Background Social diversity can affect healthcare outcomes in situations when access to healthcare is limited for specific groups. Although the principle of equality is one of the central topics on the agenda of the European Union (EU), its scope in the field of healthcare, however, is relatively unexplored. The aim of this study is to identify and systematically analyze primary and secondary legislation of the EU Institutions that concern the issue of access to healthcare for various minority groups. In our research, we have concentrated on three features of diversity: a) gender identity and sexual orientation, b) race and ethnicity, and c) religion or belief. Method and materials For the purpose of this analysis, we conducted a search of database Eur-Lex, the official website of European Union law and other public documents of the European Union, based on specific keywords accompanied by review of secondary literature. Relevant documents were examined with regard to the research topic. Our search covered documents that were in force between 13 December 2007 and 31 July 2019. Results Generally, the EU legal system prohibits discrimination on grounds of religion or belief, racial or ethnic origin, sex, and sexual orientation. However, with regard to the issue of non-discrimination in access to healthcare EU secondary law provides protection against discrimination only on the grounds of racial or ethnic origin and sex. The issue of discrimination in healthcare on the grounds of religion or belief, gender identity and sexual orientation is not specifically addressed under EU secondary law. Discussion The absence of regulations regarding non-discrimination in the EU secondary law in the area of healthcare may result from the division of competences between the European Union and the Member States. Reluctance of the Member States to adopt comprehensive antidiscrimination regulations leads to a situation, in which protection in access to healthcare primarily depends on national regulations. Conclusions Our study shows that EU antidiscriminatory law with regard to access to healthcare is fragmentary. Prohibition of discrimination of the level of European binding law does not fully encompass all aspects of social diversity.

Background: Persons with schizophrenia are vulnerable regarding human rights violations. Aims: The aim of this research is to systematically analyse judgements by the European Court of Human Rights (ECtHR) involving persons with schizophrenia. Methods: A systematic search of judgements by the ECtHR, using the search term ‘schizophrenia’. Descriptive statistics and a qualitative thematic analysis were performed. Results: A total of n = 105 judgements were included, originating in n = 29 countries. Article 5 (Right to liberty and security) of the European Convention on Human Rights was ruled by the ECtHR to have been violated in 45.7% of judgements, Article 3 (Prohibition of torture) in 20.0% and Article 8 (Right to respect for private and family life) in 19.0%. Relevant themes were inadequate access to mental health care, especially in prisons and during police operations, involuntary confinement, detention and ill-treatment as a risk factor for psychosis, the right to family life versus the rights of others, extradition/expulsion and protection of other persons’ human rights against violent behaviour by persons with schizophrenia. Discussion: Persons with schizophrenia often do not receive adequate treatment and are especially vulnerable in prisons, where ill-treatment can be an additional risk factor. They can have both offender and victim status. The judgements suggest that the ECtHR has a balanced view on involuntary confinement. National legislation and internal hospital guidelines should be written in a manner to help minimise human rights violations against persons with schizophrenia.

Diversity competency is an approach for improving access to healthcare for members of minority groups. It includes a commitment to institutional policies and practices aimed at the improvement of the relationship between patients and healthcare professionals. The aim of this research is to investigate whether and how such a commitment is included in internal documents of hospitals in Croatia, Germany, Poland, and Slovenia. Using the methods of documentary research and thematic analysis we examined internal documents received from hospitals in these countries. In all four countries, the documents concentrate on general statements prohibiting discrimination with regard to healthcare provision. Specific regulations concerning ethnicity and culture focus on the issue of language barriers. With regard to religious practices, the documents from Croatia, Poland, and Slovenia focus on dominant religious groups. Observance of other religious practices and customs is rarely addressed. Healthcare needs of patients with non-heteronormative sexual orientation, intersexual, and transgender patients are explicitly addressed in only a few internal documents. Diversity competency policies are not comprehensively implemented in hospital internal regulations in hospitals under investigation. There is a need for the development and implementation of comprehensive policies in hospitals aiming at the specific needs of minority groups.

