Case SK 16/071

The complainant’s principle allegation was that the portion of Article 52(2) of the Code of Medical Ethics (the “Code”) that read “a physician shall not discredit another physician publicly in any way whatsoever” violated the freedom of expression guaranteed in Article 54 of the Constitution of the Republic of Poland (the “Constitution”).

The complainant was employed as an assistant professor at the Chair and Teaching Hospital for Paediatric Infectious Diseases of the Medical University in Wroclaw when she became involved in a dispute with the Chair Holder regarding “the plausibility of lumbar punctures in children who had undergone postmeasles encephalitis.” In addition to informing the medical self-governing body of the issue, the complainant also issued two press publications against such treatment in Agora magazine. After these public statements, the Regional Medical Court, part of the medical self-governing body, passed a judgment that the complainant was guilty of medical misconduct for violating Article 52(2) of the Code. A reprimand was issued to the complainant and she brought an appeal before the Supreme Medical Court. In 2006, the Supreme Medical Court upheld the finding of guilt, but lessened the repercussion to a warning. Both courts based their decisions on the making of a public statement discrediting another physician, without considering the veracity of such statement or the implications for public interest.

In this constitutional challenge, the complainant alleged that the reading of Article 52(2) of the Code in conjunction with Articles 15(1), 41, and 42(1) of the Act of 17 May 1989 Chambers of Physicians (“ACP”):

1. Violated Article 54(1) of the Constitution read in conjunction with Articles  31(3)(requiring that any limitation on constitutional rights be imposed by a statute and for certain objectives) and 17(1)(permitting self-governments to be created within professions, concerned with proper practice and protection of the public interest) of the Constitution; and
2. Violated Article 63 (guaranteeing the right to submit petitions, proposals and complaints to public authorities or social institutions) of the Constitution in conjunction with Article 10 (guaranteeing freedom of expression) of the Convention for the Protection of Human Rights and Fundamental Freedoms (the “Convention”).

The ACP establishes laws that require physicians to follow the principles of ethics, grants jurisdiction to the medical courts for conduct against the principles of ethics, and provides the available sanctions from which the courts can choose in the case of a violation of the principles of ethics.

As a preliminary matter on the question of admissibility, the Constitutional Tribunal first noted that corporate deontological norms, such as the medical guidelines in question, which contained normative content were subject to its judicial review of constitutionality.

With regards to the violation of the freedom of expression and the right to criticize contained in Article 54(1) of the Constitution in conjunction with Article 31(3) of the Constitution, the Constitutional Tribunal held that the interpretations of Article 52(2) of the Code by the medical courts violated the freedom of expression. The Constitutional Tribunal acknowledged that the freedom of expression under the Constitution was not absolute. If the Code was read to mean that only discrediting public comments against other physicians were prohibited then the Constitutional Tribunal found that this would not violate the freedom of expression. The interpretation of the provision by the medical courts, however, had the practical effect of prohibiting all public criticisms of other physicians, regardless of the truth behind the statements and any public interest involved. The failure to distinguish between critical statements and discrediting statements led the Constitutional Tribunal to find Article 52(2) of the Code, as applied, unconstitutional. The Court further noted the requirement under Art. 17 of the Constitution that self-governments created within professions must supervise the functioning of the profession for the protection of the public interest.

With regards to the violation of Article 63 of the Constitution in conjunction with Article 10 of the Convention, the Constitutional Tribunal held that the charge of violation was unjustified in the present case as the “right to petition” was not involved because an press publication on the defective professional practice of another physician did not “[constitute] a form of ‘public’ expression of a motion or complaint to the authorities of the medical self-government.”

Ultimately, the Constitutional Tribunal issued a scope judgment holding that Article 52(2) of the Code was unconstitutional in part, but that to remedy the situation required only a change in the interpretation of the provision by the medical courts rather than legislative action. It recommended an amendment to the Code to clarify that “discrediting” statements are those that are “false or not connected with the protection of the public interest, made exclusively or primarily in order to undermine the authority of another physician of the trust they enjoy.”

The Constitutional Tribunal also held that with regards to persons penalized by the medical courts for violations of Article 52(2) of the Code without the courts’ consideration of the veracity of the statements or the impact for public interest, this decision could serve as the basis for reopening those proceedings for reconsideration.

“5.1. …. Freedom of expression, however, applies also to other aspects of public and private life. The jurisprudential line of the CT is in this matter compatible with the jurisprudence of the ECHR, which emphasizes the particular significance of the freedom of expression in the shaping of attitudes and opinions in issues which attract public interest and concern (serious issues affecting the public interest, see, inter alia, judgment of the ECHR in the cases of Hertel v. Switzerland of 25 August 1998, No. 25181/94, § 47). Clearly, the problems of protection of health and the functioning of the health service, particularly to the extent in which they deal with issues significant for the safety of patients, must be considered such issues affecting public interest (same ECHR in its judgments in cases of: Bergens Tidende v. Norway of 2 May 2000, No. 26123/95, § 51 and Selistö v. Finland of 16 November 2004, No. 56767/00, § 51.”

