57
who is unaware of her sexual and reproductive rights may have a less assertive attitude towards her
rights. This could lead her to have greater confidence in her doctor’s criteria, or to health
professionals adopting a paternalistic attitude towards their patient. Both situations could open the
way to a situation of the exercise of power where health professionals take decisions without taking
into account the autonomy and wishes of their patient. The Court identifies some of the gender
stereotypes frequently applied to women in the health sector that have serious effects on the
autonomy of women and their decision-making power: (i) women are seen as vulnerable beings,
incapable of taking reliable or consistent decisions, which results in health professionals denying
women the information they require in order to give their informed consent; (ii) women are
considered impulsive and indecisive and in need of the guidance of a more stable person with better
judgment, usually a protective man, and (iii) it is the woman who should bear the responsibility for
the couple’s sexual health, so that, within a relationship, it is the woman who has the task of choosing
and using a method of contraception.241 Consequently, in this case, the Court will pay special
attention to this aspect in order to recognize and reject the stereotypes that lead to the impairment
of the rights recognized in the Convention.
188. In addition, the Court finds it essential that medical personnel avoid inducing a patient to give
her consent to sterilization because she fails to understand the information provided. Moreover, they
must refrain from going ahead with the procedure without this consent – particularly in cases where
the woman has scarce financial resources and/or low levels of education – on the pretext that the
measure is necessary as a means of population and birth control. This may, in turn, lead to the
situation in which a decision in favor sterilizing the woman and not the man is induced, based on the
stereotype that it is the woman, who plays the main role in procreation, who should be responsible
for contraception (infra para. 246).
iii)
The principle of full and informed consent
189. Lastly, the Court emphasizes that consent must be full and informed. Full consent can only
be obtained after adequate, complete, reliable, comprehensible and accessible information has been
received and fully understood. After analyzing several sources, the Court considers that, at the very
least, health care providers should offer the following information: (i) an evaluation of the diagnosis;
(ii) the purpose, method, probable duration, and expected benefits and risks of the proposed
treatment; (iii) the possible adverse effects of the proposed treatment; (iv) treatment alternatives,
including those that are less invasive, together with the possible pain or discomfort, risks, benefits
and secondary effects of the alternative treatments proposed; (v) the consequences of the treatment,
and (vi) what may occur before, during and after the treatment. 242
Cf. 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 October 2012 and October 2015, which include the
Recommendations on the human rights impact of gender stereotyping in the context of reproductive health care of 2011, pp.
332 to 336 (2012) and pp. 418 to 422 (2015).
241
Cf. Nuremberg Code of medical ethics, 1947; Declaration of Helsinki, Principles 25 to 27; Declaration of Lisbon on the
rights of patients, Principles 3, 7 and 10; 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, 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. 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); 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. 15 and 16; 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
242