A/HRC/41/33/Add.433/Add.4 It should also be stressed that Article 4(4) of the Directive 2001/83/EC4 states: “This Directive shall not affect the application of national legislation prohibiting or restricting the sale, supply or use of medicinal products as contraceptives or abortifacients. The Member States shall communicate the national legislation concerned to the Commission.” This provision gives Member States the right to establish restrictions to both national marketing authorisations and authorisations granted by the European Commission on the basis of Article 13(1) of Regulation (EC) No 726/20045, which reads as follows: “Without prejudice to Article 4(4) and (5) of Directive 2001/83/EC, a marketing authorisation which has been granted in accordance with this Regulation shall be valid throughout the Community”. In conclusion, it should be noted that in line with Article 2(2) of the Act of 7 January 1993 on family planning, protection of the human foetus and conditions for the admissibility of abortion, central and local administration authorities, within their respective competences defined in special provisions, are required to guarantee the citizens free access to methods and means for conscious procreation. Additionally, according to this paragraph of the report, access to emergency contraception in Poland is hampered both by doctors calling on the so-called conscientious objection and refusing, on this basis, to prescribe those pills, as well as by pharmacists, who by invoking this clause refuse to sell the emergency contraception. It should be clearly emphasized that in Poland the doctor has the right to abstain from performing health services that are inconsistent with his/her conscience (under certain conditions). The nurse and midwife may refuse to perform a medical order and perform other health service that is not in accordance with their conscience or the scope of their qualifications (also under certain conditions)., The pharmacist, however, does not have such a right. Admittedly, there were claims regarding the introduction of the possibility of referring to the so-called "conscience clause" by pharmacists, but they have not contributed to changing the regulations in force in this area. Ad Part VI “Health”, paragraph 48 This paragraph addresses the issue of voluntary sterilisation, pointing out at the same time that “women with intellectual and psycho-social disabilities living in institutions are sterilised” without their free and informed consent. It should be emphasized that in Poland, surgical sterilisation cannot be treated as a method of contraception, because it involves irreversible loss of the ability of fertilization. The most common type of procedure during surgical sterilisation is the binding of the fallopian tubes. The purpose of this procedure is to close the light or interrupt the continuity of the fallopian tubes. Another method is to attach a clamping clip. The procedures are performed using laparoscopy. Performing a procedure, which leads to losing the ability of conception is only possible if the doctor has established clear health indications (i.e. if the next pregnancy endangers the life or health of the woman). It is the sole responsibility of the doctor to establish clear health indications for such a procedure, as well as the type of procedure to be performed. The doctor declares the health condition of the person concerned after a personal examination of that person, following indications of current medical knowledge, methods and means available to them for prevention, diagnosis and treatment of diseases, and in accordance with the principles of professional ethics and due care. Simultaneously, it should be pointed out that medical procedures such as bilateral binding and crushing of fallopian tubes, bilateral endoscopic closure of the fallopian tubes or cutting of both fallopian tubes are among the guaranteed services specified in Appendix No 1 to the Decree of the Minister of Health of November 22, 2013 on guaranteed hospital 4 5 Directive 2001/83/EC of the European Parliament and the Community code relating to medicinal products for human use of the Council of November 6, 2001. Regulation (EC) No 726/2004 of the European Parliament and of the Council of March 31, 2004 laying down Community procedures for the authorisation and supervision of medicinal products for human and veterinary use and establishing a European Medicines Agency. 7