Czechia-28th Session November 2017-Forced sterilization

Para 43) The rights of patients are regulated by the Health Services Act in line with international standards including the Convention on Human Rights and Biomedicine. A precondition of any medical intervention is the patient’s free and informed consent unless in emergency situations like saving life. The patient has the right to be respected, treated with dignity, consideration and respect for privacy and has the right to receive health services at the appropriate scientific level and in the least restrictive environment while ensuring quality and safety. The patient also has the right to choose the health service provider, to request another medical opinion and decide on the presence during the medical intervention. The patient must be informed about the following: cause of the illness, its stage and expected development, the purpose, nature, expected benefit and possible consequences and risks of the proposed medical services, other options, their suitability, benefits and risks, further treatment needed and limitations and recommendations for their lifestyle with respect to their health condition. Health professionals are adequately trained in these principles. All of this applies, of course, to gynaecological and obstetric care. Para 47) The Act on Specific Health Services considers the free and informed consent of the patient as the precondition for carrying out the sterilisation. A patient with limited legal capacity can be sterilised only for serious medical reasons. The patient's guardian gives consent to sterilization, but the patient must be fully involved in the consent process and their opinion is taken into account adequately to their intellectual maturity. The sterilization authorization is given by an independent expert committee, which always invites the patient to the meeting and comprehensibly informs them about the nature of the medical intervention, its permanent consequences and possible risks. If the committee grants consent with the intervention, it must also be approved by a court. Sterilisations of persons with limited legal capacity are thus subject to those strengthened guarantees to prevent illegal interference with their rights. Czechia has no information about extensive violations of those rules in the past. Para 60) Although Czechia only noted the recommendations on establishing a special compensation mechanism, it adopted in 2021 an Act on Providing Compensation to Unlawfully Sterilised Persons effective from 1 January 2022. The Act specifies the conditions of providing a one-off sum of CZK 300 000 to persons illegally sterilised between 1 July 1966 and 31 March 2012. A sterilisation is illegal without a free and informed consent. The claim must be filed at the Ministry of Health till the end of 2024. The request for compensation must describe the facts of the case like the health facility, the date and circumstances of the intervention. The request is decided by the Ministry of Health in an administrative proceeding and the decision may be subject of judicial review. The Act also bans the shredding or other destruction of the necessary medical records for 10 years. Until 25 July 2022, the Ministry of Health registered 325 compensation requests, of which 65 were approved, 75 were rejected and the others suspended based on the failure to prove the illegality of the sterilisation due to the absence of medical documentation. With this special mechanism, no amendments are currently planned to the general limitation period that would, due to the principle of legal certainty, not apply to previous cases anyway. However, the existence of the mechanism does not prevent a court action for compensation of illegal sterilisations. Para 61) The rules for sterilisations also apply to persons with full legal capacity. According to the Act on specific health services, a sterilisation can be made only based on a written request or with a written consent of the patient. Before intervention, the physician must provide written information to the patient about its nature, permanent consequences and possible risks. The record of providing the information is signed by the physician, the patient and a witness, and it is included in their medical records. A model of the informed consent was published in the Journal of the Ministry of Health and healthcare facilities use it directly or a basis for their own text. It has been translated to the Roma language. A minimum gap of 7 days between providing the information and granting the consent with sterilisation for medical reasons and 14 days for sterilisation for non-medical reasons is required in order to give the patient time to consider all the circumstances. The final consent must be given by the patient immediately before the operation. The Ministry of Health also supports the raising of public awareness of patients’ rights and the training of physicians in this area.