110. Second, the Commission observes that the alleged consent given by the family raises serious doubts about the way in which it was obtained and its authenticity, for what is written indicates “the procedure … that will be performed on my father” when the signature that appears below the legend is that of Margarita Tapia, Mr. Poblete Vilches’s wife. In this respect, the Commission notes that on July 11, 2006, Mr. Vinicio Poblete Tapia’s representative filed a brief with the First Civil Court in which he indicated that said authorization was counterfeit, since Margarita Tapia was Mr. Poblete Vilches’s wife and not his daughter.116 Despite this filing and the doubts it gives rise to, from a mere reading of the purported consent it is does not appear that the domestic authorities, in the context of the investigation, undertook any actions aimed at clarifying this situation and in particular verifying whether informed consent was or was not obtained from the family. 111. Third, the medical record does not include any information or record that would suggest that the purported consent was given in compliance with the three above-mentioned requirements. That is, from the record it does not appear (i) that anyone was informed of the nature of the procedure, the treatment options, and reasonable alternatives, including risks and benefits; (ii) that the needs of the family members were taken into account to ensure they understood the information given; or (iii) that it was ensured that the consent was free and voluntary. The Commission considers that the reference cited in the medical record is by any measure insufficient to evaluate whether informed consent was obtained incorporating each of these elements. 112. Finally, the Commission observes that while the lack of consent may be based on emergency situations or if it impossible to reach family members, in the instant case there is no element to indicate that it was impossible, on January 26, 2001, to obtain the family members’ consent. Nor is there information that enables the IACHR to consider that the failure to satisfy each of the elements mentioned was due to an emergency situation that made it impossible to adequately inform the family members so that they could understand the procedure and give their consent in proper form. In effect, in the record it appears that it was indicated that Mr. Poblete was more stable at the moment the procedure was performed. In any event, as a basis for arguing that an element of informed consent was missing one must indicate just what the emergency situation is and that information must be included in the medical record, making it possible to verify the suitability of the course of action adopted by the medical personnel. The medical record does not include any reference either before or after the procedure indicating that the basis for not obtaining consent, in light of the standards cited, was a pressing emergency situation. 113. As regards the second time Mr. Poblete Vilches was admitted to the Hospital Sótero del Río, the Commission observes that even though he was considered a patient in need of intensive treatment in the ICU, due to the lack of beds it was decided to keep him in “intermediate treatment.” The IACHR will analyze this situation in the next section of this report, which addresses the rights to life, humane treatment, and health of Mr. Poblete Vilches. For the purposes of analyzing informed consent, the Commission observes that the medical record includes an entry according to which medical personnel who spoke with the family about the decision “to manage [him] in intermediate care (and not in the ICU)” expressed doubts as to whether they understood the situation. 114. The Commission underlines that the medical personnel acknowledged the lack of clarity of the family members with respect to the situation. Moreover, the totality of the indicia indicate there they were not adequately informed and consulted with respect to the options and needs of the patient. On the contrary, the Hospital personnel explained to them the situation of lack of beds but not with the aim for them to consent. The Hospital indicated to them that Mr. Poblete Vilches was not going to receive the intensive treatment but were not consulted on that matter, they had no option to choose between alternatives. The Commission considers that this reference in the 116 Annex 83. Brief from the representative of Vinicio Poblete Tapia filed with the First Civil Court on July 11, 2006 (Attached to the communication from the State of September 23, 2008). 22