Information Note on the Court’s case-law 266
Judgment 20.9.2022 [Section III]
Respect for private life
Sterilisation without consent in breach of domestic law, failure of domestic courts to establish responsibility and provide redress: violation
Sterilisation without consent not reaching requisite severity threshold, given unexpected and urgent context and lack of bad faith on doctors’ part: inadmissible
Facts – The applicant, who was pregnant at the relevant time, underwent an emergency Caesarean section in a public hospital. During the intervention, doctors identified a rupture of the uterus. A medical panel was urgently convened and decided that the applicant should be sterilised, to avoid the real and life-threatening risk of the uterus rupturing again in a future pregnancy. The applicant became aware of the sterilisation only after the procedure had been performed.
The applicant brought an unsuccessful civil claim against the hospital, seeking compensation in respect of non-pecuniary damage in connection with her sterilisation. She appealed without success.
Law – Article 3: The applicant complained that she had been subjected to inhuman and degrading treatment as a result of being sterilised without her consent.
The Court was mindful that sterilisation constituted a major interference with a person’s reproductive health status and concerned one of the essential bodily functions of human beings (V.C. v. Slovakia). It had had psychological and emotional effects on the applicant and her relationship with her husband, and she had felt humiliated and degraded.
At the same time, the health professionals in question had, during a routine medical intervention, suddenly been faced with a situation (ruptured uterus) where they had had to decide as a matter of urgency on the scope of the surgery, and where even a hysterectomy (removal of the uterus) could have been justified. The decision to keep the uterus, suture the rupture and sterilise the applicant had been taken by a panel of doctors, including the chief medical officer, after a thorough consideration, on medical grounds confirmed by a subsequent expert report, and considered by those professionals to be necessary to prevent a future risk to the applicant’s life. The doctors had not acted in bad faith, let alone with an intent of ill-treating or degrading the applicant, but had been driven by genuine concerns for health and safety. There were also no additional elements, such as, for instance, the applicant’s particular vulnerability, to enable the Court to conclude that the requisite threshold of severity had been reached, in the particular circumstances of the present case, to bring Article 3 into play.
Conclusion: inadmissible (ratione materiae).
Article 8: The domestic courts had dismissed the applicant’s claim for compensation at two levels of jurisdiction, based on the following arguments, which had also been relied upon by the government:
(a) The applicant had consented to the sterilisation as that intervention had been performed as an expansion of the scope of the Caesarean section. However, the relevant consent form, which the applicant had signed, had explicitly excluded sterilisation. Moreover, the expert report and first-instance court had pointed to the applicant’s lack of informed consent for her sterilisation. Sterilisation was not a procedure that could be routinely carried out as part, or as an expansion, of any medical intervention, unless the patient had given express, free and informed consent to that particular procedure. The only exception concerned emergency situations where medical treatment could not be delayed and appropriate consent could not be obtained;
(b) An unexpected complication had required urgent action to save the applicant’s life, and even more radical action would have been justified. However, such a threat was not imminent and was only likely to materialise in the event of a future pregnancy. It could also have been prevented by means of alternative, less intrusive methods. In those circumstances, the applicant’s informed consent could not be dispensed with on the basis of an assumption on the part of the hospital staff that she would act in an irresponsible manner with regard to her health in the future;
(c) It had in any event been open to the applicant to have recourse to in vitro fertilisation. The Court could not accept the argument to the effect that no damage had been inflicted on the applicant’s health as a result of the procedure under this consideration. It could not be reconciled with the alleged necessity to sterilise the applicant with a view to preventing future pregnancies so as to avoid any possibly life-threatening deterioration of her health. Moreover, at the relevant time the applicant had been at her full reproductive age and had been permanently deprived of her natural reproductive capacity, thereby causing serious damage to her health.
It was therefore clear that the applicant had suffered an infringement of her right to respect for her private life as a result of the doctors’ failure to seek and obtain her express, free and informed consent as regards her sterilisation, in line with domestic law.
Moreover, the national courts had refused to establish the doctors’ responsibility for the sterilisation, thereby endorsing the approach which had stood in conflict with the principle of the patient’s autonomy, established both in domestic law and at the international level. The medical intervention with such serious consequences had been performed without respecting the rules and safeguards created by the domestic system itself, which was difficult to reconcile with the procedural safeguards enshrined in Article 8. The applicant had also not been afforded any redress for the infringement of her right to respect for private life.
Conclusion: violation (unanimously).
Article 41: EUR 7,500 in respect of non-pecuniary damage.
(See also V.C. v. Slovakia, 18968/07, 8 November 2011, Legal Summary; N.B. v. Slovakia, 29518/10, 12 June 2012)