TrustHLT/LaCour huggingface dataset:
AP3 (Applicant): The World Health Organization considers intervention that are normally performed in Czech maternity hospitals either expressly harmful or improperly used, and does not recommend them for the lack of evidence on their positive effects.
AP3 (Applicant): For example, the overuse of episiotomy, the birth position on the back, fundal pressure applied on the abdomen, or the separation of children from their mothers.
AP3 (Applicant): Not only are these practices performed without an informed consent, but they are even conducted against the express will of the women.
AP3 (Applicant): It is not exceptional that women after birth suffer from post-traumatic stress disorder and compare the treatment by hospital staff to a rape.
AP3 (Applicant): What is more, women cannot even make an informed choice on which hospital to choose to give birth.
AP3 (Applicant): The state refuses to publish data on the rate of interventions in individual maternity hospitals.
AP3 (Applicant): The new documentary called Five Births, shot in one of Prague's hospitals, shows standard practice in Czech maternity hospitals.
AP3 (Applicant): The documentary was submitted to the court, and it is also available with English subtitles on YouTube.
AP3 (Applicant): The documentary shows, among other things, the dangerous pressure applied on the woman's abdomen without informing her in advance or requesting her consent.
AP3 (Applicant): It also documents the separation of infants from their mothers.
AP3 (Applicant): The court also received many statements from women describing their experience in Czech maternity hospitals and the statements of two midwives who encountered harmful practices as a standard way of working during their service in hospitals, not to mention rude or violent treatment of both women and children.
AP3 (Applicant): The court is also familiar with the cases of sterilization of women without their consent, right in Czech hospitals.
AP3 (Applicant): Women should have a possibility to avoid the risk of physical and psychological violence by unknown hospital staff in a strange alien environment during such an important and intimate moment as childbirth.
AP3 (Applicant): In Czech hospitals, women cannot avoid or refuse participation of unknown hospital staff in their childbirth.
AP3 (Applicant): This brings me to international obligations adopted by the Czech Republic because the denial of health care during home birth is in direct conflict with them.
AP3 (Applicant): The right to health care is specified in many conventions, for example, in the Convention on the Elimination of All Forms of Discrimination Against Women.
AP3 (Applicant): According to official interpretation, the right to health care includes the aspect of acceptability, which means that reproductive health services must be acceptable to all women, particularly those who are outside the dominant culture.
AP3 (Applicant): The committee in charge of implementation of this convention repeatedly said, most recently in its report to the Croatian government, that women should have a choice of place for birth, including midwife-assisted home birth.
AP3 (Applicant): The Convention on the Rights of the Child enshrines the best interest of the child as a primary consideration and also child's rights to health and health care.
AP3 (Applicant): By its denial of health care provided during home birth, the government deters women from exercising their right to choose a place of birth, which, paradoxically, it at the same time recognizes.
AP3 (Applicant): Whose rights are then protected?
AP3 (Applicant): The child's or those of a completely different party?
AP3 (Applicant): At the EU level, the government should have implemented the directive concerning the recognition of professional qualification and enable midwives to conduct their profession, including providing care during spontaneous birth and the care of newborns, independently of a physician's supervision.
AP3 (Applicant): In effect, the directive has not been implemented in practice in Czech Republic.
AP3 (Applicant): Midwives cannot fully use their competencies, neither in hospital nor in home environment of women.
AP3 (Applicant): The mere existence of this directive proves the consensus of EU countries regarding the issue of a qualified midwife as an independent health care professional.
AP3 (Applicant): Fortunately, the Czech approach and the violation of the aforementioned obligations by threatening and criminalizing midwives is isolated.
AP3 (Applicant): Members of member countries of the Council of Europe agree that care during home birth should be allowed, either by tolerating this care or directly providing it.
AP3 (Applicant): Therefore, the Czech government calls for its margin of appreciation.
AP3 (Applicant): But it actually calls for an option to violate its international obligations.
AP3 (Applicant): The observance of international obligations is not necessarily connected with many positive obligations, such as high investments, providing of care by the states or its organizations, or the reimbursement of care from public health insurance schemes.
