CEDH · CASELAW;COMMUNICATEDCASES;ENG — 2 avril 2025

.s800EAC49 { font-size:12pt } .s379BC09C { margin-top:36pt; margin-bottom:0pt; text-align:right } .sBB9EE52A { font-family:Arial } .s10950C61 { margin-top:0pt; margin-bottom:0pt; text-indent:14.2pt; text-align:justify } .s5E1364CA { margin-top:0pt; margin-bottom:12pt; text-align:center; page-break-inside:avoid; page-break-after:avoid; font-size:14pt } .s339D85E6 { margin-top:0pt; margin-bottom:14pt; text-align:center; page-break-inside:avoid; page-break-after:avoid } .s665E407E { margin-top:66pt; margin-bottom:14pt; text-align:center; page-break-inside:avoid; page-break-after:avoid } .s29100277 { font-family:Arial; font-weight:bold } .sA36B60A1 { font-family:Arial; font-style:italic } .s5FFF0A75 { margin-top:0pt; margin-bottom:0pt; font-size:7pt } .s32563E28 { margin-top:0pt; margin-bottom:0pt } .sD37F5C3B { margin-top:66pt; margin-bottom:0pt; page-break-inside:avoid; page-break-after:avoid; font-size:7pt } Published on 22 April 2025   FIRST SECTION Application no. 17259/17 Gianluca CIUCCI and Constanza PICCIONI against Italy lodged on 21 February 2017 communicated on 2 April 2025 SUBJECT MATTER OF THE CASE The application concerns the administration of blood transfusions to the first applicant, a Jehovah’s Witness, against his will. On 10 February 2014, the first applicant was admitted awake and conscious to the Siena University Hospital and diagnosed with an acute respiratory distress syndrome. The doctors were informed by the first applicant’s wife (the second applicant) that he was a Jehovah’s Witness refusing blood transfusions and were presented with an advance medical directive, signed by the applicant on 1 January 2014. On 11 February 2014, following deterioration of his medical conditions, physicians considered necessary to place the first applicant under external mechanical respiratory support. Considering the risk of haemorrhagic complications associated with the medical procedure, advice was sought from a legal expert of the hospital who noted that, lacking national legislation on advanced medical directives, it was necessary to refer to the hospital’s internal guidelines establishing that, in case of unconscious patients, blood products were to be administered when necessary. The second applicant was informed of the need to place him under external mechanical respiratory support and of the associated risk of haemorrhages. Due to complications during the said medical procedure, blood transfusions were administered. The second applicant and a trusted person applied to the Siena guardianship judge ( giudice tutelare ) for the official appointment of the trusted person as a limited guardian ( amministratore di sostegno ) in order to ensure respect of the first applicant’s advanced medical directive. On 12 February 2014, the judge considered that the protection of health was of such paramount importance that the first applicant’s previously expressed wishes had to be disregarded. The judge appointed as a limited guardian a person unknown to the applicants and authorised any necessary medical treatment, including blood transfusions. Pursuant to this decision, further transfusions were performed until the first applicant regained consciousness. The second applicant and the trusted person challenged the decision before the Siena Court of Appeal, claiming a violation of the first applicant’s right to self-determination and freedom of religion as recognised by the Italian Constitution and the Convention. On 18 March 2014, the Court of Appeal revoked the appointment of the legal guardian. On 27 October 2016, the applicants’ appeal on points of law was dismissed by the Court of Cassation. In its decision the court referred, inter alia, to the principle established in its judgment no. 23676 of 15   September 2008 according to which, to be valid, the refusal of medical treatments must be expressed, unequivocal and actual. A manifestation of dissent formulated ex ante at a time when the patient’s life was not in danger is not sufficient as it shall be expressed after the patient has been informed of the severity of his/her medical condition. The first applicant complains under Articles 8 and 9 of the Convention that while his refusal to certain medical treatments had been clearly expressed, they were ignored by the domestic authorities. In particular, he maintains that at the material time there was no legal framework setting out the conditions to ensure respect for patient autonomy in the healthcare system at national level. In the first applicant’s view, the contested medical treatments were also contrary to Article 14 taken together with Articles 8 and 9 of the Convention. Relying on Articles 8 and 9 of the Convention, the second applicant complains that the forced blood transfusions performed on her husband infringed her right to family life as their shared religious beliefs were a fundamental element of their marriage. She further claims that the profound distress she sustained on account of the events violated her right to private life.       QUESTIONS TO THE PARTIES 1.     Having regard to the object of the domestic judicial proceedings and to the content of the decisions thereof, in particular the Siena Court of Appeal’s decision of 18 March 2014, have the applicants complied with the time-limit laid down in Article   35 §   1 of the Convention?   2.     Can the second applicant claim to be a victim of alleged violations of the Convention, within the meaning of Article 34 (see mutatis mutandis, Koch   v. Germany , no. 497/09, §§ 43-50, 19 July 2012; and Lindholm and the Estate after Leif Lindholm v. Denmark , no. 25636/22, § 58, 5   November 2024)?   3.     Has there been an interference with the applicants’ right to respect for their family and/or private life contrary to Article   8 of the Convention read in the light of Article 9 of the Convention (see Pindo Mulla v. Spain [GC], no.   15541/20, § 98, 17 September 2024)? If so, was that interference in accordance with the law and necessary in terms of Article   8 §   2?   4.     Has the first applicant suffered discrimination contrary to Article 14 of the Convention read in conjunction with Articles 8 and 9 of the Convention?   In answering the questions, the parties are asked to describe the domestic legal framework addressing informed consent and the refusal of medical treatment which was in place at the material time. They are invited to refer to both legislative provisions and domestic case-law.