European Court of Human Rights Upholds the “Inalienable Right to Self-Determination”

Budapest 8 October 2012. The Mental Disability Advocacy Center and the Disability Rights Center call on the Hungarian government to overhaul the system in which people can be detained and forcibly treated with psychiatric medication. We make this request based on (1) the UN Committee on the Rights of Persons with Disabilities which last month recommended that Hungary should, “ensure that health care services, including all mental health care services, are based on the free and informed consent of the person concerned.” And (2) because of a recent judgment by the European Court of Human Rights (ECtHR).

Last week the ECtHR issued a very strong judgment on the rights of people with psycho-social disabilities to be free from arbitrary interference with their rights to liberty and to self-determination (the judgment in the case of Plesó v. Hungary, dated 2 October 2012, can be found here).

The ECtHR found a violation of Article 5(1) of the European Convention on Human Rights (the right to liberty) and awarded the applicant 10,000 EUR. It commented on the arbitrariness of the local decision ordering Mr Plesó’s involuntary hospitalisation. In doing so, the Court articulated strong principles upholding the rights of persons with psycho-social (mental health) disabilities to make choices about their own treatment and of the need for less restrictive alternatives to detention. In particular:

First, the Court upheld the value of autonomy and self-determination, including the right to refuse treatment, for people with psycho-social disabilities, stating that “it is incumbent on the authorities to strike a fair balance between the competing interests emanating, on the one hand, from society’s responsibility to secure the best possible health care for those with diminished faculties (for example, because of lack of insight into their condition) and, on the other hand, from the individual’s inalienable right to self-determination (including the right to refusal of hospitalisation or medical treatment, that is, his or her ‘right to be ill’).”  The ECtHR found that the Hungarian courts had perceived the applicant’s refusal to undergo hospitalisation as proof of his lack of insight, rather than as “the exercise of his right to self-determination.”

Second, the Court emphasised the need to consider less restrictive measures as alternatives to detention, reiterating that “any encroachment in the Convention rights of those belonging to particularly vulnerable groups such as psychiatric patients can be justified only by ‘very weighty reasons.’” 

Thirdly, the Court said that, “compulsory psychiatric treatment often entails a medical intervention in defiance of the subject’s will, such as forced administration of medication, which will give rise to an interference with respect for his or her private life, and in particular his or her right to personal integrity”, citing this as a reason for States to avoid compulsory hospitalisation.

The case was initiated by the Mental Disability Advocacy Center in 2008, and later litigated by the Disability Rights Center, an NGO in Hungary.


Facts of the case

The events that led to Mr. Plesó bringing his case to the European Court of Human Rights with MDAC’s help began in 2006, when he was 31 years old and living in Dunakeszi, a town on the Danube, just north of Budapest. His mother thought that he was behaving strangely and complained to her psychiatrist about it.  This led to the applicant eventually being examined by his mother’s psychiatrist, and a psychologist in 2007. The psychiatrist diagnosed him as having “paranoid schizophrenia under observation.” The applicant’s mother continued to complain about his behavior to the psychiatrist who informed her that he would have to seek treatment voluntarily. When he did not do so, in November 2007, the psychiatrist applied to the Dunakeszi District Court to order mandatory hospital treatment. 

The District Court held a hearing on 11 December at which the applicant was present and was represented by a guardian ad litem (an attorney appointed by the court to represent someone in a specific proceeding) . During the hearing, the judge ordered that Mr. Plesó be examined by a forensic psychiatrist, Dr. H, who conducted the examination during a break in the hearing (which lasted only forty minutes), reporting her opinion to the court verbally when the hearing resumed, without the applicant or his guardian ad litem being informed of the opinion or given any chance to challenge it. Dr H’s opinion was that the applicant suffered from delusional schizophrenia and that his condition would deteriorate if he were not hospitalised. However, she recommended that a decision on mandatory treatment be postponed for six months to allow a period of observation. The judge pointed out that this was not possible under Hungarian law. On 18 December, the court held another hearing at which the applicant challenged Dr.H’s opinion and argued through his guardian ad litem that he did not pose a danger to himself or others. Nevertheless, the judge ordered his mandatory detention that day.

On 27 December 2007, Mr. Plesó contacted MDAC seeking legal advice. MDAC assisted him and his guardian ad litem in filing an appeal against the mandatory detention order.  His appeal was dismissed by the Pest County Regional Court on 12 February 2008. On 27 March 2008 he started mandatory treatment in a closed ward of the Vác Hospital. On 25 April 2008, his detention was reviewed by the competent court. Based on a forensic psychiatrist’s report that the applicant suffered from schizophrenia but did not present a danger to himself or others and was willing to accept treatment on a voluntary basis, the court ordered his release.

János Fiala-Butora of the Disability Rights Center, who represented Mr. Plesó in the case, said of the victory, “The judgment is a vindication of my client’s rights and of the rights of other people with psycho-social disabilities who have been arbitrarily and illegally deprived of their liberty and subjected to mandatory psychiatric treatment.”

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