Background The aim of the study was a comparative analysis of legislative measures against discrimination in healthcare on the grounds of a) race and ethnicity, b) religion and belief, and c) gender identity and sexual orientation in Croatia, Germany, Poland and Slovenia. Methods We conducted a search for documents in national legal databases and reviewed legal commentaries, scientific literature and official reports of equality bodies. We integrated a comparative method with text analysis and the critical interpretive approach. The documents were examined in their original languages: Croatian, German, Polish, and Slovenian. Results All examined states prohibit discrimination and guarantee the right to healthcare on the constitutional level. However, there are significant differences among them on the statutory level, regarding both anti-discriminatory legal measures and other legislation affecting access to healthcare for groups of diverse race or ethnicity, religion or belief, sexual orientation or gender identity. Croatia and Slovenia show the most comprehensive legislation concerning non-discrimination in healthcare in comparison to Germany and even more Poland. Except for Slovenia, explicit provisions protecting equal access for members of the abovementioned groups are insufficiently represented in healthcare legislation. Conclusions The study identified legislative barriers to access to healthcare for persons of diverse race or ethnicity, religion or belief, sexual orientation or gender identity in Croatia, Germany, Poland and Slovenia. The discrepancies in the level of implementation of anti-discriminatory measures among these states show that there is a need for comprehensive EU-wide regulations, which would implement the principle of equal treatment in the specific context of healthcare. General anti-discrimination regulations should be strengthened by inclusion of anti-discrimination provisions directly into national legislation relating specifically to the area of healthcare.

Background: Human rights violations such as torture are associated with a high risk of posttraumatic stress disorder (PTSD). The judgements of the European Court of Human Rights (ECtHR) include a normative perspective on PTSD and address central ethical questions. Objective: To help bridge the gap between the psycho-medical and the legal discourse on human rights violations and to illustrate their medico-ethical implications by systematically assessing and categorizing all judgements by the ECtHR dealing with PTSD. Method: The ECtHR database was searched for 'post-traumatic stress disorder'. A descriptive statistic was performed on the Articles of the European Convention on Human Rights involved and violations to these articles. In a qualitative analysis, the judgements were thematically grouped. Results: The search yielded n = 103 judgements, of which n = 90 were included. There were mostly violations of Article 3 (prohibition of torture), Article 8 (Right to respect for private and family life) and Article 6 (Right to a fair trial). PTSD in these judgements is normatively discussed with regards to ethical, social and political themes such as inadequate access to healthcare, especially in prison, matters of asylum, expulsion and extradition, protection of minorities and minors, as well as rights and duties of traumatized witnesses. Conclusion: PTSD plays a central role in a large number of ECtHR judgements. Our results show that PTSD as a medical diagnosis also encompasses legal, ethical, social, and political dimensions. This knowledge is essential for healthcare professionals working with traumatized persons, but can also be relevant for political decision-makers.Trastorno por estrés postraumático, derechos humanos y acceso a la asistencia sanitaria: un análisis de las sentencias del Tribunal Europeo de Derechos Humanos desde una perspectiva ética Antecedentes: las violaciones de derechos humanos como la tortura están asociadas con un alto riesgo de trastorno de estrés postraumático (TEPT). Las sentencias del Tribunal Europeo de Derechos Humanos (TEDH) incluyen una perspectiva normativa sobre el trastorno de estrés postraumático y abordan cuestiones éticas fundamentales. Objetivo: ayudar a cerrar la brecha entre el discurso psico-médico y legal sobre las violaciones de los derechos humanos e ilustrar sus implicaciones médico-éticas evaluando y categorizando sistemáticamente todas las sentencias del TEDH relacionados con el trastorno de estrés postraumático. Método: Se buscó en la base de datos del TEDH para 'trastorno por estrés postraumático'. Se realizó una estadística descriptiva sobre los artículos del Convenio Europeo de Derechos Humanos involucrados y las violaciones a estos artículos. En un análisis cualitativo, las sentencias se agruparon temáticamente. Resultados: La búsqueda arrojó n = 103 sentencias, de las cuales se incluyeron n = 90. En su mayoría fueron violaciones del artículo 3 (prohibición de la tortura), artículo 8 (derecho al respeto de la vida privada y familiar) y artículo 6 (derecho a un ...