Implementation of this process includes adopting legislative, policy, and administrative measures, and it extends to physicians, health professionals, and social workers, in both public and private hospitals, and from other health institutions and detention centers. 309 164. As regards the first element of the process of informed consent – informing on the nature of the procedure, treatment options, and reasonable alternatives, which includes the possible benefits and risks of the procedures proposed – the Commission has noted that the information that is provided to the patient must be complete, accessible, reliable, timely, and proactive. 310 “In order for the information to be complete, it is incumbent upon the health professionals to obtain and disclose all relevant information of the highest quality regarding diagnosis, proposed treatment and its effects, risks, and alternatives. In order to be accessible, it must be provided under adequate conditions and in a language and manner that is culturally acceptable to the person consenting,” 311 which includes the use of translation and interpretation services. It is not enough for the information to be complete and accessible; the information must be reliable. Finally, the information should be provided in a timely manner and at the initiative of the provider, that is, prior to applying the intervention and without any need to request it. 165. With respect to the second element of informed consent – taking into account the needs of the person and ensuring that he or she understands the information provided – the IACHR observes that medical professionals have a major duty to ensure that the information they provide is understood, so that the patient or his or her representative may make a truly informed decision with respect to the intervention and/or treatment proposed. In this regard, one should pay particular attention to the needs and conditions of the patient, as well as the methods used to provide the information. 312 166. As regards the third element of informed consent – ensuring that the consent given is free and voluntary – the Commission considers that for it to be effective, consent should be granted through a process free of any coercion or manipulation. Due to the imbalance of power characteristic of the relationship between health professionals and their patients it has been recognized that the time and way in which information is provided may unduly influence the decision as to whether to accept the treatment proposed. The Commission recognizes that while consent may be granted verbally or in writing, for the purposes of safeguarding the rights involved the State should take measures to facilitate written consent. 313 167. Finally, the Commission recognizes that there are exceptional situations in which consent does not apply. Those exceptions are related to situations associated with emergencies, for example when a person must be given medical treatment to preserve his or her life or health, but neither the person nor a family member can give consent. 314 168. As indicated above, in relation to persons institutionalized in mental health centers, the states are the ones responsible for ensuring their integrity and health, which stems from its special position as guarantor. 315 169. Indeed, the states have various obligations to persons with disabilities who are institutionalized. The CRPD Committee has held that states should provide health care based on the free and IACHR. Report No. 72/14. Case 12,655. Merits I.V. Bolivia. August 15, 2014. Para 119. Citing, IACHR, Access to Information on Reproductive Health from a Human Rights Perspective, November 22, 2011, para. 44. 310 IACHR. Report No. 72/14. Case 12,655. Merits I.V. Bolivia. August 15, 2014. Para 120. Citing, IACHR, Access to Information on Reproductive Health from a Human Rights Perspective, November 22, 2011, para. 45. 311 IACHR. Report No. 72/14. Case 12,655. Merits. I.V. Bolivia. August 15, 2014. Para. 120. Citing, United Nations, Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Anand Grover, submitted pursuant to resolution 6/29 of the Human Rights Council, A/64/272 of August 10, 2009, para. 23. 312 IACHR. Report No. 72/14. Case 12,655. Merits. I.V. Bolivia. August 15, 2014. Para. 121. 313 IACHR. Report No. 72/14. Case 12,655. Merits I.V. Bolivia. August 15, 2014. Para 122. Citing, IACHR, Access to Information on Reproductive Health from a Human Rights Perspective, November 22, 2011, para. 72. 314 IACHR, Access to Information on Reproductive Health from a Human Rights Perspective, November 22, 2011, para. 74. 315 United Nations, Committee on the Rights of Persons with Disabilities. Views adopted. Marlon James Noble, Australia, October 10, 2016, para. 8.9. 309 30