Judgment S.O. v. Spain - Spanish authorities failed to protect Venezuelan woman who had undergone a medical procedure without her informed consent

issued by the Registrar of the Court   ECHR 160 (2025)   26.06.2025   Spanish authorities failed to protect woman who had undergone a medical   procedure without her informed consent   In today’s Chamber judgment1 in the case of S.O. v. Spain (application no. 5742/22) the European   Court of Human Rights held, unanimously, that there had been:   a violation of Article 8 (right to respect for private and family life) of the European Convention on   Human Rights.   The case concerned the removal of Ms S.O.’s nipple and areola, allegedly carried out without her   consent, during an operation to save her breasts from cancer, and subsequent court proceedings.   The Court found in particular that the Spanish authorities had failed to examine whether the doctors   had informed her of the specific possibility of the nipple and areola being removed. The Spanish   authorities had not responded adequately to S.O.’s claim concerning the absence of valid informed   consent. They had failed to implement the existing legal framework correctly and sufficiently to   protect her autonomy, in violation of Article 8.   Principal facts   The applicant, S.O., is a Venezuelan national who was born in 1956 and lives in Madrid.   In 2016 S.O. was diagnosed with breast cancer for the second time, this time in her right breast. In   January 2017 the Gómez Ulla Hospital in Madrid proposed to her that she undergo breast-   conserving surgery. She signed an informed-consent form.   In February of that year S.O. was operated on. Two samples of breast tissue were immediately   analysed, and the decision was made to lower the incision and to remove the nipple and the areola.   S.O. complained to the Health Department of the Madrid Autonomous Community in September   2017. She claimed 100,000 euros in compensation, asserting that her nipple and areola had been   removed although no cancer had been present there, and that she had given informed consent only   to the breast-conserving surgery and the removal of lymph nodes.   In the absence of a reply to her administrative complaint, she took the case to the Spanish courts.   However, the Madrid High Court of Justice in September 2020 considered that the consent she had   given had been adequate, noting, in particular, that “oncological safety” (seguridad oncológica) had   been the primary objective and that the possibility of varying the surgical technique had been   included in the information given to S.O.   Complaints, procedure and composition of the Court   Relying on Article 8 (right to respect for private and family life), Ms S.O. complained that she had not   given valid consent to the removal of her nipple-areola complex.   The application was lodged with the European Court of Human Rights on 21 January 2022.   1. Under Articles 43 and 44 of the Convention, this Chamber judgment is not final. During the three-month period following its delivery,   any party may request that the case be referred to the Grand Chamber of the Court. If such a request is made, a panel of five judges   considers whether the case deserves further examination. In that event, the Grand Chamber will hear the case and deliver a final   judgment. If the referral request is refused, the Chamber judgment will become final on that day.   Once a judgment becomes final, it is transmitted to the Committee of Ministers of the Council of Europe for supervision of its execution.   Further information about the execution process can be found here: www.coe.int/t/dghl/monitoring/execution.   Judgment was given by a Chamber of seven judges, composed as follows:   Kateřina Šimáčková (the Czech Republic), President,   María Elósegui (Spain),   Gilberto Felici (San Marino),   Andreas Zünd (Switzerland),   Diana Sârcu (the Republic of Moldova),   Mykola Gnatovskyy (Ukraine),   Vahe Grigoryan (Armenia),   and also Martina Keller, Deputy Section Registrar.   Decision of the Court   The Court noted, firstly, that the procedure performed by the hospital had potentially significant   impacts on a woman’s physical and mental wellbeing, her image and self-esteem, and her sexual life.   This particular case and the issue of consent therefore came under Article 8. The Court was satisfied   that the legal framework in place in Spain around medical consent was adequate.   In this case, S.O.’s consent had been sought and given concerning the intervention in general, albeit   without specific discussion around the risk of removal of the nipple and areola as part of the overall   aim of removing the cancer. It noted that the High Court had considered this to have been adequate.   Regarding the consent form the Court held that it had not been sufficiently clear for a person with   no medical knowledge which of the surgeries included on it could be considered as a modification of   surgical technique covered by the informed-consent form, in particular that signing it meant   accepting the removal of the nipple and areola as a possibility. The Court reiterated that, under   Spanish law, where written consent was required, the consent form had to contain sufficient   information regarding the procedure and its risks to enable the patient to make an informed   decision.   The High Court had not examined whether the doctors had informed her of the specific possibility of   the nipple and areola being removed. The Court held that given the nature and purpose of breast-   conserving surgery, the general risks and consequences associated with it and with incomplete   removal of a tumour, and S.O.’s specific circumstances, the doctors had been required to inform her   beforehand about the possibility of a removal of her areola and nipple. The Spanish courts should   have been aware of the repercussions to S.O.’s self-image and sexual life and should have addressed   that in proceedings.   Overall, the Spanish authorities had not responded adequately to S.O.’s claim concerning the   absence of valid informed consent. They had failed to implement the existing legal framework   correctly and sufficiently to protect her autonomy, in violation of Article 8.   The judgment is available only in English.   This press release is a document produced by the Registry. It does not bind the Court. Decisions,   judgments and further information about the Court can be found on www.echr.coe.int. 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