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*439This case presents the question of how to determine the amount of restitution a possessor of child pornography must pay to the victim whose childhood abuse appears in the pornographic materials possessed. The relevant statutory provisions are set forth at
Petitioner Doyle Randall Paroline pleaded guilty to such an offense. He admitted to possessing between 150 and 300 images of child pornography, which included two that depicted the sexual exploitation of a young girl, now a young woman, who goes by the pseudonym "Amy" for this litigation. The question is what causal relationship must be established between the defendant's conduct and a victim's losses for purposes of determining the right to, and the amount of, restitution under ยง 2259.
I
Three decades ago, this Court observed that "the exploitive use of children in the production of pornography has become a serious national problem." New York v. Ferber,
One person whose story illustrates the devastating harm caused by child pornography is the respondent victim in this case. When she was eight and nine years old, she was sexually abused by her uncle in order to produce child pornography. Her uncle was prosecuted, required to pay about $6,000 in restitution, and sentenced to a lengthy prison term. The victim underwent an initial course of therapy beginning in 1998 and continuing into 1999. By the end of this period, her therapist's notes reported that she was " 'back to normal' "; her involvement in dance and other age-appropriate activities, and the support of her family, justified an optimistic assessment. App. 70-71. Her functioning appeared to decline in her teenage years, however; and a major blow to her recovery came when, at the age of 17, she learned that images of her abuse were being trafficked on the Internet. Id., at 71. The digital images were available nationwide and no doubt worldwide. Though the exact scale of the trade in her images is unknown, the possessors to date easily number in the thousands. The knowledge that her images were circulated far and wide renewed the victim's trauma and made it difficult for her to recover from her abuse. As she explained in a victim impact statement submitted to the District Court in this case:
"Every day of my life I live in constant fear that someone will see my pictures and recognize me and that I *441will be humiliated all over again. It hurts me to know someone is looking at them-at me-when I was just a little girl being abused for the camera. I did not choose to be there, but now I am there forever in pictures that people are using to do sick things. I want it all erased. I want it all stopped. But I am powerless to stop it just like I was powerless to stop my uncle.... My life and my feelings are worse now because the crime has never really stopped and will never really stop.... It's like I am being abused over and over and over again." Id ., at 60-61.
The victim says in her statement that her fear and trauma make it difficult for her to trust others or to feel that she has control over what happens to her. Id., at 63.
The full extent of this victim's suffering is hard to grasp. Her abuser took away her childhood, her self-conception of her innocence, and her freedom from the kind of nightmares and memories that most others will never know. These crimes were compounded by the distribution of images of her abuser's horrific acts, which meant the wrongs inflicted upon her were in effect repeated; for she knew her humiliation and hurt were and would be renewed into the future as an ever-increasing number of wrongdoers witnessed the crimes committed against her.
Petitioner Paroline is one of the individuals who possessed this victim's images. In 2009, he pleaded guilty in federal court to one count of possession of material involving the sexual exploitation of children in violation of
After briefing and hearings, the District Court declined to award restitution.
The victim sought a writ of mandamus, asking the United States Court of Appeals for the Fifth Circuit to direct the District Court to order Paroline to pay restitution in the amount requested. In re Amy,
The Fifth Circuit reheard the case en banc along with another case, in which the defendant, Michael Wright, had raised similar issues in appealing an order of restitution under ยง 2259, see United States v. Wright,
Paroline sought review here. Certiorari was granted to resolve a conflict in the Courts of Appeals over the proper causation inquiry for purposes of determining the entitlement to and amount of restitution under ยง 2259. 570 U.S. ----,
II
Title
Section 2259 states a broad restitutionary purpose: It requires district courts to order defendants "to pay the victim ... the full amount of the victim's losses as determined by the court," ยง 2259(b)(1), and expressly states that "[t]he issuance of a restitution order under this section is *1719mandatory," ยง 2259(b)(4)(A). Section 2259(b)(2) provides that "[a]n order of restitution under this section shall be issued and enforced in accordance with section 3664," which in turn provides in relevant part that "[t]he burden of demonstrating the amount of the loss sustained by a victim as a result of the offense shall be on the attorney for the Government," ยง 3664(e).
