The View of the European Court of Human Rights on Competent Patients’ Right of Informed Consent. Research in the Light of Articles 3 and 8 of the European Convention on Human Rights

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It is an internationally recognized principle that patients should give their informed consent to a treatment in order to avoid a violation of their right to personal autonomy. This article discusses this principle in the light of Articles 3 and 8 of The European Convention on Human Rights and the view of the European Court of Human Rights on this matter. Indeed, nowadays more complaints related to (the lack of) informed consent not only concern a possible violation of Article 8 of the Convention, but Article 3 has also gained importance, especially when a treatment is intrusive.

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References

2

E.g., E. Wicks, ‘The Right to Refuse Medical Treatment under the European Convention on Human Rights’, Med.L.Rev. 9(1) (2001) 39-40; Articles 2, 5, 9 and 14 could also be relevant in this respect.

3

ECtHR 5 October 2006, Trocellier v. France, no. 75725/01, para. 4; J. Velaers, ‘Het menselijk lichaam en de grondrechten’, in: P. Reyngaert, J. Taels and G. Vanheeswijck (eds.), Over zichzelf beschikken? Juridische en ethische bijdragen over het leven, het lichaam en de dood (Antwerp: Maklu, 1996) p. 196; P. De Herdt, Art. 8 e.v.r.m. en het Belgische Recht. De bescherming van privacy, gezin, woonst en communicatie (Gent: Mys & Breesch, 1998) pp. 138-139; S. Dewulf, The Signature of Evil — (Re)Defining Torture in International Law (Antwerp: Intersentia, 2011) pp. 320-321; T. Goffin, De professionele autonomie van de arts. De rechtspositie van de arts in de arts-patiëntrelatie (Brugge: die Keure, 2011) pp. 433-434; M. Hartlev, ‘Patients’ Rights’, in: B. Toebes, M. Hartlev, A. Hendriks and J. Rothmar Herrmann (eds.), Health and Human Rights in Europe (Antwerp, Intersentia, 2012) p. 123.

7

E.g., ECtHR 9 March 2004, Glass. v. The United Kingdom, no. 61827/00; ECtHR 5 October 2006, Trocellier v. France, no. 75725/01; ECtHR 13 May 2008, Juhnke v. Turkey, no. 52515/99; ECtHR 2 June 2009, Codarcea v. Roumania, no. 31675/04; Hartlev, supra note 3, 123.

8

M. Donnelly, Healthcare Decision-Making and the Law. Autonomy, Capacity and the Limits of Liberalism (Cambridge: Cambridge University Press, 2014) p. 52.

9

Wicks, supra note 2, 17.

10

Velaers, supra note 3, 193; Dewulf, supra note 3, 320; A. Hendriks, ‘The Council of Europe and Health and Human Rights’, in: Toebes et al. (eds.), supra note 3, pp. 38-39.

11

ECtHR 29 April 2002, Pretty v. The United Kingdom, no. 2346/02, paras. 61-63; ECtHR 22 July 2003, y.f. v. Turkey, no. 24209/94, para. 33; ECtHR 13 May 2008, Juhnke v. Turkey, no. 52515/99, para. 76; ECtHR 7 October 2008, Bogumil v. Portugal, no. 35228/03, para. 84; N.A. Moreham, ‘The right to respect for private life in the European Convention on Human Rights: a re-examination’, e.h.r.l.r. 1 (2008) 44-79, www.westlaw.uk, 4; Cf. infra section 2.2 for a further explanation on the preconditions of this second paragraph.

14

Hartlev, supra note 3, 122.

15

E. Jackson, Medical Law. Text, Cases and Materials (Oxford: Oxford University Press, 2006) p. 282; Donnelly, supra note 8, 72-74.

16

ECtHR 10 June 2010, Jehovah’s Witnesses of Moscow and others v. Russia, no. 302/02, para. 138; Wicks, supra note 2, 26.

17

ECtHR 24 February 1998, Larissis and Others v. Greece, no. 140/1996/759/958-960, paras. 51, 54 and 59.

18

Ibid., 282; Donnelly, supra note 8, 59-60. Confirmed in: ECtHR 22 July 2003, y.f. v. Turkey, no. 24209/94, para. 34; ECtHR 13 May 2008, Juhnke v. Turkey, no. 52515/9, para. 76 and Cf. infra section 3.2.3.

19

ECtHR 10 June 2010, Jehovah’s Witnesses of Moscow and others v. Russia, no. 302/02, para. 139. See also: ECtHR 24 February 1998, Larissis and Others v. Greece, no. 140/1996/759/958-960, para. 45.

