Consent and student medics – European Court ruling

The European Court of Human Rights gave judgment last week in Konovalova v Russia. It’s an important decision for maternity rights across Europe, which emphasises the need for women’s informed consent to all decisions in childbirth, even those that health professionals might consider routine or unimportant.

Ms Konolova gave birth in 1999 in hospital in St Petersburg. During her labour, she was informed that medical students would be present. She objected but the students were permitted to observe the birth nonetheless. She brought legal proceedings against the hospital, alleging that the students had attended without her consent.Student-midwives The Russian courts rejected her complaint and found that Russian law did not require consent for students presence during medical procedures and that the hospital booklet had informed her of their possible presence.

Ms Konolova made an application to the European Court claiming a violation of her right to private life under Article 8 of the European Convention on Human Rights. The Court did not hesitate in its assertion of Ms Konolova’s right to informed consent. It reiterated its finding in Ternovszky v Hungary that decisions about the manner in which a woman gives birth are essential aspects of a woman’s privacy and autonomy. As the Court said:

Article 8 encompasses the physical integrity of a person, 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.”

The Court found that the presence of students at a birth could only be justified if it satisfied the test under Article 8(2), i.e. it was in accordance with the law, including the principles of certainty and foreseeability, and necessary in a democratic society. The Court held that Russian law did not contain adequate safeguards to protect patients from arbitrary interferences with their private life. There was no legal provision requiring patients’ consent for students’ participation in their treatment and the hospital’s information about students was ‘vague’ and did not specify the extent of their involvement in treatment.

If it were ever in doubt, the decision makes it clear that all decisions in childbirth require women’s informed consent.

When it comes to student attendance at births, hospitals should take the following measures to ensure that they do not violate women’s rights:

– Publish a clear policy on student attendance at births that is given to all women ante-natally. It should specify the extent of their participation in any procedures. The policy must make it clear that women have the choice to decline to allow students in the room.
– Ask for women’s consent to student participation at the time of the birth, explaining who the students are, what they will be doing and giving the woman the choice to decline their attendance.
– Respect a woman’s decision to decline to allow students in the room.

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