The threshold question the Court faces is whether ยง 2259 limits restitution to those losses proximately caused by the defendant's offense conduct. The Fifth Circuit held that it does not, contrary to the holdings of other Courts of Appeals to have addressed the question. Compare, e.g.,
As a general matter, to say one event proximately caused another is a way of making two separate but related assertions. First, it means the former event caused the latter. This is known as actual cause or cause in fact. The concept of actual cause "is not a metaphysical one but an ordinary, matter-of-fact inquiry into the existence ... of a causal relation as laypeople would view it." 4 F. Harper, F. James, & O. Gray, Torts ยง 20.2, p. 100 (3d ed. 2007).
Every event has many causes, however, see ibid., and only some of them are proximate, as the law uses that term. So to say that one event was a proximate cause of another means that it was not just any cause, but one with a sufficient connection to the result. The idea of proximate cause, as distinct from actual cause or cause in fact, defies easy summary. It is "a flexible concept," Bridge v. Phoenix Bond & Indemnity Co.,
As noted above, ยง 2259 requires a court to order restitution for "the full amount of the victim's losses," ยง 2259(b)(1), which the statute defines to include "any costs incurred by the victim" for six enumerated categories of expense, ยง 2259(b)(3). The reference to "costs incurred by the victim" is most naturally understood as costs stemming from the source that qualifies an individual as a "victim" in the first place-namely, ones arising "as a result of" the offense. Thus, as is typically the case with criminal restitution, ยง 2259 is intended to compensate victims for losses caused by the offense of conviction. See
*446But there is a further question whether restitution under ยง 2259 is limited to losses proximately caused by the offense. As noted, a requirement of proximate cause is more restrictive than a requirement of factual cause alone. Even if ยง 2259 made no express reference to proximate causation, the Court might well hold that a showing of proximate cause was required. Proximate cause is a standard aspect of causation in criminal law and the law of torts. See 1 LaFave ยง 6.4(a), at 464-466; W. Keeton, D. Dobbs, R. Keeton, & D. Owen, Prosser and Keeton on Law of Torts ยง 41, p. 263 (5th ed. 1984) (hereinafter Prosser and Keeton). Given proximate cause's traditional role in causation analysis, this Court has more than once found a proximate-cause requirement built into a statute that did not expressly impose one. See Holmes,
Here, however, the interpretive task is easier, for the requirement of proximate cause is in the statute's text. The statute enumerates six categories of covered losses. ยง 2259(b)(3). These include certain medical services, ยง 2259(b)(3)(A) ; physical and occupational therapy, ยง 2259(b)(3)(B) ; transportation, temporary housing, and child care, ยง 2259(b)(3)(C) ; lost income, ยง 2259(b)(3)(D) ; attorney's fees and costs, ยง 2259(b)(3)(E) ; and a final catchall category for "any other losses suffered by the victim as a proximate result of the offense," ยง 2259(b)(3)(F).
The victim argues that because the "proximate result" language appears only in the final, catchall category of losses set forth at ยง 2259(b)(3)(F), the statute has no proximate-cause requirement for losses falling within the prior enumerated categories.
*1721She justifies this reading of ยง 2259(b) in part on *447the grammatical rule of the last antecedent, "according to which a limiting clause or phrase ... should ordinarily be read as modifying only the noun or phrase that it immediately follows." Barnhart v. Thomas,
Other canons of statutory construction, moreover, work against the reading the victim suggests. "When several words are followed by a clause which is applicable as much to the first and other words as to the last, the natural construction of the language demands that the clause be read as applicable to all." Porto Rico Railway, Light & Power Co. v. Mor,
The victim says that if Congress had wanted to limit the losses recoverable under ยง 2259 to those proximately caused by the offense, it could have written the statute the same way it wrote ยง 2327, which provides for restitution to victims of telemarketing fraud. Section 2327, which is written and structured much like ยง 2259, simply defines the term "full amount of the victim's losses" as "all losses suffered by the victim as a proximate result of the offense." ยง 2327(b)(3). In essence the victim argues that the first five categories of losses enumerated in ยง 2259(b)(3) would be superfluous if all were governed by a proximate-cause requirement. That, *448however, is unpersuasive. The first five categories provide guidance to district courts as to the specific types of losses Congress thought would often be the proximate result of a Chapter 110 offense and could as a general matter be included in an award of restitution.
