2 TABLE OF CONTENTS I INTRODUCTION OF THE CASE AND PURPOSE OF THE DISPUTE ......................................................................... 4 II PROCEEDINGS BEFORE THE COURT ................................................................................................................. 5 III JURISDICTION ............................................................................................................................................... 8 IV PRELIMINARY OBJECTIONS ............................................................................................................................ 8 A. Objection concerning the alleged lack of jurisdiction ratione loci ......................................................... 8 A.1 Arguments of the State and observations of the Commission and the representative ........................................ 8 A.2 Considerations of the Court ....................................................................................................................... 9 B. Objection concerning the alleged failure to exhaust domestic remedies .............................................. 9 B.1 Arguments of the State and observations of the Commission and the representative ........................................ 9 B.2 Considerations of the Court ......................................................................................................................12 V PRELIMINARY CONSIDERATIONS ....................................................................................................................14 A. Determination of the presumed victims ...............................................................................................15 B. The factual framework of the case .......................................................................................................15 C. Other human rights violations alleged by the representative ..............................................................16 VI EVIDENCE ......................................................................................................................................................17 A. Documentary, testimonial and expert evidence ...................................................................................17 B. Admission of the evidence ...................................................................................................................17 B.1 Admission of the documentary evidence ....................................................................................................17 B.2 Admission of the statements and of the expert opinions ..............................................................................18 C. Assessment of the evidence.................................................................................................................19 VII FACTS ...........................................................................................................................................................19 A. Background information ......................................................................................................................19 B. The caesarean section and the tubal ligation surgical procedure .........................................................19 C. Medical audits and report of the Ethics Tribunal of the La Paz Departmental Medical Association .......22 C.1 First medical audit ..................................................................................................................................22 C.2 Second medical audit ..............................................................................................................................23 C.3 Third medical audit .................................................................................................................................23 C.4 Report of the Ethics Tribunal of the La Paz Departmental Medical Association .................................................24 D. Administrative proceeding ...................................................................................................................26 E. Criminal proceedings ...........................................................................................................................27 E.1 First oral proceeding ...............................................................................................................................27 E.2 Second oral proceeding ...........................................................................................................................28 E.3 Third oral proceeding ..............................................................................................................................30 F. Physical and psychological effects of the surgical procedure ...............................................................33 VIII MERITS .......................................................................................................................................................34 VIII-1 RIGHTS TO PERSONAL INTEGRITY, TO PERSONAL LIBERTY, TO DIGNITY, TO PRIVACY AND FAMILY LIFE, TO ACCESS TO INFORMATION, TO RAISE A FAMILY, AND TO RECOGNITION OF JURIDICAL PERSONALITY, IN RELATION TO THE OBLIGATIONS TO RESPECT AND TO ENSURE RIGHTS WITHOUT DISCRIMINATION, AND ALSO ARTICLE 7 OF THE CONVENTION OF BELÉM DO PARÁ .........................................................................................35 A. Arguments of the parties and of the Commission ................................................................................35 A.1 Arguments on the right to personal integrity (Article 5(1) of the American Convention) ...................................35 A.2 Arguments on the right of access to information (Article 13(1) of the American Convention) ............................36 A.2.a Access to information and informed consent ..................................................................................36 A.2.b The right to know the truth ..........................................................................................................38 A.3 Arguments on the rights to dignity, to private and family life, and to raise a family (Articles 11(1), 11(2) and 17(2) of the American Convention) ......................................................................................................................38 A.4 Arguments on the right to recognition of juridical personality (Article 3 of the American Convention) ................39 A.5 Arguments on the prohibition of discrimination in relation to the alleged non-consensual sterilization (Article 1(1) of the American Convention in relation to Articles 5(1), 11(1), 11(2), 13(1) and 17(2) of this instrument) ...................39 A.6 Arguments on the right of women to a life free from violence (Article 7 of the Convention of Belém do Pará) .....41 B. Considerations of the Court .................................................................................................................42 B.1 Scope of the rights established in the American Convention in this case ........................................................42 B.2 Consent in international law, comparative law and jurisprudence ..................................................................47 B.2.a The elements of consent in international law and jurisprudence........................................................49 B.2.b The elements of consent derived from domestic legal systems ........................................................60 B.2.c Conclusion .................................................................................................................................63 B.3 Determination of the scope of the State’s international responsibility ............................................................63 B.3.a Duty of prevention with regard to the rights recognized in Articles 5, 7, 11, 13 and 17 of the American Convention and 7(b) of the Convention of Belém do Pará ...................................................................................65 B.3.b Obligation to respect the rights recognized in Articles 5, 7, 11, 13 and 17 of the American Convention and 7(a) of the Convention of Belém do Pará ..........................................................................................................69 B.3.c Duty not to discriminate when respecting and ensuring the rights recognized in Articles 5, 7, 11, 13 and 17 of the American Convention .......................................................................................................................75