element 4 = the defendants breach of duty must have caused the death of the victim
if the death would not have occurred had the defendant fulfilled the duty to the standard of the reasonable man then they are the factual cause of the death
r v broughton
medical evidence stated there was a 90% chance of survival if there had not been a breach but this did not prove defendant caused the death beyond a reasonable doubt because of that 10% chance she died anyway
evans
self-injection is not a novus actus interveniens in gross negligence manslaughter, defendants breach occurred following the self-injection