Reading the statute to impose a general proximate-cause limitation accords with common sense. As noted above, proximate cause forecloses liability in situations where the causal link between conduct and result is so attenuated that the so-called consequence is more akin to mere fortuity. For example, suppose the traumatized victim of a Chapter 110 offender needed therapy and had a car accident on the way to her therapist's office. The resulting medical costs, in a literal sense, would be a factual result of the offense. But it would be strange indeed to make a defendant pay restitution for these costs. The victim herself concedes Congress did not intend costs like these to be recoverable under ยง 2259. Brief for Respondent Amy 45. But she claims that it is unnecessary to "read ... into" ยง 2259 a proximate-cause limitation in order to exclude costs of that sort.
The victim may be right that the concept of proximate cause is not necessary to impose sensible limitations on restitution *1722for remote consequences. But one very effective way, and perhaps the most obvious way, of excluding costs like those arising from the hypothetical car accident described above would be to incorporate a proximate-cause limitation into the statute. Congress did so, and for reasons given above the proximate-cause requirement applies to all the losses described in ยง 2259. Restitution is therefore proper under ยง 2259 only to the extent the defendant's offense proximately caused a victim's losses.
III
*449There remains the difficult question of how to apply the statute's causation requirements in this case. The problem stems from the somewhat atypical causal process underlying the losses the victim claims here. It is perhaps simple enough for the victim to prove the aggregate losses, including the costs of psychiatric treatment and lost income, that stem from the ongoing traffic in her images as a whole. (Complications may arise in disaggregating losses sustained as a result of the initial physical abuse, but those questions may be set aside for present purposes.) These losses may be called, for convenience's sake, a victim's "general losses." The difficulty is in determining the "full amount" of those general losses, if any, that are the proximate result of the offense conduct of a particular defendant who is one of thousands who have possessed and will in the future possess the victim's images but who has no other connection to the victim.
In determining the amount of general losses a defendant must pay under ยง 2259 the ultimate question is how much of these losses were the "proximate result," ยง 2259(b)(3)(F), of that individual's offense. But the most difficult aspect of this inquiry concerns the threshold requirement of causation in fact. To be sure, the requirement of proximate causation, as distinct from mere causation in fact, would prevent holding any possessor liable for losses caused in only a remote sense. But the victim's costs of treatment and lost income resulting from the trauma of knowing that images of her abuse are being viewed over and over are direct and foreseeable results of child-pornography crimes, including possession, assuming the prerequisite of factual causation is satisfied. The primary problem, then, is the proper standard of causation in fact.
A
The traditional way to prove that one event was a factual cause of another is to show that the latter would not have *450occurred "but for" the former. This approach is a familiar part of our legal tradition, see 1 LaFave ยง 6.4(b), at 467-468; Prosser and Keeton ยง 41, at 266, and no party disputes that a showing of but-for causation would satisfy ยง 2259's factual-causation requirement. Sometimes that showing could be made with little difficulty. For example, but-for causation could be shown with ease in many cases involving producers of child pornography, see ยง 2251(a); parents who permit their children to be used for child-pornography production, see ยง 2251 (b); individuals who sell children for such purposes, see ยง 2251A; or the initial distributor of the pornographic images of a child, see ยง 2252.
In this case, however, a showing of but-for causation cannot be made. The District Court found that the Government failed to prove specific losses caused by Paroline in a but-for sense and recognized that it would be "incredibly difficult" to do so in a case like this.