61
135. Furthermore, and bearing in mind that any treatment should be chosen on
the basis of the patient´s best interest and the respect for his or her autonomy,
health care staff should apply the least restrictive possible restraint techniques and
only for such period of time as it is absolutely necessary and under conditions which
respect the patient´s dignity and minimize the risks of impairing his or her health.120
136. The hands of Mr. Damião Ximenes-Lopes were tied at the back between
Sunday evening and Monday morning, though the need to continue implementing
containment procedures had not been reassessed, and he was allowed to walk
without proper supervision. This kind of physical restraint to which the alleged victim
was subjected is not consistent with the need to provide the patient with a decent
treatment, nor does it protect his psychological, physical or moral integrity.
B) Duties of the State regarding persons with mental illness
137. The Court has already pointed out that from the generic obligation to ensure
the rights to life and humane treatment, special duties of protection and prevention
are derived, which, in the instant case, entail the duties to take care and regulate.
1. The duty to take care
138. In order to determine the duties of the State regarding persons with mental
illness, the Court deems it necessary to bear in mind, firstly, the special position as
guarantor the State has in regard to the persons who are in its custody or under its
care and with whom the State has the positive duty to provide the necessary
conditions to lead a decent life.121
139. Secondly, the Court considers that the foregoing is particularly true of
persons who are under health treatment, since the ultimate purpose of the provision
of health services is the improvement of the patient´s physical or mental condition,
which significantly increases the duties of the State and requires it to adopt such
measures as are available and necessary to prevent the impairment of the patient´s
condition as well as to optimize his or her health.
120
Cf. Principles for the Protection of People with Mental Illness and the Improvement of Health
Care, supra note 32, principle 11(11); Madrid Declaration on Ethical Standards for Psychiatric Practice,
supra note 117, preamble; Division of Mental Health and Prevention of Substance Abuse of the World
Health Organization. Ten Basic Principles of Mental Health Care Law, supra note 37, principle 4(3); and
Declaration of Hawaii/II, adopted by the WPA General Assembly on July, 10 1983, supra note 117, p. 1.
121
Cf. Case of Baldeón-García, supra note 4, para. 120; Case of López-Álvarez. Judgment of
February 1, 2006. Series C No. 141, paras. 104 to 106; Case of García-Asto and Ramírez-Rojas, supra
note 20, para. 221; Case of the Indigenous Community Yakye Axa, supra note 30, para. 162, Case of Lori
Berenson-Mejía, supra note 24, para. 102; Case of Tibi, supra note 111, para. 150; Case of the “Juvenile
Reeducation Institute”, supra note 108, para. 152; Case of the Gómez-Paquiyauri Brothers, supra note
108, para. 98; Case of Bulacio. Judgment of September 18, 2003. Series C No. 100, para. 138, and Case
of Juan Humberto Sánchez, supra note 30, para. 111. In this regard, Case of the Urso Branco Prison.
Provisional Measures. Order of the Inter-American Court of Human Rights of September 21, 2005,
Considering Sixth; and Case of the Gómez-Paquiyauri Brothers. Provisional Measures. Order of the InterAmerican Court of Human Rights of May 7, 2004, Considering Thirteenth.