KKO:2023:93 – Legal remedies available to a person subjected to involuntary medication

Questions before the Court and description of the incident

Judgment KKO 2023:93 of the Supreme Court concerned the question of whether or not A's access to legal remedies was sufficient with respect to involuntary administration of medication and whether or not A was entitled to compensation from the State for violation of fundamental rights and human rights. The amount of compensation was also under consideration.

A had been ordered to involuntary psychiatric hospital treatment on 26 June 2020. A had been medicated against their will during the treatment. A's involuntary hospital care was terminated on 3 September 2020.

A filed an appeal with the Administrative Court on 29 June 2020. The appeal included the matter of A having been medicated against their will. By a decision issued on 6 October 2020, the Administrative Court dismissed A's demand for terminating the involuntary administration of medication. The Supreme Administrative Court dismissed A's application for leave to appeal by a decision issued on 21 December 2020.

On 2 July 2020, A submitted to the District Court a petition for injunction, in which A demanded the District Court to prohibit the joint municipal authority from medicating A against their will. A withdrew the petition after their hospital treatment was terminated.

A also lodged a complaint regarding their treatment to the National Supervisory Authority for Welfare and Health, Valvira, on 30 June 2020. On 7 July 2020, Valvira transferred the complaint to the Regional State Administrative Agency for consideration. In a decision issued on 24 September 2020, the Regional State Administrative Agency stated that there was no reason to suspect that A's treatment had involved misconduct.

Fundamental and human rights concerning legal remedies related to involuntary administration of medication

Pursuant to Section 21(1) of the Constitution of Finland, everyone has the right to have his or her case dealt with appropriately and without undue delay by a competent court of law or, as well as to have a decision pertaining to his or her rights or obligations reviewed by a court of law or other independent body for the administration of justice.

Pursuant to Article 8(1) of the European Convention on Human Rights, everyone has the right to respect for his private life. Pursuant to subsection 2 of the Article, there shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.

In its judgment X v. Finland of 3 July 2012, the European Court of Human Rights considered, among other things, whether the involuntary administration of medication to X violated X's rights protected under the Convention on Human Rights. The European Court of Human Rights found that the medical intervention in defiance of the patient’s will constituted interference with the patient's private life, and in particular with their physical integrity (section 212 of the judgment).

The European Court of Human Rights noted that a care order issued for the involuntary hospitalisation of a patient contained an automatic authorisation to treat the patient, even against his or her will. Furthermore, the European Court of Human Rights stated that decisions taken by a doctor concerning the medication of a patient against the patient's will were not subject to appeal. The European Court of Human Rights also noted that the appellant had made a number of complaints to multiple authorities, but they could not intervene in the case (sections 218 and 219 of the judgment).

The European Court of Human Rights considered that the decision to confine the appellant for involuntary treatment included an automatic authorisation to proceed to involuntary administration of medication. The decision-making was free from any kind of immediate judicial scrutiny. The appellant did not have any remedy available whereby they could have required a court to rule on the lawfulness, including proportionality, of the involuntary administration of medication, or to have it discontinued. Thus, the law did not provide for protection of the appellant's private life in accordance with Article 8(2) of the Convention on Human Rights, and the Article had been violated (sections 220 – 222 of the judgment). The European Court of Human Rights stated that, in view of the violation of Article 8 of the Convention in the case, there was no need to examine the complaint under Article 13 of the Convention separately (section 230 of the judgment).

It can be concluded from the case law of the European Court of Human Rights concerning Article 8 of the Convention on Human Rights that the Article does not necessarily require that a person subjected to involuntary administration of medication must be able to get the matter before a court, but that review by another independent judicial body could be considered a sufficiently efficient means of legal remedy (see e.g. Atudorei v. Romania 16/09/2014, sections 164 - 166).

Provisions on legal remedies valid at the time of the incident

According to legislation valid during the period of treatment referred to in the claim, it was not necessary to issue an administrative decision on the administration of medication against the patient's will. The law also did not provide for the right to petition for change in the content of treatment, including administration of medication, by lodging an appeal with a court or other independent judicial body.

The patient had the right to submit an objection to the director responsible for health care in the health care unit in question in accordance with section 10 of the Act on the Status and Rights of Patients.

Furthermore, the patient had the right to appeal to authorities, in this case Valvira and the Regional State Administrative Agency, in accordance with section 10a of the Act on the Status and Rights of Patients. It was also possible to appeal to the Parliamentary Ombudsman of Finland and the Chancellor of Justice of the Government of Finland.

Pursuant to section 53b of the Administrative Procedure Act concerning consideration of an administrative complaint, the supervisory authority shall take the measures that it considers appropriate on the basis of the administrative complaint. Pursuant to section 53c of the Act, in its decision on an administrative complaint matter, a supervisory authority may draw the attention of the supervised entity to the requirements of good administration or inform it of the authority’s understanding of lawful conduct, or the supervised entity may be given an admonition, unless the nature or severity of the act forming the subject of the complaint requires measures to institute a procedure provided in another act.

Pursuant to section 53d of the Administrative Procedure Act, no appeal may be made against a decision given in an administrative complaint matter. The detailed rationale for the provision (Government proposal HE 50/2013 vp, p. 28) state that it was not possible to decide on anyone's right, benefit or obligation in an administrative complaint matter, and a decision issued in a complaint matter and any administrative guidance issued as a result of an administrative complaint did not have legal consequences corresponding to those of a decision issued in an administrative matter.

Conclusion of the Supreme Court

The Supreme Court found that A had expressed through various means that they objected to the administration of medication. However, A was unable to obtain a decision by a court or other independent judicial body concerning the lawfulness and proportionality of the involuntary administration of medication or an order on the termination of medication through the means available to A. Thus, Finnish law did not offer A such means of legal remedies that would have met the requirements set out in section 21 of the Constitution of Finland and Article 8 of the Convention on Human Rights. A's fundamental rights and human rights had been violated. The Supreme Court found EUR 3,000 to be reasonable compensation for the violation.