54 “[w]hen obtaining informed consent, the physician should be particularly cautious if the subject is in a dependent relationship with the physician or may consent under duress.”221 182. Consent is personal because it must be given by the person who will undergo the procedure. Indeed, according to the Declarations of Helsinki and of Lisbon, as well as the Declaration on forced sterilization, all adopted by the World Medical Association, only the patient may agree to undergo a medical procedure.222 In addition, the UNESCO Universal Declaration on Bioethics and Human Rights refers to “consent by the person concerned, based on adequate information.”223 In the case of sterilization, the Court considers that, owing to its nature and the serious consequences on reproductive capacity, in relation to a woman’s autonomy, which entails respecting her decision on whether or not to have children and the circumstances in which she wishes to have them (supra para. 162), she is the only person authorized to give consent, rather than third persons. Thus, it is not permissible to request the authorization of the partner or of any other person in order to perform sterilization.224 The Court also considers that, as it has established, sterilization is usually not an emergency procedure (supra paras. 177 and 178), so that if the woman is unable to give her consent, it is not permissible to resort to a third person, but rather it is necessary to wait until she can give this. General Recommendation No. 21 (1994) of the Committee for the Elimination of Discrimination against Women, General Comment No. 28 (2000) of the Human Rights Committee, and also the 1993 WHO manual, FIGO and its recommendations from 1989 on, and the United Nations Interagency Statement all indicate that, although the decision on sterilization can be taken by the couple, this does not mean that the husband’s authorization is required for the performance of this surgical procedure, because it is a decision that only the woman may make based on her reproductive freedom and autonomy.225 UN, Principles for the protection of persons with mental illness and the improvement of mental health care, A/RES/46/119, December 17, 1991, Principle 11(2); 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 and 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. 24, Women and health, 1999, para. 22 (evidence file, volume VIII, annex 39 to the brief with motions, pleadings and evidence, folio 2711); Universal Declaration on Bioethics and Human Rights, Article 6; 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. 13 and 14; WMA, the World Medical Association Statement on Forced and Coerced Sterilisation, adopted by the 63rd General Assembly, Bangkok, Thailand, October 2012, which emphasizes that “consent to sterilization should be free of any material or social incentives which might distort freedom of choice” (evidence file, volume VIII, annex 31 to the brief with motions, pleadings and evidence, folios 2613 to 2614); 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 to 2454 and 2457). 221 Cf. Declaration of Helsinki, Principle 23. Cf. Declaration of Helsinki, Principle 22; Declaration of Lisbon on the rights of patients, Principle 3; the World Medical Association Statement on Forced and Coerced Sterilisation (evidence file, volume VIII, annex 31 to the brief with motions, pleadings and evidence, folios 2613 to 2614). 222 223 Cf. Universal Declaration on Bioethics and Human Rights, Article 6(1). Cf. 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), and UN, Human Rights Committee, General Comment No. 28, The equality of rights between men and women, March 29, 2000, para. 20. Also, the Special Rapporteur on the right of everyone to the highest attainable standard of physical and mental health considered that “any requirement for preliminary authorization by a third party is a violation of a woman’s autonomy.” Cf. 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, para. 57. 224 Cf. UN, Committee for the Elimination of Discrimination against Women, General Recommendation No. 21, 1994, para. 22 (evidence file, volume VIII, annex 38 to the brief with motions, pleadings and evidence, folio 2700); UN, Human Rights Committee, General Comment No. 28, The equality of rights between men and women, March 29, 2000, para. 20; WHO, 225