¹ Pindo Mulla v Spain App no 15541/20 (ECtHR, GC, 17 September 2024).

² ‘Grand Chamber of the European Court Upholds Patient Autonomy for Jehovah’s Witnesses: Court Rules Unanimously in the Case of Pindo Mulla v. Spain’, 11 October 2024, available at https://www.jw.org/en/news/region/spain/Grand-Chamber-of-the-European-Court-Upholds-Patient-Autonomy-for-Jehovahs-Witnesses, accessed 20 November 2024.

³ Bayatyan v Armenia App no 23459/03 (ECtHR, GC, 7 July 2011).

⁴ P Muzny, ‘Bayatyan v Armenia: The Grand Chamber Renders a Grand Judgment’ (2012) 12:1 Human Rights Law Review 135–147.

⁵ Pindo Mulla at para 11.

⁶ She reportedly described the transfusions with the following words: ‘like a rape of my person, something disgusting, … very, very bad’ (ibid at para 35).

⁷ Ibid at para 87.

⁸ See Pretty v the United Kingdom App no 2346/02 (ECtHR, 29 April 2002) at para 63; Lambert and Others v France App no 46043/14 (ECtHR, GC, 5 June 2015) at para 180. In Lambert and Others, the issue was far more complex, involving a patient in a vegetative state whose wishes had to be reconstructed from statements made prior to the accident that left him unable to communicate.

⁹ Pindo Mulla at para 98.

¹⁰ T Lesseliers, ‘Pindo Mulla v. Spain – Blood Transfusions to Jehovah’s Witnesses: Is Protecting Personal Autonomy Through Procedural Justice Enough?’, Strasbourg Observers, 15 November 2024, available at https://strasbourgobservers.com/2024/11/15/pindo-mulla-v-spain-blood-transfusions-to-jehovahs-witnesses-is-protecting-personal-autonomy-through-procedural-justice-enough, accessed 20 November 2024.

¹¹ T Brace, ‘Jehovah’s Witnesses and the law: “Caesar’s things to Caesar, but God’s things to God”’ in E Barker and JT Richardson (eds), Reactions to the Law by Minority Religions (Routledge 2021) 37–57, at 52.

¹² See the example given by I Trispiotis, ‘Mandatory Vaccinations, Religious Freedom, and Discrimination’ (2022) 11:1 Oxford Journal of Law and Religion 145–164, at 146.

¹³ Jehovah’s Witnesses of Moscow v Russia App no 302/02 (ECtHR, 10 June 2010) at paras 131–142; Taganrog LRO and Others v Russia Apps no 32401/10 and 19 others (ECtHR, 7 June 2022) at paras 161–165.

¹⁴ M-J Valero-Estarellas, ‘Neutrality, Margin of Appreciation and Religious Autonomy: Advancing Pluralism and Non-Discrimination in Strasbourg’ (2023) 15 Revue du droit des religions 161–175, at 171.

¹⁵ Among the extensive literature on this subject, see e.g. OM Arnardóttir, ‘The “procedural turn” under the European Convention on Human Rights and presumptions of Convention compliance’ (2017)15:1 International Journal of Constitutional Law 9–35.

¹⁶ More recent developments suggest that the approach adopted in this judgment will also prove disappointing for Jehovah’s Witnesses. The criteria set out in Pindo Mulla were applied late last year in a Danish case concerning a Jehovah’s Witness who was given an emergency transfusion after suffering a serious injury. Due to a subarachnoid haemorrhage, he was unable to confirm his religion-based objection to the procedure, and his prior (unequivocal) advance medical directives were deemed insufficient by the national authorities. They were also considered insufficient by the Court to establish a violation of the Convention. See Lindholm and the estate after Leif Lindholm v Denmark App no 25636/22 (ECtHR, 5 November 2024).

¹⁷ The possibility of such a moral conflict has been noted by A Ponce Tamayo, ‘Respeto a la autonomía personal y objeción de conciencia a tratamientos médicos. Comentario a la Sentencia del Tribunal Europeo de Derechos Humanos Pindo Mulla contra España (Demanda Nº 15541/20), de 17 de septiembre de 2024’ (2024) 66 Revista General de Derecho Canónico y Derecho Eclesiástico del Estado 1–14, at 1.

¹⁸ Lesseliers (note 10).