21

ECtHR 10 June 2010, Jehovah’s Witnesses of Moscow and others v. Russia, no. 302/02, paras. 139-140.

23

Lemmens, supra note 20, 97.

24

ECtHR 8 November 2011, v.c. v. Slovakia, no. 18968/07, para. 112. The guidance provided by the case-law is rather general. A more detailed picture of the scope of the right to information can be found in paras. 35-36 of the Explanatory Report on the Biomedicine Convention: http://conventions.coe.int/Treaty/EN/Reports/Html/164.htm; See also for a detailed illustration: Hartlev, supra note 3, 130-132.

25

ECtHR 5 October 2006, Trocellier v. France, no. 75725/01, para. 4; ECtHR 2 June 2009, Codarcea v. Roumania, no. 31675/04, para. 105; ECtHR 13 January 2013, Csoma v. Romania, no. 8759/05, para. 42.

26

ECtHR 8 November 2011, v.c. v. Slovakia, no. 18968/07, paras. 112-113.

27

ECtHR 10 June 2010, Jehovah’s Witnesses of Moscow and others v. Russia, no. 302/02, para. 136.

30

ECtHR 10 June 2010, Jehovah’s Witnesses of Moscow and others v. Russia, no. 302/02, para. 136; X, ‘Note under ehrm 10 June 2010, Jehovah’s Witnesses of Moscow and others v. Russia’, ncjm-Bull. 8 (2010) 1073.

34

ECtHR 9 March 2004, Glass. v. The United Kingdom, no. 61827/00, para. 82; ECtHR 13 May 2008, Juhnke v. Turkey, no. 52515/99, para. 76; Hendriks, supra note 10, 39.

35

ECtHR 7 October 2008, Bogumil v. Portugal, no. 35228/03.

36

ECtHR 7 October 2008, Bogumil v. Portugal, no. 35228/03, para. 76: ‘Dans ces conditions, la Cour, faute d’éléments suffisants à cet effet, n’estime pas établi que le requérant ait donné son consentement à l’intervention en cause. Rien n’indique par ailleurs qu’il aurait refusé l’intervention chirurgicale et qu’il ait été forcé à la subir’.

39

T. Goffin, ‘Het einde van de geïnformeerde toestemming? Als medische noodzakelijkheid de regels bepaalt’, T.Gez. 1 (2010-2011) 45-46.

41

ECtHR 9 March 2004, Glass. v. The United Kingdom, no. 61827/00, (express informed consent of the mother of a severely handicapped child — administration of damorphine); ECtHR 13 May 2008, Juhnke v. Turkey, no. 52515/99, (express informed consent of a detained female prisoner — gynaecological examination).

42

See for a further explanation: Hartlev, supra note 3, 134-135; Hendriks, supra note 10, 38-39.

44

ECtHR 26 May 2011, r.r. v. Poland, no. 27617/04, para. 183; ECtHR 24 June 2014, Petrova v. Latvia, no. 4605/05, para. 85; ECtHR 13 January 2015, Elberte v. Latvia, no. 61243/08, para. 103. As for actions (of members) of private hospitals, a State can only be indirectly liable for their behaviour when this follows from the state’s violation of the positive obligations under Article 8. Cf. infra section 2.3.

46

ECtHR 9 March 2004, Glass. v. The United Kingdom, no. 61827/00, para. 71; ECtHR 5 October 2006, Trocellier v. France, no. 75725/01, para. 4; ECtHR 2 June 2009, Codarcea v. Roumania, no. 31675/04, para. 105.

47

Velaers, supra note 3, 134-151; Hartlev, supra note 3, 125-130; Donnelly, supra note 8, 65-69 and 79.

49

ECtHR 26 April 1979, Sunday Times v. The United Kingdom, no. 6538/74, para. 47.

50

ECtHR 26 April 19, Sunday Times v. The United Kingdom, no. 6538/74, paras. 48-49; S. Smis, C. Janssens, S. Mirgaux and K. Van Laethem, Handboek Mensenrechten. De international bescherming van de Rechten van de mens (Antwerp: Intersentia, 2011) p. 233.

51

ECtHR 24 September 1992, Herczegfalvy v. Austria, no. 10533/83, para. 88; ECtHR 24 June 2014, Petrova v. Latvia, no. 4605/05, para. 86; De Herdt, supra note 3, 19-21.

52

ECtHR 13 January 2015, Elberte v. Latvia, no. 61243/08, paras. 112-113.

