From institution to autonomy: High Court endorses at-home care model
Stewart v Metro North Hospital and Health Service [2025] HCA 34
The recent High Court decision in Stewart vs Metro North Hospital and Health Service reshapes how courts assess damage for future care - particularly where plaintiffs prefer supported home living over institutional care.
This article explores the case and what it means for insurers, defendants and claimants navigating catastrophic injury claims.
Background
In 2016, 63-year-old Michael Stewart was residing in Margate, Queensland with his brother. Although separated from his wife, Ms Carol Schwarzman (his litigation guardian), they maintained an amicable relationship and shared custody of their son, Jesse.
In early 2016, Mr Stewart presented to Redcliffe Hospital with nausea and abdominal pain. His treatment in Hospital resulted in catastrophic injuries including bowel perforations, sepsis, cardiac arrest, and stroke. These complications left Mr Stewart with permanent brain damage, paralysis of his right upper limb, chronic pain, and the need for a colostomy bag.
Following his discharge from hospital in late 2016, Mr Stewart was placed in a residential aged care facility. His physical condition deteriorated due to inadequate therapy and exercise at the facility. He was also unable to keep a dog or have his son stay overnight.
Mr Stewart argued that the residential aged care facility failed to meet his medical, social, and nursing needs and that he intended to move to a private rental residence, using any compensation awarded to facilitate such a move.
Procedural history
At trial, Mr Stewart’s litigation guardian sought damages to allow him to move from institutional care to a rented residence supported by professional carers. The aim was to restore a sense of normalcy, dignity and autonomy in Mr Stewart’s life. This home-based care model was estimated at $4.91 million – $3.8 million higher than his previous institutional care arrangement.
The trial judge accepted Mr Stewart’s preference for home care and acknowledged that such an arrangement could yield therapeutic benefits. However, the Court ultimately found that the additional cost unjustified, noting the comparable care he was already receiving at the aged care facility. Damages were assessed based on continued institutional care.
The Queensland Court of Appeal unanimously upheld the trial judge’s reasoning on the basis that the statutory test of ‘reasonable necessity’ under the Civil Liability Act 2003 (Qld) required more than the plaintiff’s personal preference. While preference was taken into account, the additional cost of Mr Stewart’s proposed home-based plan was deemed unreasonable.
Mr Stewart sought leave to appeal this decision to the High Court of Australia.
High Court’s decision
In a landmark judgment handed down on 3 September 2025, the High Court unanimously allowed Mr Stewart’s appeal.
Central to the case was the interpretation of the High Court’s decision in Sharman v Evans (1977) 138 CLR 563, a New South Wales case which similarly discussed the ‘reasonableness’ of home-based care.
The Court found that the lower courts had erred in their interpretation of ‘reasonableness’ by focusing too narrowly on a cost-to-benefit analysis of the Mr Stewart’s ultimate health outcomes when assessing damages.
Reaffirming that damages aim to return a plaintiff to the position they would have been in ‘but for’ the defendant’s negligence, the Court asked whether Mr Stewart’s decision to pursue home-based care constituted a ‘reasonable’ response to the harm he had suffered.
Unlike Sharman v Evans, where the majority held that the consideration of ‘reasonableness’ did not require any separation of roles between the plaintiff and defendant, the Court articulated a two-stage framework for assessing ‘reasonableness’ in this context:
- First, the plaintiff must show that their chosen course of action was reasonably required to address the consequences of the injury.
- Second, if that threshold is met, the defendant must prove that the plaintiff acted unreasonably in declining a materially similar, less expensive alternative.
Applying this framework, the Court concluded that Mr Stewart’s preference for home care was reasonable in the circumstances. Before suffering the catastrophic injuries, he lived at home with his family, and returning to this environment offered a more authentic restoration of his pre-injury lifestyle than institutional care could provide. Additionally, the Court held that MNHHS had failed to discharge its burden of proving that Mr Stewart’s rejection of institutional care was unreasonable.
The matter has been remitted to the Supreme Court of Queensland for reassessment of damages.
Implications
This decision clarifies the interpretation of ‘reasonableness’ under the Civil Liability Act 2003 (Qld), in the context of future care for plaintiffs with catastrophic injuries. By rejecting a narrow cost–benefit framework as in Sharman v Evans, and endorsing a holistic, plaintiff-centred approach, the High Court has reaffirmed that damages must reflect not only clinical outcomes but also the restoration of dignity, autonomy, and pre-injury lifestyle.
The ruling is likely to influence future claims by strengthening the evidentiary value of a plaintiff’s personal preferences and lived experience when assessing future care options. Defendants now face a higher threshold in arguing that cheaper alternatives are sufficient, especially where those alternatives fail to meaningfully replicate a plaintiff’s pre-injury lifestyle.
It’s likely this ruling will lead to more claims for home care. Where plaintiffs can show that home care is reasonably required, the onus shifts to the defendant to prove that the plaintiff unreasonably refused an alternative option.
This means defendants and insurers must ensure they have a full understanding of the plaintiff’s living arrangements and lifestyle prior to the injury and be prepared (if the plaintiff demonstrates that their choice was reasonably required) to present evidence to demonstrate the benefits of the care option they propose – including whether these options offer a better quality of life or improvement in mental and physical health of the plaintiff. and that the plaintiff acted unreasonably in refusing the option.
Given the significant cost differences between home care and institutional care, courts are likely to be called on more frequently to decide what care is ‘reasonable’ in the circumstances.
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