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dominance over the persons who are under their custody. This intrinsic imbalance in
power between hospitalized patients and the persons having authority over them is
usually greater in psychiatric institutions. Torture and other forms of cruel, inhuman,
or degrading treatment, when inflicted on these people, affect their psychic, physical,
and moral integrity, entail an insult to their dignity, and seriously restrict their
autonomy, which could aggravate their condition.
108. All the foregoing circumstances require the strict supervision of such
institutions. The States have the duty to supervise and guarantee that in all
psychiatric institutions, either public or private, the patients´right to receive a
worthy, human, and professional treatment be preserved and that said patients be
protected against exploitation, abuse, and degradation.
109. Mental health care should be available to every person who needs it. Any
treatment of persons with mental disabilities should serve the patient best interest,
aim at preserving his dignity and autonomy, reducing the impact of his illness, and
improving his life quality37 (infra paras. 135, 138, and 139).
110. Upon examining the violations to life and personal integrity to the prejudice of
Mr. Damião Ximenes-Lopes, the Court shall refer to the Inter-American Convention
on the Elimination of All Forms of Discrimination against Persons with Disabilities, an
instrument which is part of the legal framework designed to the protection of human
rights in the Inter-American system, which was ratified by the State on August 15,
2001, as a source of interpretation to determine the duties of the State regarding the
American Convention in the instant case.
111. Furthermore, the main standards applicable to mental health treatment have
been established within the scope of the World Health Organization and of the PanAmerican Health Organization. The Court considers that such instruments as the UN
Principles for the Treatment of People with Mental Health Disabilities and the
Improvement of Health Care and the Standard Rules on the Equalization of
Opportunities for Persons with Disabilities, approved by UN General Assembly
Resolution No. 48/96 of December 20, 1993, as well as the technical standards
provided for in the Caracas and the Madrid Declarations are of particular importance
for the analysis and careful examination of the compliance of the treatment given to
Mr. Damião Ximenes-Lopes with the existing international standards in this field. The
Court shall give special consideration to such instruments upon examining the
violation of Articles 4 and 5 of the American Convention in the instant case.
VII
PROVEN FACTS
112. Having examined the body of evidence in the record of this case, the
statements by the parties, as well as the partial acknowledgment of international
liability by the State, the Court finds the following facts to be proven. This chapter
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Cf. World Health Organization. Division of Mental Health and Prevention of Substance Abuse. Ten
Basic Principles of Mental Health Care Law (1996), principles 2, 4, and 5.