“5.1…Wolność słowa obejmuje jednak i inne przejawy życia publicznego oraz sferę prywatną. Linia orzecznicza TK jest w tym punkcie zgodna z judykaturą ETPC, która podkreśla szczególne znaczenie, jakie wolność słowa ma dla kształtowania się postaw i opinii w sprawach budzących publiczne zainteresowanie i zatroskanie (serious issues affecting the public interest; zob. m.in. wyrok ETPC w sprawach Hertel przeciwko Szwajcarii z 25 sierpnia 1998 r., nr 25181/94, § 47). Nie ulega zaś wątpliwości, że problematyka ochrony zdrowia i funkcjonowania służby zdrowia – zwłaszcza w zakresie, w jakim dotykają kwestii istotnych dla bezpieczeństwa pacjentów – należą do tego typu spraw (identycznie ETPC w wyrokach w sprawach: Bergens Tidende przeciwko Norwegii z 2 maja 2000 r., nr 26132/95, § 51 oraz Selistö przeciwko Finlandii z 16 listopada 2004 r., nr 56767/00, § 51).”

“5.6. In conclusion, the Tribunal recognizes the need for certain limitations of the freedom of expression and the right to criticism in relations between physicians due to the necessity of protecting the confidence that patients repose in the health service and which is indispensable for the proper functioning of this profession as a whole, as well as due to the nature of patient-physician relations based on confidence that a patient reposes in the physician and finally due to the specifics of diagnostic and therapeutic decisions, usually made without complete knowledge of all the circumstances of a given case. The reporting procedure provided for under Art. 52(3) of the CME aims to reconcile these competing values. This, however, does not mean that the mechanism specified therein will always be sufficient or adequately effective for the protection of the value fundamental in the examined extent, that is, the health and life of patients. In casu, within the limits dictated by the protection of this value and, what is obvious, the veracity of the produced statements, the necessity to publicly criticise another physician may arise. Hence, an interpretation of Art. 52(2) of the CME consistent with the constitutionally approved system of values may not head towards absolute inadmissibility of public criticism of a physician by another physician nor towards relieving the medical courts of hearing evidence of truth and of evaluating conflicting interests in a given case.”

“5.6. Podsumowując, Trybunał uznaje potrzebę istnienia pewnych ograniczeń wolności słowa i prawa do krytyki w relacjach pomiędzy lekarzami, ze względu nakonieczność ochrony zaufania pacjentów do służby zdrowia, niezbędnego do prawidłowego funkcjonowania tej profesji jako całości, specyfikę relacji pacjent – lekarz, opartej na zaufaniu pacjenta do lekarza, wreszcie specyfikę decyzji diagnostycznych i terapeutycznych, podejmowanych z reguły w warunkach braku pełnego rozeznania wszelkich uwarunkowań danego przypadku. Uzgodnieniu tych konkurujących ze sobą wartości służy procedura informacyjna ustanowiona w art. 52 ust. 3 KEL. Nie znaczy to jednak, że opisany tam mechanizm zawsze będzie wystarczający i dostatecznie skuteczny, aby zapewnić ochronę wartości podstawowej w analizowanym zakresie – tj. zdrowia i życia pacjentów. In casu, w granicach podyktowanych ochroną tej wartości oraz – co oczywiste – prawdziwością formułowanych twierdzeń, może zaistnieć konieczność wystąpienia z publiczną krytyką innego lekarza. Interpretacja zakwestionowanego art. 52 ust. 2 KEL zgodna z aprobowanym konstytucyjnie systemem wartości nie może zatem zmierzać w kierunku uznania całkowitej niedopuszczalności publicznej krytyki lekarza przez innego lekarza i zwolnienia sądów lekarskich z przeprowadzania dowodu prawdy oraz dokonywania ocen wartościujących konkurujące ze sobą w konkretnym wypadku interesy.”

“5.4. … The trust reposed by patients in physicians, their competences and employed methods of treatment is, as stressed by the President of the SMC, an indispensable element of proper functioning of the health service in general, as well as of the success of individual therapies.”

“5.4. … Koniecznym elementem prawidłowego funkcjonowania służby zdrowia w wymiarze ogólnym oraz powodzenia terapii w wymiarze indywidualnym jest – podkreślane przez Prezesa NRL – zaufanie pacjenta do lekarza, jego kompetencji i stosowanych metod diagnostyki leczenia.”

“5.4. … Also the element of protecting the public good connected with the social image of the health service and its employees is subject to consideration in juxtaposition to other values, protected by law under both the Constitution and statutes, such as: the right of patients to proper medical care or their right to access information.”

“5.4. … Także element ochrony dobra publicznego związanego ze społecznym wizerunkiem służby zdrowia i jej pracowników podlega jednak ważeniu w zestawieniu z innymi wartościami, prawnie chronionymi zarówno na poziomie konstytucyjnym, jak i ustawowym, takimi jak: prawo pacjentów do właściwej opieki zdrowotnej, czy prawo do informacji.”