X. v. Finland

In the case of X. v. Finland (Applicatioin no. 34806/04) the ECtHR found - among others - the violation of Article 8 of the ECHR in relation with the applicant's forced medication in a mental hospital which was based on a law lacking proper safeguards against arbitrariness.

In its judgment the  Court  reiterated  that  a  medical  intervention  in  defiance  of  the subject’s will gives rise to an interference with respect for his or her private life, in particular his or her right to physical integrity. Such an interference would constitute a breach of Article 8 of the ECHR, unless it was in accordance with the law, pursued a legitimate aim or aims under paragraph 2 of Article 8, and was necessary in a democratic society. In this respect, the  notion  of  necessity  implies  that  the  interference  corresponds  to  a pressing social  need  and,  in  particular,  that  it  is  proportionate  to  the legitimate  aims  pursued.  In  determining  whether  an  interference  was “necessary in a democratic society” a margin  of  appreciation  that is left  to  the  states shall be taken into account.

The Court noted that it had not been disputed by the Finnish government that the forced administration of medication constituted an interference  with  the  applicant’s  right  to  respect  for  her physical  integrity. It thus remained to be determined  whether  the  interference  was  justified  under  tparagraph 2 of Article 8. The Court stated that the expression “in accordance with the law”, within  the  meaning  of  Article  8 

requires  firstly  that  the  impugned measure should have some basis in domestic law; it also refers to the quality of  the  law  in  question,  requiring  that  it  should  be  accessible  to  the  person concerned, who must moreover be able to foresee its consequences for him, and  compatible  with  the  rule  of  law  (see e.g. Herczegfalvy  v.  Austria, 24 September 1992, § 88, Series A no. 244).

As  to  the  legal  basis  in  Finnish  law,  the  Court reiterated  that  in  accordance  with  the  case-law  of  the  Convention institutions the term “law” is to be understood in its “substantive” sense, not its “formal” one:

In a sphere covered by written law, the “law” is the enactment in force as the competent courts  have interpreted  it  (see, inter  alia, Société  Colas  Est  and  Others  v. France,  no.  37971/97,  §  43,  ECHR  2002-III).

In  this  respect,  the  Court found that its power to review compliance with domestic law was limited, it was the national authorities to interpret  and  apply  that  law in the first place. After the examination of the relevant law the Court  was satisfied that the interference complained of had had a legal basis in Finnish law.

As to the quality of  the law, the Court noted that the requirements of  the accessibility  and  the  foreseeability  of  the  law did not  raise  any problems in the current case. However, the Court reiterated that paragraph 2 of Article 8 also requires the law in question to be “compatible with the rule of law”.

In the  context  of forced  administration  of  medication,  the  domestic  law  must provide some protection to the individual against arbitrary interference with his or her rights under Article 8. The Court must thus examine the “quality” of the legal rules applicable to the applicant in the instant case.

The  Court  noted  in  the  first  place  that the relevant section  of the Finnich Mental Health Act contained detailed  provisions  on  the treatment  of  mental  illness, and in particular, that it is for the physician attending to the patient to decide on  the  treatment  to  be  given,  regardless  of  the  patient’s  will. A care  order  issued  for  an  involuntary  hospitalisation  of  a psychiatric patient is understood to contain also an automatic authorisation to  treat  the  patient, even against  his  or  her  will. There is  no obligation for doctors to have the patient's consent in written form or to seek such a consent from the patient’s relatives or guardian/trustee. The law allows forced administration of medication in case the patient refuses to give his or her  consent  or  withdraws previous consent. The decisions taken by the treating doctor concerning medication  of  a  patient are  not  subject  to  appeal.

The  Court considered that  forced  administration  of  medication represented a serious interference with a person’s physical integrity and must accordingly be based on a “law” that guarantees proper  safeguards against arbitrariness.

In the present case such safeguards were missing. The decision to confine  the  applicant  to  involuntary treatment  included  an  automatic authorisation  to proceed  to forced  administration  of  medication  when the applicant refused  the  treatment.  The decision-making  was  solely  in the hands  of  the  treating doctors who  could take  even  quite  radical  measures regardless of the applicant’s will. Moreover, their decision-making was free from any kind of immediate judicial scrutiny: the applicant did not have any remedy available whereby she  could  require  a  court  to  rule  on  the lawfulness,  including  proportionality,  of  the  forced  administration  of medication and to have it discontinued.

On these grounds the Court found that the forced administration of medication in  the  present  case  was implemented  without  proper  legal safeguards.  The  Court  concluded  that, even  if  there  could  be  said  to  be  a general legal basis for the measures provided for in Finnish law, the absence of sufficient safeguards against  forced  medication by  the  treating  doctors deprived the  applicant of  the  minimum  degree  of protection  to  which she was entitled under the rule of law in a democratic society. The interference in question was “in accordance with the law” as required by paragraph 2 of Article 8 of the ECHR, therefore there  had been a  violation  of Article 8 of the ECHR.