MINELRES: ERRC/NEKI: International Legal Action on Hungarian sterilisation case

[MINELRES moderator]

Original sender: European Roma Rights Center <errc@errc.org>


Budapest, 12 February 2004

Young Hungarian Romani woman sterilised without any prior explanation
from doctors: ERRC and NEKI initiate international legal action.

On 2 January 2001, a Hungarian Romani woman was sterilised by doctors at
Fehergyarmat hospital. While on the operating table she was asked to
sign forms giving her consent to this and other operations, without a
full explanation about sterilisation. No information was provided to her
as to the nature of the intervention, or what the consequences of being
sterilised would be. Nor did doctors tell her what the risks involved in
the operation were. The right to be fully informed before an operation
is a cornerstone of modern medical practice and is anchored at the core
of international human rights law. Nevertheless, despite suing the
hospital in Hungarian Courts, she has yet to obtain justice.

After the operation, when she learnt that she had been sterilised, the
victim (Ms.S.) said "We wanted a big family. I wanted to give birth
again. But I simply cannot."

ERRC and NEKI are therefore helping the victim, Ms. S., take her case to
the United Nations Committee on the Elimination of Discrimination
against Women.

ERRC Legal Director, Branimir Plese, said "This is a sadly typical
example of women's and patients' rights violations in the health care
systems in Central and Eastern Europe. Many men and women are treated as
passive objects by an authoritarian caste of professionals uninterested
in facilitating the individual's right to decide in matters related to
her own medical care. Due to high levels of anti-Romani sentiment in the
region, Romani women are particularly exposed. We hope that by bringing
this case to the United Nations, we can change the practices of some
doctors, and that Governments will take note and tighten relevant laws
and regulations, so that cases of this kind may not happen again. Most
importantly of course, we seek, finally, justice for the victim, after
her long ordeal."


Note to editors:

On 12 February 2004, the European Roma Rights Center (ERRC) and the
Legal Defence Bureau for National and Ethnic Minorities (NEKI) jointly
filed a complaint against Hungary with the United Nations Committee on
the Elimination of Discrimination against Women (CEDAW) relating to an
illegal sterilisation of a young Hungarian woman of Romani origin (Ms.
S.). The complaint asserts that Hungary, as a State Party to the
Convention on the Elimination of All Forms of Discrimination against
Women, is in violation of Article 10.h. (no adequate information on
contraceptive measures and family planning), Article 12 (the lack of
informed consent on the part of the victim as a violation of her right
to appropriate health care services), and Article 16.1.e. (the states
interference with the victims ability have children in the future).

The facts of the case
On 2 January 2001, Ms. S' birth pains started. She was taken by
ambulance to the public hospital in Fehergyarmat, in pain, having lost
her amniotic fluid and bleeding heavily. During an examination the
attending physician informed Ms. S. that her unborn baby had died in her
womb and that a caesarean section needed to be immediately performed to
remove the dead embryo. While on the operating table the doctor asked
her to sign a statement of consent to the caesarean section. At the
bottom of this form the doctor had added in a hand-written, barely
readable script - a consent to sterilisation. He wrote the Latin
equivalent of the Hungarian word for sterilisation on the consent form,
a word unknown to Ms. S. She signed the consent forms. The hospital
records show that only 17 minutes passed from the ambulance arriving at
the hospital until the completion of both operations. Before leaving the
hospital, Ms. S. sought out the doctor to ask him for information on her
state of health and when she could try to have another child. It was
only then that she learnt the meaning of the word sterilisation and that
she could not become pregnant again. This information had a profound
effect on Ms. S. as she has strict religious beliefs that prohibit any
form of contraception, including sterilisation.

At no point prior to the operation did Ms. S. receive full information
about the nature of sterilisation, its risks and consequences, or about
other forms of contraception. This lack of informed consent before a
medical intervention, and the resulting inability to reproduce, amounts
to a clear and compelling violation of numerous international legal
standards.

Relevant international law provisions
The United Nations Committee on the Elimination of Discrimination
against Women, in its General Recommendation 24, explained that "Women
have the right to be fully informed, by properly trained personnel, of
their options in agreeing to treatment or research, including likely
benefits and potential adverse effects of proposed procedures and
available information." The Recommendation further states that
"Acceptable [health care] services are those that are delivered in a way
that ensures that a woman gives her fully informed consent, respects her
dignity, guarantees her needs and perspectives. States parties should
not permit forms of coercion, such as non-consensual sterilisation."

The European Convention on Human Rights and Biomedicine states that "An
intervention in the health field may only be carried out after the
person has given free and informed consent to it. This person shall
beforehand be given appropriate information as to the purpose and nature
of the intervention as well as on its consequences and risks." The World
Health Organisation's Declaration on Patients Rights states that
"patients have the right to be fully informed about their health status,
including the medical facts about their condition; about the proposed
medical procedures, together with the potential risks and benefits of
each procedure; about alternatives to the proposed procedures, including
the effect of non-treatment, and about the diagnosis, prognosis and
progress of treatment." It further states that "Information must be
communicated to the patient in a way appropriate to the latter's
capacity for understanding, minimising the use of unfamiliar technical
terminology. If the patient does not speak the common language, some
form of interpreting should be available."

The UN Convention on the Elimination of Discrimination against Women
states that "[women] have the right to decide freely and responsibly on
the number and spacing of their children." The Committee that oversees
the Convention emphasised, in their General Recommendation 21, that
"Decisions to have children or not ... must not be limited by
Government. The means to reproduction were taken away from Ms.S. by
Hungarian State actors, the doctors at the hospital, in violation of the
Convention.

Legal action in Hungary
On 15 October 2001, Ms. S and her attorney filed a civil claim for
damages against the hospital. They requested that the Town Court of
Fehergyarmat find the hospital in violation of the plaintiff's civil
rights and that it had acted negligently in its professional duty of
care with regard to the sterilisation of Ms. S in the absence of her
full and informed consent. The Town Court turned down the claim in its
decision of 22 November 2002. On appeal, the Szabolcs-Szatmar-Bereg
County Court held that the hospital doctors had indeed acted negligently
in failing to provide Ms. S with the relevant information about the
sterilisation and stressed that "the information given to the plaintiff
concerning her sterilisation was not detailed ... [and that she] ... was
not informed of the exact method of the operation, of the risks of its
performance, and of the possible alternative procedures and methods".
Nevertheless, and contrary to international jurisprudence as well as
medical practice, the same Court then went on to conclude that
sterilisations as such are fully reversible operations and that as Ms.
S. had provided no proof that she had suffered a lasting detriment, she
was not entitled to compensation.

Having obtained no redress in Hungary, with the assistance of the ERRC
and NEKI, Ms. S. has now decided to turn to the United Nations Committee
on the Elimination of Discrimination against Women and request that
international justice be served.

For further details on this case, please contact Alan Anstead at ERRC
(Alan.Anstead@errc.org) or Dr Bea Bodrogi at NEKI (bbodrogi@yahoo.com). 
Further information on the human rights situation of Roma in Hungary is
available on the ERRC website (www.errc.org) and the NEKI website
(www.neki.hu).

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