TrustHLT/LaCour huggingface dataset:
GR2 (Government): When a sudden abruption of oxygen supply to the fetus occur during labor, an immediate delivery, and I mean delivery within few minutes, is the only measure to save the baby.
GR2 (Government): If profuse bleeding occurs during labor or shortly after a baby was born, you may lose the mother, the baby, or both.
GR2 (Government): If the health status of a newborn deteriorates, changes abruptly shortly after delivery, and adequate measures must be undertaken without a delay to minimize possible health consequences.
GR2 (Government): Such situations, they do require not only presence of competent people, but also a competent environment.
GR2 (Government): Any unnecessary delay in such situations could have possibly devastating health consequences.
GR2 (Government): The ability to provide health care in properly equipped environment is achievement of a particular society, and it comes from many resources, including organization, structure, and content of health care, together with economic tools to ensure sustainability of that process.
GR2 (Government): The Czech Republic has an extensive network of obstetrical units with excellent system of referral and readiness for prenatal transport.
GR2 (Government): However, underlined, any place of delivery must be ready to provide emergency care and must comply with the requirements for material and technical equipment, as well as personal staffing, in order to prevent the acute situation which I have mentioned.
GR2 (Government): This systematic approach of the Czech Republic in organizing and evaluating health care in that segment resulted in excellent results of prenatal care in the Czech Republic, one of the best in the world which could be documented.
GR2 (Government): While considering the state's rights or obligations to regulate private lives in many other fields in order to protect health of a person, we always should have in mind that in case of delivery, we safeguard at least two people at one time.
GR2 (Government): Mr. President, honorable judges, thank you for your attention.
Mark Villiger (JudgeP): Thank you, Mr. Velebil.
Mark Villiger (JudgeP): I now call Mr. Zahumenský, please.
AP1 (Applicant): this case concerns violation of fundamental rights of women and families regarding childbirth, which is still present in the Council of Europe post-Soviet countries.
AP1 (Applicant): The applicants are two educated women who consciously opted for an assisted home birth.
AP1 (Applicant): This decision was not based on a whim of their own comfort.
AP1 (Applicant): This was a responsible and informed choice for a safe delivery, as confirmed by the international data, and also a choice intended to avoid Czech abusive childbirth system.
AP1 (Applicant): In the former communist Czechoslovakia, women were subject to invasive procedures without their consent.
AP1 (Applicant): Babies were removed from mothers after delivery.
AP1 (Applicant): The court is familiar with the sterilization of women without their consent due to an alleged risk of further deliveries.
AP1 (Applicant): Certainly, the situation has improved.
AP1 (Applicant): However, Czech women still face paternalistic system where human rights are infringed upon the alleged interest of scientific approach.
AP1 (Applicant): The court held in the past that women may decide on the circumstances of the delivery and root in favor of the applicant in case Tarnovsky.
AP1 (Applicant): We will show that women in the Czech Republic find themselves in a very similar situation.
AP1 (Applicant): I will focus on answers to questions 1, 2, and 3, and 5.
AP1 (Applicant): Mr. Horisci will provide more detailed answer to question 2
AP1 (Applicant): and will answer the rest of the questions of the court.
AP1 (Applicant): Mrs. Dupska gave birth to her first child
AP1 (Applicant): in 2007 in Ostrava Hospital, which was a traumatic experience to her.
AP1 (Applicant): In 2010, the applicant became pregnant again and decided to give birth to her child at home.
AP1 (Applicant): Due to the legislation in the Czech Republic, the applicant was denied medical care and the possibility to give birth at home with an assistance of a health professional.
AP1 (Applicant): Due to her experience, the applicant opted for an unassisted child delivery.
AP1 (Applicant): The denial of medical care in home delivery resulted in much greater risk of health complication of the applicant and her son.
AP1 (Applicant): The applicant was also subject to a stressful decision of whether to undergo the delivery in a hospital with the possibility of all negative procedures she had undergone before, or opt for a home delivery alone and without assistance.
