November 25, 2003
His Excellency Mikulas Dzurinda
Republic of Slovakia
Dear Prime Minister Dzurinda:
We write as a follow-up to the letter dated March 7, 2003 sent by nine Members of the Helsinki Commission regarding reports that Romani women were sterilized without informed consent. We were heartened by your March 20 letter, in which you stated so strongly your commitment to ensure respect for human rights in Slovakia.
Unfortunately, we believe that there were significant deficiencies in the Slovak Government’s recently concluded investigation into this matter: conflicts of interest were not adequately addressed; human rights activists and possible victims were threatened with criminal charges for speaking out; investigators failed to evaluate whether consent, when given, was informed; and some Romani women and their lawyers were blocked from accessing their own medical records. The attached memorandum summarizes these shortcomings.
Against this backdrop, Deputy Prime Minister Pal Csaky’s assertion that "illegal sterilizations" have not taken place rings hollow, especially as a closer examination of your government’s own reports confirms that some women, including minors, were in fact sterilized without consent. Moreover, such denials detract from the positive steps your government is taking--which we welcome--to implement reforms in the health care system intended to ensure that, in the future, sterilizations are only performed when informed consent is given.
Mr. Minister, we hope that your government will indeed press ahead with planned changes to the health care system, as recommended by the Council of Europe’s Commissioner for Human Rights. In addition, we urge you to institute legal changes that will guarantee patients’ rights to their medical records and allow independent expert medical testimony so that individual victims may pursue their cases in court, should they wish to do so.
As is the case in every country, including our own, the protection and promotion of human rights requires constant vigilance. To that end, we once again urge your government to adopt and implement comprehensive anti-discrimination legislation, consistent with Slovakia’s commitment in the 1999 Istanbul OSCE Summit Document.
CHRISTOPHER H. SMITH, M.C.
BEN NIGHTHORSE CAMPBELL, U.S.S.
BENJAMIN L. CARDIN, M.C.
HILLARY RODHAM CLINTON, U.S.S.
JOSEPH R. PITTS, M.C.
LOUISE McINTOSH SLAUGHTER, M.C.
ROBERT B. ADERHOLT, M.C.
ALCEE L. HASTINGS, M.C.
Shortcomings of the Slovak Government’s Investigation
into Reports of Sterilization without Informed Consent (concluded October 2003)
Conflict of interest. In organizing its investigation, the government failed to address the inherent conflict of interest that exists when a government investigates the alleged wrongdoing of its own agents. Although there are no indications that sterilizations without informed consent occurred as a result of a state policy, the state may have been negligent in ensuring that the past practice of targeting Romani women for sterilizations had ceased. In addition, the majority of sterilizations are reportedly performed in public hospitals by medical doctors who are public employees.
Documented violations brushed aside. Although government officials have generally denied--particularly in statements to the press--that "illegal sterilizations" were performed, a closer examination of the government’s own reports confirms that 1) some minors were sterilized without parental consent as required; and 2) other women were sterilized without consent based on the mistaken theory that the sterilizations performed at the time of their caesareans were necessary to save their lives. (Revised regulations for conducting sterilizations, still being drafted, would appear to prevent sterilizations being performed under such circumstances in the future.)
Failure to determine if consent was informed. In general, the government limited its investigation to the question of whether sterilized women had a signed consent form in their files. While a signed consent form may constitute prima facie evidence of consent, it does not conclusively demonstrate that the consent was informed or voluntary. In fact, a key argument advanced by non-governmental groups was that some forms were signed by Romani women who could not read or understand the forms; who were in advanced stages of labor; who were under sedation for surgery; or who signed the forms because they were given incorrect medical information regarding the necessity of sterilization. In such cases, informed consent was not obtained.
Threats of criminal charges against human rights activists and possible victims. Human rights activists who investigated and reported this issue were threatened with criminal charges for "spreading alarming information." Police investigators also threatened possible victims with criminal charges during the course of interrogations supposedly conducted to obtain their testimony regarding sterilizations. The constant threat to bring criminal charges against anyone who alleges that sterilizations had been performed without informed consent cannot be reconciled with the investigation's stated goal of getting at the truth.
Access to medical records blocked. In some cases, Romani women and their attorneys were denied access to their medical files. In one case, a hospital refused to comply with two court decrees ordering the hospital to provide access to records. Some doctors have also refused to cooperate with procedural requirements necessary for civil suits to proceed, effectively blocking that possible avenue for redress.