Alina
Tryfonidou, Associate Professor in EU Law, School of Law,
University of Reading
In a much awaited judgment
delivered earlier this week in Case C-528/13 Léger, the
Court of Justice ruled that permanent Member State bans on the donation of
blood by gay and bisexual men which are based merely on the fact that they had
had sexual relations with another man, may, in certain circumstances, be
justified by the need to ensure a high level of health protection. Below, I
will explain why this is a disappointing ruling which may, fairly, subject the
Court to accusations of, at best, not going far enough in the protection of LGB
rights and, at worst, deep-seated homophobia. Before exploring the reasons behind
these accusations, nonetheless, I shall summarise the legal and factual
background to the case and the main parts of the Court’s judgment.
The Law
In order to minimise any risk
of transmission of infectious diseases as a result of blood transfusion, Directive
2002/98 (‘the 2002 Directive’) sets standards of
quality and safety for the collection, testing, processing, storage and
distribution of human blood and blood components. The above instrument is
implemented by Directive
2004/33 (‘the 2004 Directive’), which, in its Annex
III, sets out the criteria for excluding certain categories of persons from
blood donations: Point 2.1 of the Annex provides that a permanent ban can be
imposed on, inter alia, ‘persons whose sexual behaviour puts them at high risk
of acquiring severe infectious diseases that can be transmitted by blood’ (‘the
2.1 category’), whilst Point 2.2.2 of the same Annex, provides that a temporary
ban may be imposed on ‘persons whose behaviour or activity places them at risk
of acquiring infectious diseases that may be transmitted by blood’ (‘the 2.2.2.
category’). The contested French measure – L’Arrêté
du 12 Janvier 2009 fixant les critères de selection des donneurs de sang (‘the
Decree’) – which was adopted in 2009 in implementation of the 2004 Directive,
and which, as its name suggests, sets the criteria for selection of blood donors
in France – provides a permanent contraindication
to blood donation (only) for a ‘man who has had sexual relations with another
man’; other categories of persons, such as persons who have had unprotected sex
with a casual partner or who have had multiple partners in the last four
months, are only temporarily banned from giving blood.
The Facts
The judgment under
examination was a response to a request for a preliminary ruling made to the
ECJ from the Tribunal administrative, Strasbourg. The question referred arose
in proceedings brought by Mr Geoffrey Léger against the French Blood Agency and
the French Minister for Social Affairs, Health and Women’s Rights, challenging
the refusal (which was based on the impugned Decree) of the healthcare
professional responsible for donations at the French Blood Agency, to accept Mr
Léger’s blood donation, on the sole ground that he had had sexual relations
with another man. The question that emerged was whether the permanent ban on
blood donation by a man who had had sexual relations with another man laid down
by the Decree was consistent with the 2004 Directive. In other words, can the
fact that a man has sexual relations with another man in itself amount to a valid reason for permanently excluding him
from being a blood donor?
The Judgment
The Court began its judgment
by noting that permanent deferral from blood donation under the 2004 Directive requires
the existence of a greater risk (‘high risk’) of acquiring severe infectious
diseases that may be transmitted by blood than that for temporary deferral. The
Court, then, explained, that the main question is whether a man who has had
sexual relations with another man satisfies the requirement of a ‘high risk’
which justifies the imposition of a permanent ban on blood donation.
The Court explained that this
question must be answered by the referring court, which must take into account
for this purpose current medical, scientific, and epidemiological knowledge about
France. In answering that question, the national court must ensure that the way
that it interprets the 2004 Directive is not contrary to the fundamental human
rights protected in the EU legal order and, in particular, that it does not
breach the prohibition of discrimination on the basis of sexual orientation
which is provided in Article 21 of the EU Charter of Fundamental Rights (‘the
Charter’). The Court pointed out that the Decree may discriminate on grounds of
sexual orientation contrary to the above provision, as it ‘determines the
deferral from blood donation on the basis to [sic] the homosexuality of the
male donors who, on account of the fact that they have had homosexual sexual
relations, are treated less favourably than male heterosexual persons.’ The
Court then proceeded to note that this may, nonetheless, be justified under
Article 52(1) of the Charter. It noted that although the permanent
contraindication provided for in the contested Decree contributes to minimising
the risk of transmitting an infectious disease to recipients of blood
transfusion and, thus, to the general objective of ensuring a high level of
health protection, this needs to be proportionate in order to be justified. In
particular it noted that, firstly, the referring court must verify whether
scientific or technical progress in the field of science or health (which
enables the detection of HIV) now allows a high level of health protection for
recipients to be ensured in situations involving men who have had sexual
relations with other men and, secondly, even if this cannot be verified, it stressed
that ‘a permanent deferral from blood donation for the whole group of men who
have had sexual relations with other men is proportionate only if there are no
less onerous methods of ensuring a high level of health protection for
recipients.’ In particular, as regards the latter, the ECJ pointed out that the
referring court must determine whether the questionnaire and individual
interview with a medical professional (which are mentioned in the 2004
Directive as methods which enable the determination of the level of risk of
individual blood donors) may, in fact, enable medical staff to identify the
type of behaviour presenting a risk for the health of recipients and in this
way impose a more limited exclusion, which does not cover the entire group of men who have had sexual relations with a man.