AP1 (Applicant): Mrs. Krejzova gave birth to two children at home
AP1 (Applicant): with the assistance of a midwife.
AP1 (Applicant): She was unable to find a midwife because under the new legislation, there is heavy fines as regarding her third child.
AP1 (Applicant): So the applicant was forced to give birth at hospital.
AP1 (Applicant): In the hospital, she was forced to stay there longer than she wanted.
AP1 (Applicant): She was separated from her child, and she was not able to deliver her third child.
AP1 (Applicant): In a way, she perceived the safest for her child, but caused a lot of stress to her.
AP1 (Applicant): Both applicants believed that their situation are in violation of the right to private life.
AP1 (Applicant): The court repeatedly held that private life is a broad term, and it incorporates the right to respect for both the decision to become and not to become a parent.
AP1 (Applicant): The right concerning the decision to become a parent includes the right of choosing the circumstances of becoming a parent.
AP1 (Applicant): Pregnancy and giving birth presents the most vulnerable and fundamental period in the lives of both women and their child.
AP1 (Applicant): Therefore, giving birth inconstantly forms part of one's private life.
AP1 (Applicant): The court in Ternovsky case rejected the difference proposed by the government between the choice of home delivery and assisted home delivery.
AP1 (Applicant): In its judgment, the court held that the choice for home deliveries entailed the involvement of health professionals.
AP1 (Applicant): Therefore, the applicant answer in the positive to the first questions raised by the court.
AP1 (Applicant): The court invited the applicant to express their opinion whether the complaints should be examined under the positive obligation or negative obligation of the state.
AP1 (Applicant): The applicant believed that both obligations are in stake.
AP1 (Applicant): First of all, similarly to the conclusion reached by the court in the Ternovsky judgment, there was violation of the negative obligation in the present case.
AP1 (Applicant): As I will explain in detail later, Czech legislation has been unpredictable and inconsistent.
AP1 (Applicant): Violation of the rights of private life has no legitimate aim.
AP1 (Applicant): In addition, the applicant believed that there has been a violation of the positive obligation of the state.
AP1 (Applicant): According to the case law of the court, the states have a general obligation to regulate the provisions of medical services.
AP1 (Applicant): In the Czech Republic, due to regulation or lack thereof, midwives are discriminated from practicing their profession.
AP1 (Applicant): The state seeks ways to regulate the equipment of health care facility in such a way that deliveries are possible only in hospitals, make the assistance of midwives financially unavailable, and otherwise restrict their profession.
AP1 (Applicant): The present situation is de facto impossible to change.
AP1 (Applicant): And midwives are not allowed to influence the system of childbirth delivery and care in the Czech Republic.
AP1 (Applicant): This is evidenced by the makeup of the task force for deliveries commissioned by the Ministry of Health in 2013.
AP1 (Applicant): After a few introductory meetings, both midwives and parents' representatives were dismissed, which left only those members of the group unwilling to change anything about the present system.
AP1 (Applicant): The applicant concludes that for an effective exercise of the right to home delivery, as part of the right to influence the circumstances of delivery, the state should cancel the penalization of midwives and ensure the equality of medical services provided in hospital and in home deliveries.
AP1 (Applicant): The government states that the rights claimed by the applicants are in conflict with other international obligations of the Czech Republic.
AP1 (Applicant): The applicant believes that this conflict is not real and it's artificially created.
AP1 (Applicant): This statement is supported by the following reasons.
AP1 (Applicant): First of all, the applicants need to underline that they are not aware of any binding international treaty granting legal protection to fetus.
AP1 (Applicant): As regarding the rights of mothers, the government did not present any data providing that assistant home birth provides any additional risk to low-risk women.
AP1 (Applicant): Secondly, if we accept the argument that the alleged dangerous assistant home deliveries are in violation of the international obligations, we would have to conclude that these international obligations are also violated by such countries as Germany, Austria, United Kingdom, or Sweden, as assistant home deliveries are legal and common practice in these countries.
