Case Summary and Outcome

The European Court of Human Rights, by a majority, held that disciplinary sanctions imposed on a doctor for statements denying the effectiveness of vaccines did not violate his right to freedom of expression. The case concerned an Austrian general practitioner who was fined after publishing an article on his professional website claiming that vaccinations were ineffective and questioning the existence of viruses as pathogens. The Court found that the sanction was prescribed by domestic law, which prohibits doctors from providing unobjective or untrue information. It accepted that the government’s aims of protecting public health and maintaining public trust in the medical profession were legitimate. The Court reasoned that while doctors have the right to participate in public debates and express minority views, this right can be restricted when they disseminate categorical and scientifically untenable information, particularly on a platform connected to their medical practice. It concluded that the domestic courts had struck a fair balance between the competing interests, especially given the doctor’s professional duties and the relatively low, suspended fine.

Facts

Dr. Klaus Bielau, an Austrian general practitioner, operated a “holistic medicine” website where he posted an article containing controversial statements about vaccination. He claimed, among other things, that “chemical vaccinations never protect against disease” and that viruses are “a speculation, an assumption, a supposition that is completely unproven.” [para. 6]

The Disciplinary Council of the Austrian Medical Association found him guilty of disciplinary offences for damaging the reputation of the medical profession and breaching his professional duties under sections 136(1)(1) and (2) of the Medical Practitioners Act. The Council based its decision on a finding that he had violated section 53(1) of the same Act and the Regulation on Medical Practitioners and the Public, which prohibit doctors from providing “unobjective [unsachlich], untrue [unwahr] or prejudicial to the reputation of his or her profession” information “in connection with the exercise of his or her profession.” [para. 15]  He was fined €2,000, suspended pending a one-year probation.

Dr. Bielau appealed, arguing his right to freedom of expression under Article 10 of the European Convention on Human Rights (the Convention) was violated. The Styria Regional Administrative Court dismissed his complaint, finding his statements were “purely one-sided and negative,” not in line with medical science or reason, and that the restriction was justified to protect public health and patient trust. The court relied on information from the World Health Organization (WHO) and a second expert opinion.

Dr. Bielau then appealed to the Constitutional Court, which declined to deal with the case and referred it to the Supreme Administrative Court. The Supreme Administrative Court also dismissed his appeal, finding the statements were made in connection with his profession via his practice website and that the fine was not a disproportionate restriction on his freedom of expression under Article 10(2) of the Convention.

Dr. Bielau subsequently lodged an application with the European Court of Human Rights.

Decision Overview

The European Court of Human Rights (ECtHR) delivered the judgment. The main issue was whether the disciplinary sanction imposed on Dr. Bielau for his website statements amounted to a violation of his right to freedom of expression under Article 10 of the Convention.

Dr. Bielau argued that the domestic courts had incorrectly applied the Medical Practitioners Act, as his website articles could not be considered advertising under the relevant legal provisions. He maintained that his comments about vaccination risks were protected speech that served the interests of individuals seeking alternative medical perspectives. He asserted that even if his statements were “offensive, shocking, or disturbing,” he should not be subject to disciplinary actions since they did not harm the profession’s reputation and were not made in the exercise of his profession. He further contended that the disciplinary measures lacked a legitimate aim and were disproportionate.

The Government acknowledged an interference but argued it was justified under Article 10(2). They submitted that the restriction pursued the legitimate aims of protecting public health and maintaining trust in the medical profession by preventing the spread of “unobjective or unfounded information.” [para. 27] While accepting that critical opinion on vaccination was allowed, the Government stressed that restrictions were necessary to limit “purely one-sided and medically clearly refuted allegations” to protect public health and the reputation of the medical profession. [para. 28] The Government therefore argued that the interference was proportionate, as “protecting public health clearly outweighed an individual’s right to disseminate unobjective or even wrong information.” [para. 29]

The Court observed that, according to established case-law, such as Frankowicz v. Poland, the disciplinary sanction constituted an interference with the applicant’s rights under Article 10(1). It first found the interference to be “prescribed by law,” noting that the relevant provisions of the Medical Practitioners Act and its associated Regulation were formulated with sufficient precision and had been consistently interpreted by the domestic courts. Second, it had “no doubt” that the measure pursued the legitimate aims of “the protection of health” and “the protection of the rights of others,” specifically to ensure that the public are “guided by objective considerations when using medical services.” [para. 39]

The Court then examined whether the interference was necessary and proportionate. It characterized Dr. Bielau’s assertions, such as “chemical vaccinations never protect against diseases” and “we do not fall ill through bacteria and viruses”, as “categorical,” “purely one-sided and negative,” and “scientifically untenable,” lacking any “nuanced criticism” and contradicting established medical science and expert reports. [para. 41]

The Court emphasized the special duties of doctors, noting their relationship with patients is “based on trust, confidentiality and confidence.” [para. 43] It held that while doctors have the right to participate in public health debates and express minority opinions, “the exercise of that right is, however, not without limits, particularly when connected to the exercise of their profession.” [para. 44] It found that the applicant’s website was connected to his practice and served an advertising purpose, thereby engaging his professional obligations. The Court also noted the wide potential impact of the statements, as the internet allows content to easily reach the general public, including individuals lacking medical knowledge.

The Court further noted that two separate domestic expert reports had found the applicant’s claims to be contrary to the established state of medical science, including guidance by WHO, with some statements deemed not even in line with reason. In this context, it referenced its Grand Chamber judgment in Vavřička and Others v. the Czech Republic, which recognizes vaccination as one of the most successful public health interventions. The Court also found the case more analogous to Vérités Santé Pratique SARL v. France, where it upheld a sanction for disseminating unverified medical information discrediting conventional treatments for serious illnesses like cancer, than to Hertel v. Switzerland, in which the applicant’s assertions about potential health risks associated with microwave-cooked food were viewed as non-categorical and published in a venue with a limited audience.

As to the nature and severity of the sanction, the Court highlighted that the €2,000 fine was disciplinary, not criminal; represented a very small fraction (approximately 5.5%) of the maximum possible fine; and was suspended. It concluded that this was a proportionate response to the violation.

In conclusion, the Court held that the domestic authorities had struck a fair balance between the competing interests and provided “relevant and sufficient” reasons for their decisions. It found no strong reason to substitute its view for that of the national courts, and thus, by six votes to one, held there had been no violation of Article 10.

Dissenting Opinion

In a dissenting opinion, Judge Vehabović argued that the majority had undervalued the context of the applicant’s homeopathic website and the limited reach of his message. He contended that Dr. Bielau’s statements could not be regarded as “devoid of reason” and that his invitation to adopt “healthy doubt” towards conventional medicine was neither “absolutist or unreasonable.” The dissent further stated that the sanction was disproportionate and that an invitation to “question vaccination” was not equivalent to purely one-sided information.