A/HRC/41/33/Add.4 health care services. Sterilisation without clear medical indications is prohibited in the Polish law and is subject to punishment pursuant to Article 156(1)(1) of the Act of June 6, 1997 — Penal Code. In light of the provision in question, causing serious damage to health in the form of, i.a, deprivation of human reproductive capacity is punishable by imprisonment for a term of between 1 and 10 years. In light of the above, it is difficult to understand the statement that “women with intellectual disabilities are subjected to sterilisation without obtaining their free and informed consent” (it is illegal and penalized). The issue of the patient’s consent for a health care service is clearly regulated in Poland. The legal basis for the obligation to obtain consent to provide health services is the provision of the Act of December 5, 1996 on the professions of a doctor and dental practitioner and of the Act of November 6, 2008 on patients’ rights and the ombudsman of patients’ rights. In light of the above regulations, a doctor may conduct an examination or provide other health care services, subject to the exceptions defined in the Act, after obtaining the patient’s consent. If the patient is minor or incapable of giving informed consent, the consent of their statutory representative is required, and if the patient does not have a statutory representative or it is impossible to communicate with the representative — a permit from the custody court is required. If it is necessary to examine a minor or a person incapable of giving informed consent, the consent may be expressed by the actual caregiver. If the patient is 16 or older, the patient’s consent is required as well. However, if a minor aged 16 or more, an incapacitated person, a mentally ill patient or an intellectually disabled patient, who nevertheless has sufficient insight, objects the medical procedures, then a permit from a custody court will be required alongside the consent of the statutory representative or the actual caregiver, or if the representative or the caregiver withholds the consent. If the abovementioned people do not have sufficient insight and are not capable of expressing informed consent (due to their condition resulting i.a. from a mental illness, degree of disability or the advancement of reasons for their incapacitation), the decision relating to the consent for examination or other health care services is the responsibility of their statutory representative or the custody court. Only a patient whose physical and mental condition makes it possible to comprehend the information provided by the doctor, and afterwards make a decision about whether or not to undergo a specific medical procedure on the basis of the information provided, is capable of expressing consent to a health care service. The doctor is responsible for deciding whether the patient’s condition makes it possible for them to express informed consent. If the patient is minor or incapable of giving informed consent, does not have a statutory representative or actual caregiver or it is impossible to communicate with these persons, the doctor, after the examination, may proceed to provide further health services — as a rule — only after obtaining the consent of the custody court. The above-mentioned regulations constitute general principles for granting or refusing the considered consent, therefore they apply to all circumstances relating to the provision of health care services, except for those in relation to which the provisions of separate acts introduce specific regulations. Ad Part VI “Health”, paragraph 50 According to this paragraph “the mechanism for resolving disagreements between the doctors and pregnant women in cases of the risk to pregnant woman’s or foetal health, the Patients’ Ombudsperson appeal procedure, is not effective”. According to the Act of November 6, 2008 on the patient’s rights and the Patient’s Rights Ombudsman the patient has a right to object against physician’s opinion or medical statement. The objection procedure was adopted as a result of the European Court of Human Rights judgement in Tysiac v. Poland and in order to execute it (and also in order to execute the judgement in R.R. v. Poland). The objection can be submitted to the Medical Commission at the Patient Rights Ombudsman office if the opinion or judgment affects the patient's rights or obligations determined by the law. 8