Blood, Autonomy and Ethical Practice: Insights from the 2024 European Court of Human Rights Decision of Mulla v Spain.

Abstract

This editorial reviews the important decision by the European Court of Human Rights in Pindo Mulla v Spain (17 September 2024) (Pindo Mulla). It identifies the reasoning process of the Grand Chamber in adopting an analysis consistent with the 1990 decision of the Ontario Court of Appeal in Malette v Shulman (1990) 67 DLR (4th) 321 that, when an adult is competent, they are entitled to make autonomous decisions, including by an advance care directive, about matters such as administration of blood products, even though their decision will foreseeably have highly adverse consequences for their health and even for their survival. The emphasis placed by the Grand Chamber on the entitlement to autonomous decision-making by adult patients as entitlement to the right to respect for private life, viewed in light of the right to freedom of religions is likely to have significant ramifications in reducing the potential for paternalist decision-making in a variety of cases where patients indicate that they reject certain forms of treatment. The editorial reviews practical clinical and administrative challenges raised by the Pindo Mulla case and recommendations made by a 2025 New South Wales coronial decision directed toward addressing some of the issues.