Background

In Lindholm and the estate after Leif Lindholm v Denmark [2024] ECHR 835, the applicants were Lilian Elisabeth Lindholm, born in 1953 and the estate of her late husband, Leif Ingolf Lindholm, both of whom were Jehovah’s Witnesses.

In 2014, Mr Lindholm was admitted to the emergency unit of the local hospital in Odense after a serious fall resulting in injury. He had been warfarin on prescription to reduce the risk of cerebral thrombosis. His daughter had told the healthcare staff that, as a Jehovah’s Witness, he did not wish to receive a blood transfusion and gave them an advance medical directive and a Health Care Power of Attorney making that position clear. Mr Lindholm then suffered a subarachnoid haemorrhage, and though the family maintained that he did not wish to receive blood products in any form, he was nevertheless given an emergency transfusion. He died on 21 October 2014; it was common ground that the cause of death was not linked to the blood transfusion [6-26].

In 2018, the High Court of Eastern Denmark found in part that the applicants’ rights under Articles 8 and 9 ECHR had been breached [32]; however, that finding was overturned on appeal by the Supreme Court, which held that

“section 19 of the Health Act allows life-saving treatment to be administered to an unconscious patient regardless of any advance directive from him or her about not wanting to be treated. The rule is general and is not restricted to blood transfusions. Therefore, the blood transfusion that was given to L was not a violation of Article 14 of the Convention on Human Rights, read in conjunction with Articles 8 and 9” [33” emphasis added].

Admissibility and merits

On the preliminary issue of admissibility, the ECtHR ruled Mrs Lindholm’s application admissible but the application by her late husband’s estate inadmissible [60].

As to merits, the applicants maintained that the effect of the relevant section of the Health Act was to disable the refusal of blood transfusions by Jehovah’s Witnesses during a medical emergency when the patient could not confirm his or her refusal. That had disproportionate effects on the rights of Jehovah’s Witnesses to personal autonomy; it was only in the case of Witnesses that a treating doctor could decide on their rights to personal integrity, autonomy and religious conscience, and there had been no justification for that difference in treatment [103].

The Danish Government replied that s.19 of the Health Act did not target Jehovah’s Witnesses and blood transfusions. It was of a general nature and it did not establish a difference in the treatment of persons in relevantly similar situations – and if it did so, that difference had an objective and reasonable justification [104].

The judgment

The Court noted that the blood transfusion administered to Mr Lindholm without his consent had a legal basis in s.19 of the Health Act [106]. The Supreme Court had observed that s.19 of the Health Act allowed for the life-saving treatment of an unconscious patient regardless of any advance directive from him or her about refusing treatment. The provision was general and was not restricted to blood transfusions. The blood transfusion at issue was compliant with Article 14, read in conjunction with Articles 8 and 9 ECHR [107]. Further, while the Court was willing to accept that Jehovah’s Witnesses may have been more affected than other groups by blood transfusions authorised under section 19 of the Health Act [109], any possible indirect discrimination had “objective and reasonable” justification because

“it pursued a legitimate aim, namely the protection of health, and there was a reasonable relationship of proportionality between the means employed and the aim sought to be realised” [110].

That part of the application was therefore manifestly ill-founded within the meaning of Article 35 § 3 (a) ECHR and, consequently, inadmissible. There had not been any violation of Article 8 read in the light of Article 9 [111].