A judgment that cites Strasbourg extensively, ignores Luxembourg entirely, and tells an EU Member State’s clinical institutions that their only accountability mechanism no longer works.

On 24 March 2026, the Supreme Court of Lithuania handed a senior psychiatrist his job back. Aleksandras Alekseičikas, head of the Borderline Conditions Unit at the Vilnius City Mental Health Center and a household name in Lithuanian clinical circles, had been fired in November 2024 after telling two national publications that homosexuality is a sutrikimas (disorder) and an iškrypimas (perversion), and that he “helps” such patients “even today.” Two lower courts upheld the dismissal. The country’s apex civil court, in Civil Case No. e3K-3-53-1120/2026, reversed it.

The reasoning, wrapped in expansive readings of Article 10 ECHR and citations to Mustafa Erdoğan v Turkey and P v Poland, was that Alekseičikas had spoken as a private citizen, that his employer had failed to prove “concrete harm,” and that firing him was disproportionate. In plain language: a psychiatric department head can publicly call his own patient population perverts, announce he treats them for it, and the Supreme Court of an EU Member State will protect his right to keep the post.

The Luxembourg jurisprudence the judgment does not address

The more significant feature of the Supreme Court’s reasoning, from a doctrinal standpoint, lies not in what it says but in what it omits. The judgment does not engage with the Court of Justice of the European Union’s jurisprudence on authority-backed discriminatory speech, a line of case law that is directly relevant to the questions before the Court. That line begins with Feryn (C-54/07, 2008), continues through Asociaţia Accept (C-81/12, 2013), and culminates in the Grand Chamber’s ruling in NH v Rete Lenford (C-507/18, 2020). At paragraph 48 of Rete Lenford, the CJEU held that “freedom of expression is not an absolute right” and that its exercise may be subject to limitations, under Article 52(1) of the Charter, where necessary to protect the rights and freedoms of others. The underlying case concerned an Italian lawyer who had publicly stated he would not hire LGBTIQ+ staff; the Grand Chamber held that the statement fell within the material scope of Directive 2000/78/EC regardless of the absence of an identifiable victim. The factual distance between a legal practitioner publicly excluding a protected group from his hiring pool and a senior psychiatrist publicly characterising members of that group as suffering from a “perversion” he treats is, doctrinally, modest. Both cases involve a figure of professional authority publicly pathologising a protected group in a manner capable of dissuading members of that group from accessing employment, professional services, or care.

As a court of last instance, the Supreme Court was under an obligation pursuant to Article 267 TFEU to refer the question to the Court of Justice unless the answer was acte clair or acte éclairé. Neither condition is straightforwardly satisfied here: the Luxembourg line suggests a different analytical outcome than the one the Supreme Court reached, and the question whether Directive 2000/78/EC extends to public statements by senior clinical personnel pathologising a protected group is one on which the Court of Justice has not yet ruled directly. A preliminary reference would have been the appropriate procedural course. It was not made. The contrast with the Lithuanian Constitutional Court’s ruling of 11 January 2019 in case 16/2016 is instructive: in that ruling, the Constitutional Court engaged substantively with CJEU case law, citing Römer (C-147/08), Parris (C-443/15), Schumacker (C-279/93), and Garcia Avello (C-148/02) in the course of reading sexual orientation and gender identity into the scope of Article 29 of the Constitution. The Supreme Court of March 2026 operated in a legal environment in which Luxembourg’s relevance to Lithuanian equality questions was plainly established. Its decision not to engage with that jurisprudence, and not to refer the question, is itself a datum worth noting.

The regulatory context the ruling confirms

The judgment should also be read against the wider regulatory environment in which it operates, because that environment significantly limits the institutional tools available for accountability in cases of this kind. Conversion practices are not prohibited by law in Lithuania. This places Lithuania outside a growing European consensus that now includes Malta (2016), Germany (2020, covering minors and non-consenting adults), France (2022), Belgium (2023), and regional legislation in several Spanish autonomous communities. The regulation of psychological and psychotherapeutic practice in Lithuania is similarly incomplete: there is no dedicated Law on Psychological Practice, no statutory protection of title, and disciplinary authority is largely delegated to professional associations whose sanctioning capacity is uneven. In this regulatory setting, the Vilnius City Mental Health Center had effectively one instrument at its disposal in responding to the public statements at issue: its internal Code of Ethics, and in particular the loyalty principle at section 5.4. By holding that the employer’s invocation of that principle was a disproportionate response absent demonstrable concrete harm, the Supreme Court has meaningfully narrowed the practical utility of the one accountability mechanism available to Lithuanian clinical institutions in such cases.

The ruling should further be situated alongside several unresolved issues in Lithuania’s LGBTIQ+ rights framework. Legal gender recognition legislation, required by the European Court of Human Rights in L v. Lithuania (App. No. 27527/03, 2007), has not been adopted in the eighteen and a half years since the judgment, and the case remains under enhanced supervision by the Committee of Ministers of the Council of Europe. A comprehensive statutory framework for gender-neutral partnerships has not been adopted, notwithstanding the Constitutional Court’s ruling of 17 April 2025 creating a court-recognition pathway. ILGA-Europe’s Rainbow Map and Index 2025 ranks Lithuania 36th of 49 European countries. The Alekseičikas ruling does not itself create these gaps, but it is consistent with, and arguably contributes to, a pattern in which substantive doctrinal advances are offset by uneven enforcement and by institutional decisions that leave accountability mechanisms weaker than they were before.