95
which the physician has failed to comply with that ethical and legal requirements of medical practice,
in order to establish the corresponding responsibilities and have access to compensation. These
measures should include the availability of and access to administrative and judicial remedies to file
claims if prior, free, full and informed consent has not been obtained, and the right for such claims
to be examined promptly and impartially. To the contrary, this would deny the practical effects of
the rule of informed consent .
311. In brief, the Court considers that there is growing recognition that the practice of nonconsensual, involuntary, coerced or forced sterilization cannot remain unpunished, because this
would lead to perpetuating discriminatory stereotypes in the area of reproductive health at the
institutional level based on the belief that women are not competent to take decisions concerning
their own bodies and health. This does not necessarily mean that criminal proceedings are required
in every case, but that the State should provide mechanisms for filing complaints, which are adequate
and effective to establish individual responsibilities, in either the disciplinary, administrative or
judicial sphere, as appropriate, so as to ensure adequate redress to the victim.
312. That said, in its case law this Court has established that the obligation to conduct a criminal
investigation and the corresponding right of the presumed victims or their next of kin derives not
only from the treaty-based norms of international law that are binding for the States Parties, but is
also derived from domestic law relating to the obligation to investigate, ex officio, certain wrongful
acts, and from the laws that permit victims or their next of kin to file actions and submit complaints,
evidence and motions or any other element in order to play a procedural role in the criminal
investigation with the aim of establishing the truth of the facts. 388 Given the fact that, in this case,
criminal proceedings were instituted for the offense of injuries, the Court will now examine whether
the corresponding actions aimed at establishing the criminal responsibility of the physician for the
non-consensual sterilization of I.V. were in accordance with the American Convention.
B.2
Determination of the effects of the closure of the criminal proceedings
313. According to the widely disseminated jurisprudence of the countries of this hemisphere
surgical procedures of a therapeutic nature (curative or palliative) do not correspond to the offense
of “injuries.” Even though this circumstance has not been alleged, and considering that it would be
an effective plea for the defense, it is an inherent duty of a rigorous judicial process to examine and
discard this possibility, in order to make it clear that the closure of the criminal proceedings
prejudiced the victim.
314. In this case, the purpose of the procedure performed on I.V. was of a preventive, therapeutic
nature, which would not constitute “injuries” if it had been carried out in accordance with the rules
of medical practice; that is, respecting the obligation of care that corresponds to the profession,
because, to the contrary, the physician would have incurred fault liability (imprudence or negligence).
The non-criminal nature of procedures is conditioned by the observance of the duty of care in
accordance with the rules of medical practice. This duty obliges doctors to take special care to ensure
that their interventions will improve the patient’s health and will not cause new and greater harms
or paradoxical effects. Health, according to the classic definition of the WHO, 389 is a state of biological
and psychological balance. In the case of I.V., it has been proved that, as a result of the sterilization,
even though the risk of a possible future pregnancy was neutralized, she has suffered very severe
Cf. Case of García Prieto et al. v. El Salvador. Preliminary objection, merits, reparations and costs. Judgment of
November 20, 2007. Series C No. 168, para. 104, and Case of Velásquez Paiz et al. v. Guatemala, supra, para. 144.
388
The Preamble to the Constitution of the World Health Organization, which was adopted by the International Health
Conference held in New York from June 19 to July 22, 1046, signed on July 22, 1946 and entered into force on April 7, 1948,
defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or
infirmity.”
389