qualify as superseding causes.

Suppose A shoots B.

B requires emergency surgery.

A doctor makes an ordinary mistake during treatment.

B dies.

The defense may argue:

“The doctor killed B.”

But the prosecution may respond:

“A created the medical emergency that required the doctor’s intervention.”

The causal chain therefore may remain intact.

The law does not ordinarily assume that injured victims will receive perfectly executed medical treatment.

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5. Medical Negligence as an Intervening Cause

Medical negligence can nevertheless qualify as an intervening cause.

The doctor’s conduct occurs after the defendant’s conduct and before the victim’s death.

That makes it an intervening event in the causal sequence.

But an intervening cause is not necessarily a superseding cause.

Cornell explains that an intervening cause may break the chain of causation between an earlier wrongful act and later harm, depending on the circumstances. Cornell Legal Information Institute — Intervening Cause

The critical question therefore becomes:

Was the medical negligence sufficiently extraordinary and independent to supersede the defendant’s original conduct?

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6. Ordinary Medical Negligence vs. Extraordinary Negligence

This distinction is central.

Ordinary or foreseeable medical negligence

A medical professional makes a mistake that occurs within the general range of risks associated with medical treatment.

Extraordinary medical negligence

The medical conduct is so abnormal, independent, or unforeseeable that it may constitute a completely new source of the victim’s death.

The second situation provides a much stronger argument for superseding causation.

But the line is not always clear.

Medical treatment is inherently complex. Errors can occur even when professionals are acting in good faith and attempting to save a patient’s life.

The question is therefore not simply:

“Did the doctor make a mistake?”

It is:

“Was the doctor’s conduct so independent and extraordinary that it should legally replace the defendant’s conduct as the cause of death?”

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7. Criminal Causation Is Not Civil Medical Malpractice

An important distinction must be made between civil medical malpractice and criminal causation.

Cornell defines malpractice as professional negligence involving a breach of professional standards. Cornell Legal Information Institute — Malpractice

A doctor may therefore be civilly liable for negligence.

That does not automatically mean the doctor became the superseding cause of a death for purposes of the original defendant’s criminal prosecution.

Similarly, proving that medical treatment was negligent does not automatically establish that the original defendant is no longer responsible for homicide.

The standards and purposes of civil liability and criminal liability are different.

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8. Why the Distinction Matters

Imagine that A severely injures B.

B is taken to a hospital.

The treating physician negligently fails to diagnose an obvious complication.

B dies.

There are potentially two separate legal questions:

Question 1

Was the physician negligent?

Question 2

Did the physician’s negligence supersede A’s conduct for purposes of A’s criminal liability?

The answer to the first question does not necessarily determine the answer to the second.

The doctor may have acted negligently while A remains legally responsible for the death.

This is because multiple causes can coexist.

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9. Multiple Causes of Death

Death can have multiple causes.

A victim may have:

• a gunshot wound;
• blood loss;
• an underlying medical condition;
• an infection;
• complications from surgery;
• medication errors; and
• delayed treatment.

The presence of multiple causes does not necessarily mean that the original defendant escapes responsibility.

Cornell recognizes that criminal causation can involve multiple contributing causes and that the substantial-factor approach may sometimes be used where multiple causes are involved. Cornell Legal Information Institute — Substantial Factor Test

The key issue is whether the defendant’s conduct remained sufficiently significant and legally connected to the death.

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10. The Defendant Does Not Have to Be the Sole Cause

Criminal causation does not necessarily require the defendant to be the only cause of death.

Suppose:

A stabs B.

B loses significant blood.

Doctors fail to administer an appropriate treatment promptly.

B dies.

A may still have caused the death even though the medical error contributed.

The prosecution does not necessarily have to establish:

“Nothing else contributed to the death.”

It generally needs to establish the causal relationship required by the particular offense and applicable law.

This is especially important in complicated medical cases, where multiple factors frequently operate simultaneously.

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11. The “But-For” Question

The first practical question is often:

But for the defendant’s conduct, would the victim have died when and in the manner alleged?

Suppose A shoots B.

B would not have needed emergency surgery but for A’s shooting.

If B dies from complications associated with that surgery, the original shooting may remain an actual cause.

Cornell’s discussion of but-for causation describes it as a necessary component of causation under much of criminal law. Cornell Legal Information Institute — But-For Cause

The but-for inquiry does not, however, end the analysis.

Legal causation must still be considered.

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12. The Proximate Cause Question

After establishing actual causation, the court may ask:

Was the defendant’s conduct still a legally sufficient cause of the death?

