with sufficient precision to enable the individual – if need be with appropriate advice – to regulate his conduct.”359 213. The Health Code of El Salvador establishes that one of the exceptions to the inviolability of professional confidentiality is “if respecting it would violate the laws in force.”360 Also, criminal law establishes the duty of physicians to respect professional secrecy and, therefore, refrain from testifying while, on the other hand, establishing an obligation to report the occurrence of a wrongful act. And, while an article of the Code of Criminal Procedure establishes an exception to the reporting obligation when the physician has become aware of the act “under the protection of professional secrecy,”361 article 312 of the Criminal Code defines the failure of public officials to report wrongful acts as an offense, without establishing any exception.362 Therefore, the Court underscores that the law is not sufficiently clear about whether physicians who become aware of a possible wrongful act due to information protected by professional secrecy have an obligation to report it, and does not establish specific regulations concerning professional secrecy in relation to obstetric emergencies. 214. In this regard, expert witness Oscar A. Cabrera pointed out that “[t]he lack of regulatory frameworks that clearly establish the exceptional nature of restrictions to medical confidentiality, as well as the very limited cases in which those restrictions are acceptable, results in granting absolute discretionality to the medical staff to determine how they comply with their duties and obligations.”363 The Court recalls that, according to a study conducted in El Salvador, 80% of the obstetric gynecologists interviewed believed that it was compulsory to report all cases of obstetric emergencies (supra para. 45). Moreover, the possible result of this lack of clarity has been that, in El Salvador, it is frequent that the report of a suspected abortion is filed by the administrative or medical staff of the health institution where the woman was being treated (supra para. 45). 215. Taking the foregoing into account, the Court considers that the law did not establish clearly whether or not a reporting duty existed that would have obliged the medical staff to reveal Manuela’s confidential data. The Court also notes that this lack of clarity in the law caused the medical staff to understand that they were obliged to report this type of situation because, to the contrary, they could be sanctioned. Moreover, it could also have the result, as in this case (supra para. 195), that the medical staff prioritize the report over the provision of emergency medical care to the woman who needs this. Thus, the Court stresses that, in the case of obstetric emergencies, the law should indicate clearly that, the duty to preserve medical professional secrecy is an exception to the general reporting obligation established in article 229 of the Code of Criminal Procedure,364 as well as the reporting obligation imposed ECHR, Case of S. and Marper v. The United Kingdom [Grand Chamber], No. 30562/04 and 30566/04. Judgment of December 4, 2008, para. 95, and Case of Avilkina and Others v. Russia, No. 1585/09. Judgment of June 6, 2013, para. 35. 359 Health Code of El Salvador. Legislative Decree No. 955 of 1988, articles 37 and 38. Available at: http://asp.health.gob.sv/regulacion/pdf/ley/codigo_de_health.pdf 360 Code of Criminal Procedure of El Salvador, Legislative Decree No. 776 of 1996, article 232.2 Available at: http://www.oas.org/juridico/spanish/mesicic3_slv_procesal.pdf 361 Criminal Code of El Salvador, Legislative Decree No 1030 of 1997, article 312. Available at: https://www.oas.org/dil/esp/Codigo_Penal_El_Salvador.pdf 362 363 Affidavit made by Oscar A. Cabrera on March 6, 2021 (evidence file, folio 4029). Article 229 of the Code of Criminal Procedure establishes that: “Anyone who witnesses the perpetration of an offense subject to public prosecution is obliged to immediately inform the Prosecutor General, the police or the nearest magistrate. If the knowledge originates from news stories or reports, the complaint is optional. If the offense depends on an individual complaint, it is not possible to proceed without this, except for acts that require urgent investigation.” Code of Criminal Procedure of El Salvador, Legislative Decree No. 776 of 1996, article 229. Available at: http://www.oas.org/juridico/spanish/mesicic3_slv_procesal.pdf 364 62