AP3 (Applicant): The only thing it requires is to legally accept the option to arrange health care between a woman and a qualified and registered midwife.
AP3 (Applicant): As we documented in the file, a system that does not prevent the work of midwives is significantly safer and also cheaper.
AP3 (Applicant): I would like to conclude my speech by pointing out that the chamber, in response to poor conditions in Czech maternity hospitals, considered it necessary to invite the government to keep the relevant provisions under constant review, reflecting medical, scientific, and legal developments.
AP3 (Applicant): Unfortunately, this appeal has had absolutely no effect.
AP3 (Applicant): Svatopluk Nemecek, the Minister of Health Care, made the following comment on the judgment for the media.
AP3 (Applicant): The European Court of Human Rights clearly stated that the Czech legislation is completely all right, and there is no reason to change it.
AP3 (Applicant): No changes in legislation or practice that would improve the rights of expectant women have been adopted.
AP3 (Applicant): If any, these were only ostensible and do not solve the heart of the matter.
AP3 (Applicant): The expert committee at the Office of the Government last met six months ago and has not been summoned again since.
AP3 (Applicant): It is important that there is a clear signal recognizing the competence of millions of women every year to make decisions on the most important and sensitive moment in their lives, the birth of their child.
AP3 (Applicant): A signal ensuring the protection of the women and children's health and also dignity.
AP3 (Applicant): We consider the practice of punishing women for their choices made in line with their beliefs by denying health care a violation of the convention.
AP3 (Applicant): And now let me give the floor to Mr. Hořejšík.
AP2 (Applicant): you are about to assess whether a state may justifiably eliminate women's options in birth giving and to constitute an obstetric monopoly.
AP2 (Applicant): Moreover, you are about to take a stand whether a state may enforce to anyone to undertake an undesired and unnecessary medical treatment, a treatment enforced upon the most natural event, not upon a pathology, a treatment that commonly expresses women, and particularly the applicant, to obstetric violence in the moments of the utmost vulnerability and dependency.
AP2 (Applicant): The court is ultimately to cope with the issue whether a state may deny women's competencies, both in terms of the discretion in decision making in relation to their own body, and both in terms of their parental competencies.
AP2 (Applicant): Finally, and most importantly, this court is called upon to confirm that it is human rights which prevail over expertise, and it is not the other way around.
AP2 (Applicant): Please bear in mind that the core question in the present case is not whether women have the right to choose circumstances of their delivery or not.
AP2 (Applicant): The case of Ternovsky already made that clear.
AP2 (Applicant): Instead, the core question is whether there were convincing and weighty reasons which would justify the government to deprive women of such choice at all, and to constitute an obstetric monopoly literally out of blue sky after 20 years of providing women to enjoy such care and such choice, doing so despite an absolute lack of scientific data, eliminating no specific risks, and targeting no specific aim.
AP2 (Applicant): Leaving those who refused to surrender to the forced hospital treatment, such as Ms. Dubska,
AP2 (Applicant): alone at homes, unattended, and exposed to substantially higher risks, constituting an act of retrogression, breaching international treaties, and impairing women's rights.
AP2 (Applicant): The government proclaims that the elimination of women's options in birth giving represents a balanced price for securing better safety of a child.
AP2 (Applicant): Such argument, however, reveals in full that the government deems the interests of the mother and child to be in opposition.
AP2 (Applicant): However, this is incompatible with the Convention on the Rights of Child, as well as with the case law of this court.
AP2 (Applicant): Mother and child form an elementary and natural unit.
AP2 (Applicant): As confirmed earlier by this court in the case of VO versus France, the interests of mother and child are by default identical.
AP2 (Applicant): Hence, it is the mother who is the most natural and the best guardian of these identical interests.
AP2 (Applicant): This same conclusion has been confirmed by various international treaties.
AP2 (Applicant): The position of the primary caregiver, of course, does not come up only with rights, but also with liabilities.
