Medical mistakes come in many shapes and sizes, but criminal law adopts a one size fits all approach-which, to my mind, can be a bad fit. For individuals at the sharp end, the stakes are high and stark: manslaughter prosecution or no action. Involuntary manslaughter is an amorphous category covering a wide range of unintentional (but culpable) killings, and medical cases are prosecuted with reference to the catch all concept of "gross negligence". This is not unique as an example of objective criminal liability; in fact, crimes of negligence are on the increase. 1 But its use in homicide, coupled with the absence of a lesser or inchoate crime, renders this an unsatisfactory "all or nothing" scenario, often hinging on moral luck 2 and prosecutorial (and expert witness) performance. Although relatively rare, such prosecutions have risen markedly over the past twenty years. To the best of my knowledge, since 1925, 65 health professionals have been charged with medical manslaughter-with over 50 of these since 1990. 3 Understandably, this has caused much anxiety for healthcare professionals and invited academic inquiry. 4 This article considers how criminal law should deal with fatal medical error. I will attempt to defend the following thesis: that the current test for liability (gross negligence) is unclear, unprincipled, often unfair and ought to be abolished. I will argue that subjective reckless manslaughter is the proper place to set the bar for liability. * Senior Lecturer in Law, University of Bristol. This is the revised version of the Baron Ver Heyden de Lancey lecture, at the University of Cambridge 27th April 2009. Thanks go to John Spencer for his invitation to deliver the lecture and to Lee Price, Celia Wells and Richard Young for their helpful comments on an earlier draft. 1 For example, supplying intoxicating substances to the under aged (Intoxicating Substance (Supply) Act 1985, s. 1(1)); causing death by dangerous driving (Road Traffic Act 1988, s. 1); insider trading (Criminal Justice Act 1993, s. 52(2)(a)); harassment (Protection from Harassment Act 1997, ss. 1(1) and 2(1)); providing money or property for the purposes of terrorism (Terrorism Act 2000, ss. 15-18); money laundering (Proceeds of Crime Act 2002, s. 330(2)(b)); and causing or allowing the death of a child or vulnerable adult (Domestic Violence, Crime and Victims Act 2004, s. 5).