AP1 (Applicant): If these countries violated their international obligation, the institutions responsible for enforcing the conventions would undoubtedly raise this issue.
AP1 (Applicant): The government, however, failed to present any such evidence.
AP1 (Applicant): And according to the applicants, this has never happened.
AP1 (Applicant): Thirdly, the government conveniently omits the fact that some women will always opt for home delivery.
AP1 (Applicant): This is evidenced by the experience from other countries between 1% and 3% of deliveries are planned home deliveries in Germany, United Kingdom, Ireland, and France.
AP1 (Applicant): This number is even higher in the countries where deliveries outside hospitals are common and supported.
AP1 (Applicant): As well as from the Czech Republic, where a significant number of women, despite government restrictions, opt for home delivery.
AP1 (Applicant): Are these women and children also protected by international obligations of the Czech Republic?
AP1 (Applicant): The government present contrasting arguments when it emphasizes the safety of unborn children, but it refuses to provide medical care for children both at home.
AP1 (Applicant): And while the international obligations of the countries where assisted home deliveries is possible have not been questioned, the situation in the Czech Republic was already commented by the Committee on the Elimination of Discrimination Against Women, CEDAW, which watches over the obligation of the state according to the UN Convention.
AP1 (Applicant): Besides urging the Czech Republic to consider steps to ensure the availability of assisted home deliveries, it also emphasized the violation of the rights of women in hospitals.
AP1 (Applicant): Finally, as regarding to access to the health care services, the applicants want to bring the court's attention to the wording of the second paragraph of Article 12 of the Condemnation on the Elimination of Discrimination Against Women, stating that, state parties shall ensure to women appropriate services in connection with pregnancy, confinement, and postnatal period, granting free services where necessary.
AP1 (Applicant): The applicants thus conclude that their request to ensure assisted home deliveries is not in conflict with any international obligations of the Czech Republic.
AP1 (Applicant): On the contrary, all the international conventions mentioned by the government fully support the right of women to assistance during the home delivery.
AP1 (Applicant): The applicants are pleased to provide additional information regarding Czech legislation regulating home deliveries.
AP1 (Applicant): The government stated that the relevant legislation was specific, foreseeable, and consistent, both before April 2012 and after.
AP1 (Applicant): The applicant disagreed with this statement and will show that particularly until September 2010, the legislation was far from specific and failed to be foreseeable.
AP1 (Applicant): After September 2010, the legislation became stricter for the practice of midwives as they were effectively dissuaded from providing assistance in home deliveries.
AP1 (Applicant): When Mrs. Dubska's child was conceived in April 2010,
AP1 (Applicant): there was no regulation on childbirth officially published in a collection of acts.
AP1 (Applicant): The analysis of the Public Defender of Rights from 2010 showed that there are significant differences regarding the practice.
AP1 (Applicant): Although the Ministry of Health claimed that midwives are not allowed to perform an assisted home delivery, the Public Defender's office found that in three of the regions of the Czech Republic, South Bohemia, Visočina, and Olomouc, there are private health care facilities legally allowed to perform physiological birth at home.
AP1 (Applicant): The Public Defender criticized the ministry for an insufficient legislative effort as the regulation published in the Ministry bulletin fails to replace the missing legislation.
AP1 (Applicant): Since 2010, there is a regulation on the equipment of the health care facilities, which includes the facilities of midwives where deliveries are not performed, and the facilities where physiological births are performed at childbirth houses.
AP1 (Applicant): However, there is still no regulation on home deliveries.
AP1 (Applicant): The regional offices issue licenses to midwives with an explicit prohibition of performing physiological births, or they issue licenses for the facilities of midwives where no deliveries are performed.
AP1 (Applicant): In addition, there are still some midwives who have the registration according to the old, prior 2010 legislation without any restrictions.
AP1 (Applicant): Thus, the legislation is still unpredictable and unclear.