AP2 (Applicant): It is the expectant mother who carries various choices in relation to her early maternity and bears the respective responsibility for these.
AP2 (Applicant): This principle explicitly also applies on the period of birth giving, as confirmed by Lady Hale in the Montgomery decision of the United Kingdom Supreme Court, which has been submitted to the file.
AP2 (Applicant): Having said that, the mother's responsibility to make respective choices on her and her child's behalf and to bear the respective liability, therefore, necessitates the existence of multiple real and effective alternatives.
AP2 (Applicant): Otherwise, the choice becomes illusory only.
AP2 (Applicant): As confirmed by the said Montgomery decision, an effective choice among the alternatives cannot be narrowed by a preselection or even a selection by the medical professionals.
AP2 (Applicant): Since this conclusion is undisputed between the parties at the level of application of law, the applicant struggles to see why such principles should not be equally applicable at the level of legislation itself, provided, of course, that the alternatives are not unreasonable and they are not unaffordable for the state at the same time.
AP2 (Applicant): An option of unassisted home birth is certainly not unreasonable.
AP2 (Applicant): It was evidenced by the applicant to provide, in case of low-risk pregnancies, similar safety for the child and even better safety for the mother.
AP2 (Applicant): Similarly, it was evidenced to be financially less requiring than purely obstetric model of care.
AP2 (Applicant): Finally, it was also evidenced that such model of maternity care may be easily implemented in the Czech medical services, since the Czech laws already mandate for 20 minutes reach for emergency care and also mandate equipment necessary for the transport of the newborns.
AP2 (Applicant): Despite all the above, the government deprived the applicant, as well as deprived any other women, to her right to choose the circumstances of her delivery and instead supports the obstetric monopoly claiming that it is the child who deserves the exclusive protection of the state.
AP2 (Applicant): Such an approach, however, degrades the international acknowledged concept of parents, or rather mothers, in the given circumstances, as the primary caregivers.
AP2 (Applicant): Not only such approach prefers the state-procured care instead of the parents' care, but above all, it assumes beforehand that a child actually needs such state's care.
AP2 (Applicant): In different words, the states considers, a priori, any pregnant woman to be incompetent of making choices which are the best for her and her child, and thus it deprives her of making such choice at all.
AP2 (Applicant): Indeed, through the optics of the Czech legislation, any pregnant woman is considered to be an unreasonable person whose unborn child actually needs the state's protection against her.
AP2 (Applicant): This approach not only undermines the concept of a reasonable person, who is a typical target and a typical benchmark for modern state's legislations, but it also deeply belittles women and underscores the shallowest gender stereotypes.
AP2 (Applicant): This cannot be found to be compatible with Article VIII of the Convention.
AP2 (Applicant): However, let's not stay with abstract subjections, and let's see the applicant.
AP2 (Applicant): A highly educated woman occupying a managerial position, a loving mother to three children, two of which she delivered at home, a reasonable person and a decent citizen, a woman who is competent to make decisions upon a thorough assessment of all the circumstances and who is competent to assume all related liabilities, a true ally of our nation indeed.
AP2 (Applicant): However, irrespective of these qualities and irrespective of intending to give birth virtually next to a hospital, the government deprived her of her choice.
AP2 (Applicant): I'm wondering whether the government would now be willing to call the applicant unreasonable right here and right now.
AP2 (Applicant): Anonymously, it did so by its legislation.
AP2 (Applicant): It was the applicant whose choice was eliminated only due to a different priority of values and due to refusal to accept the exclusive obstetric dogmas.
AP2 (Applicant): And it was the applicant whose reasonable approach was called to be equal to alcohol and drugs abuse by the government in its submissions.
AP2 (Applicant): The fact that the elimination of women's choice in delivery is incompatible with the Convention becomes even more apparent when taken into account that this elimination goes hand in hand with constituting an obstetric monopoly in maternity services, a monopoly by which the government globally forces women to surrender to medical treatment designed to solve pathologies, a treatment which is absolutely unnecessary in case of low-risk mothers, a treatment which even increases the probability of complications during delivery.
