The presentation discusses the ETACA Guidelines and is structured into three main parts, followed by conclusions. 

Part one provides context for the ETACA guidelines and introduces some of their most critical aspects in light of the European Charter of Fundamental Rights. 

Part two analyzes the Swedish experience with cooperative compliance over the years. The Swedish case is unique and extensively debated. The Swedish Constitution establishes a principle of open access to all documents held by public authorities: this includes information and documents part of cooperative compliance programs. Insights are drawn from Swedish literature and praxis to assess how well the ETACA guidelines consider or do not consider the consequences of the principle of publicity of documents held by public authorities. 

Part three examines international legal instruments, such as the Council of Europe Convention on Access to Official Documents, that may introduce legal challenges similar to those presented by the Swedish Constitution but that remain largely undebated in the context of cooperative compliance projects. An argument is made for if and how the ETACA guidelines meet the international legal standards. 

The conclusions outline a few lessons learned from the discussion.

This paper provides a critical examination of the ETACA Guidelines. Part I ofthe paper offers an overview of the ETACA Guidelines, focusing on their corecomponents, followed by an introduction to Sweden’s experience with cooperative compliance. Part II critically analyzes the ETACA Guidelines through thelens of the Swedish legal system, highlighting Sweden’s distinctive approach, which has been widely debated due to its constitutional principle of open accessto nearly all documents held by public authorities. By leveraging insightsfrom Swedish literature and praxis, this analysis evaluates how well the ETACA guidelines account for—or neglect—the implications of the principle of publicity concerning public authority-held documents. The examination then extendsto a European and international perspective, encompassing the EU legal framework,the International Covenant on Civil and Political Rights, the Councilof Europe Convention on Access to Official Documents, and the Agenda 2030. These European and international instruments pose potential legal challenges similar to those arising under the Swedish Constitution, yet such challenges are overlooked in the context of the ETACA Guidelines. The paper discusses whether and how the ETACA Guidelines align with European and international legal standards and concludes outlining areas where the ETACA Guidelines might need refinement to better meet these legal standards.

Current advancements in medicine, science, and technology, resulting in innovative diagnostic and therapeutic approaches, the development of new drugs, and the recentering of medical practices on patients and out-of-hospital treatment, have resulted in significant transformations in healthcare and well-being procedures. In this context, medical abortion, or medication abortion, stands as a notable breakthrough in reproductive health technology, as it replaces invasive surgical procedures and all they entail with the administration of drugs in the form of pills or tablets. According to medical literature, medication abortion is safer, decreases maternal mortality, and has an efficacy rate of over 98% in terminating early unwanted pregnancies. Simply by providing an alternative, one that removes surgery, delays, and any of the personal, social, and economic consequences that are firmly tied to traditional procedures, medical abortion helps ensure that a woman’s sexual and reproductive health rights remain upheld, and that more timely and more informed choices can be made.

Medical services are eligible for VAT exemptions under the provisions of the VAT Directive.42 Article 132(1)(b) of the VAT Directive specifically exempts hospital and medical care, as well as closely related activities performed by public bodies, and art. 132(1)(c) specifically establishes exemptions for services rendered by medical and paramedical professionals in the course of their professions. Moreover, Annex III of the VAT Directive outlines a list of goods and services that qualify for reduced VAT rates under Article 98. Point (3) of Annex III includes pharmaceutical products utilized for healthcare, disease prevention, medical and veterinary treatment, as well as contraceptive and sanitary products. Considering that surgical abortion is considered a healthcare service and that the drugs used in medical abortion are classified as pharmaceutical products, both these procedures to terminate pregnancy fall within the scope of the VAT Directive.

This paper investigates the regulatory framework governing abortion within thescope of EU VAT, covering both surgical and pharmaceutical procedures, to assess whether or not any disparity in the VAT treatment between these two approaches exists that could potentially lead to gender discrimination or other types of discrimination. To do so, it first examines abortion within the international and European human rights framework from a gender perspective. Such an analysis is then used to scope the EU VAT legal frameworks that are applicable to medical services and pharmaceutical products, and to identify their essential characteristics as outlined in the EU VAT Directive and interpreted by the European Court of Justice. Then the paper discusses the provision of abortion, both surgical and medical, in the broader context of the EU VAT framework, evaluating the compatibility of the EU VAT treatment of abortion with human rights principles and those descending from the primary legal framework that safeguards women’s rights and the right to health. Finally, the paper explores potential avenues for future research in this area and presents concluding remarks summarizing the findings.