Whether the “death or serious bodily injury results from the use of” language in 21 U.S.C. § 841(b)(1)(C) permits the enhanced penalty when the distributed drug merely contributed to death but was not a but-for cause of it.
Holding
No. Except in the unresolved circumstance of multiple independently sufficient causes, § 841(b)(1)(C) requires proof beyond a reasonable doubt that use of the defendant's drug was a but-for cause of the victim's death or serious bodily injury.
Reasoning
The enhancement increased both the mandatory minimum and maximum punishment available to Burrage. Under Alleyne and Apprendi, that fact therefore functioned as an element of the aggravated offense and had to be submitted to the jury and proved beyond a reasonable doubt.
Because the Controlled Substances Act does not define “results from,” the Court gave the phrase its ordinary meaning. An outcome ordinarily “results from” an act when the outcome would not have occurred without that act. This is the familiar requirement of actual, or but-for, causation.
But-for causation does not demand that the defendant's conduct be the only cause of a result. If the defendant's conduct combines with other conditions to produce death, it is still a but-for cause if the victim would have lived without its added effect. The Court illustrated this principle with the proverbial straw that breaks the camel's back.
The Court distinguished the rare situation in which two independent acts are each sufficient to cause the same harm at the same time. In that setting, ordinary but-for analysis may fail because the victim would have died from either act alone. The Court did not decide whether a special causation rule applies in such cases, because the evidence did not show that Banka's heroin use alone was independently sufficient to kill him.
The Government's proposed contributing-cause rule would impose the enhancement whenever the drug made any meaningful incremental contribution to a fatal combined effect. The statutory text, however, says that death must result from use of the distributed substance, not from a mixture of causes to which that substance contributed. Congress could have adopted broader language, but did not.
A contributing-cause standard would also lack a determinate threshold: neither the Government nor the courts could specify how substantial a contribution must be. That uncertainty is especially problematic where medical evidence is expressed in probabilities and where the Government must establish an element beyond a reasonable doubt. The rule of lenity reinforced the Court's refusal to adopt a broader, defendant-disfavoring interpretation.
The record did not establish that Banka would have lived but for the heroin Burrage distributed; the Government conceded as much. The jury instruction requiring only a contributing cause therefore misstated the governing standard, requiring reversal of Burrage's conviction on the death-results count. Burrage remained guilty of the underlying heroin-distribution offense.