This is where medical negligence becomes particularly important.

If the medical treatment was a foreseeable response to the defendant’s injury, the original conduct may remain a proximate cause.

If the medical intervention was extraordinary and completely independent, it may be considered superseding.

Cornell explains that proximate cause is a legal limitation on factual causation and can involve considerations such as foreseeability and the existence of superseding causes. Cornell Legal Information Institute — Proximate Cause

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13. Ordinary Errors in Treatment

Imagine this scenario:

A seriously injures B.

B requires emergency surgery.

The surgeon accidentally damages a nearby blood vessel.

B dies.

This is tragic.

But whether the surgeon’s mistake supersedes A’s conduct depends on the governing law and facts.

The medical error may be viewed as:

• a foreseeable risk of emergency treatment;
• a contributing cause;
• an intervening cause; or
• in an exceptional case, a superseding cause.

The classification cannot be determined merely by observing that the doctor made an error.

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14. Grossly Abnormal Medical Conduct

Now change the facts.

A causes a relatively minor injury to B.

B is hospitalized.

A medical professional then intentionally administers a lethal substance for an unrelated reason.

B dies.

The medical professional’s conduct is far more likely to be characterized as an independent cause.

The difference is significant.

In the first example, the medical conduct is connected to treating the injury.

In the second, the medical professional introduces a completely new and unrelated source of death.

This illustrates the importance of independence.

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15. Intentional Medical Conduct

Intentional conduct by a medical professional can present an especially strong superseding-cause argument.

Suppose A causes a nonfatal injury to B.

A doctor intentionally kills B for a reason unrelated to treating the injury.

B dies.

The doctor’s intentional act may be treated very differently from ordinary medical negligence.

An intentional and independent act can constitute a powerful argument that the original defendant did not legally cause the final death.

But even here, the precise rule depends on the offense, jurisdiction, and facts.

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16. Medical Treatment and the Original Risk

A useful way to analyze these cases is to identify the risk created by the defendant.

Suppose A shoots B.

The shooting creates risks including:

• blood loss;
• infection;
• organ damage;
• complications from surgery;
• complications from medication;
• further medical deterioration.

These risks are connected to the original injury.

If one of those risks materializes, the causal chain may remain intact.

The defendant may argue that the medical error created a new danger.

The prosecution may respond that medical complications are part of the foreseeable consequences of serious injury.

The court must determine which characterization is legally appropriate.

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17. Medical Negligence and Superseding Cause

A medical error is more likely to be treated as superseding when it is:

• highly extraordinary;
• completely independent of the original injury;
• intentional and unrelated to treatment;
• grossly abnormal;
• unforeseeable under the circumstances; or
• so dominant that the original injury becomes merely historical.

A medical error is less likely to be superseding when it is:

• connected to treating the original injury;
• a foreseeable risk of treatment;
• an ordinary mistake;
• a complication of necessary care; or
• part of the medical chain initiated by the defendant’s conduct.

Again, the precise test varies among jurisdictions.

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18. Medical Negligence and the Victim’s Vulnerability

Medical causation can become even more complicated when the victim has a preexisting condition.

Suppose A seriously injures B.

B has an undiscovered heart condition.

The stress of the injury and subsequent treatment triggers a fatal cardiac event.

A may argue:

“The heart condition caused the death.”

But the existence of a preexisting condition does not necessarily eliminate causation.

The original injury may have triggered the fatal chain.

This is related to the broader principle that defendants may sometimes be responsible for consequences made more severe by the victim’s unusual physical condition.

The precise application depends on the jurisdiction and offense.

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19. Refusal of Medical Treatment

Another difficult situation arises when the victim refuses treatment.

Suppose A seriously injures B.

Doctors recommend surgery.

B refuses.

B later dies.

The defendant may argue:

“The victim chose not to receive treatment.”

But the refusal does not automatically become a superseding cause.

Courts may consider:

• whether the refusal was informed;
• whether the victim understood the consequences;
• whether the refusal was rational under the circumstances;
• whether the refusal was connected to the original injury;
• whether the defendant’s conduct created the medical crisis; and
• whether the victim’s decision was sufficiently independent and unforeseeable.

The causal analysis must remain contextual.

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20. Medical Treatment Delays

Suppose A seriously injures B.

B reaches the hospital.

Treatment is delayed because medical staff fail to recognize the seriousness of the injury.

B dies.

The delay may contribute to the death.

But the existence of delay does not automatically sever causation.

The question remains whether the defendant’s original conduct remained a legally sufficient cause of death.

