May a physician publicly speak out against health policy?

Doctors, like any other citizen, are entitled to freedom of expression, but they are subject to specific deontological limits. Two Court of Cassation rulings of April 3, 2026 (D.25.0015.F and D.24.0004.F) clarify that the Order of Physicians may not simply curtail this freedom on the basis of his own preferences or non-binding opinions. As long as criticism rests on a factual basis and does not violate confraternity, the physician enjoys far-reaching protection under the European Convention on Human Rights (ECHR).

The facts and legal context

In the aftermath of the COVID-19 pandemic, several physicians were disciplined for their public statements:

• Case Study 1 (Value Judgments): A child psychiatrist strongly criticized the crisis management and vaccination campaign. He argued that governments were instrumentalizing fear and qualified the policy as “perversion.” The Order imposed a one-month suspension because his statements were “without nuance” and would undermine confidence in the medical profession.
• Case Study 2 (Legal Basis): Another doctor received a three-month suspension for her remarks at an event about the ineffectiveness of oral masks and the dangers of vaccines for pregnant women. The Order based this sanction on her failure to follow internal “communication advice” from the National Council. In addition, she was sanctioned for publicly describing fellow GPs as “fearful” and “cowards”.

The decision of the Court of Cassation.

The Court of Cassation overturned the disciplinary convictions in both cases as to the freedom of speech:

1. No substitution of value judgments: A disciplinary authority may not restrict the freedom of expression of a social debate by simply substituting its own value judgment for that of the physician. When a physician expresses an opinion (a value judgment), the Order may sanction it only if it demonstrates that the factual basis on which the physician relies is incorrect or insufficient.
2. Non-binding opinions are not “law.” Restrictions on freedom of expression must be “provided by law” under Article 10.2 ECHR. The Court held that National Order Council opinions have no coercive force and thus cannot serve as a “law” to restrict a doctor's freedom of expression.

Important side note: The sanction in the second case for lack of confraternity (denigrating colleagues) did stand.

Legal analysis and interpretation

These rulings are important for disciplinary law and the fundamental rights of health care providers. They confirm that doctors do not have to merely follow the ‘official’ line in public debate.

While the right to freedom of expression is not absolute and may be restricted to protect public health, Article 10.2 ECHR requires that any such restriction be necessary, proportionate and adequately justified in a democratic society.

The principle of legality is central here. The Order of Physicians has a legal duty to establish deontological rules, but non-binding recommendations or advice on how a physician should communicate in times of crisis cannot be turned into binding norms that override the Constitution or the ECHR.

Moreover, when a criticized statement is primarily a “value judgment,” the legislator or disciplinary judge may not demand absolute proof of its correctness; it is sufficient that a “sufficient factual basis” is available. In debates of public interest, especially when scientific certainties are (still) lacking, freedom of expression is not limited to widely held opinions. The right also extends to information that hurts, shocks or concerns. Consequently, disciplinary authorities are prohibited from restricting the expression of a value judgment by merely using their own, ‘preferred’ value judgment as a standard.

However, freedom of expression is not a license to insult. The duty of confraternity (Articles 12 and 13 of the Code of Medical Deontology) remains a mandatory standard. Publicly scolding or denigrating colleagues does not fall within the protected freedom of expression of scientific or social debate.

What this specifically means

• For the medical professional: You have the right to criticize public policy and scientific consensus, including to a wide audience. As long as your statements rely on a factual basis, the Order cannot sanction you merely because your opinion differs from theirs or from non-binding guidelines. However, always remain courteous to colleagues; personal attacks are still severely punished.
• For the Order of Physicians (and other disciplinary bodies): Disciplinary boards should be extremely cautious about sanctioning dissident opinions in social debates. They cannot sanction a physician merely because the value judgment expressed differs from the consensus or opinions without first solidifying that the factual foundation of that opinion is insufficient or untrue.

Frequently asked questions (FAQ)

Is doctors' freedom of speech unlimited?
No. While doctors enjoy broad freedom, especially regarding value judgments in public debate, their statements must always rest on a “sufficient factual basis.” Spreading pure, unsubstantiated lies falls outside this protection.

Can the Order of Physicians impose sanctions for critical statements in the press?
Yes, in principle this can be done if the honor, dignity or confidence in the profession is severely damaged. However, disciplinary authorities may only restrict freedom of expression if there is a compelling social need, and in doing so may not merely impose their own views.

Are the Order's guidelines on communication mandatory?
No, many of these guidelines are formulated as opinions. While they have moral authority, they do not constitute binding legislation that can simply restrict your fundamental rights.

Can I be disciplined if I criticize colleagues?
Yes, if this criticism degenerates into publicly denigrating or insulting colleagues. This falls under the violation of confraternity and can be sanctioned.

Conclusion

Therulings of the Court of Cassation of April 3, 2026 enshrineg the right of doctors to participate, from their expertise and with a sufficient factual basis, in critical social debates without having to immediately fear disciplinary reprisals. Disciplinary bodies in Belgium may not punish dissenting value judgments simply because they themselves prefer a different perspective or deviate from non-binding opinions.