Khan v Meadows – Case Summary

Khan v Meadows

Supreme Court

Citations: [2021] UKSC 21.


The defendant was a general medical practitioner. The claimant asked to be tested for genetic markers of a hereditary disease. She was concerned that any children she might have would suffer from the disease. The defendant tested the claimant, but negligently failed to inform her that she was a carrier for the disease. The claimant later gave birth to a child who suffered from the disease. The boy also had an unrelated disability.

The claimant sued the defendant in negligence. She claimed both damages associated with the hereditary disease as well as the costs imposed by the unrelated disability. The defendant admitted liability. However, they argued that they should not be liable for the costs associated with the unrelated disability.

  1. Was the defendant liable for the costs associated with the unrelated disability?

The Supreme Court held in favour of the defendant. The doctor had not undertaken responsibility for the progression of the pregnancy. He had only undertaken to provide advice as to a particular risk. Therefore, the risk of a completely unrelated disability did not fall within the scope of the defendant’s duty of care.

This Case is Authority For…

The ‘SAAMCO’ principle (derived from South Australia Asset Management Corpn v York Montague Ltd [1997] AC 191) holds that in pure economic loss cases, the defendant is only liable for those losses which fall within the ‘scope’ of his duty of care. In other words, the defendant is only liable for those risks which he has undertaken to guard the claimant against.

The SAAMCO principle prevents liability for losses which would have happened even if the defendant’s advice had been correct and not a breach. For example, imagine in this case that the doctor had been correct to tell the claimant that she was not a carrier of the disease. There would have been no breach, but the claimant would have still had a child with the unrelated disability. Therefore, under SAAMCO, the risk of having a child with an unrelated disability was not within the scope of the duty.

The Supreme Court confirmed that SAAMCO applies to clinical negligence claims. However, in most cases there will be no need to specifically discuss it. This is because it is normally obvious that the harm falls within the scope of the defendant’s duty.


Lords Hodge and Sales gave guidance on the questions which should be asked when the SAAMCO principle is in issue:

  1. The actionability question: ‘Is the harm (loss, injury and damage) which is the subject matter of the claim actionable in negligence?’
  1. The scope of duty question: ‘What are the risks of harm to the claimant against which the law imposes on the defendant a duty to take care?’
  2. The breach question: ‘Did the defendant breach his or her duty by his or her act or omission? (the breach question)’
  3. The factual causation question: ‘Is the loss for which the claimant seeks damages the consequence of the defendant’s act or omission?’
  4. The duty nexus question: ‘Is there a sufficient nexus between a particular element of the harm for which the claimant seeks damages and the subject
    matter of the defendant’s duty of care as analysed at stage 2 above?’
  5. The legal responsibility question: ‘Is a particular element of the harm for which the claimant seeks damages irrecoverable because it is too remote, or
    because there is a different effective cause (including novus actus interveniens) in relation to it or because the claimant has mitigated his or her loss or has failed to avoid loss which he or she could reasonably have been expected to avoid?’

Lord Burrows argued against this approach, stating that the ordinary approach to determining negligence cases (duty/breach/causation/remoteness) was perfectly satisfactory. In particular, he noted that the approach above fails to consider whether the defendant had a duty of care in the first place.