A delay may be:

• ordinary;
• negligent;
• unusually negligent;
• grossly negligent; or
• so extraordinary that it becomes a superseding event.

The classification depends on the facts and governing law.

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21. The Case of Henderson v. Kibbe

The Supreme Court’s decision in Henderson v. Kibbe illustrates the importance of causation in a homicide prosecution involving a victim abandoned in a dangerous condition.

The defendants had robbed and assaulted an intoxicated man and left him partially undressed on a rural road in extremely cold conditions. The question included whether the defendants’ conduct was sufficiently connected to the victim’s death and how the jury should be instructed concerning causation.

The Supreme Court discussed the relationship between foreseeability, causation, and the defendants’ mental state. Cornell Legal Information Institute — Henderson v. Kibbe

Although the case did not concern medical malpractice, its broader lesson is important:

Causation in criminal homicide is a legal element that must connect the defendant’s conduct to the death.

Medical treatment therefore cannot simply be inserted into the chain and assumed either to preserve or destroy causation.

The court must analyze the entire sequence.

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22. Medical Negligence and Mens Rea

Medical negligence also interacts with mens rea.

Suppose A intentionally shoots B.

A clearly possesses a particular mental state with respect to the shooting.

But whether A is guilty of homicide depends on more than the mental state surrounding the shooting.

The prosecution may also need to establish:

• the required result;
• actual causation;
• legal causation; and
• any additional statutory requirements.

Conversely, a doctor may be negligent without possessing the mens rea required for intentional homicide.

This illustrates why causation and mens rea must be analyzed separately.

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23. Negligent Homicide and Medical Negligence

Medical negligence becomes especially interesting when the alleged criminal defendant is the medical professional.

A physician’s conduct may be negligent without necessarily being criminal.

Criminal negligence generally requires a level of fault greater than ordinary civil negligence in jurisdictions that recognize criminal negligence as a basis for homicide.

Cornell defines ordinary negligence as failure to act with the level of care a reasonable person would exercise under similar circumstances. Cornell Legal Information Institute — Negligence

But criminal liability depends on the governing statute and required mental state.

Therefore:

Medical error ≠ automatically criminal homicide.

The prosecution must establish the applicable criminal standard of culpability as well as causation.

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24. Criminal Negligence vs. Medical Malpractice

This distinction is essential.

Medical malpractice

Usually concerns professional negligence and civil liability.

Criminal negligence

Concerns conduct sufficiently blameworthy to satisfy the criminal statute.

A doctor may commit malpractice without committing a crime.

Conversely, exceptionally reckless or grossly negligent medical conduct may satisfy a criminal homicide statute in jurisdictions that recognize such liability.

The question is therefore not simply:

“Was the treatment negligent?”

It is:

“Did the medical professional’s conduct satisfy the criminal offense’s required level of culpability and causation?”

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25. A Practical Medical Causation Framework

When medical negligence appears in a criminal homicide case, the following framework is useful.

Step 1: Identify the defendant’s original conduct

What did the defendant do or fail to do?

Step 2: Identify the original injury

What harm did the defendant cause?

Step 3: Determine factual causation

Would the victim have suffered the fatal sequence but for the defendant’s conduct?

Step 4: Identify the medical intervention

What treatment occurred after the original injury?

Step 5: Identify the medical error

What exactly did the medical professional do incorrectly?

Step 6: Determine whether the error contributed to death

Medical evidence must establish the causal significance of the error.

Step 7: Ask whether the medical conduct was foreseeable

Was the medical event within the range of consequences associated with treating the original injury?

Step 8: Ask whether the medical conduct was independent

Did it create a genuinely new source of danger?

Step 9: Consider whether the medical conduct was extraordinary

Was it ordinary negligence, serious negligence, gross negligence, or an entirely abnormal event?

Step 10: Analyze superseding causation

Did the medical conduct break the legal chain between the original injury and death?

Step 11: Analyze mens rea

What mental state is required for the homicide offense being charged?

Step 12: Apply the governing jurisdiction’s law

Different jurisdictions formulate causation and criminal negligence differently.

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26. A Hypothetical: Ordinary Medical Error

A intentionally stabs B.

B is taken to the hospital.

During surgery, the surgeon makes a negligent mistake that contributes to B’s death.

A argues that the surgeon’s negligence superseded the stabbing.

The analysis should consider:

• whether B required surgery because of A;
• whether the surgery was a foreseeable response;
• whether the medical error was within the ordinary risks of treatment;
• whether A’s injury remained a substantial or legally sufficient cause;
• whether the medical error was extraordinary; and
• whether the governing law recognizes a superseding cause on these facts.