53

ECtHR 24 September 1992, Herczegfalvy v. Austria, no. 10533/83, para. 91.

54

ECtHR 25 March 1983, Silver and Others v. The United Kingdom, no. 5947/72; 6205/73; 7052/75; 7061/75; 7107/75; 7113/75; 7136/75, para. 88.

55

Lemmens, supra note 20, 109-110; W. Buelens, ‘Dwangbehandeling, afzondering en het evrm’, in: T. Vansweevelt and F. Dewallens (eds.), Handboek gezondheidsrecht. Volume i. Zorgverleners: statuut en aansprakelijkheid (Antwerp: Intersentia, 2014) pp. 514-533; Donnelly, supra note 8, 67-68.

56

Wicks, supra note 2, 29; Hartlev, supra note 3, 128.

57

ECtHR 5 July 1999, Matter v. Slovakia, no. 31534, para. 65.

58

ECtHR 7 October 2008, Bogumil v. Portugal, no. 35228/03, para. 89.

59

ECtHR 10 June 2010, Jehovah’s Witnesses of Moscow and others v. Russia, no. 302/02, para. 136. Cf. supra section 2.1.

60

Hartlev, supra note 3, 127.

66

ECtHR 8 November 2011, v.c. v. Slovakia, no. 18968/07, para. 139; ECtHR 13 January 2015, Elberte v. Latvia, no. 61243/08, para. 103.

67

ECtHR 23 March 2010, m.a.k. and r.k. v. United Kingdom, no. 45901/05 and 40146/06, para. 68; De Herdt, supra note 3, 36.

71

ECtHR 13 May 2008, Juhnke v. Turkey, no. 52515/99, para. 81. For other cases related to gynaecological examinations and discussed under Article 3, Cf. infra section 3.4.

72

For example: ECtHR 16 June 2005, Storck v. Germany, no. 61603/00.

73

ECtHR 13 June 1979, Marckx v. Belgium, no. 6833/74, para. 31; ECtHR 26 March 1985, X and Y v. The Netherlands, no. 8978/80, para. 23; ECtHR 20 March 2007, Tysiac v. Poland, no. 5410/03, para. 110; ECtHR 8 November 2011, v.c. v. Slovakia, no. 18968/07, para. 140.

74

ECtHR 16 June 2005, Storck v. Germany, no. 61603/00, para. 151.

75

ECtHR 28 April 2009, k.h. and Others v. Slovakia, no. 32881/04, para. 45; De Herdt, supra note 3, 49; H.D.C. Roscam Abbing, ‘Artikel 8: recht op privéleven’, in: J.K.M. Gevers (eds.), Het evrm en de gezondheidszorg (Nijmegen: Ars Aequi Libri, 1994) pp. 115-117.

76

ECtHR 20 March 2007, Tysiac v. Poland, no. 5410/03, para. 111; Moreham, supra note 11, 44-79, www.westlaw.uk, 3.

77

ECtHR 20 March 2007, Tysiac v. Poland, ibid., para. 110; ECtHR 26 May 2011, r.r. v. Poland, no. 27617/04, para. 185.

78

ECtHR 5 October 2006, Trocellier v. France, no. 75725/01, para. 4; ECtHR 2 June 2009, Codarcea v. Roumania, no. 31675/04, paras. 102 and 104.

79

ECtHR 5 October 2006, Trocellier v. France, ibid.; ECtHR 2 June 2009, Codarcea v. Roumania, ibid., paras. 102 and 105; ECtHR 13 January 2013, Csoma v. Romania, no. 8759/05, para. 42.

80

ECtHR 5 October 2006, Trocellier v. France, ibid.

81

De Herdt, supra note 3, 45.

84

ECtHR 16 June 2005, Storck v. Germany, no. 61603/00, para. 150. In the latter case the applicant was a psychiatric patient in a private psychiatric hospital. Yet we do believe that the specific reasoning in this case should be applied to all hospitals.

85

ECtHR 19 February 1998, Guerra and Others v. Italy, no. 116/1996/735/932, para. 60 (health risk resulting from environmental pollution); ECtHR 9 June 1998, McGinley and Egan v. the United Kingdom, no. 10/1997/794/995-996, para. 101 (health risk resulting from participation in nuclear tests); ECtHR 19 October 2005, Roche v. the United Kingdom, no. 32555/96, para. 162 (health risk resulting from the exposure to toxic chemicals).

86

ECtHR 2 June 2009, Codarcea v. Roumania, no. 31675/04, para. 104.