AP1 (Applicant): In our opinion, the major change after 2010 is that all midwives with their different types of registration are being systematically threatened by the regional offices that should they assist with home deliveries, they will be subject to severe penalties.
AP1 (Applicant): The regional court in Brno in May 2012 stated that midwives face severe financial penalties in the Czech Republic.
AP1 (Applicant): The court concluded that the situation is very similar to the matters in the case of Tarnovsky.
AP1 (Applicant): The regional court rejected the application of a woman for assisted home delivery with the opinion that the court cannot replace the missing legislation on home deliveries.
AP1 (Applicant): It is apparent that midwives face penalty of up to almost 400,000 euro, which, together with the fact that two leading representatives of natural birth movement were convicted in criminal proceedings, effectively dissuades midwives from practicing home delivery assistance.
Mark Villiger (JudgeP): Thank you very much, Mr. Zahumenský. I call Mr. Hořejší.
AP2 (Applicant): Dear Mr. President, Honorable Members of the Court,
AP2 (Applicant): I would like to extend the argumentation of my colleague, Mr. Zalomensky, with the answers to queries number two,
AP2 (Applicant): four, and six as previously circulated by the Court.
AP2 (Applicant): Therefore, I will focus on the query relating to the assessment of Mrs. Krajewa's complaint under the positive
AP2 (Applicant): and negative obligations of the state, and a query relating to the funding of midwives' care in the Czech Republic.
AP2 (Applicant): The last but not least, I will address my comments to the issue of interest pursued by the current Czech legislation, as well as to the issue of a fair balance between the private rights of the applicant and the public interest of the state.
AP2 (Applicant): The applicant has been invited to express her opinion whether her complaint is to be examined under the positive or the negative obligations of the state under Article 8 of the Convention.
AP2 (Applicant): In order to do so, the applicant is going to draw the Court's attention to the following areas.
AP2 (Applicant): First, the applicant is going to outline certain factual and legal circumstances of her case.
AP2 (Applicant): Second, the applicant is going to outline the underlying principles of both the positive and negative obligations of the state.
AP2 (Applicant): Third, the applicant is going to present a reasoning supporting the conclusion that the complaint should be examined under the positive obligations of the state.
AP2 (Applicant): And finally, the applicant is going to introduce a reasoning why the complaint should be examined from the perspective of the negative obligations of the state at the same time.
AP2 (Applicant): As to the domestic law, until April 2012, the Czech legislation did not contain, on a statutory level, any restrictions as to the places at which midwives could provide their assistance at planned home births.
AP2 (Applicant): Therefore, until April 2012, expectant mothers, including the applicant, technically could use the care of midwives at home births.
AP2 (Applicant): That said, the possibility to use such a care was highly unclear, insecure, and unpredictable for expectant mothers due to the governmental and ministerial decrees and the administrative practices of health care public authorities.
AP2 (Applicant): The SAT, substantive legislation, imposed additional obligations to midwives, mainly in the field of mandatory technical, material, and personal requirements.
AP2 (Applicant): The nature and extent of these operational requirements has corresponded to the operational requirements of hospitals, and therefore could not be satisfied by standalone midwives.
AP2 (Applicant): Imposing such extensive requirements to midwives, the provision of their care was effectively suspended.
AP2 (Applicant): The legal circumstances changed rapidly as of 1 April 2012, when the Act on Health Care Services came into force.
AP2 (Applicant): This Act contains a statutory ban from all medical personnel to provide medical care outside medical facilities, allowing only for a fairly limited amount of exemptions, such as the first-aid rescue.
AP2 (Applicant): Therefore, since April 2012, it has become legally impossible for any midwife to assist at births taking place outside maternity hospitals.
AP2 (Applicant): As to the facts of the case, the applicant became pregnant in August 2011 and delivered her child in May 2012.
AP2 (Applicant): Therefore, during the prevailing part of her pregnancy, the applicant's rights and obligations were governed by the legal regulation, which was highly unclear, unforeseeable, and arbitrary.
