Credit: Council of Europe
In a new judgment, the European Court of Human Rights has addressed a novel issue in human rights law: whether allowing medical students to observe a childbirth without the mother’s explicit consent violated her right to privacy. [ECtHR Press Release] The applicant, Ms. Yevgeniya Konovalova, argued that the unauthorized presence of medical students during her childbirth unlawfully interfered with her privacy rights and was neither necessary nor proportionate to the needs of a democratic society. The Court unanimously held that Russia violated Article 8 (right to respect for private and family life) of the European Convention on Human Rights, and ordered the State to pay Ms. Konovalova 3,000 euros in non-pecuniary damages and 200 euros for costs and expenses. ECtHR, Konovalova v. Russia, no. 37873/04, ECHR 2014, Judgment of 9 October 2014.
Facts of the Case
On April 23, 1999, Ms. Konovalova went into labor and was taken to the S. M. Kirov Military Medical Academy Hospital by ambulance. There, she received a booklet that contained a warning notice of student participation in the hospital’s clinical teaching program. It read, “We ask you to respect the fact that medical treatment in our hospital is combined with teaching for students studying obstetrics and gynaecology. Because of this, all patients are involved in the study process.”
Later that afternoon, Ms. Konovalova was informed that her delivery, which was scheduled for the following day, would be attended by medical students. After a night of drug-induced sleep, she gave birth, objecting in the delivery room to the presence of the medical students, who were also briefed on her health and medical treatment. Id. at paras. 6-7, 12, 15-16.
At the time of Ms. Konovalova’s childbirth, the Russian Health Care Act provided that information about a patient’s health or medical care or treatment constituted confidential medical information. Article 54 of the Act indicated that medical students were allowed to participate in medical treatment in accordance with a set of rules to be issued by an executive healthcare agency. These rules were not issued until January 2007 and provided that student involvement in medical treatments required the consent of the patient or his or her representative. Id. at paras. 20-31.
In August 1999, Ms. Konovalova filed a complaint with the hospital, alleging that measures had been taken to delay the birth and had caused her pain and suffering. The hospital conducted an internal inquiry and dismissed the complaint, concluding that “[t]he treatment was carried out in the best interests of the mother and foetus.” Id. at paras. 17-19.
The following July, Ms. Konovalova sued the hospital. The District Court rejected her claims, instead finding that the quality of her treatment was adequate, the Health Care Act did not require the hospital to obtain written consent before allowing student participation, and that she had been notified of the clinical teaching program beforehand. On appeal, the St. Petersburg City Court upheld the District Court’s judgment. Id. at paras. 20, 23, 25.
In August 2004, Ms. Konovalova lodged her application with the European Court of Human Rights, alleging that the medical students’ presence interfered with her right to privacy and subjected her to inhuman or degrading treatment. Id. at paras. 1, 35.
The Court’s Discussion of the Article 8 Violation
The Court referred to Article 8 of the European Convention on Human Rights, which states that “[e]veryone has the right to respect for his private and family life” and that “[t]here shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society.” Id. at para. 35.
Interference with Applicant’s Private Life
The Court first considered whether there was an interference with Ms. Konovalova’s private life. The Court confirmed that a person’s private life includes an array of information, including information that “individuals can legitimately expect to not be exposed to the public without their consent.” The Court noted that the concept of private life extends to physical integrity, “since a person’s body is the most intimate aspect of private life, and medical intervention, even if it is of minor importance, constitutes an interference with this right.” Id. at paras. 39-41.
The Court concluded that the medical students’ observation of the sensitive medical procedure undergone by Ms. Konovalova, combined with their access to her confidential medical information, constituted an interference with her private life within the meaning of Article 8. Id. at para. 41.
Whether the Interference Accorded with National Law
Next, the Court considered whether the interference was in accordance with Russian law. The Court reflected that Article 8(2) requires that a measure “should have some basis in domestic law,” and that the law should be “accessible to the person concerned and foreseeable as to its effects.” In order to be foreseeable, the law must set forth precise conditions indicating when the measure may be applied. With respect to medical treatment, domestic law must protect individuals from arbitrary interference with their Article 8 rights. Id. at para. 42.
Because Article 54 of the Health Care Act allowed medical students to assist in medical treatments, the Court determined that the interference with Ms. Konovalova’s private life was not “devoid of any legal basis.” Nevertheless, the Court observed that Article 54 was a provision “of a general nature,” and did not provide any safety measures to protect patients’ private lives. This absence of safeguards was, in the Court’s view, a “serious shortcoming.” Id. at paras. 43-45.
Furthermore, the Court determined that the hospital booklet notifying patients of the clinical teaching program was “rather vague,” failed to specify “the exact scope and degree of this involvement,” and was presented in a manner that suggested student involvement was mandatory. Thus, the Court could infer neither that Ms. Konovalova had received prior notification nor that she could foresee its exact consequences. When Ms. Konovalova did learn of the medical students’ presence, it was between sessions of drug-induced sleep and under extreme stress and fatigue. It was unclear whether she could have made an “intelligible informed decision.” Id. at paras. 46-47.
Owing to the lack of sufficient procedural safeguards against arbitrary interference with Ms. Konovalova’s Article 8 rights, the Court concluded that the presence of medical students during the birth was unlawful and that the State was in violation of Article 8 of the European Convention. Id. at paras. 49-50.
Because the Court found the interference unlawful, it declined to examine the issue of whether the infringement on Ms. Konovalova’s Article 8 rights was necessary in a democratic society.
The Court’s Discussion of Article 3
Ms. Konovalova also alleged that the care provided to her during childbirth was deficient and intentionally delayed so that medical students could attend, in violation of Article 3 (prohibition of torture) of the European Convention. The Court found the allegations unsubstantiated because Russia’s local courts had examined the issue closely, relying in particular on a report compiled by medical experts, and had determined the complaints to be unfounded. The facts before the Court offered no additional details that would allow it to reach a different conclusion. Id. at paras. 51-53.
Similar Decisions Involving the Right to Privacy
The European Court of Human Rights has previously decided other cases involving the confidentiality of information about one’s health. In Avilkina and Others v. Russia, the Administrative Centre of Jehovah’s Witnesses in Russia and three Jehovah’s Witnesses who had refused blood transfusions while in public hospitals complained that their medical files were disclosed to prosecution authorities. The Court found that, with respect to two of the applicants, the State violated Article 8 because the authorities had not struck a fair balance between the right to respect for their private life and the prosecutor’s aim to protect public health. See ECtHR, Avilkina and Others v. Russia, no. 1585/09, ECHR 2013, Judgment of 6 June 2013, paras. 5-22, 54.
In the case of L.H. v. Latvia, the applicant alleged that a State agency’s non-consensual collection of her personal medical information violated her right to respect for her private life. The Court found that Latvia violated Article 8 because the law giving the State agency authority to collect medical information insufficiently detailed the scope of the authorities’ discretion and the manner in which they should exercise their authority. See ECtHR, L.H. v. Latvia, no. 52019/07, ECHR 2014, Judgment of 29 April 2014, paras. 3, 60.
For a summary of additional judgments on these topics, see the European Court’s factsheets on Protection of Personal Data and Health.
The European Court of Human Rights
The European Court of Human Rights is a full-time regional human rights court based in Strasbourg, France. The Court decides complaints submitted by individuals or States concerning alleged violations of the European Convention on Human Rights. Visit IJRC’s Online Resource Hub for more information about the European Court of Human Rights.