59 patient’s culture and in such a way that the patient can understand.” 247 In this regard, the information should include not only what the physician may consider reasonable and necessary to share, but should also focus on what is important for the patient. In other words, the information provided must have both an objective and a subjective element. Taking into account the particularities of the person is especially important when patients belong to vulnerable groups with specific needs for protection owing to factors of exclusion, marginalization or discrimination, that are relevant for understanding the information. Furthermore, the Court considers that, to ensure that the information is fully understood and an informed decision can be taken, it is necessary to ensure a reasonable period of reflection, which could vary according to the conditions of each case and the circumstances of each person. This constitutes a guarantee that is especially effective to avoid non-consensual or involuntary sterilizations.248 193. The Court understands that the elements indicated in the preceding paragraph are relevant in the process to obtain informed consent for female sterilization, owing to the discrimination and negative or prejudicial stereotypes that women face in the area of health care (supra para. 187). Moreover, in these cases, the obligation to provide information is increased owing to the nature and entity of the procedure. The special considerations that health care personnel should take into account when obtaining informed consent to sterilization, and the necessary information that such personnel should provide so that the patient may take an informed decision, should include, in addition to the above, the information that sterilization constitutes a permanent method and, since the patient may subsequently regret her sterility, the provision of information on the existence of alternative, less invasive, methods of contraception, even male contraceptive methods, because these could be an appropriate alternative. Furthermore, it is desirable to take into consideration, and provide information on the fact that, since it involves a surgical procedure, sterilization could have risks or side effects, and that there is a measurable failure rate in any method of sterilization, but also that there could be consequences if the treatment is rejected. 249 However, it should be made 247 Declaration of Lisbon on the rights of patients, Principle 7. The ECHR considered in the case of V.C v. Slovakia that V.C. had given her consent while in labor, only two and a half hours after she had been brought to the hospital, and in circumstances that did not allow her to take a free decision, after having considered what was at stake and the implications of her decision on sterilization. Cf. ECHR, Case of V.C. v. Slovakia, No. 18968/07. Judgment of November 8, 2011, paras. 111 and 117 (evidence file, volume VIII, annex 28 to the brief with motions, pleadings and evidence, folios 2531 to 2577). Similarly, the Committee for the Elimination of Discrimination against Women, in the case of A.S v Hungary, concluded that the 17-minute timespan and the circumstances under which A.S. decided to undergo sterilization had not allowed her to give free, full and informed consent. Cf. UN, Committee for the Elimination of Discrimination against Women, A.S. v. Hungary (Communication No. 4/2004), CEDAW/C/36/D/4/2004, August 29, 2006, para. 11.3. 248 Cf. WHO, Female sterilization: a guide to provision of services, 1993 (evidence file, volume XIII, annex 3 to the State’s final arguments, folios 5496 to 5499; 5510 to 5520 and 5530 to 5531); FIGO, Recommendations on ethics issues in obstetrics and gynecology by the FIGO Committee for the Study of Ethical Aspects of Human Reproduction and Women’s Health of November 2003, October 2012 and October 2015, which include the Guidelines regarding informed consent, adopted in 1995 and reaffirmed and supplemented in 2007, pp. 166 to 167 (2003), pp. 316 to 318 (2012) and pp. 399 to 401 (2015), as well as the Ethical recommendations on female sterilization of 1989, 1990, 2000 and 2011, pp. 55 to 57 and 213 to 218 (2003), pp. 436 to 440 (2012) and pp. 537 to 541 (2015); UN, Committee for the Elimination of Discrimination against Women, General Recommendation No. 21, 1994, paras. 21 to 23 (evidence file, volume VIII, annex 38 to the brief with motions, pleadings and evidence, folio 2700); UN, Committee for the Elimination of Discrimination against Women, General Recommendation No. 24, Women and health, 1999, paras. 20 to 22 (evidence file, volume VIII, annex 39 to the brief with motions, pleadings and evidence, folio 2711); UN, Human Rights Committee, General Comment No. 28, The equality of rights between men and women, March 29, 2000, para. 20; UN, Report of the Special Rapporteur on violence against women, its causes and consequences, Ms. Radhika Coomaraswamy, Policies and practices that impact women’s reproductive rights and contribute to, cause or constitute violence against women, E/CN.4/1999/68/Add.4, January 21, 1999, para. 52; UN, Report of the Special Rapporteur on the right of everyone to the highest attainable standard of physical and mental health, Anand Grover, A/64/272, August 10, 2009, paras. 54 and 55; WMA, the World Medical Association Statement on Forced and Coerced Sterilisation, adopted by the 63rd General Assembly, Bangkok, Thailand, October 2012 (evidence file, volume VIII, annex 31 to the brief with motions, pleadings and evidence, folios 2613 and 2614), and United Nations Interagency Statement “Eliminating forced, coercive and otherwise involuntary sterilization,” adopted by OHCHR, UN Women, UNAIDS, UNDP, UNFPA, UNICEF and WHO, 2014 (evidence file, volume VIII, annex 25 to the brief with motions, pleadings and evidence, folios 2452 249

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