In simple terms, the right to liberty and security is the right to be physically free and not to be unlawfully detained. In the context of an individual’s right to health, the right to liberty and security also protects a person from involuntary placement in a medical institution.
A person’s health & Liberty and security
Everyone has the right to health, but this does not mean that medical treatment should be arbitrarily imposed without a person’s consent. Involuntary placement in a medical institution may constitute an unlawful deprivation of liberty.
According to the European Convention on Human Rights, deprivation of liberty for the following health-related reasons may be lawful:
- for ill persons: to prevent the spread of infectious diseases
- for persons of unsound mind: when such a measure is truly necessary (e.g., to prevent a person from causing harm to oneself or others)
- for alcoholics and drug addicts: e.g., to prevent dangerous behaviour or health risks
Mandatory treatment of infectious diseases
In Estonia Communicable Diseases Prevention and Control Act states that persons with dangerous communicable diseases who pose a risk to others and refuse or violate their treatment regime can be involuntarily hospitalised. This typically needs a court ruling but in urgent cases for public safety, a physician may make the decision, with treatment lasting up to 48 hours after commencement. If such a person's location is unknown, the healthcare provider must notify the police and, if required, local authorities for placement in a closed institution. Involuntary treatment decisions, including its application, extension, or termination, are generally court-decided, following the Code of Civil Procedure, but the attending physician can apply for preliminary legal protection. Such individuals must be placed in isolated, infection-safe wards, and their communication may be limited to prevent disease spread.
Involuntary mental health care
According to Estonian law, a person is admitted to the psychiatric department of a hospital for emergency psychiatric care without the consent of the person or his or her legal representative, or the treatment of a person is continued regardless of his or her wishes only if all of the following circumstances exist:
- the person has a severe mental disorder which restricts his or her ability to understand or control his or her behaviour
- without in-patient treatment, the person endangers the life, health or safety of himself or herself or others due to a mental disorder
- other psychiatric care is not sufficient
Involuntary psychiatric treatment shall be applied only on the basis of a court ruling. Involuntary psychiatric treatment may also be applied without a court ruling if it is inevitable for the protection of the person or the public and if a court ruling cannot be received as quickly as necessary.
Involuntarily placement
If there is reasonable belief that a person requires involuntary placement they can be taken to a psychiatric department of a hospital by various individuals, such as emergency medical staff, police, or someone close to them. The police may assist healthcare providers with detainment, medical examination, and transfer to the hospital based on a physician's written request. The physician must promptly inform the patient and their representative about their decision. Once placed in involuntary treatment without a court ruling, a representative, chosen physician, or lawyer can meet with the person, with the duration of such a meeting determined by the attending physician based on the patient's health.
Read more about Involuntary placement & Mental health care in this Guide.
Mandatory treatment of child alcoholics and drug addicts
The Estonian law does not foresee mandatory (forced) medical treatment for adult alcoholics and drug addicts.
However, child alcoholics and drug addicts may be subject to mandatory medical (narcological) treatment only in those cases where the child has such severe intoxication from alcohol, narcotic or psychotropic drugs that:
- the child’s life is endangered
- the child is endangering his or her family, himself or herself or other persons due to mental dysfunction.
The medical treatment can be undertaken on an outpatient basis (organized by a narcologist in cooperation with a general practitioner) or on an inpatient basis (in a hospital).