The two-limb test from R v Van Boxtel for ill health as a mitigating factor in sentencing (increased burden of imprisonment, and serious risk of gravely adverse effect on health) continues to apply. A sentencing judge's failure to expressly refer to the increased burden limb in sentencing reasons does not vitiate the sentencing discretion where the judge acknowledged the factor during the plea hearing and set out the relevant evidence, and where a markedly different sentence would not have followed.
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