I INTRODUCTION

When does cost become a reason to deny a plaintiff their ordinary life? That question sat at the heart of Stewart v Metro North Hospital and Health Service [2025] HCA 34 (Stewart), a unanimous High Court decision handed down on 3 September 2025.[1] The case required the Court to determine whether a catastrophically injured plaintiff was entitled to damages for the cost of home-based care, significantly more expensive than institutional care, so that he could live alongside his son, his brother, and a dog. Two courts below said no. The High Court said yes, and in doing so clarified a principle that will reshape the assessment of future care damages across Australia.

II BACKGROUND: NEGLIGENCE, NURSING HOMES, AND A LIFE PUT ON HOLD

In 2016, Michael Stewart, then aged 63, presented to Redcliffe Hospital in Queensland with nausea and abdominal pain.[2] He was provided negligent care from the treating hospital, Metro North Hospital and Health Service (MNHHS). Mr Stewart suffered bowel perforations, sepsis, cardiac arrest and a stroke, which left him with significant brain damage, right-sided paralysis, aphasia and a colostomy bag.[3] By reason of these injuries, his life expectancy during the period of the court trial was five years.[4]

Prior to the subject injuries, Mr Stewart had lived at home with his brother, where his teenage son, Jesse, and family dog would regularly visit. Following his discharge from the hospital, Mr Stewart was placed in Ozanam Villa Aged Care Facility to be looked after. The Aged Care Facility required advanced notice for visits, prohibited dogs, and made overnight stays for Jesse difficult.[5] In consequence of this environment and his disengagement from therapy, Mr Stewart’s physical health began to deteriorate. Oftentimes, he would communicate his longing to go home through sounds and hand gestures.[6]

Liability, having been admitted by MNHHS, was the sole issue for determination at trial, quantum. The trial judge considered three care options before the court: continued constitutional care for the expected life expectancy of five years at $304,650.46; enhanced institutional care with additional therapy at $1,081,895.56; and home-based care with professional nursing at $4,910,342.52.[7] The trial judge awarded the second option, citing, "Consistent provision of additional care from external care assistants ... would be likely to engage him to a much greater degree."⁸ The Queensland Court of Appeal upheld that decision, applying a cost-benefit analysis that weighed the health advantages of home care against the significantly higher cost and found it disproportionately fatal to Mr Stewart’s claim.[8]

III THE HIGH COURT'S DECISION: RESTORATION, NOT PROPORTIONALITY

The High Court unanimously allowed the appeal. In a joint judgement delivered by Gageler CJ, Gordon, Edelman, Jagot and Beech-Jones JJ, the court held that both the trial judge and the Court of Appeal had erred in law. The error lay in treating reasonableness as a proportionality exercise, weighing health benefits against financial cost, rather than as an enquiry into whether the plaintiff’s chosen response was a reasonable way to address the consequences of the tort.[9]

The foundation of the Court's reasoning was the compensatory principle: that an injured party is entitled to be placed, so far as money can do it, in the same position as they would have been had the tort not been committed. The Court addressed its earlier decision in Sharman v Evans (1977) 138 CLR 563, which the lower courts had relied upon to justify proportionality analysis.[10] The Court declined to overrule Sharman, but confined it carefully to its facts, a case where home care was rejected because it posed genuine health risks to the plaintiff, not merely because it cost more. The proportionality approach suggested by some justices in that decision was expressly disapproved as inconsistent with the compensatory principle and out of step with contemporary care standards.[11]

The court held that the enquiry into reasonableness must be holistic. Relevant factors for this notion include the plaintiff’s pre-injury circumstances, the psychological benefits of the proposed arrangement, their genuine preferences, and whether the chosen option constitutes a genuine attempt to better the plaintiff’s life.[12] Essentially, the burden of proving that a cheaper option was unreasonably refused lies with the defendant as opposed to the plaintiff.[13] In the subject matter, the evidence established that Mr Stewart’s deterioration at Ozanam was attributable to his isolation from family and that no enhanced institutional arrangement could replicate the motivating effect of life at home.[14]

The court also observed changing conditions in the care sector. They recognised that a preference for home care in the modern context is not unusual, regardless of the position in 1977. This is attributed to the significant improvement in the quality and availability of professional home-based care, resulting in such arrangements becoming more common.[15]Courts must therefore assess reasonableness against contemporary standards of care, not historical assumptions about what institutional settings can or cannot provide.

IV IMPLICATIONS: WHAT STEWART MEANS FOR PERSONAL INJURY PRACTICE 

The decision has immediate practical significance for plaintiffs in catastrophic injury claims. A preference for home care is not simply a lifestyle choice to be weighed against cost. It reflects a legally recognised aspect of the plaintiff’s right to restoration. Where that preference is reasonable and consistent with the plaintiff’s pre-injury circumstances, courts should not impose a cheaper institutional alternative based on cost alone.[16]

For defendants and insurers, the decision requires a recalibration of litigation strategy. A mere cost comparison is no longer sufficient to defeat a home care claim. Instead, defendants must adduce positive evidence that the plaintiff’s preferred arrangement is objectively unreasonable or that a rejected alternative would have achieved substantially equivalent restorative outcomes, not merely comparable clinical results.[17]

The implications of the subject case extend beyond Queensland and its legal system. While Stewart was decided under theCivil Liability Act 2003 (Qld), the court's reasoning is grounded in the common law compensatory principle applicable across all Australian jurisdictions. Legal practitioners in New South Wales, Victoria, and elsewhere can reasonably expect analogous arguments to be advanced in future care disputes under their own civil liability frameworks.

However, there are limits to the decision. The court was careful to note that reasonableness remains a factual enquiry, and not every preference for home care will succeed. Where home care carries genuine health risks, or where the proposed arrangement departs substantially from the plaintiff’s pre-injury circumstances, the outcome may differ. The decision in Sharman was not overruled, and defendants retain the ability to contest the reasonableness of a plaintiff’s preferred arrangement on appropriate grounds.[18]

V CONCLUSION: THE COMPENSATORY PRINCIPLE REASSERTED

Stewart is a fundamental case in personal injury law; it affirms existing doctrines surrounding the protection of plaintiffs. The compensatory principle outlines the legal system, ensuring it provides plaintiffs with the resources to be placed in the position they were before they suffered negligence by the defendant. In the subject matter, the position included a son, a dog, and a home, factors that a court cannot refuse to fund.

The court’s decision serves as a reminder that damages for negligence travel beyond restoring the plaintiff’s physical health. They are established on restoring the life the plaintiff lived before the life-altering incident. This compensatory principle is constantly reinforced in Stewart, where the unanimous reaffirmation is bound to be felt in courtrooms and care plans in years to come.

VI REFERENCES

[1] Stewart v Metro North Hospital and Health Service [2025] HCA 34 (‘Stewart’).

[2] Ibid.

[3] Ibid [2] - [5].

[4] Ibid [7]. 

[5] Ibid [8] - [9].

[6] Ibid [11]. 

[7] Civil Liability Act 2–3 (Qld) s 59.

[8] Ibid [14] - [16]. 

[9] Stewart [2025] HCA 34, [14].

[10] 'Sharman v Evans (1977) 138 CLR 563 ('Sharman').

[11] Stewart [2025] HCA 34, [18]-[19].

[12] Ibid [24]-[25].

[13] Ibid [28].

[14] Ibid [33]-[35].

[15] Ibid [36].

[16] Ibid [50].

[17] Stewart [2025] HCA 34, [42]-[44].

[18] Ibid [45].