medication, which may cause suffering and significant harm to the individual’s health. Treating a patient without consent may even reach the threshold of torture and ill-treatment.417 The formal and illusory nature of voluntary placement and treatment of patients is also confirmed by the fact that the patients cannot leave psychiatric establishments voluntarily. The essence of voluntariness implies that a patient should be able to withdraw informed consent for hospitalisation at any time and leave the psychiatric institution. According to Article 17 (1) (b) of the Law of Georgia on Psychiatric Care, a patient on voluntary treatment can be discharged from the hospital at any stage. The exception is when the patient's condition has changed and he or she refuses treatment, during which review of his or her legal status is required.418 Institutions, bypassing formal procedures, place patients in conditions of de facto restriction of liberty. According to the management of the Tbilisi Mental Health Center, patients cannot be allowed to be discharged freely without a family member on the grounds that if the life or health of an outpatient is endangered, the institution will be held responsible.419 The Public Defender considers that formally voluntary psychiatric inpatients requesting discharge, should be immediately discharged if there is no legal basis for the use of involuntary psychiatric care. In a number of recommendations, the Public Defender referred to the Ministry of Internally Displaced Persons from the Occupied Territories of Georgia, Labor, Health and Social Affairs, to examine the cases of hospitalization of patients receiving formal voluntary psychiatric care against their will. Against this background, LEPL “Agency for Regulation of Medical and Pharmaceutical Activities” with the revision act of 2020, fined LTD Kutaisi Mental Health Center (Ltd Mental Health and Drug Prevention Center) on the ground that a patient on voluntary treatment was discharged without the decision of the Psychiatric Commission.420 The decision of the Psychiatric Commission is one of the grounds for discharging a patient on voluntary treatment under Article 17.3.a of the Law of Georgia on Psychiatric Care, however, it is not mandatory to fulfill in case of patient’s request as defined under Article 17.3.b. According to the law, in addition to the right to leave the hospital at any time, patients on voluntary treatment have the right to leave the hospital for a short period of time without being discharged from Interim report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment submitted before the General Assembly, A/63/175, 28 July 2008, para. 63, available at, < https://digitallibrary.un.org/record/635981?ln=en >, [last visited: 30.12.2020]. 418 Law of Georgia on Psychiatric Care, Article 17.4. 419 Judgment of the European Court of Human Rights in the case of Fernandes de Oliveira v. Portugal, no. 78103/14, 31 January of 2019, para. 124-132. The Grand Chamber did not find the violation of the right to life by the state, for fleeing a patient on voluntary treatment from a psychiatric institution, and for committing suicide. The judgment stated that although patients are vulnerable when there is no real and imminent danger, especially in the case of a person receiving voluntary treatment, the institution / state is not liable for that and is not considered to be in violation of a positive obligation. Also, in the 2020 report of the CPT on the visit to the Republic of Moldova (CPT/Inf (2020) 27), the European Committee for the Prevention of Torture called on Moldova to terminate the practice when the investigation is launched against the staff of the institution if civil patients, whether voluntary or involuntary, “escaped” from the institution, committes a criminal offence, The report further notes that such approach may represent a strong incentive for imposing additional restrictions on movement of patients, para. 143, available at: < https://rm.coe.int/16809f8fa8 >, [last visited: 30.12.2020]. 420 Revision act NR/R-794-154 of LEPL “Agency for Regulation of Medical and Pharmaceutical Activities” 2020 of 16 July 2020. 417 125