The mere existence of medical negligence does not automatically end A’s responsibility.

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27. A Hypothetical: Extraordinary Medical Conduct

A causes B a minor injury.

B is hospitalized.

A doctor, acting for an entirely unrelated personal reason, intentionally administers a lethal substance.

B dies.

Here the causal analysis is dramatically different.

The doctor’s conduct is:

• intentional;
• independent;
• unrelated to treatment;
• extraordinary; and
• directly responsible for the death.

A has a much stronger argument that the doctor’s conduct superseded the original injury.

A may still be guilty of the offense arising from the original injury, but the homicide causation question is fundamentally different.

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28. A Hypothetical: Delayed Diagnosis

A seriously injures B.

B is taken to a hospital.

Doctors negligently fail to diagnose the injury promptly.

B’s condition worsens.

B dies.

This is more difficult.

The medical error is connected directly to treating the original injury.

The delay may be foreseeable in the broad sense that medical diagnosis is part of the response to injury.

The original defendant may therefore remain a legal cause.

But the precise outcome depends on the jurisdiction, the seriousness of the original injury, the medical evidence, the nature of the error, and the applicable causation doctrine.

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29. A Hypothetical: Independent Cause of Death

A lightly injures B.

B is hospitalized.

While B is receiving treatment, an unrelated catastrophic event occurs and causes fatal injuries.

The original injury played little or no role in the death.

Here the defendant’s conduct may fail the actual-causation requirement itself.

The problem is therefore different from a case where medical negligence merely contributes to a death that would not have occurred without the original injury.

This illustrates why the analysis should always begin with actual causation before moving to superseding cause.

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30. The Importance of Medical Evidence

Medical causation cases often depend heavily on expert evidence.

The court may need to understand:

• the original injury;
• the natural progression of that injury;
• the treatment provided;
• the treatment that should have been provided;
• the medical error;
• the physiological mechanism of death;
• alternative causes;
• the contribution of each cause; and
• whether the death would have occurred without the original injury.

Legal causation is ultimately a legal determination, but medical evidence may be essential to understanding the factual chain.

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31. Causation Cannot Be Determined Merely by the Last Event

One of the most dangerous errors in medical causation is assuming:

“The last person who acted before death caused the death.”

That is not how legal causation works.

The final event may be only one part of a longer causal sequence.

For example:

Assault → injury → ambulance → surgery → complication → death

The fact that surgery occurred immediately before death does not automatically make surgery the legally responsible cause.

Similarly, the fact that the original defendant acted first does not automatically make that defendant responsible for everything that happened afterward.

Causation requires analysis of the entire chain.

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32. Medical Negligence as a Superseding Cause: The Central Question

The central question can be stated simply:

Did the medical negligence merely contribute to the consequences of the defendant’s injury, or did it become a new and independent cause of death?

This question brings together the major principles of criminal causation.

If the medical treatment continues the original risk:

Causation is more likely to remain intact.

If the medical treatment introduces an extraordinary new risk:

Superseding causation becomes more plausible.

If the medical treatment is completely unrelated:

The original defendant has a stronger argument that the chain was broken.

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33. Why the Rule Cannot Be Absolute

There is no sensible rule saying:

“Medical negligence always breaks causation.”

That would create an extraordinary incentive for defendants to argue that every medical error should erase responsibility.

Nor would it be sensible to say:

“Medical negligence can never break causation.”

That would make defendants responsible for events that may have become completely independent of their conduct.

The better approach is contextual.

The court must examine:

• the original conduct;
• the original injury;
• the medical treatment;
• the nature of the medical error;
• foreseeability;
• independence;
• the causal contribution of each event; and
• the requirements of the charged offense.

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34. Medical Negligence and the Principle of Fair Attribution

At its deepest level, medical causation reflects the principle of fair attribution.

Criminal law asks not merely:

“Who contributed to the chain?”

It asks:

“Who can fairly be held criminally responsible for this result?”

That question prevents both extremes.

The first extreme is excessive responsibility:

The defendant caused the original injury, so the defendant must be responsible for everything afterward.

The second is excessive fragmentation:

A doctor made a mistake, so the original defendant is automatically innocent of the victim’s death.

Neither approach is satisfactory.

The law instead examines whether the original criminal conduct remained a legally meaningful cause of the death.

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35. Common Mistakes

Mistake 1: Assuming medical negligence automatically breaks causation

It does not.

Mistake 2: Assuming medical negligence can never break causation

It can, in appropriate circumstances.

Mistake 3: Confusing malpractice with criminal liability

Civil medical negligence and criminal homicide require different legal analyses.