Comments
This case comes at a time
when a number of countries – both within and outside the EU – have relaxed, or consider
relaxing, their blanket bans on blood donation by gay and bisexual men. In
fact, France itself has, in recent months, begun to examine whether it should
relax the ban at issue in this case. Bans on blood donation by gay and bisexual
men were introduced back in the 1980s, in response to the AIDS epidemic, as it
was widely considered that men having sex with men were more likely to contract
HIV, which is the virus that causes AIDS. It is worth pointing out that recent
studies have shown no change in the safety of blood supply in countries which
have relaxed restrictions on blood donations by gay and bisexual men.
At first glance, one may view
the judgment in Léger favourably, in
that the Court does admit that blood donation bans which are purely based on
the fact that a man has had sex with another man are discriminatory on the
ground of sexual orientation and, thus, are contrary to Article 21 of the
Charter, unless justified. In fact, the Court not only provides detailed guidance
to the national court for determining whether such bans are justified but,
also, prompts the latter to apply a strict proportionality test, by examining
whether it is possible to achieve the same aim (i.e. a high level of health
protection) by adopting less restrictive measures, this demonstrating that a
finding that a ban is considered by the national authorities (merely) reasonable
does not suffice for justifying it. Accordingly, the judgment makes it clear
that Member States no longer have a carte blanche when determining whether –
and to what extent – they will ban or restrict blood donations by gay and
bisexual men but they must ensure that they comply with EU law and, in
particular, with EU fundamental human rights and the principle of
proportionality.
Nonetheless, a closer look at
the judgment reveals that there is a fundamental flaw in the Court’s reasoning
and this is that it perpetuates stereotypical assumptions about the sexual behaviour
of gay and bisexual men, which contribute to the continuing stigmatisation of
this segment of the EU society. In particular, by holding that in certain
circumstances permanent bans on blood donation which are imposed automatically when a man declares that
he is gay or bisexual are permitted under EU law, the Court implies that it is
acceptable to use a person’s sexual orientation for the purpose of making
assumptions about his sexual behaviour, in this context the assumption being
that all gay and bisexual men engage
in promiscuous, unprotected, sex. Moreover, maintaining a complete ban on blood
donations by all gay and bisexual men
appears to entail a significant contradiction when this is done in Member
States like the Netherlands or Belgium, which have been pioneers in permitting
same-sex marriage. Isn’t it contradictory to recognise that some gay and
bisexual men may wish to marry their long term partner and have a stable,
committed, and monogamous relationship with him, whilst at the same time a
permanent ban on blood donations by all gay
and bisexual men is maintained, because it is assumed that they are (all)
engaging in promiscuous sexual behaviour which places them at a high risk of
contracting serious disease? Accordingly, instead of reinforcing stereotypes
which lead to inaccurate assumptions about a certain part of the population
(gay and bisexual men), the Court should come to terms with reality and
recognise that there is a wide range of sexual behaviours among men and women,
and among LGB and heterosexual individuals and, thus, the sexual behaviour of
an individual depends neither on his or her sex nor on his or her sexual
orientation. This means that the sexual orientation of a person should not be
treated as the factor that defines
his or her sexual behaviour and, hence, it is inappropriate to consider that a
person engages in sexually risky behaviour only
because of their sex or sexual orientation.
Another problematic aspect of
the judgment is that, unlike the Advocate
General, the Court does not appear concerned at all by
the fact that the contested measure draws a (completely unjustifiable) distinction
between gay and bisexual men, on the one hand, and other segments of the
population which engage in behaviour which puts them at a high risk of
contracting a serious disease, on the other. More specifically, the contested
French Decree appears to be singling out gay and bisexual men as the only category of persons that deserves
to be permanently excluded from blood donations. Sex workers, heterosexual
persons who have unprotected sex with multiple partners, and intravenous drug
users are, clearly, categories of persons who are in high risk of contracting a
serious disease that can be transmitted via blood transfusion. Why, then, is it
acceptable that the French Decree does not permanently exclude these categories
of persons from blood donation? Doesn’t this fact, in itself, demonstrate that
the permanent ban imposed on gay and bisexual men is unjustifiable and disproportionate?
Moreover, given that the 2004 Directive and the French Decree require blood
donors to answer questions about, inter alia, their sex life, and to have an
interview with medical professionals, the latter are able to single out individuals (rather than categories of
individuals) who in actual fact
(rather than as a result of a mere assumption) engage in behaviour that places
them at a high risk of contracting a serious disease. This is another factor
that demonstrates that maintaining a blanket and permanent ban on blood
donation by gay and bisexual man is disproportionate in all circumstances and cannot be considered justified in certain
contexts (which is what the Court appears to suggest in its judgment).
Accordingly, and agreeing
with the Advocate General, the Court should rule that ‘the mere fact that a man
has had or has sexual relations with another man does not, in and of itself,
constitute a sexual behaviour placing him at a high risk of acquiring severe
infectious diseases which can be transmitted by blood’. The correct approach
would, hence, be for the Court to respond in this case by saying that Member
States should under no circumstances be permitted to impose a permanent ban on
blood donation on men simply and merely because they are gay or bisexual. The
sexual orientation of an individual can under no circumstances be considered a
sufficient reason for including him or her within a category of persons who
engage in risky sexual behaviour; rather, the inclusion in such a category
should be strictly dependent on the actual
behaviour of the individual. This means that Member States should be required to
provide in their laws that medical professionals should, in all instances, use
the interviews and questionnaires which are, already, provided in the 2004
Directive, as a means to identify persons who should either permanently or
temporarily be prevented from donating blood.