AP2 (Applicant): In such legally unclear environment, the applicant found herself in a substantial uncertainty as to whether she could enjoy the care of a midwife at the planned home delivery or not.
AP2 (Applicant): Such uncertainty led her to address her concerns and requirements for a clarification of her position to several health care public authorities, as well as to an appropriate public health care insurance company.
AP2 (Applicant): Upon these inquiries, she was informed that there is no midwife authorized by the state that could provide her with the requested assistance.
AP2 (Applicant): Speaking about the underlying principles for rights protected under Article 8 of the Convention, the applicant would like to emphasize that although there are different prerequisites for coming down to the conclusion whether the positive or the negative obligations of the states were breached, the underlying principles of all these obligations are the same as already ruled by the court.
AP2 (Applicant): Therefore, the state is obliged to strictly comply with the requirements of legality, legitimacy, and proportionality, both when establishing a framework allowing individuals to exercise their right for private and family life, as well as when limiting this right in justified cases.
AP2 (Applicant): In this particular case, these principles were substantially interfered into as the government prevented the applicant to enjoy her right to choose the circumstances of her delivery.
AP2 (Applicant): Assessing the applicant's complaint under the positive obligations of the states, the positive obligations need to be identified first.
AP2 (Applicant): In its elementary extent, Article 8, Subsection 1 of the Convention, imposes an obligation on the high states through the Convention to procure that right for family and private life of persons under their jurisdictions is observed.
AP2 (Applicant): Such an obligation includes an obligation of the state to procure that such right of persons for physical and psychical integrity is protected in a way that allows its effective exercise.
AP2 (Applicant): Moreover, such an obligation does not entail only the establishment of the appropriate framework, but also, as previously ruled by the Court, includes adoption of all other measures that are necessary to procure the same.
AP2 (Applicant): The set regulations shall also apply in relation to the right of an expectant mother to decide on the circumstances of her delivery, which falls within the category of private and family life.
AP2 (Applicant): The applicant, therefore, summarizes that the government is, in line with Article 8, Subsection 1 of the Convention, obliged to establish an appropriate legislative framework, as well as to procure adoption of all other measures in order to allow prospective mothers a real and effective free choice of the circumstances of their delivery.
AP2 (Applicant): It clearly follows from the previous decisions of the Court, namely from the Ternovsky against Hungary decision, that it is usual, expectable, and reasonable that a woman does not give birth to her child alone without an assistant, but does so subject to an assistance of a qualified person.
AP2 (Applicant): Consequently, an effective opportunity to exercise the choice of circumstances of delivery requires that such choice involves a set of places defined by the law in advance at which expectant mothers may legitimately benefit from the state-guaranteed health care during the delivery.
AP2 (Applicant): The applicant is strongly convinced that such set of places cannot be, a priori, limited only to maternity hospitals.
AP2 (Applicant): In relation to specifying the positive obligations of the states, the applicant finds highly inspiring the joint concurrent opinion of the Honorable Judges Sajó and Tulkens under the Ternovsky against Hungary decision, which defines the principle of these obligations.
AP2 (Applicant): The concurrent joint opinion sets forth the following two requirements to be met.
AP2 (Applicant): First, the appropriate legal framework must allow the expectant mother to decide on the delivery circumstances in the broadest possible extent.
AP2 (Applicant): Second, such choice may be, in the least extent possible and always in a reasoned way, restricted so that a justifiable balance between such expectant mother's choice, her health, her child's health, and objective capabilities of the state to procure the adequate health care is established.
AP2 (Applicant): Subject to certain simplification, the court rules that while finding a justifiable balance between the concurrent rights, the primary right of a woman to decide on the circumstances of her delivery may be reasonably restricted in the minimum extent possible.
AP2 (Applicant): The legal regulation of check obstetrics, however, annuls such choice entirely, doing so on two levels of legal regulation.
AP2 (Applicant): On the statutory level, the regulation sets forth that the assistant's birth may occur only in medical facilities, hence entirely preventing the expectant mother's to enjoy assistance at home birth.