Mistake 4: Focusing only on the final event

The entire causal chain must be examined.

Mistake 5: Ignoring factual causation

Before asking whether medical negligence superseded the defendant’s conduct, determine whether the defendant’s conduct was actually a cause of the death.

Mistake 6: Treating the defendant as the only possible cause

Multiple causes may coexist.

Mistake 7: Treating the doctor as automatically responsible

Medical negligence does not automatically become the legally dominant cause.

Mistake 8: Ignoring mens rea

Homicide requires the mental state specified by the applicable statute.

Mistake 9: Forgetting jurisdictional differences

Causation rules and standards for criminal negligence vary considerably.

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Key Takeaways

• Medical negligence can create difficult causation questions in criminal homicide.
• Medical treatment is generally an intervening event, but not every intervening event is superseding.
• The defendant’s conduct may remain an actual cause even after medical intervention.
• Legal causation asks whether the defendant’s conduct remains sufficiently connected to the death.
• Ordinary medical negligence does not automatically break causation.
• Extraordinary or completely independent medical conduct may potentially become a superseding cause.
• Multiple causes of death can coexist.
• The defendant does not necessarily have to be the sole cause of death.
• Medical malpractice and criminal homicide are legally distinct.
• A medical professional may be civilly negligent without being criminally liable.
• A medical professional may potentially face criminal liability when the applicable statute’s required level of culpability is satisfied.
• Medical evidence is often essential to establish the factual chain.
• The ultimate legal question is whether the defendant’s original conduct remained a legally sufficient cause of the victim’s death.

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Frequently Asked Questions

Does medical negligence automatically break the chain of causation?

No. Medical negligence is an intervening event, but it becomes a superseding cause only when it is legally sufficient to break the causal chain.

Can a person who injures someone be guilty of homicide if doctors later make a mistake?

Yes, potentially. If the original injury remained a legally sufficient cause of death, medical negligence may not relieve the original defendant of homicide liability.

What if the doctor is grossly negligent?

Gross negligence may strengthen an argument for superseding causation, but it does not automatically establish it. The facts and governing jurisdiction remain important.

What if the doctor intentionally kills the patient?

An intentional and independent act by a medical professional may provide a much stronger basis for treating the doctor’s conduct as a superseding cause.

Does the defendant have to be the only cause of death?

No. Multiple causes can contribute to a death. The defendant’s conduct may remain legally sufficient even when another cause also contributed.

Is medical malpractice the same as criminal negligence?

No. Medical malpractice is generally a civil professional-negligence concept. Criminal negligence requires the level of culpability specified by the applicable criminal statute.

Why does foreseeability matter?

Because medical treatment is often a foreseeable response to serious injury. A foreseeable medical complication is less likely to supersede the defendant’s conduct than an extraordinary and independent event.

Can delayed medical treatment break causation?

Potentially, but not automatically. The court must examine whether the delay was sufficiently independent and extraordinary to supersede the original injury.

What if the victim would have survived without the medical error?

That fact can be highly significant to factual causation, but the ultimate legal analysis still requires consideration of proximate cause and superseding causation.

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Conclusion

Medical negligence creates one of the most difficult boundaries in criminal causation.

A defendant may create the original danger, but medical professionals may later make decisions that contribute to the victim’s death. The law must determine whether those decisions merely form part of the natural consequences of the original injury or whether they become an independent cause that supersedes the defendant’s conduct.

The answer cannot be determined simply by asking who acted last.

Nor can it be determined merely by asking whether a doctor made a mistake.

The central inquiry is whether the defendant’s conduct remained a legally sufficient cause of the death.

Ordinary medical treatment, foreseeable complications, treatment errors, and other responses to an injury may leave the original causal chain intact.

Extraordinary, independent, and highly abnormal medical conduct may instead break that chain.

The distinction is particularly important in homicide because causation is not merely a factual question. It is a component of criminal responsibility.

A defendant may have caused the initial injury without necessarily causing the ultimate death. Conversely, the existence of negligent medical treatment does not necessarily transform the doctor into the sole legal cause of death.

The law therefore looks at the entire sequence:

Criminal conduct → injury → medical intervention → medical complication → death

The task is to determine whether that sequence remains legally connected or whether an independent event has interrupted it.

Ultimately, medical causation in criminal homicide is an application of a broader principle:

Criminal responsibility follows legally attributable consequences, not simply the last event in a chain of events.

That principle allows criminal law to recognize the complexity of medical treatment while still holding defendants responsible for the consequences of dangers they themselves unlawfully created.