AP2 (Applicant): What we see here is the government creating a monopoly in provision of maternity services, which consequently gives rise to a monopoly in the given field of expertise.
AP2 (Applicant): Such a widespread monopoly based on an exclusive expertise constitutes a real threat to a legal system based on a rule of law.
AP2 (Applicant): Such a monopoly is capable of pushing through the respective legislation, control its exercise, and through the exclusivity in assessment of what lacks artist principle is also to control the judicial review.
AP2 (Applicant): In all those elements, it substantially deforms priority of principle values instead of adhering to the standards of human rights and reasonableness in general.
AP2 (Applicant): An obstetric monopoly creates its own dogmas and standards that are vastly incompatible with the former.
AP2 (Applicant): According to the obstetric monopoly, it is the expertise which the law must follow.
AP2 (Applicant): It is the experts to ex arbiters and to decide whether human rights are compatible with the expertise or not.
AP2 (Applicant): This can be easily substantiated by various pieces of evidence on the file already.
AP2 (Applicant): For instance, Mr. Chevenak calls for an expert review
AP2 (Applicant): of the Tarnowski decision.
AP2 (Applicant): He calls for repression against those positions not adhering strictly to the monopoly standards, and he calls women's reproductive rights as right revisionism that threatens physicians' integrity.
AP2 (Applicant): Similarly, the Czech obstetric boss calls the respective EU directive on midwives to be incompliant with the lacks artist principles.
AP2 (Applicant): The governance of expertise over human rights coined by the obstetric monopoly also deforms the perception of reasonableness and common standards.
AP2 (Applicant): As already on the file, where a reasonable person indicates mistreatment, manipulation, impairment of women's dignity and competencies, or even express physical violence against women, the expert-based monopoly explains the same in the name of safety and necessity.
AP2 (Applicant): For instance, Mr. Fajrajsil here,
AP2 (Applicant): the government's expert and the chairman of the Czech obstetric bar, publicly declares that women may be shunted at at childbirth and that they are supposed to obey to this.
AP2 (Applicant): If the government believes that this is something worth protection, then the applicant clearly does not.
AP2 (Applicant): It is therefore of utmost importance to flatly refuse the claimed governance of the monopolist expertise over human rights.
AP2 (Applicant): They are the human rights that are the ultimate criterion for any conduct of both the states and individuals, irrespective of how expert conduct is concerned.
AP2 (Applicant): Allowing any expert to determine the scope and nature of human rights is the first step, which leads, according to Hayek, to serfdom.
AP2 (Applicant): The present case invokes issues relating to one of the elementary human rights, right for self-determination and preserving physical and psychical integrity.
AP2 (Applicant): By its legislation, the government forces women, including the applicant, to surrender to medical treatment and delivery and thus authoritatively decide on disposal of their bodies.
AP2 (Applicant): Yet in a situation that is inherently natural and not pathological.
AP2 (Applicant): Just to remind the obvious, such forced medical treatment cannot be parallel to any other event in one's life and inherently does not affect man.
AP2 (Applicant): Beside bluntly violating human rights, the government also exposes women to systematic and widespread obstetric violence, as broadly evidenced by the applicant.
AP2 (Applicant): Just imagine you are a woman about to deliver in the Czech Republic.
AP2 (Applicant): You cannot but to go to hospital, irrespective of your wishes, unless you are prepared to assume risks of unattended delivery.
AP2 (Applicant): Once you do, you have almost 50% chance of your genitals being cut in, irrespective of your wishes.
AP2 (Applicant): You have 87% chance of receiving a substantial amount of medications, which you had to avoid during the whole pregnancy.
AP2 (Applicant): It is highly likely that your child will be separated from you right after the delivery.
AP2 (Applicant): To sum up, Czech legislation usurps the woman's right to decide on their body, denies their most natural competences, and exposes them to undesired medical treatment interlaced with obstetric violence.
AP2 (Applicant): All under the cover of a false proclamation of the child safety.