87

ECtHR 26 May 2011, r.r. v. Poland, no. 27617/04, paras. 196-198.

88

ECtHR 28 April 2009, k.h. and Others v. Slovakia, no. 32881/04, paras. 47-56.

89

ECtHR 13 May 2008, Juhnke v. Turkey, no. 52515/99, para. 76.

91

ECtHR 28 July 1999, Selmouni v. France, no. 25803/94, para. 101.

93

O. Lewis, ‘Protecting the Rights of People with Mental Disabilities: The European Convention on Human Rights’, European Journal of Health Law 9 (4) (2002) 293-320, at p. 303.

94

ECtHR 18 January 1978, Ireland v. United Kingdom, no. 5310/71, para. 162.

95

ECtHR 16 December 1999, V. v. United Kingdom, no. 24888/94, para. 71; ECtHR 26 October 2000, Kudla v. Poland, no. 30210/96, para. 92.

100

ECtHR 24 September 1992, Herczegfalvy v. Austria, no. 10533/83, para. 82.

101

See for example: ECtHR 5 April 2005, Nevmerzhitsky v. Ukraine, no. 54825/00, para. 93; ECtHR 19 June 2007, Ciorap v. Moldavia, no. 12066/02, para. 76.

102

See for example: ECtHR 7 October 2008, Bogumil v. Portugal, no. 35228/03, para. 69; ECtHR 11 July 2006, Jalloh v. Germany, no. 54810/00, para. 69.

103

See for example: ECtHR 5 April 2005, Nevmerzhitsky v. Ukraine, no. 54825/00, para. 96.

105

See for example: ECtHR 5 April 2005, Nevmerzhitsky v. Ukraine, no. 54825/00, paras. 95-96; ECtHR 19 June 2007, Ciorap v. Moldavia, no. 12066/02, paras. 81-82.

106

See for example: ECtHR 5 April 2005, Nevmerzhitsky v. Ukraine, no. 54825/00, para. 93.

107

ECtHR 31 March 2009, Horoz v. Turkey, no. 1639/03, para. 28.

108

For example: ECtHR 29 April 2002, Pretty v. the United Kingdom, no. 2346/02.

109

ECtHR 10 June 2010, Jehovah’s Witnesses of Moscow and others v. Russia, no. 302/02, paras. 135-142. Cf. supra sections 2.1.2.3 and 2.2.3.

110

ECtHR 5 April 2005, Nevmerzhitsky v. Ukraine, no. 54825/00, para. 93: ‘. . . force-feeding that is aimed at saving the life of a particular detainee who consciously refuses to take food’ (own emphasis); ECtHR 19 June 2007, Ciorap v. Moldava, no. 12066/02, para. 83: ‘In view of the lack of medical evidence that the applicant’s life or health were in serious danger, it cannot be said that the authorities acted in the applicant’s best interests in subjecting him to force-feeding’ (own emphasis).

111

ECtHR 7 October 2008, Bogumil v. Portugal, no. 35228/03, para. 77: Nul ne conteste que le requérant risquait de mourir d’une intoxication (own emphasis).

112

ECtHR 19 June 2007, Ciorap v. Moldavia, no. 12066/02, para. 83.

113

Wicks, supra note 2, 23-24.

115

ECtHR 5 April 2005, Nevmerzhitsky v. Ukraine, no. 54825/00, para. 97; ECtHR 11 July 2006, Jalloh v. Germany, no. 54810/00, para. 72; ECtHR 7 October 2008, Bogumil v. Portugal, no. 35228/03, para. 70; Dewulf, supra note 3, 322.

116

ECtHR 7 October 2008, Bogumil v. Portugal, no. 35228/03, para. 70; See also: ECtHR 11 July 2006, Jalloh v. Germany, no. 54810/00, paras. 72-74.

118

See: ECtHR 24 September 1992, Herczegfalvy v. Austria, para. 84 ; ECtHR 7 October 2008, Bogumil v. Portugal, no. 35228/03, para. 82. It will become more difficult to find a violation of Article 3 when the therapeutic necessity is present, yet, in our opinion, it will not be impossible. Cf. infra section 3.2.3.

119

ECtHR 19 June 2007, Ciorap v. Moldavia, no. 12066/02, para. 87.

120

ECtHR 5 April 2005, Nevmerzhitsky v. Ukraine, no. 54825/00, para. 97.

121

ECtHR 8 November 2011, v.c. v. Slovakia, no. 18968/07; ECtHR 12 June 2012, n.b. v. Slovakia, no. 29518/10; ECtHR 13 November 2012, i.g. and Others v. Slovakia, no. 15966/04.

