The Committee is concerned that, although the Organic Act on Disabilities was published after the State party’s ratification of the Convention, it retains a definition and understanding of disability that are based on a medical approach. This definition of persons with disabilities emphasizes their limited abilities and neglects the social and relational dimension of disability. 325 … The Committee is concerned that the State party’s civil legislation provides for a substitute decision-making model through the use of roles such as guardians and wards, and that there is no immediate plan to reform the Civil Code and the Code of Civil Procedure to include a supported decision-making model…. 326 175. Furthermore, the CRPD Committee concluded that persons with disability, characterized as “cases of acute and chronic mental disorder” (“casos oligofrénicos de gravedad y de cronicidad”), are institutionalized at the Julio Endara Psychiatric Hospital permanently, without the necessary support for them to live in the community. 327 The Commission observes that the State itself acknowledged the existence of that situation when it stated: Persons with mental disabilities confined in institutions constitute a minority and correspond to patients abandoned by their families and cases of acute and chronic mental disorder treated in strict compliance with mental health protocols. 328 176. In the instant case, the institutionalization of Mr. Guachalá at the Julio Endara Psychiatric Hospital on January 10, 2004 was done with the authorization of his mother and based on the evaluation done by the hospital authorities about the possible consequences of his cognitive or psychosocial disability. The IACHR observes that at no time did Mr. Guachalá give his informed consent to be admitted to that hospital. This has not been controverted by the State. Based on the information available in the record, there is no assessment whatsoever of the reasons why it was not possible to obtain Mr. Guachalá’s informed consent in respect of his hospitalization. Nor is there any information about – in the face of possible difficulties arising from the symptoms with which he arrived at the center – the measures adopted to seek to give him the support needed for him to be able to give such consent. To the contrary, from the medical record it appears that the staff of the hospital proceeded to totally sedate Mr. Guachalá; this will be analyzed next in relation to the medical treatment received. 177. In addition, the IACHR emphasizes that “while some forms of confinement, including retention in hospitals and psychiatric and other medical facilities, may constitute de facto deprivation of liberty, virtually all forms of confinement without informed consent represent a violation of the right to health.” 329 And this is because centers of confinement and hospitalization in general are not considered to provide an adequate therapeutic setting, as they make it difficult to establish non-violent, respectful, and healthy relationships, and because they have a negative impact on the basic and social determinants of mental health, such as the physical, psychosocial, political, and economic surroundings. 330 The IACHR also observes that the actions of the medical center were influenced by stereotypes about persons with mental disabilities and their ability to when it comes to making autonomous decision about their own health. Hospitalization and medication without their consent 325 United Nations, Committee on the Rights of Persons with Disabilities. Concluding observations on the initial report on Ecuador, October 27, 2014, paras. 8 and 24. 326 United Nations, Committee on the Rights of Persons with Disabilities. Concluding observations on the initial report on Ecuador, October 27, 2014, paras. 8 and 24. 327 United Nations, Committee on the Rights of Persons with Disabilities. Concluding observations on the initial report on Ecuador, October 27, 2014, para. 28. 328 United Nations, Committee on the Rights of Persons with Disabilitie. List of issues in relation to the initial report Ecuador, August 7, 2014, para. 16.3. 329 Report of the Special Rapporteur on the right of every person to the enjoyment of the highest possible level of physical and mental health, UN Doc. A/HRC/38/36, April 10, 2018, para. 6. 330 Report of the Special Rapporteur on the on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, UN Doc. A/HRC/38/36, April 10, 2018, para. 33; Report of the Special Rapporteur on the on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, UN Doc. A/HRC/35/21, March 28, 2017, para. 67 32