AP2 (Applicant): It is interesting, though, that women's safety, which is of equal importance, remains completely out of the government's focus, together with women's integrity and dignity.
AP2 (Applicant): As a man, and as a father of two daughters, I'm highly disturbed by a vision of them either being unable to decide on their delivery, and being forced to surrender to the state's dictate, or alternatively being punished if they struggle to surrender and insist on the exclusivity of their physical and psychical integrity.
AP2 (Applicant): The case at hand, however, is not a new story.
AP2 (Applicant): On the contrary, it is another episode of a power struggle over the control of maternity services, the displays and symptoms of which have remained the same for years.
AP2 (Applicant): A struggle that was identified and described by Marsden Wagner already 20 years ago in the Northern America and Western Europe.
AP2 (Applicant): As the acknowledgment of standards of human rights spread eastwards after the collapse of the iron curtain, it was only a matter of time when the challenged obstetric monopoly will struggle for survival on this new battlefield.
AP2 (Applicant): This was aptly identified by Judge Lemons in his dissenting opinion to the chamber judgment.
AP2 (Applicant): Although the notion of a power struggle is by definition legitimate, and it's inherent to any democracy, it is the state's task to manage it in a way not affecting the rights of its citizen.
AP2 (Applicant): Moreover, this applies when elementary human rights are at stake.
AP2 (Applicant): This outlines the most important conclusion.
AP2 (Applicant): The assessment of the extent and nature of women's reproductive rights, including the right to decide on the circumstances of delivery, is exclusively legal, not expert assessment.
AP2 (Applicant): And the result, in fact, measures the maturity of democracy.
AP2 (Applicant): There is only one final remark.
AP2 (Applicant): Over the year I devoted to defending women's rights in childbirth, I have learned that any serious discussion stops at a point at which the card of a single dead child or of sudden complication is played.
AP2 (Applicant): A mention of a single innocent victim of circumstances, or even complications beyond one's imagination, were always sufficient to instantly eradicate any contradicting scientific studies, case law, and other evidence-based arguments.
AP2 (Applicant): I may only ask myself, how comes if there are so many dead children as a result of unsolvable sudden complication that the statistics do not look different?
AP2 (Applicant): How comes that they still clearly confirm similar safety of home and hospital delivery?
AP2 (Applicant): Childbirth is highly delicate, intimate, and personal matter.
AP2 (Applicant): And any decision-making in this respect is flanked with emotions.
AP2 (Applicant): However, this case is to be assessed on the basis of solid facts.
AP2 (Applicant): Therefore, let me reiterate a few important and scientifically evidenced facts.
AP2 (Applicant): An assisted home birth and a birth in hospital are equally safe for the child.
AP2 (Applicant): Second, risks at delivery for a woman are even higher in hospital.
AP2 (Applicant): And finally, home birth does not necessitate severe interventions and medications unlike hospital birth.
AP2 (Applicant): for sure, it is tempting to delegate our choices and responsibility to the state and its experts in the name of safety.
AP2 (Applicant): True is that such resignation on liberty does not bring in any additional safety and that the original impression of safety is false, similarly to any other dictate.
AP2 (Applicant): And an authoritative system generates different types of risk, which equal, in the end of the day, the extent of the risk originally inherent to freedom.
AP2 (Applicant): I believe you agree with me saying that personal liberty is of ultimate value, and it must not be sacrificed for an illusory impression of safety.
Guido Raimondi (JudgeP): Merci beaucoup, M. Hořejší.
GR1 (Government): Mr. President, honorable judges, before answering the questions
GR1 (Government): posed in advance of this hearing, let me make a few preliminary remarks on the scope of the case.
GR1 (Government): This case is not about the circumstances of the two particular deliveries of the applicants.
GR1 (Government): One of them turned to this court when she was still pregnant, the other one shortly after giving birth.
GR1 (Government): If the concrete circumstances of these two deliveries were concerned, such as the alleged lack of privacy during applicant Krasovac's hospital birth, the applicants would have to exhaust available domestic remedies.