122

ECtHR 8 November 2011, v.c. v. Slovakia, no. 18968/07, para. 93; ECtHR 12 June 2012, n.b. v. Slovakia, no. 29518/10, para. 70; ECtHR 13 November 2012, i.g. and Others v. Slovakia, no. 15966/04, para. 114.

125

ECtHR 8 November 2011, v.c. v. Slovakia, no. 18968/07, para. 110 and 117.

128

ECtHR 10 June 2010, Jehovah’s Witnesses of Moscow and others v. Russia, no. 302/02, para. 135.

129

ECtHR 8 November 2011, v.c. v. Slovakia, no. 18968/07, paras. 105 and 107.

132

Gevers, supra note 96, 54.

133

ECtHR 8 November 2011, v.c. v. Slovakia, no. 18968/07, para. 113.

136

ECtHR 8 November 2011, v.c. v. Slovakia, no. 18968/07, para. 176-180.

137

E.g., M. Möshel, ‘Is the European Court of Human Rights’ Case Law on Anti-Roma Violence ‘Beyond Reasonable Doubt’?’, Human Rights Law Review 12(3) (2012) 479-507; L. Hoyle, ‘v.c. v. Slovakia: A reproductive rights victory misses the mark’, B. C. Int’l & Comp. L. Rev. 36(3) (2013) 17-31.

141

ECtHR 7 October 2008, Bogumil v. Portugal, no. 35228/03, para. 76: ‘Dans ces conditions, la Cour, faute d’éléments suffisants à cet effet, n’estime pas établi que le requérant ait donné son consentement à l’intervention en cause. Rien n’indique par ailleurs qu’il aurait refusé l’intervention chirurgicale et qu’il ait été forcé à la subir.’ One could say that in this way the Court wanted to introduce the notion of implied consent, as it is normally used under Article 8. Cf. supra section 2.1.2.4.

142

ECtHR 1 February 2011, Yazgül Yilmaz v. Turkey, no. 36369/06. Cf. infra section 3.4.

145

ECtHR 11 July 2006, Jalloh v. Germany, no. 54810/00, para. 70.

147

ECtHR 11 July 2006, Jalloh v. Germany, no. 54810/00, para. 70.

150

ECtHR 11 July 2006, Jalloh v. Germany, no. 54810/00, para. 72.

152

X., supra note 98, 106.

153

ECtHR 11 July 2006, Jalloh v. Germany, no. 54810/00, para. 76.

156

ECtHR27 July 2003, y.f. v. Turkey, para. 43; ECtHR 2 March 2006, Devrim Turan v. Turkey, no. 879/02, para. 20.

157

ECtHR 1 February 2011, Yazgül Yilmaz v. Turkey, no. 36369/06, para. 48. Notice that in the Juhnke case the Court was also in doubt about the desirability of a gynaecological examination to protect the guards from false allegations (ECtHR 13 May 2008, Juhnke v. Turkey, no. 52515/99, para. 81.

158

ECtHR 13 May 2008, Juhnke v. Turkey, no. 52515/99, para. 75.

159

ECtHR 27 August 1992, Tomasi v. France, no. 12850/87 paras.113-115; ECtHR27 July 2003, y.f. v. Turkey, no. 24209/94, para. 34; ECtHR 13 May 2008, Juhnke v. Turkey, no. 52515/99, para. 76.

161

ECtHR 13 May 2008, Juhnke v. Turkey, no. 52515/99, para. 76.

164

Ibid., 816.

167

ECtHR 2 March 2006, Devrim Turan v. Turkey, no. 879/02, para. 21.

168

ECtHR 8 January 2009, Filiz Uyan v. Turkey, no. 7496/03, paras.32-33. Cf.ehrr (dec.) 6 April 1994, Peters v. Netherlands, dr 1994, 75: ‘That given the generally accepted desirability to effectively control the use of drugs in prisons, the treatment complained of, i.e., that a detainee has the produce the urine in the presence of a supervisor, does not attain the minimum level of severity required in order to fall within the scope of this provision.’

169

Dewulf, supra note 3, 320; Hendriks, supra note 10, 38-39; Velaers, supra note 3, 193.

170

ECtHR 7 October 2008, Bogumil v. Portugal, no. 35228/03; ECtHR 10 June 2010, Jehovah’s Witnesses of Moscow and others v. Russia, no. 302/02.

171

ECtHR 7 October 2008, Bogumil v. Portugal, no. 35228/03, para. 71.

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