are clear expressions of the predominance of discriminatory treatments in the mental health services that
deprive persons with some type of mental disability of the ability to decide about their own body and health.
178.
On this point, and specifically on institutionalization, the Commission considers that Mr.
Guachalá’s situation fits within the issue identified by the CRPD on the existence of the model of substitute
decision-making, and the institutionalization of persons with disabilities without their consent in mental health
centers and without giving them the support needed for them to be able give it. In this sense, the IACHR
considers that the State did not allow Mr. Guachalá to exercise his right to legal capacity for the purposes of
deciding on his admission to the psychiatric hospital, since it did not give Mr. Guachalá the support needed to
guarantee that right, such that he would be able to give his informed consent with respect to his hospitalization
in the Julio Endara Psychiatric Hospital. To the contrary, Ecuador restricted Mr. Guachalá’s right to decide on
his institutionalization, based exclusively on his disability, which is a form of discrimination.
179.
In view of the foregoing, the IACHR considers that the State violated Mr. Guachalá’s right to
legal capacity (as a component of the right to the recognition of juridical personality) on institutionalizing him
in a mental health center without his informed consent. In addition, the Commission considers that for those
reasons the hospitalization of Mr. Guachalá constituted an arbitrary deprivation of liberty incompatible with
the American Convention and a form of discrimination based on his disability. Accordingly, the Commission
concludes that the State violated the rights to the recognition of juridical personality, to access to information
for giving consent in relation to health matters, and to health, established at Articles 3, 7(1), 13(1), 24, and 26
of the American Convention, in relation to Articles 1(1) and 2 of the same instrument, to the detriment of Mr.
Guachalá.
2.5.2
On the medical treatment received
180.
The Commission does not have detailed information about the diagnosis and treatment
received by Mr. Guachalá as from his hospitalization on January 10, 2004, so as to allow it to determine whether
it constituted adequate treatment in light of his particular condition. On this point, the Commission will analyze
the information available on the care received in light of the standards on legal capacity of persons with
disabilities and informed consent in health-related matters. From the facts established it appears that once Mr.
Guachalá was institutionalized in the psychiatric hospital: (i) he received medicine the same day he was
admitted with the aim of sedating him, which occurred immediately according to his mother’s testimony; (ii)
he was sedated on January 11 and 12; and (iii) the medicines given to him were changed on January 13.
181.
The IACHR emphasizes that the CRPD Committee, in its concluding observations on Ecuador,
identified situations in which persons with disabilities institutionalized in mental health centers receive forced
medical-psychiatric treatment, without their consent. 331 For that reason, the CRPD Committee recommended
to the Ecuadorian State that it “Ensure that all mental health services are delivered with the free and informed
consent of the person concerned.” 332
182.
In the instant case, the Commission notes that the documentation produced by the parties on
Mr. Guachalá’s health conditions during his hospitalization does not include any confirmation that he was given
information on his diagnosis and treatment or that he gave his consent for the purposes of receiving that
treatment. Just as in relation to his hospitalization, nor is there anything on record indicating that he was
offered the support necessary to be able to give his consent. Accordingly, the IACHR finds that the medical
center performed an unjustified paternalistic intervention since, on limiting his legal capacity without seeking
to obtain his prior, full, and informed consent, it restricted Mr. Guachalá’s autonomy, integrity, and health so as
to make a decision regarding his mental health through the medical treatment that was provided. Nor does the
IACHR find that the Ecuadorian State has facilitated alternatives to the unconsented medication and
hospitalization, for example, evaluating the advisability of effective psychosocial interventions in the
United Nations, Committee on the Rights of Persons with Disabilities. Concluding observations on the initial report of Ecuador, October
27, 2014, para. 29.
332 United Nations, Committee on the Rights of Persons with Disabilities. Concluding observations on the initial report of Ecuador, October
27, 2014, para. 29.
331
33