established by a specialist medical committee. It also states that I.V.’s expressed wish was not documented in writing because circumstances did not permit with regard to the dignity of the patient because the ligature of the fallopian tubes had not been scheduled but happened as a result of complications encountered during the surgical operation. 44. The State alleges that Article 4.10 of the Bolivian Code of Medical Ethics concerning sterilization states that the doctor should strictly observe the legal provisions in force in the country, as well as the recommendations of the World Medical Association. The State refers to Articles 14, 19, and 22 of the Code of Medical Ethics with regard to sterilization: “The sterilization of a person may only be carried out at the express, voluntary, and documented request of the person themselves, or when medical indications exist that have been strictly established by a specialist medical committee.” The State claims that Dr. Torrico acted in accordance with the terms of the Code of Medical Ethics and medical deontology and in line with recommendations by the World Medical Association and the Latin American Medical Confederation because before carrying out the salpingo-oophorectomy he described the surgical operation to I.V. and she gave her verbal consent. The State therefore sustains that Dr. Torrico proceeded to carry out the sterilization with the prior consent of I.V. in compliance with Bolivian medical laws regarding obstetric risk. 45. Moreover, the State claims that the purpose of a medical committee is to establish specialist criteria relating to the health of a patient, and that in this case, Dr. Torrico and Dr. Marco Vargas had the knowledge and degree of specialization to arrive at a specialist opinion. 46. The State claims that it would have been inadequate to have carried out an administrative procedure to complement the authorization in addition to that already made by her partner to carry out the caesarian and special procedures. The State claims that the doctors acted in accordance with the circumstances already affecting I.V.’s situation. Furthermore, the State alleges that the purpose of the procedure carried out on I.V., which was with her verbal consent, was “to protect the right to life of the patient who already had three daughters at that time.” 47. The State alleges that according to I.V.’s medical record after the caesarian, her recovery was clinically stable with poor lactation, whereas if she had suffered an “acute endometritis with placental remains, post caesarian and abscess in the abdominal wall” as claimed by the petitioner, she would have lost a lot of blood because she would have been constantly hemorrhaging, which did not happen. Also, the State claims that during the recovery process, I.V. had little vaginal discharge. Regarding the petitioner’s claims that I.V. was admitted into a private clinic, the State maintains that the petitioner does not state in which clinic she was treated, and only certificates supplied by private professionals were provided and the information in these is not reliable. 48. In relation to the internal proceedings, the State claims that the Medical Audits Committee of the Hospital de la Mujer carried out an internal medical audit as part of which they took statements from those who had taken part in the caesarian. The State alleges that these statements reveal that I.V.’s partner was not in the hospital all the time that I.V. was undergoing surgery. It also claims that they took statements from Dr. Edgar Torrico, María Modesta Ticona, junior doctor Rodrigo Arnez, and Dr. Marco Vargas, who all confirmed that I.V. was informed about the procedure during surgery and gave her verbal consent. 49. The State says that it is important that the IACHR takes into consideration that according to the statements made by Dr. Virginia Mercado who stated that the caesarian lasted longer than usual (more than one hour), this shows how complicated the operation was. 50. Once the Audits Committee of the Hospital de la Mujer had published its report, the State alleges that the Medical Audits Committee of the Department of Health was set up. The State claims that this committee backed up the report issued by the Audits Committee of the Hospital de la Mujer. The State claims that the Medical Audits Committee of the Department of Health acknowledged the serious complications that presented during the operation and which obliged 8