1.1 General considerations on informed consent in the health care setting 96. The IACHR has recognized that the right of access to information – included under Article 13 of the American Convention100 – is essential for a person to be in a position to make free and reasoned decisions with respect to intimate aspects of his or her health, body, and personality 101, including decisions on medical procedures or treatments. The Commission has referred in particular to informed consent as an ethical principle of respect for the autonomy of persons that requires that they understand the distinct treatment options available to them and are involved in their own health care.102 97. The European Court has pointed out that compliance with the State’s positive obligation to secure for their citizens their right to effective respect for their physical and psychological integrity may necessitate, in turn, the adoption of regulations concerning access to information about an individual’s health.103 98. The international community has recognized informed consent 104 as an active and continuing process that seeks to ensure that no treatment is performed without the agreement of the person to be treated and without the person having been duly informed of its effects, risks, and consequences.105 The IACHR has specified that informed consent is an appropriate process of divulging all the information necessary for a patient to be able to freely make the decision to grant (or deny) his or her consent for treatment or a medical intervention. This process seeks to ensure that persons’ human rights are fully respected in the area of health care, and that they make truly free choices.106 99. In this respect, the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Anand Grover, stated: “Informed consent is not mere acceptance of a medical intervention, but a voluntary and sufficiently informed 100 I/A Court HR, Case of Claude Reyes and others Vs. Chile, Merits, Reparations and Costs. Judgment of September 19, 2006, Series C No. 151, para. 77. 101 IACHR. Report No. 72/14. Case 12.655. Merits. I.V. Bolivia. August 15, 2014. Para 115. Quoting: IACHR, Access to Information on Reproductive Health from a Human Rights Perspective, November 22, 2011; IACHR. Guidelines for Preparation of Progress Indicators in the Area of Economic, Social and Cultural Rights, July 19, 2008, indicators on the right to health, p. 48. 102 IACHR. Report No. 72/14. Case 12.655. Merits. I.V. Bolivia. August 15, 2014. Para 115. Quoting: IACHR, Access to Information on Reproductive Health from a Human Rights Perspective, November 22, 2011, para. 43. 103 European Court of Human Rights, R.R. v. Poland, Application 27617/04, May 26, 2011, paragraph 188; Also, see IACHR, Access to Information on Reproductive Health from a Human Rights Perspective, November 22, 2011, paragraph 61. For a different treatment of related issues, see: United Nations, Human Rights Council, Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, Juan E. Méndez, A/HRC/22/53, February 1, 2013, paragraphs 32, 46 and 48. 104 IACHR. Report No. 72/14. Case 12.655. Merits. I.V. Bolivia. August 15, 2014. Para 116. “Informed consent” is the most commonly used term. Nonetheless, some argue that the term may be misinterpreted and that it should be replaced by the term “informed choice.” This is because the choice not to give consent is essential to the integrated concept of voluntary or consent voluntarily given. See, B.M. Dickens, R.J Cook, Dimensions of informed consent to treatment, Ethical and legal issues in reproductive health, International Journal of Gynecology & Obstetrics 85 (2004), pp. 309‐314. 105 IACHR. Report No. 72/14. Case 12.655. Merits. I.V. Bolivia. August 15, 2014. Para 116. Quoting: United Nations, Report of the Special Rapporteur on the right of everyone to the enjoyment o the highest attainable standard of physical and mental health, Anand Grover, presented in accordance with Human Rights Council resolution 6/29, A/64/272 of August 10, 2009; United Nations, Committee on the Elimination of Discrimination against Women, Communication No. 4/2004, Case of A.S. v. Hungary, August 29, 2006, CEDAW/C/36/D/4/2004, para. 11.3. For example, the Amsterdam Declaration on Patients’ Rights provides: “Patients have the right to be fully informed about their health status, including the medical facts about their condition; about the proposed medical procedures, together with the potential risks and benefits of each procedure; about alternatives to the proposed procedures, including the effect of non-treatment; and about the diagnosis, prognosis and progress of treatment.” (ICP/HLE 121, 1994). 106 IACHR. Report No. 72/14. Case 12.655. Merits. I.V. Bolivia. August 15, 2014. Para 118. Quoting: IACHR, Access to Information on Reproductive Health from a Human Rights Perspective, November 22, 2011, para. 42. 19