to investigate the presumed homicide if the medical staff had not disclosed Manuela’s
information, so that the measure could be a necessary measure and it is necessary to examine
the proportionality of the restriction.
Proportionality of the restriction
220. On this point, it is necessary to examine whether the restriction was strictly
proportionate, so that the sacrifice inherent in it was not exaggerated or disproportionate to
the advantages obtained from the said limitation. 369 In this regard, the Court has indicated
that the restriction must be proportionate to the interest that justifies it and be closely
adapted to the achievement of that legitimate objective, interfering as little as possible in the
effective exercise of the rights at stake. 370 Indeed, even if a restriction is established by law,
is suitable and necessary, the Court must determine whether it is strictly proportionate.
221. Manuela went to the hospital after suffering an obstetric emergency, shared the
information she considered pertinent with her physician, and allowed the physician to examine
her. The information obtained by the physician while treating Manuela was subsequently used
in the criminal proceedings against her. Therefore, Manuela had to decide between not
receiving medical care or that this care would be used against her in the criminal proceedings.
222. The Court notes that the failure to respect medical confidentiality may prevent people
from seeking medical care when they need this, endangering their health and that of the
community in cases of contagious diseases.371 Specifically, in cases in which women need
medical care following a delivery or in an obstetric emergency, CEDAW has indicated that:
“... lack of respect for the confidentiality of patients […] may deter women from seeking
advice and treatment and thereby adversely affect their health and well-being. Women will
be less willing, for that reason, to seek medical care for diseases of the genital tract, for
contraception or for incomplete abortion and in cases where they have suffered sexual or
physical violence.372
223. Similarly, the Human Rights Committee has indicated that the “legal duty imposed upon
health personnel to report on cases of women who have undergone abortions may inhibit
women from seeking medical treatment, thereby endangering their lives.” 373
224. In this sense, the Court considers that, in cases related to obstetric emergencies such
as this one, the disclosure of medical date may restrict the access to adequate medical
attention for women who need medical care, but who avoid going to a hospital for fear of
being criminalized, and this jeopardizes their right to health, personal integrity and life.
Indeed, in such case, there is an apparent conflict between two rules: the duty to respect
Cf. Case of Chaparro Álvarez and Lapo Íñiguez v. Ecuador, supra, para. 93, and Advisory Opinion OC-28/21
of June 7, 2021, supra, para. 122.
369
Cf. Compulsory Membership in an Association Prescribed by Law for the Practice of Journalism (Arts. 13 and
29 American Convention on Human Rights), Advisory Opinion OC-5/85, November 13, 1985. Series A No. 5, para.
46, and Advisory Opinion OC-28/21 of June 7, 2021, supra, para. 122.
370
Cf. ECHR, Case of Y.Y. v. Russia, No. 40388/06. Judgment of February 23, 2016, para. 38; Case of Mockuté
v. Lithuania, No. 66490/09. Judgment of February 27, 2018, para. 93, and Affidavit made by Oscar A. Cabrera on
March 6, 2021 (evidence file, folio 4019).
371
CEDAW, General recommendation No. 24: Women and health, February 2, 1999, para. 12(d). See also, Report
of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, UN Doc.
A/HRC/22/53, February 1, 2013, para. 46.
372
Cf. Human Rights Committee, Concluding observations on the fourth periodic report of Chile,
CCPR/C/79/Add.104, March 30, 1999, para. 15; Concluding observations on the third periodic report of Venezuela,
CCPR/CO/71/VEN, August 17, 2001, para. 19, and Concluding observations on the seventh periodic report of El
Salvador, CCPR/C/SLV/CO/7, May 9, 2018, para. 16.
373
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